ENROLLED
       2015 Legislature                                          SB 704
       
       
       
       
       
       
                                                              2015704er
    1  
    2         An act relating to the Florida Statutes; repealing ss.
    3         88.7011, 120.745, 163.336, 218.077(5), 220.33(7),
    4         253.01(2)(b), 288.106(4)(f), 339.08(1)(n), 381.0407,
    5         403.709(1)(f), 409.911(10), 409.91211, 430.04(15),
    6         430.502(10)-(12), 443.131(5), 624.351, 624.352, and
    7         626.2815(7), F.S., and amending ss. 110.123, 339.135,
    8         409.912, 409.9122, 576.061, 828.27, and 1002.32, F.S.,
    9         to delete provisions which have become inoperative by
   10         noncurrent repeal or expiration and, pursuant to s.
   11         11.242(5)(b) and (i), F.S., may be omitted from the
   12         2015 Florida Statutes only through a reviser’s bill
   13         duly enacted by the Legislature; amending ss.
   14         409.91195, 409.91196, 409.962, 636.0145, 641.19,
   15         641.225, and 641.386, F.S., to conform cross
   16         references; providing an effective date.
   17          
   18  Be It Enacted by the Legislature of the State of Florida:
   19  
   20         Section 1. Section 88.7011, Florida Statutes, is repealed.
   21         Reviser’s note.—Repealed to conform to s. 58, ch. 2011-92, Laws
   22         of Florida, which repealed s. 88.7011 effective on a date
   23         contingent upon the provisions of s. 81, ch. 2011-92.
   24         Section 81, ch. 2011-92, provides that “[e]xcept as
   25         otherwise expressly provided in this act, this act shall
   26         take effect upon the earlier of 90 days following Congress
   27         amending 42 U.S.C. s. 666(f) to allow or require states to
   28         adopt the 2008 version of the Uniform Interstate Family
   29         Support Act, or 90 days following the state obtaining a
   30         waiver of its state plan requirement under Title IV-D of
   31         the Social Security Act.” Public Law No. 113-183 was signed
   32         by the President on September 29, 2014; a portion of that
   33         law requires that the 2008 version of the Uniform
   34         Interstate Family Support Act is required.
   35         Section 2. Paragraph (g) of subsection (3) of section
   36  110.123, Florida Statutes, is amended to read:
   37         110.123 State group insurance program.—
   38         (3) STATE GROUP INSURANCE PROGRAM.—
   39         (g) Participation by individuals in the program is
   40  available to all state officers, full-time state employees, and
   41  part-time state employees and is voluntary. Participation in the
   42  program is also available to retired state officers and
   43  employees who elect at the time of retirement to continue
   44  coverage under the program, but may elect to continue all or
   45  only part of the coverage they had at the time of retirement. A
   46  surviving spouse may elect to continue coverage only under a
   47  state group health insurance plan, a TRICARE supplemental
   48  insurance plan, or a health maintenance organization plan.
   49         1. Full-time state employees described in subparagraph
   50  (2)(c)1. are eligible for health insurance coverage in calendar
   51  year 2014 as long as they remain employed by an employer
   52  participating in the state group insurance program during the
   53  year. This subparagraph expires December 31, 2014.
   54         2. Employees paid from other-personal-services (OPS) funds
   55  are not eligible for coverage before January 1, 2014.
   56         Reviser’s note.—Amended to delete subparagraph (3)(g)1., which
   57         expired pursuant to its own terms, effective December 31,
   58         2014, and to delete subparagraph (3)(g)2. to repeal a
   59         provision that has served its purpose.
   60         Section 3. Section 120.745, Florida Statutes, is repealed.
   61         Reviser’s note.—The cited section, which relates to legislative
   62         review of agency rules in effect on or before November 16,
   63         2010, was repealed pursuant to its own terms, effective
   64         July 1, 2014.
   65         Section 4. Section 163.336, Florida Statutes, is repealed.
   66         Reviser’s note.—The cited section, which relates to the coastal
   67         resort area redevelopment pilot project, expired pursuant
   68         to its own terms, effective December 31, 2014.
   69         Section 5. Subsection (5) of section 218.077, Florida
   70  Statutes, is repealed.
   71         Reviser’s note.—The cited subsection, which relates to the
   72         Employer-Sponsored Benefits Study Task Force, was repealed
   73         pursuant to its own terms, effective June 30, 2014.
   74         Section 6. Subsection (7) of section 220.33, Florida
   75  Statutes, is repealed.
   76         Reviser’s note.—The cited subsection, which relates to payment
   77         of estimated tax due no later than Sunday, June 30, 2013,
   78         by June 28, 2013, expired pursuant to its own terms,
   79         effective July 1, 2014.
   80         Section 7. Paragraph (b) of subsection (2) of section
   81  253.01, Florida Statutes, is repealed.
   82         Reviser’s note.—The cited paragraph, which relates to transfer
   83         of moneys, for the 2013-2014 fiscal year only, from the
   84         Internal Improvement Trust Fund to the Save Our Everglades
   85         Trust Fund for Everglades restoration pursuant to s.
   86         216.181(12), expired pursuant to its own terms, effective
   87         July 1, 2014.
   88         Section 8. Paragraph (f) of subsection (4) of section
   89  288.106, Florida Statutes, is repealed.
   90         Reviser’s note.—The cited paragraph, which permits reduction of
   91         local financial support requirements of s. 288.106 by one
   92         half for a qualified target industry business located in
   93         one of a specified list of counties under certain
   94         circumstances, expired pursuant to its own terms, effective
   95         June 30, 2014.
   96         Section 9. Paragraph (n) of subsection (1) of section
   97  339.08, Florida Statutes, is repealed.
   98         Reviser’s note.—The cited paragraph, which relates to
   99         expenditure of funds to pay administrative expenses
  100         incurred in accordance with applicable laws by the
  101         multicounty transportation authority created under chapter
  102         343 where jurisdiction for the authority includes a portion
  103         of the State Highway System and the expenses are in
  104         furtherance of the provisions of chapter 2012-174, Laws of
  105         Florida, to provide a financial analysis of the cost
  106         savings to be achieved by the consolidation of transit
  107         authorities within the region, expired pursuant to its own
  108         terms, effective July 1, 2014.
  109         Section 10. Paragraph (a) of subsection (4) of section
  110  339.135, Florida Statutes, is amended to read:
  111         339.135 Work program; legislative budget request;
  112  definitions; preparation, adoption, execution, and amendment.—
  113         (4) FUNDING AND DEVELOPING A TENTATIVE WORK PROGRAM.—
  114         (a)1. To assure that no district or county is penalized for
  115  local efforts to improve the State Highway System, the
  116  department shall, for the purpose of developing a tentative work
  117  program, allocate funds for new construction to the districts,
  118  except for the turnpike enterprise, based on equal parts of
  119  population and motor fuel tax collections. Funds for
  120  resurfacing, bridge repair and rehabilitation, bridge fender
  121  system construction or repair, public transit projects except
  122  public transit block grants as provided in s. 341.052, and other
  123  programs with quantitative needs assessments shall be allocated
  124  based on the results of these assessments. The department may
  125  not transfer any funds allocated to a district under this
  126  paragraph to any other district except as provided in subsection
  127  (7). Funds for public transit block grants shall be allocated to
  128  the districts pursuant to s. 341.052. Funds for the intercity
  129  bus program provided for under s. 5311(f) of the federal
  130  nonurbanized area formula program shall be administered and
  131  allocated directly to eligible bus carriers as defined in s.
  132  341.031(12) at the state level rather than the district. In
  133  order to provide state funding to support the intercity bus
  134  program provided for under provisions of the federal 5311(f)
  135  program, the department shall allocate an amount equal to the
  136  federal share of the 5311(f) program from amounts calculated
  137  pursuant to s. 206.46(3).
  138         2. Notwithstanding the provisions of subparagraph 1., the
  139  department shall allocate at least 50 percent of any new
  140  discretionary highway capacity funds to the Florida Strategic
  141  Intermodal System created pursuant to s. 339.61. Any remaining
  142  new discretionary highway capacity funds shall be allocated to
  143  the districts for new construction as provided in subparagraph
  144  1. For the purposes of this subparagraph, the term “new
  145  discretionary highway capacity funds” means any funds available
  146  to the department above the prior year funding level for
  147  capacity improvements, which the department has the discretion
  148  to allocate to highway projects.
  149         3. Notwithstanding subparagraphs 1. and 2. and ss.
  150  206.46(3) and 334.044(26), and for fiscal years 2009-2010
  151  through 2013-2014 only, the department shall annually allocate
  152  up to $15 million of the first proceeds of the increased
  153  revenues estimated by the November 2009 Revenue Estimating
  154  Conference to be deposited into the State Transportation Trust
  155  Fund to provide for the portion of the transfer of funds
  156  included in s. 343.58(4)(a)1.a. or 2.a., as applicable. The
  157  transfer of funds included in s. 343.58(4) shall not negatively
  158  impact projects included in fiscal years 2009-2010 through 2013
  159  2014 of the work program as of July 1, 2009, as amended pursuant
  160  to subsection (7). This subparagraph expires July 1, 2014.
  161         Reviser’s note.—Amended to delete subparagraph (4)(a)3., which
  162         expired pursuant to its own terms, effective July 1, 2014.
  163         Section 11. Section 381.0407, Florida Statutes, is
  164  repealed.
  165         Reviser’s note.—The cited section, the Managed Care and Publicly
  166         Funded Primary Care Program Coordination Act, was repealed
  167         by s. 51, ch. 2012-184, effective October 1, 2014. Since
  168         the section was not repealed by a “current session” of the
  169         Legislature, it may be omitted from the 2015 Florida
  170         Statutes only through a reviser’s bill duly enacted by the
  171         Legislature. See s. 11.242(5)(b) and (i).
  172         Section 12. Paragraph (f) of subsection (1) of section
  173  403.709, Florida Statutes, is repealed.
  174         Reviser’s note.—The cited paragraph, which relates to transfer
  175         of moneys, for the 2013-2014 fiscal year only, from the
  176         Solid Waste Management Trust Fund to the Save Our
  177         Everglades Trust Fund for Everglades restoration pursuant
  178         to s. 216.181(12), expired pursuant to its own terms,
  179         effective July 1, 2014.
  180         Section 13. Subsection (10) of section 409.911, Florida
  181  Statutes, is repealed.
  182         Reviser’s note.—The cited subsection, which relates to the
  183         Medicaid Low-Income Pool Council, expired pursuant to its
  184         own terms, effective October 1, 2014.
  185         Section 14. Section 409.912, Florida Statutes, is amended
  186  to read:
  187         409.912 Cost-effective purchasing of health care.—The
  188  agency shall purchase goods and services for Medicaid recipients
  189  in the most cost-effective manner consistent with the delivery
  190  of quality medical care. To ensure that medical services are
  191  effectively utilized, the agency may, in any case, require a
  192  confirmation or second physician’s opinion of the correct
  193  diagnosis for purposes of authorizing future services under the
  194  Medicaid program. This section does not restrict access to
  195  emergency services or poststabilization care services as defined
  196  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
  197  shall be rendered in a manner approved by the agency. The agency
  198  shall maximize the use of prepaid per capita and prepaid
  199  aggregate fixed-sum basis services when appropriate and other
  200  alternative service delivery and reimbursement methodologies,
  201  including competitive bidding pursuant to s. 287.057, designed
  202  to facilitate the cost-effective purchase of a case-managed
  203  continuum of care. The agency shall also require providers to
  204  minimize the exposure of recipients to the need for acute
  205  inpatient, custodial, and other institutional care and the
  206  inappropriate or unnecessary use of high-cost services. The
  207  agency shall contract with a vendor to monitor and evaluate the
  208  clinical practice patterns of providers in order to identify
  209  trends that are outside the normal practice patterns of a
  210  provider’s professional peers or the national guidelines of a
  211  provider’s professional association. The vendor must be able to
  212  provide information and counseling to a provider whose practice
  213  patterns are outside the norms, in consultation with the agency,
  214  to improve patient care and reduce inappropriate utilization.
  215  The agency may mandate prior authorization, drug therapy
  216  management, or disease management participation for certain
  217  populations of Medicaid beneficiaries, certain drug classes, or
  218  particular drugs to prevent fraud, abuse, overuse, and possible
  219  dangerous drug interactions. The Pharmaceutical and Therapeutics
  220  Committee shall make recommendations to the agency on drugs for
  221  which prior authorization is required. The agency shall inform
  222  the Pharmaceutical and Therapeutics Committee of its decisions
  223  regarding drugs subject to prior authorization. The agency is
  224  authorized to limit the entities it contracts with or enrolls as
  225  Medicaid providers by developing a provider network through
  226  provider credentialing. The agency may competitively bid single
  227  source-provider contracts if procurement of goods or services
  228  results in demonstrated cost savings to the state without
  229  limiting access to care. The agency may limit its network based
  230  on the assessment of beneficiary access to care, provider
  231  availability, provider quality standards, time and distance
  232  standards for access to care, the cultural competence of the
  233  provider network, demographic characteristics of Medicaid
  234  beneficiaries, practice and provider-to-beneficiary standards,
  235  appointment wait times, beneficiary use of services, provider
  236  turnover, provider profiling, provider licensure history,
  237  previous program integrity investigations and findings, peer
  238  review, provider Medicaid policy and billing compliance records,
  239  clinical and medical record audits, and other factors. Providers
  240  are not entitled to enrollment in the Medicaid provider network.
  241  The agency shall determine instances in which allowing Medicaid
  242  beneficiaries to purchase durable medical equipment and other
  243  goods is less expensive to the Medicaid program than long-term
  244  rental of the equipment or goods. The agency may establish rules
  245  to facilitate purchases in lieu of long-term rentals in order to
  246  protect against fraud and abuse in the Medicaid program as
  247  defined in s. 409.913. The agency may seek federal waivers
  248  necessary to administer these policies.
  249         (1) The agency shall work with the Department of Children
  250  and Families to ensure access of children and families in the
  251  child protection system to needed and appropriate mental health
  252  and substance abuse services. This subsection expires October 1,
  253  2014.
  254         (2) The agency may enter into agreements with appropriate
  255  agents of other state agencies or of any agency of the Federal
  256  Government and accept such duties in respect to social welfare
  257  or public aid as may be necessary to implement the provisions of
  258  Title XIX of the Social Security Act and ss. 409.901-409.920.
  259  This subsection expires October 1, 2016.
  260         (3) The agency may contract with health maintenance
  261  organizations certified pursuant to part I of chapter 641 for
  262  the provision of services to recipients. This subsection expires
  263  October 1, 2014.
  264         (2)(4) The agency may contract with:
  265         (a) An entity that provides no prepaid health care services
  266  other than Medicaid services under contract with the agency and
  267  which is owned and operated by a county, county health
  268  department, or county-owned and operated hospital to provide
  269  health care services on a prepaid or fixed-sum basis to
  270  recipients, which entity may provide such prepaid services
  271  either directly or through arrangements with other providers.
  272  Such prepaid health care services entities must be licensed
  273  under parts I and III of chapter 641. An entity recognized under
  274  this paragraph which demonstrates to the satisfaction of the
  275  Office of Insurance Regulation of the Financial Services
  276  Commission that it is backed by the full faith and credit of the
  277  county in which it is located may be exempted from s. 641.225.
  278  This paragraph expires October 1, 2014.
  279         (b) An entity that is providing comprehensive behavioral
  280  health care services to certain Medicaid recipients through a
  281  capitated, prepaid arrangement pursuant to the federal waiver
  282  provided for by s. 409.905(5). Such entity must be licensed
  283  under chapter 624, chapter 636, or chapter 641, or authorized
  284  under paragraph (c) or paragraph (d), and must possess the
  285  clinical systems and operational competence to manage risk and
  286  provide comprehensive behavioral health care to Medicaid
  287  recipients. As used in this paragraph, the term “comprehensive
  288  behavioral health care services” means covered mental health and
  289  substance abuse treatment services that are available to
  290  Medicaid recipients. The secretary of the Department of Children
  291  and Families shall approve provisions of procurements related to
  292  children in the department’s care or custody before enrolling
  293  such children in a prepaid behavioral health plan. Any contract
  294  awarded under this paragraph must be competitively procured. In
  295  developing the behavioral health care prepaid plan procurement
  296  document, the agency shall ensure that the procurement document
  297  requires the contractor to develop and implement a plan to
  298  ensure compliance with s. 394.4574 related to services provided
  299  to residents of licensed assisted living facilities that hold a
  300  limited mental health license. Except as provided in
  301  subparagraph 5., and except in counties where the Medicaid
  302  managed care pilot program is authorized pursuant to s.
  303  409.91211, the agency shall seek federal approval to contract
  304  with a single entity meeting these requirements to provide
  305  comprehensive behavioral health care services to all Medicaid
  306  recipients not enrolled in a Medicaid managed care plan
  307  authorized under s. 409.91211, a provider service network
  308  authorized under paragraph (d), or a Medicaid health maintenance
  309  organization in an AHCA area. In an AHCA area where the Medicaid
  310  managed care pilot program is authorized pursuant to s.
  311  409.91211 in one or more counties, the agency may procure a
  312  contract with a single entity to serve the remaining counties as
  313  an AHCA area or the remaining counties may be included with an
  314  adjacent AHCA area and are subject to this paragraph. Each
  315  entity must offer a sufficient choice of providers in its
  316  network to ensure recipient access to care and the opportunity
  317  to select a provider with whom they are satisfied. The network
  318  shall include all public mental health hospitals. To ensure
  319  unimpaired access to behavioral health care services by Medicaid
  320  recipients, all contracts issued pursuant to this paragraph must
  321  require 80 percent of the capitation paid to the managed care
  322  plan, including health maintenance organizations and capitated
  323  provider service networks, to be expended for the provision of
  324  behavioral health care services. If the managed care plan
  325  expends less than 80 percent of the capitation paid for the
  326  provision of behavioral health care services, the difference
  327  shall be returned to the agency. The agency shall provide the
  328  plan with a certification letter indicating the amount of
  329  capitation paid during each calendar year for behavioral health
  330  care services pursuant to this section. The agency may reimburse
  331  for substance abuse treatment services on a fee-for-service
  332  basis until the agency finds that adequate funds are available
  333  for capitated, prepaid arrangements.
  334         1. The agency shall modify the contracts with the entities
  335  providing comprehensive inpatient and outpatient mental health
  336  care services to Medicaid recipients in Hillsborough, Highlands,
  337  Hardee, Manatee, and Polk Counties, to include substance abuse
  338  treatment services.
  339         2. Except as provided in subparagraph 5., the agency and
  340  the Department of Children and Families shall contract with
  341  managed care entities in each AHCA area except area 6 or arrange
  342  to provide comprehensive inpatient and outpatient mental health
  343  and substance abuse services through capitated prepaid
  344  arrangements to all Medicaid recipients who are eligible to
  345  participate in such plans under federal law and regulation. In
  346  AHCA areas where eligible individuals number less than 150,000,
  347  the agency shall contract with a single managed care plan to
  348  provide comprehensive behavioral health services to all
  349  recipients who are not enrolled in a Medicaid health maintenance
  350  organization, a provider service network authorized under
  351  paragraph (d), or a Medicaid capitated managed care plan
  352  authorized under s. 409.91211. The agency may contract with more
  353  than one comprehensive behavioral health provider to provide
  354  care to recipients who are not enrolled in a Medicaid capitated
  355  managed care plan authorized under s. 409.91211, a provider
  356  service network authorized under paragraph (d), or a Medicaid
  357  health maintenance organization in AHCA areas where the eligible
  358  population exceeds 150,000. In an AHCA area where the Medicaid
  359  managed care pilot program is authorized pursuant to s.
  360  409.91211 in one or more counties, the agency may procure a
  361  contract with a single entity to serve the remaining counties as
  362  an AHCA area or the remaining counties may be included with an
  363  adjacent AHCA area and shall be subject to this paragraph.
  364  Contracts for comprehensive behavioral health providers awarded
  365  pursuant to this section shall be competitively procured. Both
  366  for-profit and not-for-profit corporations are eligible to
  367  compete. Managed care plans contracting with the agency under
  368  subsection (3) or paragraph (d) shall provide and receive
  369  payment for the same comprehensive behavioral health benefits as
  370  provided in AHCA rules, including handbooks incorporated by
  371  reference. In AHCA area 11, the agency shall contract with at
  372  least two comprehensive behavioral health care providers to
  373  provide behavioral health care to recipients in that area who
  374  are enrolled in, or assigned to, the MediPass program. One of
  375  the behavioral health care contracts must be with the existing
  376  provider service network pilot project, as described in
  377  paragraph (d), for the purpose of demonstrating the cost
  378  effectiveness of the provision of quality mental health services
  379  through a public hospital-operated managed care model. Payment
  380  shall be at an agreed-upon capitated rate to ensure cost
  381  savings. Of the recipients in area 11 who are assigned to
  382  MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those
  383  MediPass-enrolled recipients shall be assigned to the existing
  384  provider service network in area 11 for their behavioral care.
  385         3. Children residing in a statewide inpatient psychiatric
  386  program, or in a Department of Juvenile Justice or a Department
  387  of Children and Families residential program approved as a
  388  Medicaid behavioral health overlay services provider may not be
  389  included in a behavioral health care prepaid health plan or any
  390  other Medicaid managed care plan pursuant to this paragraph.
  391         4. Traditional community mental health providers under
  392  contract with the Department of Children and Families pursuant
  393  to part IV of chapter 394, child welfare providers under
  394  contract with the Department of Children and Families in areas 1
  395  and 6, and inpatient mental health providers licensed pursuant
  396  to chapter 395 must be offered an opportunity to accept or
  397  decline a contract to participate in any provider network for
  398  prepaid behavioral health services.
  399         5. All Medicaid-eligible children, except children in area
  400  1 and children in Highlands County, Hardee County, Polk County,
  401  or Manatee County of area 6, which are open for child welfare
  402  services in the statewide automated child welfare information
  403  system, shall receive their behavioral health care services
  404  through a specialty prepaid plan operated by community-based
  405  lead agencies through a single agency or formal agreements among
  406  several agencies. The agency shall work with the specialty plan
  407  to develop clinically effective, evidence-based alternatives as
  408  a downward substitution for the statewide inpatient psychiatric
  409  program and similar residential care and institutional services.
  410  The specialty prepaid plan must result in savings to the state
  411  comparable to savings achieved in other Medicaid managed care
  412  and prepaid programs. Such plan must provide mechanisms to
  413  maximize state and local revenues. The specialty prepaid plan
  414  shall be developed by the agency and the Department of Children
  415  and Families. The agency may seek federal waivers to implement
  416  this initiative. Medicaid-eligible children whose cases are open
  417  for child welfare services in the statewide automated child
  418  welfare information system and who reside in AHCA area 10 shall
  419  be enrolled in a capitated provider service network or other
  420  capitated managed care plan, which, in coordination with
  421  available community-based care providers specified in s.
  422  409.987, shall provide sufficient medical, developmental, and
  423  behavioral health services to meet the needs of these children.
  424  
  425  Effective July 1, 2012, in order to ensure continuity of care,
  426  the agency is authorized to extend or modify current contracts
  427  based on current service areas or on a regional basis, as
  428  determined appropriate by the agency, with comprehensive
  429  behavioral health care providers as described in this paragraph
  430  during the period prior to its expiration. This paragraph
  431  expires October 1, 2014.
  432         (c) A federally qualified health center or an entity owned
  433  by one or more federally qualified health centers or an entity
  434  owned by other migrant and community health centers receiving
  435  non-Medicaid financial support from the Federal Government to
  436  provide health care services on a prepaid or fixed-sum basis to
  437  recipients. A federally qualified health center or an entity
  438  that is owned by one or more federally qualified health centers
  439  and is reimbursed by the agency on a prepaid basis is exempt
  440  from parts I and III of chapter 641, but must comply with the
  441  solvency requirements in s. 641.2261(2) and meet the appropriate
  442  requirements governing financial reserve, quality assurance, and
  443  patients’ rights established by the agency. This paragraph
  444  expires October 1, 2014.
  445         (d)1. a provider service network, which may be reimbursed
  446  on a fee-for-service or prepaid basis. Prepaid provider service
  447  networks shall receive per-member, per-month payments. A
  448  provider service network that does not choose to be a prepaid
  449  plan shall receive fee-for-service rates with a shared savings
  450  settlement. The fee-for-service option shall be available to a
  451  provider service network only for the first 2 years of the
  452  plan’s operation or until the contract year beginning September
  453  1, 2014, whichever is later. The agency shall annually conduct
  454  cost reconciliations to determine the amount of cost savings
  455  achieved by fee-for-service provider service networks for the
  456  dates of service in the period being reconciled. Only payments
  457  for covered services for dates of service within the
  458  reconciliation period and paid within 6 months after the last
  459  date of service in the reconciliation period shall be included.
  460  The agency shall perform the necessary adjustments for the
  461  inclusion of claims incurred but not reported within the
  462  reconciliation for claims that could be received and paid by the
  463  agency after the 6-month claims processing time lag. The agency
  464  shall provide the results of the reconciliations to the fee-for
  465  service provider service networks within 45 days after the end
  466  of the reconciliation period. The fee-for-service provider
  467  service networks shall review and provide written comments or a
  468  letter of concurrence to the agency within 45 days after receipt
  469  of the reconciliation results. This reconciliation shall be
  470  considered final.
  471         (a)2. A provider service network which is reimbursed by the
  472  agency on a prepaid basis shall be exempt from parts I and III
  473  of chapter 641, but must comply with the solvency requirements
  474  in s. 641.2261(2) and meet appropriate financial reserve,
  475  quality assurance, and patient rights requirements as
  476  established by the agency.
  477         3. Medicaid recipients assigned to a provider service
  478  network shall be chosen equally from those who would otherwise
  479  have been assigned to prepaid plans and MediPass. The agency is
  480  authorized to seek federal Medicaid waivers as necessary to
  481  implement the provisions of this section. This subparagraph
  482  expires October 1, 2014.
  483         (b)4. A provider service network is a network established
  484  or organized and operated by a health care provider, or group of
  485  affiliated health care providers, including minority physician
  486  networks and emergency room diversion programs that meet the
  487  requirements of s. 409.91211, which provides a substantial
  488  proportion of the health care items and services under a
  489  contract directly through the provider or affiliated group of
  490  providers and may make arrangements with physicians or other
  491  health care professionals, health care institutions, or any
  492  combination of such individuals or institutions to assume all or
  493  part of the financial risk on a prospective basis for the
  494  provision of basic health services by the physicians, by other
  495  health professionals, or through the institutions. The health
  496  care providers must have a controlling interest in the governing
  497  body of the provider service network organization.
  498         (e) An entity that provides only comprehensive behavioral
  499  health care services to certain Medicaid recipients through an
  500  administrative services organization agreement. Such an entity
  501  must possess the clinical systems and operational competence to
  502  provide comprehensive health care to Medicaid recipients. As
  503  used in this paragraph, the term “comprehensive behavioral
  504  health care services” means covered mental health and substance
  505  abuse treatment services that are available to Medicaid
  506  recipients. Any contract awarded under this paragraph must be
  507  competitively procured. The agency must ensure that Medicaid
  508  recipients have available the choice of at least two managed
  509  care plans for their behavioral health care services. This
  510  paragraph expires October 1, 2014.
  511         (f) An entity authorized in s. 430.205 to contract with the
  512  agency and the Department of Elderly Affairs to provide health
  513  care and social services on a prepaid or fixed-sum basis to
  514  elderly recipients. Such prepaid health care services entities
  515  are exempt from the provisions of part I of chapter 641 for the
  516  first 3 years of operation. An entity recognized under this
  517  paragraph that demonstrates to the satisfaction of the Office of
  518  Insurance Regulation that it is backed by the full faith and
  519  credit of one or more counties in which it operates may be
  520  exempted from s. 641.225. This paragraph expires October 1,
  521  2013.
  522         (g) A Children’s Medical Services Network, as defined in s.
  523  391.021. This paragraph expires October 1, 2014.
  524         (5) The agency may contract with any public or private
  525  entity otherwise authorized by this section on a prepaid or
  526  fixed-sum basis for the provision of health care services to
  527  recipients. An entity may provide prepaid services to
  528  recipients, either directly or through arrangements with other
  529  entities, if each entity involved in providing services:
  530         (a) Is organized primarily for the purpose of providing
  531  health care or other services of the type regularly offered to
  532  Medicaid recipients;
  533         (b) Ensures that services meet the standards set by the
  534  agency for quality, appropriateness, and timeliness;
  535         (c) Makes provisions satisfactory to the agency for
  536  insolvency protection and ensures that neither enrolled Medicaid
  537  recipients nor the agency will be liable for the debts of the
  538  entity;
  539         (d) Submits to the agency, if a private entity, a financial
  540  plan that the agency finds to be fiscally sound and that
  541  provides for working capital in the form of cash or equivalent
  542  liquid assets excluding revenues from Medicaid premium payments
  543  equal to at least the first 3 months of operating expenses or
  544  $200,000, whichever is greater;
  545         (e) Furnishes evidence satisfactory to the agency of
  546  adequate liability insurance coverage or an adequate plan of
  547  self-insurance to respond to claims for injuries arising out of
  548  the furnishing of health care;
  549         (f) Provides, through contract or otherwise, for periodic
  550  review of its medical facilities and services, as required by
  551  the agency; and
  552         (g) Provides organizational, operational, financial, and
  553  other information required by the agency.
  554  
  555  This subsection expires October 1, 2014.
  556         (6) The agency may contract on a prepaid or fixed-sum basis
  557  with any health insurer that:
  558         (a) Pays for health care services provided to enrolled
  559  Medicaid recipients in exchange for a premium payment paid by
  560  the agency;
  561         (b) Assumes the underwriting risk; and
  562         (c) Is organized and licensed under applicable provisions
  563  of the Florida Insurance Code and is currently in good standing
  564  with the Office of Insurance Regulation.
  565  
  566  This subsection expires October 1, 2014.
  567         (7) The agency may contract on a prepaid or fixed-sum basis
  568  with an exclusive provider organization to provide health care
  569  services to Medicaid recipients provided that the exclusive
  570  provider organization meets applicable managed care plan
  571  requirements in this section, ss. 409.9122, 409.9123, 409.9128,
  572  and 627.6472, and other applicable provisions of law. This
  573  subsection expires October 1, 2014.
  574         (8) The Agency for Health Care Administration may provide
  575  cost-effective purchasing of chiropractic services on a fee-for
  576  service basis to Medicaid recipients through arrangements with a
  577  statewide chiropractic preferred provider organization
  578  incorporated in this state as a not-for-profit corporation. The
  579  agency shall ensure that the benefit limits and prior
  580  authorization requirements in the current Medicaid program shall
  581  apply to the services provided by the chiropractic preferred
  582  provider organization. This subsection expires October 1, 2014.
  583         (9) The agency shall not contract on a prepaid or fixed-sum
  584  basis for Medicaid services with an entity which knows or
  585  reasonably should know that any officer, director, agent,
  586  managing employee, or owner of stock or beneficial interest in
  587  excess of 5 percent common or preferred stock, or the entity
  588  itself, has been found guilty of, regardless of adjudication, or
  589  entered a plea of nolo contendere, or guilty, to:
  590         (a) Fraud;
  591         (b) Violation of federal or state antitrust statutes,
  592  including those proscribing price fixing between competitors and
  593  the allocation of customers among competitors;
  594         (c) Commission of a felony involving embezzlement, theft,
  595  forgery, income tax evasion, bribery, falsification or
  596  destruction of records, making false statements, receiving
  597  stolen property, making false claims, or obstruction of justice;
  598  or
  599         (d) Any crime in any jurisdiction which directly relates to
  600  the provision of health services on a prepaid or fixed-sum
  601  basis.
  602  
  603  This subsection expires October 1, 2014.
  604         (3)(10) The agency, after notifying the Legislature, may
  605  apply for waivers of applicable federal laws and regulations as
  606  necessary to implement more appropriate systems of health care
  607  for Medicaid recipients and reduce the cost of the Medicaid
  608  program to the state and federal governments and shall implement
  609  such programs, after legislative approval, within a reasonable
  610  period of time after federal approval. These programs must be
  611  designed primarily to reduce the need for inpatient care,
  612  custodial care and other long-term or institutional care, and
  613  other high-cost services. Prior to seeking legislative approval
  614  of such a waiver as authorized by this subsection, the agency
  615  shall provide notice and an opportunity for public comment.
  616  Notice shall be provided to all persons who have made requests
  617  of the agency for advance notice and shall be published in the
  618  Florida Administrative Register not less than 28 days prior to
  619  the intended action. This subsection expires October 1, 2016.
  620         (11) The agency shall establish a postpayment utilization
  621  control program designed to identify recipients who may
  622  inappropriately overuse or underuse Medicaid services and shall
  623  provide methods to correct such misuse. This subsection expires
  624  October 1, 2014.
  625         (12) The agency shall develop and provide coordinated
  626  systems of care for Medicaid recipients and may contract with
  627  public or private entities to develop and administer such
  628  systems of care among public and private health care providers
  629  in a given geographic area. This subsection expires October 1,
  630  2014.
  631         (13) The agency shall operate or contract for the operation
  632  of utilization management and incentive systems designed to
  633  encourage cost-effective use of services and to eliminate
  634  services that are medically unnecessary. The agency shall track
  635  Medicaid provider prescription and billing patterns and evaluate
  636  them against Medicaid medical necessity criteria and coverage
  637  and limitation guidelines adopted by rule. Medical necessity
  638  determination requires that service be consistent with symptoms
  639  or confirmed diagnosis of illness or injury under treatment and
  640  not in excess of the patient’s needs. The agency shall conduct
  641  reviews of provider exceptions to peer group norms and shall,
  642  using statistical methodologies, provider profiling, and
  643  analysis of billing patterns, detect and investigate abnormal or
  644  unusual increases in billing or payment of claims for Medicaid
  645  services and medically unnecessary provision of services.
  646  Providers that demonstrate a pattern of submitting claims for
  647  medically unnecessary services shall be referred to the Medicaid
  648  program integrity unit for investigation. In its annual report,
  649  required in s. 409.913, the agency shall report on its efforts
  650  to control overutilization as described in this subsection. This
  651  subsection expires October 1, 2014.
  652         (14)(a) The agency shall operate the Comprehensive
  653  Assessment and Review for Long-Term Care Services (CARES)
  654  nursing facility preadmission screening program to ensure that
  655  Medicaid payment for nursing facility care is made only for
  656  individuals whose conditions require such care and to ensure
  657  that long-term care services are provided in the setting most
  658  appropriate to the needs of the person and in the most
  659  economical manner possible. The CARES program shall also ensure
  660  that individuals participating in Medicaid home and community
  661  based waiver programs meet criteria for those programs,
  662  consistent with approved federal waivers.
  663         (b) The agency shall operate the CARES program through an
  664  interagency agreement with the Department of Elderly Affairs.
  665  The agency, in consultation with the Department of Elderly
  666  Affairs, may contract for any function or activity of the CARES
  667  program, including any function or activity required by 42
  668  C.F.R. s. 483.20, relating to preadmission screening and
  669  resident review.
  670         (c) Prior to making payment for nursing facility services
  671  for a Medicaid recipient, the agency must verify that the
  672  nursing facility preadmission screening program has determined
  673  that the individual requires nursing facility care and that the
  674  individual cannot be safely served in community-based programs.
  675  The nursing facility preadmission screening program shall refer
  676  a Medicaid recipient to a community-based program if the
  677  individual could be safely served at a lower cost and the
  678  recipient chooses to participate in such program. For
  679  individuals whose nursing home stay is initially funded by
  680  Medicare and Medicare coverage is being terminated for lack of
  681  progress towards rehabilitation, CARES staff shall consult with
  682  the person making the determination of progress toward
  683  rehabilitation to ensure that the recipient is not being
  684  inappropriately disqualified from Medicare coverage. If, in
  685  their professional judgment, CARES staff believes that a
  686  Medicare beneficiary is still making progress toward
  687  rehabilitation, they may assist the Medicare beneficiary with an
  688  appeal of the disqualification from Medicare coverage. The use
  689  of CARES teams to review Medicare denials for coverage under
  690  this section is authorized only if it is determined that such
  691  reviews qualify for federal matching funds through Medicaid. The
  692  agency shall seek or amend federal waivers as necessary to
  693  implement this section.
  694         (d) For the purpose of initiating immediate prescreening
  695  and diversion assistance for individuals residing in nursing
  696  homes and in order to make families aware of alternative long
  697  term care resources so that they may choose a more cost
  698  effective setting for long-term placement, CARES staff shall
  699  conduct an assessment and review of a sample of individuals
  700  whose nursing home stay is expected to exceed 20 days,
  701  regardless of the initial funding source for the nursing home
  702  placement. CARES staff shall provide counseling and referral
  703  services to these individuals regarding choosing appropriate
  704  long-term care alternatives. This paragraph does not apply to
  705  continuing care facilities licensed under chapter 651 or to
  706  retirement communities that provide a combination of nursing
  707  home, independent living, and other long-term care services.
  708         (e) By January 15 of each year, the agency shall submit a
  709  report to the Legislature describing the operations of the CARES
  710  program. The report must describe:
  711         1. Rate of diversion to community alternative programs;
  712         2. CARES program staffing needs to achieve additional
  713  diversions;
  714         3. Reasons the program is unable to place individuals in
  715  less restrictive settings when such individuals desired such
  716  services and could have been served in such settings;
  717         4. Barriers to appropriate placement, including barriers
  718  due to policies or operations of other agencies or state-funded
  719  programs; and
  720         5. Statutory changes necessary to ensure that individuals
  721  in need of long-term care services receive care in the least
  722  restrictive environment.
  723         (f) The Department of Elderly Affairs shall track
  724  individuals over time who are assessed under the CARES program
  725  and who are diverted from nursing home placement. By January 15
  726  of each year, the department shall submit to the Legislature a
  727  longitudinal study of the individuals who are diverted from
  728  nursing home placement. The study must include:
  729         1. The demographic characteristics of the individuals
  730  assessed and diverted from nursing home placement, including,
  731  but not limited to, age, race, gender, frailty, caregiver
  732  status, living arrangements, and geographic location;
  733         2. A summary of community services provided to individuals
  734  for 1 year after assessment and diversion;
  735         3. A summary of inpatient hospital admissions for
  736  individuals who have been diverted; and
  737         4. A summary of the length of time between diversion and
  738  subsequent entry into a nursing home or death.
  739  
  740  This subsection expires October 1, 2013.
  741         (15)(a) The agency shall identify health care utilization
  742  and price patterns within the Medicaid program which are not
  743  cost-effective or medically appropriate and assess the
  744  effectiveness of new or alternate methods of providing and
  745  monitoring service, and may implement such methods as it
  746  considers appropriate. Such methods may include disease
  747  management initiatives, an integrated and systematic approach
  748  for managing the health care needs of recipients who are at risk
  749  of or diagnosed with a specific disease by using best practices,
  750  prevention strategies, clinical-practice improvement, clinical
  751  interventions and protocols, outcomes research, information
  752  technology, and other tools and resources to reduce overall
  753  costs and improve measurable outcomes.
  754         (b) The responsibility of the agency under this subsection
  755  includes the development of capabilities to identify actual and
  756  optimal practice patterns; patient and provider educational
  757  initiatives; methods for determining patient compliance with
  758  prescribed treatments; fraud, waste, and abuse prevention and
  759  detection programs; and beneficiary case management programs.
  760         1. The practice pattern identification program shall
  761  evaluate practitioner prescribing patterns based on national and
  762  regional practice guidelines, comparing practitioners to their
  763  peer groups. The agency and its Drug Utilization Review Board
  764  shall consult with the Department of Health and a panel of
  765  practicing health care professionals consisting of the
  766  following: the Speaker of the House of Representatives and the
  767  President of the Senate shall each appoint three physicians
  768  licensed under chapter 458 or chapter 459, and the Governor
  769  shall appoint two pharmacists licensed under chapter 465 and one
  770  dentist licensed under chapter 466 who is an oral surgeon. Terms
  771  of the panel members shall expire at the discretion of the
  772  appointing official. The advisory panel shall be responsible for
  773  evaluating treatment guidelines and recommending ways to
  774  incorporate their use in the practice pattern identification
  775  program. Practitioners who are prescribing inappropriately or
  776  inefficiently, as determined by the agency, may have their
  777  prescribing of certain drugs subject to prior authorization or
  778  may be terminated from all participation in the Medicaid
  779  program.
  780         2. The agency shall also develop educational interventions
  781  designed to promote the proper use of medications by providers
  782  and beneficiaries.
  783         3. The agency shall implement a pharmacy fraud, waste, and
  784  abuse initiative that may include a surety bond or letter of
  785  credit requirement for participating pharmacies, enhanced
  786  provider auditing practices, the use of additional fraud and
  787  abuse software, recipient management programs for beneficiaries
  788  inappropriately using their benefits, and other steps that
  789  eliminate provider and recipient fraud, waste, and abuse. The
  790  initiative shall address enforcement efforts to reduce the
  791  number and use of counterfeit prescriptions.
  792         4. The agency may contract with an entity in the state to
  793  provide Medicaid providers with electronic access to Medicaid
  794  prescription refill data and information relating to the
  795  Medicaid preferred drug list. The initiative shall be designed
  796  to enhance the agency’s efforts to reduce fraud, abuse, and
  797  errors in the prescription drug benefit program and to otherwise
  798  further the intent of this paragraph.
  799         5. The agency shall contract with an entity to design a
  800  database of clinical utilization information or electronic
  801  medical records for Medicaid providers. The database must be
  802  web-based and allow providers to review on a real-time basis the
  803  utilization of Medicaid services, including, but not limited to,
  804  physician office visits, inpatient and outpatient
  805  hospitalizations, laboratory and pathology services,
  806  radiological and other imaging services, dental care, and
  807  patterns of dispensing prescription drugs in order to coordinate
  808  care and identify potential fraud and abuse.
  809         6. The agency may apply for any federal waivers needed to
  810  administer this paragraph.
  811  
  812  This subsection expires October 1, 2014.
  813         (16) An entity contracting on a prepaid or fixed-sum basis
  814  shall meet the surplus requirements of s. 641.225. If an
  815  entity’s surplus falls below an amount equal to the surplus
  816  requirements of s. 641.225, the agency shall prohibit the entity
  817  from engaging in marketing and preenrollment activities, shall
  818  cease to process new enrollments, and may not renew the entity’s
  819  contract until the required balance is achieved. The
  820  requirements of this subsection do not apply:
  821         (a) Where a public entity agrees to fund any deficit
  822  incurred by the contracting entity; or
  823         (b) Where the entity’s performance and obligations are
  824  guaranteed in writing by a guaranteeing organization which:
  825         1. Has been in operation for at least 5 years and has
  826  assets in excess of $50 million; or
  827         2. Submits a written guarantee acceptable to the agency
  828  which is irrevocable during the term of the contracting entity’s
  829  contract with the agency and, upon termination of the contract,
  830  until the agency receives proof of satisfaction of all
  831  outstanding obligations incurred under the contract.
  832  
  833  This subsection expires October 1, 2014.
  834         (4)(17)(a) The agency may require an entity contracting on
  835  a prepaid or fixed-sum basis to establish a restricted
  836  insolvency protection account with a federally guaranteed
  837  financial institution licensed to do business in this state. The
  838  entity shall deposit into that account 5 percent of the
  839  capitation payments made by the agency each month until a
  840  maximum total of 2 percent of the total current contract amount
  841  is reached. The restricted insolvency protection account may be
  842  drawn upon with the authorized signatures of two persons
  843  designated by the entity and two representatives of the agency.
  844  If the agency finds that the entity is insolvent, the agency may
  845  draw upon the account solely with the two authorized signatures
  846  of representatives of the agency, and the funds may be disbursed
  847  to meet financial obligations incurred by the entity under the
  848  prepaid contract. If the contract is terminated, expired, or not
  849  continued, the account balance must be released by the agency to
  850  the entity upon receipt of proof of satisfaction of all
  851  outstanding obligations incurred under this contract.
  852         (b) The agency may waive the insolvency protection account
  853  requirement in writing when evidence is on file with the agency
  854  of adequate insolvency insurance and reinsurance that will
  855  protect enrollees if the entity becomes unable to meet its
  856  obligations.
  857         (18) An entity that contracts with the agency on a prepaid
  858  or fixed-sum basis for the provision of Medicaid services shall
  859  reimburse any hospital or physician that is outside the entity’s
  860  authorized geographic service area as specified in its contract
  861  with the agency, and that provides services authorized by the
  862  entity to its members, at a rate negotiated with the hospital or
  863  physician for the provision of services or according to the
  864  lesser of the following:
  865         (a) The usual and customary charges made to the general
  866  public by the hospital or physician; or
  867         (b) The Florida Medicaid reimbursement rate established for
  868  the hospital or physician.
  869  
  870  This subsection expires October 1, 2014.
  871         (19) When a merger or acquisition of a Medicaid prepaid
  872  contractor has been approved by the Office of Insurance
  873  Regulation pursuant to s. 628.4615, the agency shall approve the
  874  assignment or transfer of the appropriate Medicaid prepaid
  875  contract upon request of the surviving entity of the merger or
  876  acquisition if the contractor and the other entity have been in
  877  good standing with the agency for the most recent 12-month
  878  period, unless the agency determines that the assignment or
  879  transfer would be detrimental to the Medicaid recipients or the
  880  Medicaid program. To be in good standing, an entity must not
  881  have failed accreditation or committed any material violation of
  882  the requirements of s. 641.52 and must meet the Medicaid
  883  contract requirements. For purposes of this section, a merger or
  884  acquisition means a change in controlling interest of an entity,
  885  including an asset or stock purchase. This subsection expires
  886  October 1, 2014.
  887         (5)(20) Any entity contracting with the agency pursuant to
  888  this section to provide health care services to Medicaid
  889  recipients is prohibited from engaging in any of the following
  890  practices or activities:
  891         (a) Practices that are discriminatory, including, but not
  892  limited to, attempts to discourage participation on the basis of
  893  actual or perceived health status.
  894         (b) Activities that could mislead or confuse recipients, or
  895  misrepresent the organization, its marketing representatives, or
  896  the agency. Violations of this paragraph include, but are not
  897  limited to:
  898         1. False or misleading claims that marketing
  899  representatives are employees or representatives of the state or
  900  county, or of anyone other than the entity or the organization
  901  by whom they are reimbursed.
  902         2. False or misleading claims that the entity is
  903  recommended or endorsed by any state or county agency, or by any
  904  other organization which has not certified its endorsement in
  905  writing to the entity.
  906         3. False or misleading claims that the state or county
  907  recommends that a Medicaid recipient enroll with an entity.
  908         4. Claims that a Medicaid recipient will lose benefits
  909  under the Medicaid program, or any other health or welfare
  910  benefits to which the recipient is legally entitled, if the
  911  recipient does not enroll with the entity.
  912         (c) Granting or offering of any monetary or other valuable
  913  consideration for enrollment, except as authorized by subsection
  914  (23).
  915         (d) Door-to-door solicitation of recipients who have not
  916  contacted the entity or who have not invited the entity to make
  917  a presentation.
  918         (e) Solicitation of Medicaid recipients by marketing
  919  representatives stationed in state offices unless approved and
  920  supervised by the agency or its agent and approved by the
  921  affected state agency when solicitation occurs in an office of
  922  the state agency. The agency shall ensure that marketing
  923  representatives stationed in state offices shall market their
  924  managed care plans to Medicaid recipients only in designated
  925  areas and in such a way as to not interfere with the recipients’
  926  activities in the state office.
  927         (f) Enrollment of Medicaid recipients.
  928         (6)(21) The agency may impose a fine for a violation of
  929  this section or the contract with the agency by a person or
  930  entity that is under contract with the agency. With respect to
  931  any nonwillful violation, such fine shall not exceed $2,500 per
  932  violation. In no event shall such fine exceed an aggregate
  933  amount of $10,000 for all nonwillful violations arising out of
  934  the same action. With respect to any knowing and willful
  935  violation of this section or the contract with the agency, the
  936  agency may impose a fine upon the entity in an amount not to
  937  exceed $20,000 for each such violation. In no event shall such
  938  fine exceed an aggregate amount of $100,000 for all knowing and
  939  willful violations arising out of the same action.
  940         (22) A health maintenance organization or a person or
  941  entity exempt from chapter 641 that is under contract with the
  942  agency for the provision of health care services to Medicaid
  943  recipients may not use or distribute marketing materials used to
  944  solicit Medicaid recipients, unless such materials have been
  945  approved by the agency. The provisions of this subsection do not
  946  apply to general advertising and marketing materials used by a
  947  health maintenance organization to solicit both non-Medicaid
  948  subscribers and Medicaid recipients. This subsection expires
  949  October 1, 2014.
  950         (23) Upon approval by the agency, health maintenance
  951  organizations and persons or entities exempt from chapter 641
  952  that are under contract with the agency for the provision of
  953  health care services to Medicaid recipients may be permitted
  954  within the capitation rate to provide additional health benefits
  955  that the agency has found are of high quality, are practicably
  956  available, provide reasonable value to the recipient, and are
  957  provided at no additional cost to the state. This subsection
  958  expires October 1, 2014.
  959         (24) The agency shall utilize the statewide health
  960  maintenance organization complaint hotline for the purpose of
  961  investigating and resolving Medicaid and prepaid health plan
  962  complaints, maintaining a record of complaints and confirmed
  963  problems, and receiving disenrollment requests made by
  964  recipients. This subsection expires October 1, 2014.
  965         (25) The agency shall require the publication of the health
  966  maintenance organization’s and the prepaid health plan’s
  967  consumer services telephone numbers and the “800” telephone
  968  number of the statewide health maintenance organization
  969  complaint hotline on each Medicaid identification card issued by
  970  a health maintenance organization or prepaid health plan
  971  contracting with the agency to serve Medicaid recipients and on
  972  each subscriber handbook issued to a Medicaid recipient. This
  973  subsection expires October 1, 2014.
  974         (7)(26) The agency shall establish a health care quality
  975  improvement system for those entities contracting with the
  976  agency pursuant to this section, incorporating all the standards
  977  and guidelines developed by the Centers for Medicare and
  978  Medicaid Services Bureau of the Health Care Financing
  979  Administration as a part of the quality assurance reform
  980  initiative. The system shall include, but need not be limited
  981  to, the following:
  982         (a) Guidelines for internal quality assurance programs,
  983  including standards for:
  984         1. Written quality assurance program descriptions.
  985         2. Responsibilities of the governing body for monitoring,
  986  evaluating, and making improvements to care.
  987         3. An active quality assurance committee.
  988         4. Quality assurance program supervision.
  989         5. Requiring the program to have adequate resources to
  990  effectively carry out its specified activities.
  991         6. Provider participation in the quality assurance program.
  992         7. Delegation of quality assurance program activities.
  993         8. Credentialing and recredentialing.
  994         9. Enrollee rights and responsibilities.
  995         10. Availability and accessibility to services and care.
  996         11. Ambulatory care facilities.
  997         12. Accessibility and availability of medical records, as
  998  well as proper recordkeeping and process for record review.
  999         13. Utilization review.
 1000         14. A continuity of care system.
 1001         15. Quality assurance program documentation.
 1002         16. Coordination of quality assurance activity with other
 1003  management activity.
 1004         17. Delivering care to pregnant women and infants; to
 1005  elderly and disabled recipients, especially those who are at
 1006  risk of institutional placement; to persons with developmental
 1007  disabilities; and to adults who have chronic, high-cost medical
 1008  conditions.
 1009         (b) Guidelines which require the entities to conduct
 1010  quality-of-care studies which:
 1011         1. Target specific conditions and specific health service
 1012  delivery issues for focused monitoring and evaluation.
 1013         2. Use clinical care standards or practice guidelines to
 1014  objectively evaluate the care the entity delivers or fails to
 1015  deliver for the targeted clinical conditions and health services
 1016  delivery issues.
 1017         3. Use quality indicators derived from the clinical care
 1018  standards or practice guidelines to screen and monitor care and
 1019  services delivered.
 1020         (c) Guidelines for external quality review of each
 1021  contractor which require: focused studies of patterns of care;
 1022  individual care review in specific situations; and followup
 1023  activities on previous pattern-of-care study findings and
 1024  individual-care-review findings. In designing the external
 1025  quality review function and determining how it is to operate as
 1026  part of the state’s overall quality improvement system, the
 1027  agency shall construct its external quality review organization
 1028  and entity contracts to address each of the following:
 1029         1. Delineating the role of the external quality review
 1030  organization.
 1031         2. Length of the external quality review organization
 1032  contract with the state.
 1033         3. Participation of the contracting entities in designing
 1034  external quality review organization review activities.
 1035         4. Potential variation in the type of clinical conditions
 1036  and health services delivery issues to be studied at each plan.
 1037         5. Determining the number of focused pattern-of-care
 1038  studies to be conducted for each plan.
 1039         6. Methods for implementing focused studies.
 1040         7. Individual care review.
 1041         8. Followup activities.
 1042  
 1043  This subsection expires October 1, 2016.
 1044         (27) In order to ensure that children receive health care
 1045  services for which an entity has already been compensated, an
 1046  entity contracting with the agency pursuant to this section
 1047  shall achieve an annual Early and Periodic Screening, Diagnosis,
 1048  and Treatment (EPSDT) Service screening rate of at least 60
 1049  percent for those recipients continuously enrolled for at least
 1050  8 months. The agency shall develop a method by which the EPSDT
 1051  screening rate shall be calculated. For any entity which does
 1052  not achieve the annual 60 percent rate, the entity must submit a
 1053  corrective action plan for the agency’s approval. If the entity
 1054  does not meet the standard established in the corrective action
 1055  plan during the specified timeframe, the agency is authorized to
 1056  impose appropriate contract sanctions. At least annually, the
 1057  agency shall publicly release the EPSDT Services screening rates
 1058  of each entity it has contracted with on a prepaid basis to
 1059  serve Medicaid recipients. This subsection expires October 1,
 1060  2014.
 1061         (28) The agency shall perform enrollments and
 1062  disenrollments for Medicaid recipients who are eligible for
 1063  MediPass or managed care plans. Notwithstanding the prohibition
 1064  contained in paragraph (20)(f), managed care plans may perform
 1065  preenrollments of Medicaid recipients under the supervision of
 1066  the agency or its agents. For the purposes of this section, the
 1067  term “preenrollment” means the provision of marketing and
 1068  educational materials to a Medicaid recipient and assistance in
 1069  completing the application forms, but does not include actual
 1070  enrollment into a managed care plan. An application for
 1071  enrollment may not be deemed complete until the agency or its
 1072  agent verifies that the recipient made an informed, voluntary
 1073  choice. The agency, in cooperation with the Department of
 1074  Children and Families, may test new marketing initiatives to
 1075  inform Medicaid recipients about their managed care options at
 1076  selected sites. The agency may contract with a third party to
 1077  perform managed care plan and MediPass enrollment and
 1078  disenrollment services for Medicaid recipients and may adopt
 1079  rules to administer such services. The agency may adjust the
 1080  capitation rate only to cover the costs of a third-party
 1081  enrollment and disenrollment contract, and for agency
 1082  supervision and management of the managed care plan enrollment
 1083  and disenrollment contract. This subsection expires October 1,
 1084  2014.
 1085         (29) Any lists of providers made available to Medicaid
 1086  recipients, MediPass enrollees, or managed care plan enrollees
 1087  shall be arranged alphabetically showing the provider’s name and
 1088  specialty and, separately, by specialty in alphabetical order.
 1089  This subsection expires October 1, 2014.
 1090         (30) The agency shall establish an enhanced managed care
 1091  quality assurance oversight function, to include at least the
 1092  following components:
 1093         (a) At least quarterly analysis and followup, including
 1094  sanctions as appropriate, of managed care participant
 1095  utilization of services.
 1096         (b) At least quarterly analysis and followup, including
 1097  sanctions as appropriate, of quality findings of the Medicaid
 1098  peer review organization and other external quality assurance
 1099  programs.
 1100         (c) At least quarterly analysis and followup, including
 1101  sanctions as appropriate, of the fiscal viability of managed
 1102  care plans.
 1103         (d) At least quarterly analysis and followup, including
 1104  sanctions as appropriate, of managed care participant
 1105  satisfaction and disenrollment surveys.
 1106         (e) The agency shall conduct regular and ongoing Medicaid
 1107  recipient satisfaction surveys.
 1108  
 1109  The analyses and followup activities conducted by the agency
 1110  under its enhanced managed care quality assurance oversight
 1111  function shall not duplicate the activities of accreditation
 1112  reviewers for entities regulated under part III of chapter 641,
 1113  but may include a review of the finding of such reviewers. This
 1114  subsection expires October 1, 2014.
 1115         (31) Each managed care plan that is under contract with the
 1116  agency to provide health care services to Medicaid recipients
 1117  shall annually conduct a background check with the Department of
 1118  Law Enforcement of all persons with ownership interest of 5
 1119  percent or more or executive management responsibility for the
 1120  managed care plan and shall submit to the agency information
 1121  concerning any such person who has been found guilty of,
 1122  regardless of adjudication, or has entered a plea of nolo
 1123  contendere or guilty to, any of the offenses listed in s.
 1124  435.04. This subsection expires October 1, 2014.
 1125         (32) The agency shall, by rule, develop a process whereby a
 1126  Medicaid managed care plan enrollee who wishes to enter hospice
 1127  care may be disenrolled from the managed care plan within 24
 1128  hours after contacting the agency regarding such request. The
 1129  agency rule shall include a methodology for the agency to recoup
 1130  managed care plan payments on a pro rata basis if payment has
 1131  been made for the enrollment month when disenrollment occurs.
 1132  This subsection expires October 1, 2014.
 1133         (33) The agency and entities that contract with the agency
 1134  to provide health care services to Medicaid recipients under
 1135  this section or ss. 409.91211 and 409.9122 must comply with the
 1136  provisions of s. 641.513 in providing emergency services and
 1137  care to Medicaid recipients and MediPass recipients. Where
 1138  feasible, safe, and cost-effective, the agency shall encourage
 1139  hospitals, emergency medical services providers, and other
 1140  public and private health care providers to work together in
 1141  their local communities to enter into agreements or arrangements
 1142  to ensure access to alternatives to emergency services and care
 1143  for those Medicaid recipients who need nonemergent care. The
 1144  agency shall coordinate with hospitals, emergency medical
 1145  services providers, private health plans, capitated managed care
 1146  networks as established in s. 409.91211, and other public and
 1147  private health care providers to implement the provisions of ss.
 1148  395.1041(7), 409.91255(3)(g), 627.6405, and 641.31097 to develop
 1149  and implement emergency department diversion programs for
 1150  Medicaid recipients. This subsection expires October 1, 2014.
 1151         (34) All entities providing health care services to
 1152  Medicaid recipients shall make available, and encourage all
 1153  pregnant women and mothers with infants to receive, and provide
 1154  documentation in the medical records to reflect, the following:
 1155         (a) Healthy Start prenatal or infant screening.
 1156         (b) Healthy Start care coordination, when screening or
 1157  other factors indicate need.
 1158         (c) Healthy Start enhanced services in accordance with the
 1159  prenatal or infant screening results.
 1160         (d) Immunizations in accordance with recommendations of the
 1161  Advisory Committee on Immunization Practices of the United
 1162  States Public Health Service and the American Academy of
 1163  Pediatrics, as appropriate.
 1164         (e) Counseling and services for family planning to all
 1165  women and their partners.
 1166         (f) A scheduled postpartum visit for the purpose of
 1167  voluntary family planning, to include discussion of all methods
 1168  of contraception, as appropriate.
 1169         (g) Referral to the Special Supplemental Nutrition Program
 1170  for Women, Infants, and Children (WIC).
 1171  
 1172  This subsection expires October 1, 2014.
 1173         (35) Any entity that provides Medicaid prepaid health plan
 1174  services shall ensure the appropriate coordination of health
 1175  care services with an assisted living facility in cases where a
 1176  Medicaid recipient is both a member of the entity’s prepaid
 1177  health plan and a resident of the assisted living facility. If
 1178  the entity is at risk for Medicaid targeted case management and
 1179  behavioral health services, the entity shall inform the assisted
 1180  living facility of the procedures to follow should an emergent
 1181  condition arise. This subsection expires October 1, 2014.
 1182         (36) The agency shall enter into agreements with not-for
 1183  profit organizations based in this state for the purpose of
 1184  providing vision screening. This subsection expires October 1,
 1185  2014.
 1186         (8)(37)(a) The agency shall implement a Medicaid
 1187  prescribed-drug spending-control program that includes the
 1188  following components:
 1189         1. A Medicaid preferred drug list, which shall be a listing
 1190  of cost-effective therapeutic options recommended by the
 1191  Medicaid Pharmacy and Therapeutics Committee established
 1192  pursuant to s. 409.91195 and adopted by the agency for each
 1193  therapeutic class on the preferred drug list. At the discretion
 1194  of the committee, and when feasible, the preferred drug list
 1195  should include at least two products in a therapeutic class. The
 1196  agency may post the preferred drug list and updates to the list
 1197  on an Internet website without following the rulemaking
 1198  procedures of chapter 120. Antiretroviral agents are excluded
 1199  from the preferred drug list. The agency shall also limit the
 1200  amount of a prescribed drug dispensed to no more than a 34-day
 1201  supply unless the drug products’ smallest marketed package is
 1202  greater than a 34-day supply, or the drug is determined by the
 1203  agency to be a maintenance drug in which case a 100-day maximum
 1204  supply may be authorized. The agency may seek any federal
 1205  waivers necessary to implement these cost-control programs and
 1206  to continue participation in the federal Medicaid rebate
 1207  program, or alternatively to negotiate state-only manufacturer
 1208  rebates. The agency may adopt rules to administer this
 1209  subparagraph. The agency shall continue to provide unlimited
 1210  contraceptive drugs and items. The agency must establish
 1211  procedures to ensure that:
 1212         a. There is a response to a request for prior consultation
 1213  by telephone or other telecommunication device within 24 hours
 1214  after receipt of a request for prior consultation; and
 1215         b. A 72-hour supply of the drug prescribed is provided in
 1216  an emergency or when the agency does not provide a response
 1217  within 24 hours as required by sub-subparagraph a.
 1218         2. Reimbursement to pharmacies for Medicaid prescribed
 1219  drugs shall be set at the lowest of: the average wholesale price
 1220  (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
 1221  plus 1.5 percent, the federal upper limit (FUL), the state
 1222  maximum allowable cost (SMAC), or the usual and customary (UAC)
 1223  charge billed by the provider.
 1224         3. The agency shall develop and implement a process for
 1225  managing the drug therapies of Medicaid recipients who are using
 1226  significant numbers of prescribed drugs each month. The
 1227  management process may include, but is not limited to,
 1228  comprehensive, physician-directed medical-record reviews, claims
 1229  analyses, and case evaluations to determine the medical
 1230  necessity and appropriateness of a patient’s treatment plan and
 1231  drug therapies. The agency may contract with a private
 1232  organization to provide drug-program-management services. The
 1233  Medicaid drug benefit management program shall include
 1234  initiatives to manage drug therapies for HIV/AIDS patients,
 1235  patients using 20 or more unique prescriptions in a 180-day
 1236  period, and the top 1,000 patients in annual spending. The
 1237  agency shall enroll any Medicaid recipient in the drug benefit
 1238  management program if he or she meets the specifications of this
 1239  provision and is not enrolled in a Medicaid health maintenance
 1240  organization.
 1241         4. The agency may limit the size of its pharmacy network
 1242  based on need, competitive bidding, price negotiations,
 1243  credentialing, or similar criteria. The agency shall give
 1244  special consideration to rural areas in determining the size and
 1245  location of pharmacies included in the Medicaid pharmacy
 1246  network. A pharmacy credentialing process may include criteria
 1247  such as a pharmacy’s full-service status, location, size,
 1248  patient educational programs, patient consultation, disease
 1249  management services, and other characteristics. The agency may
 1250  impose a moratorium on Medicaid pharmacy enrollment if it is
 1251  determined that it has a sufficient number of Medicaid
 1252  participating providers. The agency must allow dispensing
 1253  practitioners to participate as a part of the Medicaid pharmacy
 1254  network regardless of the practitioner’s proximity to any other
 1255  entity that is dispensing prescription drugs under the Medicaid
 1256  program. A dispensing practitioner must meet all credentialing
 1257  requirements applicable to his or her practice, as determined by
 1258  the agency.
 1259         5. The agency shall develop and implement a program that
 1260  requires Medicaid practitioners who prescribe drugs to use a
 1261  counterfeit-proof prescription pad for Medicaid prescriptions.
 1262  The agency shall require the use of standardized counterfeit
 1263  proof prescription pads by Medicaid-participating prescribers or
 1264  prescribers who write prescriptions for Medicaid recipients. The
 1265  agency may implement the program in targeted geographic areas or
 1266  statewide.
 1267         6. The agency may enter into arrangements that require
 1268  manufacturers of generic drugs prescribed to Medicaid recipients
 1269  to provide rebates of at least 15.1 percent of the average
 1270  manufacturer price for the manufacturer’s generic products.
 1271  These arrangements shall require that if a generic-drug
 1272  manufacturer pays federal rebates for Medicaid-reimbursed drugs
 1273  at a level below 15.1 percent, the manufacturer must provide a
 1274  supplemental rebate to the state in an amount necessary to
 1275  achieve a 15.1-percent rebate level.
 1276         7. The agency may establish a preferred drug list as
 1277  described in this subsection, and, pursuant to the establishment
 1278  of such preferred drug list, negotiate supplemental rebates from
 1279  manufacturers that are in addition to those required by Title
 1280  XIX of the Social Security Act and at no less than 14 percent of
 1281  the average manufacturer price as defined in 42 U.S.C. s. 1936
 1282  on the last day of a quarter unless the federal or supplemental
 1283  rebate, or both, equals or exceeds 29 percent. There is no upper
 1284  limit on the supplemental rebates the agency may negotiate. The
 1285  agency may determine that specific products, brand-name or
 1286  generic, are competitive at lower rebate percentages. Agreement
 1287  to pay the minimum supplemental rebate percentage guarantees a
 1288  manufacturer that the Medicaid Pharmaceutical and Therapeutics
 1289  Committee will consider a product for inclusion on the preferred
 1290  drug list. However, a pharmaceutical manufacturer is not
 1291  guaranteed placement on the preferred drug list by simply paying
 1292  the minimum supplemental rebate. Agency decisions will be made
 1293  on the clinical efficacy of a drug and recommendations of the
 1294  Medicaid Pharmaceutical and Therapeutics Committee, as well as
 1295  the price of competing products minus federal and state rebates.
 1296  The agency may contract with an outside agency or contractor to
 1297  conduct negotiations for supplemental rebates. For the purposes
 1298  of this section, the term “supplemental rebates” means cash
 1299  rebates. Value-added programs as a substitution for supplemental
 1300  rebates are prohibited. The agency may seek any federal waivers
 1301  to implement this initiative.
 1302         8. The agency shall expand home delivery of pharmacy
 1303  products. The agency may amend the state plan and issue a
 1304  procurement, as necessary, in order to implement this program.
 1305  The procurements must include agreements with a pharmacy or
 1306  pharmacies located in the state to provide mail order delivery
 1307  services at no cost to the recipients who elect to receive home
 1308  delivery of pharmacy products. The procurement must focus on
 1309  serving recipients with chronic diseases for which pharmacy
 1310  expenditures represent a significant portion of Medicaid
 1311  pharmacy expenditures or which impact a significant portion of
 1312  the Medicaid population. The agency may seek and implement any
 1313  federal waivers necessary to implement this subparagraph.
 1314         9. The agency shall limit to one dose per month any drug
 1315  prescribed to treat erectile dysfunction.
 1316         10.a. The agency may implement a Medicaid behavioral drug
 1317  management system. The agency may contract with a vendor that
 1318  has experience in operating behavioral drug management systems
 1319  to implement this program. The agency may seek federal waivers
 1320  to implement this program.
 1321         b. The agency, in conjunction with the Department of
 1322  Children and Families, may implement the Medicaid behavioral
 1323  drug management system that is designed to improve the quality
 1324  of care and behavioral health prescribing practices based on
 1325  best practice guidelines, improve patient adherence to
 1326  medication plans, reduce clinical risk, and lower prescribed
 1327  drug costs and the rate of inappropriate spending on Medicaid
 1328  behavioral drugs. The program may include the following
 1329  elements:
 1330         (I) Provide for the development and adoption of best
 1331  practice guidelines for behavioral health-related drugs such as
 1332  antipsychotics, antidepressants, and medications for treating
 1333  bipolar disorders and other behavioral conditions; translate
 1334  them into practice; review behavioral health prescribers and
 1335  compare their prescribing patterns to a number of indicators
 1336  that are based on national standards; and determine deviations
 1337  from best practice guidelines.
 1338         (II) Implement processes for providing feedback to and
 1339  educating prescribers using best practice educational materials
 1340  and peer-to-peer consultation.
 1341         (III) Assess Medicaid beneficiaries who are outliers in
 1342  their use of behavioral health drugs with regard to the numbers
 1343  and types of drugs taken, drug dosages, combination drug
 1344  therapies, and other indicators of improper use of behavioral
 1345  health drugs.
 1346         (IV) Alert prescribers to patients who fail to refill
 1347  prescriptions in a timely fashion, are prescribed multiple same
 1348  class behavioral health drugs, and may have other potential
 1349  medication problems.
 1350         (V) Track spending trends for behavioral health drugs and
 1351  deviation from best practice guidelines.
 1352         (VI) Use educational and technological approaches to
 1353  promote best practices, educate consumers, and train prescribers
 1354  in the use of practice guidelines.
 1355         (VII) Disseminate electronic and published materials.
 1356         (VIII) Hold statewide and regional conferences.
 1357         (IX) Implement a disease management program with a model
 1358  quality-based medication component for severely mentally ill
 1359  individuals and emotionally disturbed children who are high
 1360  users of care.
 1361         11. The agency shall implement a Medicaid prescription drug
 1362  management system.
 1363         a. The agency may contract with a vendor that has
 1364  experience in operating prescription drug management systems in
 1365  order to implement this system. Any management system that is
 1366  implemented in accordance with this subparagraph must rely on
 1367  cooperation between physicians and pharmacists to determine
 1368  appropriate practice patterns and clinical guidelines to improve
 1369  the prescribing, dispensing, and use of drugs in the Medicaid
 1370  program. The agency may seek federal waivers to implement this
 1371  program.
 1372         b. The drug management system must be designed to improve
 1373  the quality of care and prescribing practices based on best
 1374  practice guidelines, improve patient adherence to medication
 1375  plans, reduce clinical risk, and lower prescribed drug costs and
 1376  the rate of inappropriate spending on Medicaid prescription
 1377  drugs. The program must:
 1378         (I) Provide for the adoption of best practice guidelines
 1379  for the prescribing and use of drugs in the Medicaid program,
 1380  including translating best practice guidelines into practice;
 1381  reviewing prescriber patterns and comparing them to indicators
 1382  that are based on national standards and practice patterns of
 1383  clinical peers in their community, statewide, and nationally;
 1384  and determine deviations from best practice guidelines.
 1385         (II) Implement processes for providing feedback to and
 1386  educating prescribers using best practice educational materials
 1387  and peer-to-peer consultation.
 1388         (III) Assess Medicaid recipients who are outliers in their
 1389  use of a single or multiple prescription drugs with regard to
 1390  the numbers and types of drugs taken, drug dosages, combination
 1391  drug therapies, and other indicators of improper use of
 1392  prescription drugs.
 1393         (IV) Alert prescribers to recipients who fail to refill
 1394  prescriptions in a timely fashion, are prescribed multiple drugs
 1395  that may be redundant or contraindicated, or may have other
 1396  potential medication problems.
 1397         12. The agency may contract for drug rebate administration,
 1398  including, but not limited to, calculating rebate amounts,
 1399  invoicing manufacturers, negotiating disputes with
 1400  manufacturers, and maintaining a database of rebate collections.
 1401         13. The agency may specify the preferred daily dosing form
 1402  or strength for the purpose of promoting best practices with
 1403  regard to the prescribing of certain drugs as specified in the
 1404  General Appropriations Act and ensuring cost-effective
 1405  prescribing practices.
 1406         14. The agency may require prior authorization for
 1407  Medicaid-covered prescribed drugs. The agency may prior
 1408  authorize the use of a product:
 1409         a. For an indication not approved in labeling;
 1410         b. To comply with certain clinical guidelines; or
 1411         c. If the product has the potential for overuse, misuse, or
 1412  abuse.
 1413  
 1414  The agency may require the prescribing professional to provide
 1415  information about the rationale and supporting medical evidence
 1416  for the use of a drug. The agency shall post prior
 1417  authorization, step-edit criteria and protocol, and updates to
 1418  the list of drugs that are subject to prior authorization on the
 1419  agency’s Internet website within 21 days after the prior
 1420  authorization and step-edit criteria and protocol and updates
 1421  are approved by the agency. For purposes of this subparagraph,
 1422  the term “step-edit” means an automatic electronic review of
 1423  certain medications subject to prior authorization.
 1424         15. The agency, in conjunction with the Pharmaceutical and
 1425  Therapeutics Committee, may require age-related prior
 1426  authorizations for certain prescribed drugs. The agency may
 1427  preauthorize the use of a drug for a recipient who may not meet
 1428  the age requirement or may exceed the length of therapy for use
 1429  of this product as recommended by the manufacturer and approved
 1430  by the Food and Drug Administration. Prior authorization may
 1431  require the prescribing professional to provide information
 1432  about the rationale and supporting medical evidence for the use
 1433  of a drug.
 1434         16. The agency shall implement a step-therapy prior
 1435  authorization approval process for medications excluded from the
 1436  preferred drug list. Medications listed on the preferred drug
 1437  list must be used within the previous 12 months before the
 1438  alternative medications that are not listed. The step-therapy
 1439  prior authorization may require the prescriber to use the
 1440  medications of a similar drug class or for a similar medical
 1441  indication unless contraindicated in the Food and Drug
 1442  Administration labeling. The trial period between the specified
 1443  steps may vary according to the medical indication. The step
 1444  therapy approval process shall be developed in accordance with
 1445  the committee as stated in s. 409.91195(7) and (8). A drug
 1446  product may be approved without meeting the step-therapy prior
 1447  authorization criteria if the prescribing physician provides the
 1448  agency with additional written medical or clinical documentation
 1449  that the product is medically necessary because:
 1450         a. There is not a drug on the preferred drug list to treat
 1451  the disease or medical condition which is an acceptable clinical
 1452  alternative;
 1453         b. The alternatives have been ineffective in the treatment
 1454  of the beneficiary’s disease; or
 1455         c. Based on historic evidence and known characteristics of
 1456  the patient and the drug, the drug is likely to be ineffective,
 1457  or the number of doses have been ineffective.
 1458  
 1459  The agency shall work with the physician to determine the best
 1460  alternative for the patient. The agency may adopt rules waiving
 1461  the requirements for written clinical documentation for specific
 1462  drugs in limited clinical situations.
 1463         17. The agency shall implement a return and reuse program
 1464  for drugs dispensed by pharmacies to institutional recipients,
 1465  which includes payment of a $5 restocking fee for the
 1466  implementation and operation of the program. The return and
 1467  reuse program shall be implemented electronically and in a
 1468  manner that promotes efficiency. The program must permit a
 1469  pharmacy to exclude drugs from the program if it is not
 1470  practical or cost-effective for the drug to be included and must
 1471  provide for the return to inventory of drugs that cannot be
 1472  credited or returned in a cost-effective manner. The agency
 1473  shall determine if the program has reduced the amount of
 1474  Medicaid prescription drugs which are destroyed on an annual
 1475  basis and if there are additional ways to ensure more
 1476  prescription drugs are not destroyed which could safely be
 1477  reused.
 1478         (b) The agency shall implement this subsection to the
 1479  extent that funds are appropriated to administer the Medicaid
 1480  prescribed-drug spending-control program. The agency may
 1481  contract all or any part of this program to private
 1482  organizations.
 1483         (c) The agency shall submit quarterly reports to the
 1484  Governor, the President of the Senate, and the Speaker of the
 1485  House of Representatives which must include, but need not be
 1486  limited to, the progress made in implementing this subsection
 1487  and its effect on Medicaid prescribed-drug expenditures.
 1488         (9)(38) Notwithstanding the provisions of chapter 287, the
 1489  agency may, at its discretion, renew a contract or contracts for
 1490  fiscal intermediary services one or more times for such periods
 1491  as the agency may decide; however, all such renewals may not
 1492  combine to exceed a total period longer than the term of the
 1493  original contract.
 1494         (39) The agency shall establish a demonstration project in
 1495  Miami-Dade County of a long-term-care facility and a psychiatric
 1496  facility licensed pursuant to chapter 395 to improve access to
 1497  health care for a predominantly minority, medically underserved,
 1498  and medically complex population and to evaluate alternatives to
 1499  nursing home care and general acute care for such population.
 1500  Such project is to be located in a health care condominium and
 1501  collocated with licensed facilities providing a continuum of
 1502  care. These projects are not subject to the provisions of s.
 1503  408.036 or s. 408.039. This subsection expires October 1, 2013.
 1504         (40) The agency shall develop and implement a utilization
 1505  management program for Medicaid-eligible recipients for the
 1506  management of occupational, physical, respiratory, and speech
 1507  therapies. The agency shall establish a utilization program that
 1508  may require prior authorization in order to ensure medically
 1509  necessary and cost-effective treatments. The program shall be
 1510  operated in accordance with a federally approved waiver program
 1511  or state plan amendment. The agency may seek a federal waiver or
 1512  state plan amendment to implement this program. The agency may
 1513  also competitively procure these services from an outside vendor
 1514  on a regional or statewide basis. This subsection expires
 1515  October 1, 2014.
 1516         (41)(a) The agency shall contract on a prepaid or fixed-sum
 1517  basis with appropriately licensed prepaid dental health plans to
 1518  provide dental services. This paragraph expires October 1, 2014.
 1519         (b) Notwithstanding paragraph (a) and for the 2012-2013
 1520  fiscal year only, the agency is authorized to provide a Medicaid
 1521  prepaid dental health program in Miami-Dade County. For all
 1522  other counties, the agency may not limit dental services to
 1523  prepaid plans and must allow qualified dental providers to
 1524  provide dental services under Medicaid on a fee-for-service
 1525  reimbursement methodology. The agency may seek any necessary
 1526  revisions or amendments to the state plan or federal waivers in
 1527  order to implement this paragraph. The agency shall terminate
 1528  existing contracts as needed to implement this paragraph. This
 1529  paragraph expires July 1, 2013.
 1530         (42) The Agency for Health Care Administration shall ensure
 1531  that any Medicaid managed care plan as defined in s.
 1532  409.9122(2)(f), whether paid on a capitated basis or a shared
 1533  savings basis, is cost-effective. For purposes of this
 1534  subsection, the term “cost-effective” means that a network’s
 1535  per-member, per-month costs to the state, including, but not
 1536  limited to, fee-for-service costs, administrative costs, and
 1537  case-management fees, if any, must be no greater than the
 1538  state’s costs associated with contracts for Medicaid services
 1539  established under subsection (3), which may be adjusted for
 1540  health status. The agency shall conduct actuarially sound
 1541  adjustments for health status in order to ensure such cost
 1542  effectiveness and shall annually publish the results on its
 1543  Internet website. Contracts established pursuant to this
 1544  subsection which are not cost-effective may not be renewed. This
 1545  subsection expires October 1, 2014.
 1546         (43) Subject to the availability of funds, the agency shall
 1547  mandate a recipient’s participation in a provider lock-in
 1548  program, when appropriate, if a recipient is found by the agency
 1549  to have used Medicaid goods or services at a frequency or amount
 1550  not medically necessary, limiting the receipt of goods or
 1551  services to medically necessary providers after the 21-day
 1552  appeal process has ended, for a period of not less than 1 year.
 1553  The lock-in programs shall include, but are not limited to,
 1554  pharmacies, medical doctors, and infusion clinics. The
 1555  limitation does not apply to emergency services and care
 1556  provided to the recipient in a hospital emergency department.
 1557  The agency shall seek any federal waivers necessary to implement
 1558  this subsection. The agency shall adopt any rules necessary to
 1559  comply with or administer this subsection. This subsection
 1560  expires October 1, 2014.
 1561         (10)(44) The agency shall seek a federal waiver for
 1562  permission to terminate the eligibility of a Medicaid recipient
 1563  who has been found to have committed fraud, through judicial or
 1564  administrative determination, two times in a period of 5 years.
 1565         (11)(45)(a) A provider is not entitled to enrollment in the
 1566  Medicaid provider network. The agency may implement a Medicaid
 1567  fee-for-service provider network controls, including, but not
 1568  limited to, competitive procurement and provider credentialing.
 1569  If a credentialing process is used, the agency may limit its
 1570  provider network based upon the following considerations:
 1571  beneficiary access to care, provider availability, provider
 1572  quality standards and quality assurance processes, cultural
 1573  competency, demographic characteristics of beneficiaries,
 1574  practice standards, service wait times, provider turnover,
 1575  provider licensure and accreditation history, program integrity
 1576  history, peer review, Medicaid policy and billing compliance
 1577  records, clinical and medical record audit findings, and such
 1578  other areas that are considered necessary by the agency to
 1579  ensure the integrity of the program.
 1580         (b) The agency shall limit its network of durable medical
 1581  equipment and medical supply providers. For dates of service
 1582  after January 1, 2009, the agency shall limit payment for
 1583  durable medical equipment and supplies to providers that meet
 1584  all the requirements of this paragraph.
 1585         1. Providers must be accredited by a Centers for Medicare
 1586  and Medicaid Services deemed accreditation organization for
 1587  suppliers of durable medical equipment, prosthetics, orthotics,
 1588  and supplies. The provider must maintain accreditation and is
 1589  subject to unannounced reviews by the accrediting organization.
 1590         2. Providers must provide the services or supplies directly
 1591  to the Medicaid recipient or caregiver at the provider location
 1592  or recipient’s residence or send the supplies directly to the
 1593  recipient’s residence with receipt of mailed delivery.
 1594  Subcontracting or consignment of the service or supply to a
 1595  third party is prohibited.
 1596         3. Notwithstanding subparagraph 2., a durable medical
 1597  equipment provider may store nebulizers at a physician’s office
 1598  for the purpose of having the physician’s staff issue the
 1599  equipment if it meets all of the following conditions:
 1600         a. The physician must document the medical necessity and
 1601  need to prevent further deterioration of the patient’s
 1602  respiratory status by the timely delivery of the nebulizer in
 1603  the physician’s office.
 1604         b. The durable medical equipment provider must have written
 1605  documentation of the competency and training by a Florida
 1606  licensed registered respiratory therapist of any durable medical
 1607  equipment staff who participate in the training of physician
 1608  office staff for the use of nebulizers, including cleaning,
 1609  warranty, and special needs of patients.
 1610         c. The physician’s office must have documented the training
 1611  and competency of any staff member who initiates the delivery of
 1612  nebulizers to patients. The durable medical equipment provider
 1613  must maintain copies of all physician office training.
 1614         d. The physician’s office must maintain inventory records
 1615  of stored nebulizers, including documentation of the durable
 1616  medical equipment provider source.
 1617         e. A physician contracted with a Medicaid durable medical
 1618  equipment provider may not have a financial relationship with
 1619  that provider or receive any financial gain from the delivery of
 1620  nebulizers to patients.
 1621         4. Providers must have a physical business location and a
 1622  functional landline business phone. The location must be within
 1623  the state or not more than 50 miles from the Florida state line.
 1624  The agency may make exceptions for providers of durable medical
 1625  equipment or supplies not otherwise available from other
 1626  enrolled providers located within the state.
 1627         5. Physical business locations must be clearly identified
 1628  as a business that furnishes durable medical equipment or
 1629  medical supplies by signage that can be read from 20 feet away.
 1630  The location must be readily accessible to the public during
 1631  normal, posted business hours and must operate at least 5 hours
 1632  per day and at least 5 days per week, with the exception of
 1633  scheduled and posted holidays. The location may not be located
 1634  within or at the same numbered street address as another
 1635  enrolled Medicaid durable medical equipment or medical supply
 1636  provider or as an enrolled Medicaid pharmacy that is also
 1637  enrolled as a durable medical equipment provider. A licensed
 1638  orthotist or prosthetist that provides only orthotic or
 1639  prosthetic devices as a Medicaid durable medical equipment
 1640  provider is exempt from this paragraph.
 1641         6. Providers must maintain a stock of durable medical
 1642  equipment and medical supplies on site that is readily available
 1643  to meet the needs of the durable medical equipment business
 1644  location’s customers.
 1645         7. Providers must provide a surety bond of $50,000 for each
 1646  provider location, up to a maximum of 5 bonds statewide or an
 1647  aggregate bond of $250,000 statewide, as identified by Federal
 1648  Employer Identification Number. Providers who post a statewide
 1649  or an aggregate bond must identify all of their locations in any
 1650  Medicaid durable medical equipment and medical supply provider
 1651  enrollment application or bond renewal. Each provider location’s
 1652  surety bond must be renewed annually and the provider must
 1653  submit proof of renewal even if the original bond is a
 1654  continuous bond. A licensed orthotist or prosthetist that
 1655  provides only orthotic or prosthetic devices as a Medicaid
 1656  durable medical equipment provider is exempt from the provisions
 1657  in this paragraph.
 1658         8. Providers must obtain a level 2 background screening, in
 1659  accordance with chapter 435 and s. 408.809, for each provider
 1660  employee in direct contact with or providing direct services to
 1661  recipients of durable medical equipment and medical supplies in
 1662  their homes. This requirement includes, but is not limited to,
 1663  repair and service technicians, fitters, and delivery staff. The
 1664  provider shall pay for the cost of the background screening.
 1665         9. The following providers are exempt from subparagraphs 1.
 1666  and 7.:
 1667         a. Durable medical equipment providers owned and operated
 1668  by a government entity.
 1669         b. Durable medical equipment providers that are operating
 1670  within a pharmacy that is currently enrolled as a Medicaid
 1671  pharmacy provider.
 1672         c. Active, Medicaid-enrolled orthopedic physician groups,
 1673  primarily owned by physicians, which provide only orthotic and
 1674  prosthetic devices.
 1675         (46) The agency shall contract with established minority
 1676  physician networks that provide services to historically
 1677  underserved minority patients. The networks must provide cost
 1678  effective Medicaid services, comply with the requirements to be
 1679  a MediPass provider, and provide their primary care physicians
 1680  with access to data and other management tools necessary to
 1681  assist them in ensuring the appropriate use of services,
 1682  including inpatient hospital services and pharmaceuticals.
 1683         (a) The agency shall provide for the development and
 1684  expansion of minority physician networks in each service area to
 1685  provide services to Medicaid recipients who are eligible to
 1686  participate under federal law and rules.
 1687         (b) The agency shall reimburse each minority physician
 1688  network as a fee-for-service provider, including the case
 1689  management fee for primary care, if any, or as a capitated rate
 1690  provider for Medicaid services. Any savings shall be shared with
 1691  the minority physician networks pursuant to the contract.
 1692         (c) For purposes of this subsection, the term “cost
 1693  effective” means that a network’s per-member, per-month costs to
 1694  the state, including, but not limited to, fee-for-service costs,
 1695  administrative costs, and case-management fees, if any, must be
 1696  no greater than the state’s costs associated with contracts for
 1697  Medicaid services established under subsection (3), which shall
 1698  be actuarially adjusted for case mix, model, and service area.
 1699  The agency shall conduct actuarially sound audits adjusted for
 1700  case mix and model in order to ensure such cost-effectiveness
 1701  and shall annually publish the audit results on its Internet
 1702  website. Contracts established pursuant to this subsection which
 1703  are not cost-effective may not be renewed.
 1704         (d) The agency may apply for any federal waivers needed to
 1705  implement this subsection.
 1706  
 1707  This subsection expires October 1, 2014.
 1708         (12)(47) To the extent permitted by federal law and as
 1709  allowed under s. 409.906, the agency shall provide reimbursement
 1710  for emergency mental health care services for Medicaid
 1711  recipients in crisis stabilization facilities licensed under s.
 1712  394.875 as long as those services are less expensive than the
 1713  same services provided in a hospital setting.
 1714         (13)(48) The agency shall work with the Agency for Persons
 1715  with Disabilities to develop a home and community-based waiver
 1716  to serve children and adults who are diagnosed with familial
 1717  dysautonomia or Riley-Day syndrome caused by a mutation of the
 1718  IKBKAP gene on chromosome 9. The agency shall seek federal
 1719  waiver approval and implement the approved waiver subject to the
 1720  availability of funds and any limitations provided in the
 1721  General Appropriations Act. The agency may adopt rules to
 1722  implement this waiver program.
 1723         (14)(49) The agency shall implement a program of all
 1724  inclusive care for children. The program of all-inclusive care
 1725  for children shall be established to provide in-home hospice
 1726  like support services to children diagnosed with a life
 1727  threatening illness and enrolled in the Children’s Medical
 1728  Services network to reduce hospitalizations as appropriate. The
 1729  agency, in consultation with the Department of Health, may
 1730  implement the program of all-inclusive care for children after
 1731  obtaining approval from the Centers for Medicare and Medicaid
 1732  Services.
 1733         (15)(50) Before seeking an amendment to the state plan for
 1734  purposes of implementing programs authorized by the Deficit
 1735  Reduction Act of 2005, the agency shall notify the Legislature.
 1736         (16)(51) The agency may not pay for psychotropic medication
 1737  prescribed for a child in the Medicaid program without the
 1738  express and informed consent of the child’s parent or legal
 1739  guardian. The physician shall document the consent in the
 1740  child’s medical record and provide the pharmacy with a signed
 1741  attestation of this documentation with the prescription. The
 1742  express and informed consent or court authorization for a
 1743  prescription of psychotropic medication for a child in the
 1744  custody of the Department of Children and Families shall be
 1745  obtained pursuant to s. 39.407.
 1746         Reviser’s note.—Amended to conform to the repeals of numerous
 1747         subunits pursuant to their own terms, effective at various
 1748         dates in 2013 and 2014. Material in existing s.
 1749         409.912(4)(d)4. referencing s. 409.91211 was deleted to
 1750         conform to the repeal of that section effective October 1,
 1751         2014, by s. 20, ch. 2011-135, Laws of Florida, and
 1752         confirmation of that repeal by this reviser’s bill. The
 1753         reference in subsection (26), redesignated here as
 1754         subsection (7), to the Medicaid Bureau of the Health Care
 1755         Financing Administration was redesignated as the Centers
 1756         for Medicare and Medicaid Services to conform to the
 1757         renaming of the federal agency.
 1758         Section 15. Section 409.91211, Florida Statutes, is
 1759  repealed.
 1760         Reviser’s note.—The cited section, which relates to the Medicaid
 1761         managed care pilot program, was repealed by s. 20, ch.
 1762         2011-135, Laws of Florida, effective October 1, 2014. Since
 1763         the section was not repealed by a “current session” of the
 1764         Legislature, it may be omitted from the 2015 Florida
 1765         Statutes only through a reviser’s bill duly enacted by the
 1766         Legislature. See s. 11.242(5)(b) and (i).
 1767         Section 16. Section 409.9122, Florida Statutes, is amended
 1768  to read:
 1769         409.9122 Mandatory Medicaid managed care enrollment;
 1770  programs and procedures.—
 1771         (1) It is the intent of the Legislature that the MediPass
 1772  program be cost-effective, provide quality health care, and
 1773  improve access to health services, and that the program be
 1774  statewide. This subsection expires October 1, 2014.
 1775         (2)(a) The agency shall enroll in a managed care plan or
 1776  MediPass all Medicaid recipients, except those Medicaid
 1777  recipients who are: in an institution; enrolled in the Medicaid
 1778  medically needy program; or eligible for both Medicaid and
 1779  Medicare. Upon enrollment, individuals will be able to change
 1780  their managed care option during the 90-day opt out period
 1781  required by federal Medicaid regulations. The agency is
 1782  authorized to seek the necessary Medicaid state plan amendment
 1783  to implement this policy. However, to the extent permitted by
 1784  federal law, the agency may enroll in a managed care plan or
 1785  MediPass a Medicaid recipient who is exempt from mandatory
 1786  managed care enrollment, provided that:
 1787         1. The recipient’s decision to enroll in a managed care
 1788  plan or MediPass is voluntary;
 1789         2. If the recipient chooses to enroll in a managed care
 1790  plan, the agency has determined that the managed care plan
 1791  provides specific programs and services which address the
 1792  special health needs of the recipient; and
 1793         3. The agency receives any necessary waivers from the
 1794  federal Centers for Medicare and Medicaid Services.
 1795  
 1796  School districts participating in the certified school match
 1797  program pursuant to ss. 409.908(21) and 1011.70 shall be
 1798  reimbursed by Medicaid, subject to the limitations of s.
 1799  1011.70(1), for a Medicaid-eligible child participating in the
 1800  services as authorized in s. 1011.70, as provided for in s.
 1801  409.9071, regardless of whether the child is enrolled in
 1802  MediPass or a managed care plan. Managed care plans shall make a
 1803  good faith effort to execute agreements with school districts
 1804  regarding the coordinated provision of services authorized under
 1805  s. 1011.70. County health departments delivering school-based
 1806  services pursuant to ss. 381.0056 and 381.0057 shall be
 1807  reimbursed by Medicaid for the federal share for a Medicaid
 1808  eligible child who receives Medicaid-covered services in a
 1809  school setting, regardless of whether the child is enrolled in
 1810  MediPass or a managed care plan. Managed care plans shall make a
 1811  good faith effort to execute agreements with county health
 1812  departments regarding the coordinated provision of services to a
 1813  Medicaid-eligible child. To ensure continuity of care for
 1814  Medicaid patients, the agency, the Department of Health, and the
 1815  Department of Education shall develop procedures for ensuring
 1816  that a student’s managed care plan or MediPass provider receives
 1817  information relating to services provided in accordance with ss.
 1818  381.0056, 381.0057, 409.9071, and 1011.70.
 1819         (b) A Medicaid recipient may not be enrolled in or assigned
 1820  to a managed care plan or MediPass unless the managed care plan
 1821  or MediPass has complied with the quality-of-care standards
 1822  specified in paragraphs (4)(a) and (b), respectively.
 1823         (c) Medicaid recipients shall have a choice of managed care
 1824  plans or MediPass. The Agency for Health Care Administration,
 1825  the Department of Health, the Department of Children and
 1826  Families, and the Department of Elderly Affairs shall cooperate
 1827  to ensure that each Medicaid recipient receives clear and easily
 1828  understandable information that meets the following
 1829  requirements:
 1830         1. Explains the concept of managed care, including
 1831  MediPass.
 1832         2. Provides information on the comparative performance of
 1833  managed care plans and MediPass in the areas of quality,
 1834  credentialing, preventive health programs, network size and
 1835  availability, and patient satisfaction.
 1836         3. Explains where additional information on each managed
 1837  care plan and MediPass in the recipient’s area can be obtained.
 1838         4. Explains that recipients have the right to choose their
 1839  managed care coverage at the time they first enroll in Medicaid
 1840  and again at regular intervals set by the agency. However, if a
 1841  recipient does not choose a managed care plan or MediPass, the
 1842  agency will assign the recipient to a managed care plan or
 1843  MediPass according to the criteria specified in this section.
 1844         5. Explains the recipient’s right to complain, file a
 1845  grievance, or change managed care plans or MediPass providers if
 1846  the recipient is not satisfied with the managed care plan or
 1847  MediPass.
 1848         (d) The agency shall develop a mechanism for providing
 1849  information to Medicaid recipients for the purpose of making a
 1850  managed care plan or MediPass selection. Examples of such
 1851  mechanisms may include, but not be limited to, interactive
 1852  information systems, mailings, and mass marketing materials.
 1853  Managed care plans and MediPass providers are prohibited from
 1854  providing inducements to Medicaid recipients to select their
 1855  plans or from prejudicing Medicaid recipients against other
 1856  managed care plans or MediPass providers.
 1857         (e) Medicaid recipients who are already enrolled in a
 1858  managed care plan or MediPass shall be offered the opportunity
 1859  to change managed care plans or MediPass providers on a
 1860  staggered basis, as defined by the agency. All Medicaid
 1861  recipients shall have 30 days in which to make a choice of
 1862  managed care plans or MediPass providers. Those Medicaid
 1863  recipients who do not make a choice shall be assigned in
 1864  accordance with paragraph (f). To facilitate continuity of care,
 1865  for a Medicaid recipient who is also a recipient of Supplemental
 1866  Security Income (SSI), prior to assigning the SSI recipient to a
 1867  managed care plan or MediPass, the agency shall determine
 1868  whether the SSI recipient has an ongoing relationship with a
 1869  MediPass provider or managed care plan, and if so, the agency
 1870  shall assign the SSI recipient to that MediPass provider or
 1871  managed care plan. Those SSI recipients who do not have such a
 1872  provider relationship shall be assigned to a managed care plan
 1873  or MediPass provider in accordance with paragraph (f).
 1874         (f) If a Medicaid recipient does not choose a managed care
 1875  plan or MediPass provider, the agency shall assign the Medicaid
 1876  recipient to a managed care plan or MediPass provider. Medicaid
 1877  recipients eligible for managed care plan enrollment who are
 1878  subject to mandatory assignment but who fail to make a choice
 1879  shall be assigned to managed care plans until an enrollment of
 1880  35 percent in MediPass and 65 percent in managed care plans, of
 1881  all those eligible to choose managed care, is achieved. Once
 1882  this enrollment is achieved, the assignments shall be divided in
 1883  order to maintain an enrollment in MediPass and managed care
 1884  plans which is in a 35 percent and 65 percent proportion,
 1885  respectively. Thereafter, assignment of Medicaid recipients who
 1886  fail to make a choice shall be based proportionally on the
 1887  preferences of recipients who have made a choice in the previous
 1888  period. Such proportions shall be revised at least quarterly to
 1889  reflect an update of the preferences of Medicaid recipients. The
 1890  agency shall disproportionately assign Medicaid-eligible
 1891  recipients who are required to but have failed to make a choice
 1892  of managed care plan or MediPass to the Children’s Medical
 1893  Services Network as defined in s. 391.021, exclusive provider
 1894  organizations, provider service networks, minority physician
 1895  networks, and pediatric emergency department diversion programs
 1896  authorized by this chapter or the General Appropriations Act, in
 1897  such manner as the agency deems appropriate, until the agency
 1898  has determined that the networks and programs have sufficient
 1899  numbers to be operated economically. For purposes of this
 1900  paragraph, when referring to assignment, the term “managed care
 1901  plans” includes health maintenance organizations, exclusive
 1902  provider organizations, provider service networks, minority
 1903  physician networks, Children’s Medical Services Network, and
 1904  pediatric emergency department diversion programs authorized by
 1905  this chapter or the General Appropriations Act. When making
 1906  assignments, the agency shall take into account the following
 1907  criteria:
 1908         1. A managed care plan has sufficient network capacity to
 1909  meet the need of members.
 1910         2. The managed care plan or MediPass has previously
 1911  enrolled the recipient as a member, or one of the managed care
 1912  plan’s primary care providers or MediPass providers has
 1913  previously provided health care to the recipient.
 1914         3. The agency has knowledge that the member has previously
 1915  expressed a preference for a particular managed care plan or
 1916  MediPass provider as indicated by Medicaid fee-for-service
 1917  claims data, but has failed to make a choice.
 1918         4. The managed care plan’s or MediPass primary care
 1919  providers are geographically accessible to the recipient’s
 1920  residence.
 1921         (g) When more than one managed care plan or MediPass
 1922  provider meets the criteria specified in paragraph (f), the
 1923  agency shall make recipient assignments consecutively by family
 1924  unit.
 1925         (h) The agency may not engage in practices that are
 1926  designed to favor one managed care plan over another or that are
 1927  designed to influence Medicaid recipients to enroll in MediPass
 1928  rather than in a managed care plan or to enroll in a managed
 1929  care plan rather than in MediPass. This subsection does not
 1930  prohibit the agency from reporting on the performance of
 1931  MediPass or any managed care plan, as measured by performance
 1932  criteria developed by the agency.
 1933         (i) After a recipient has made his or her selection or has
 1934  been enrolled in a managed care plan or MediPass, the recipient
 1935  shall have 90 days to exercise the opportunity to voluntarily
 1936  disenroll and select another managed care plan or MediPass.
 1937  After 90 days, no further changes may be made except for good
 1938  cause. Good cause includes, but is not limited to, poor quality
 1939  of care, lack of access to necessary specialty services, an
 1940  unreasonable delay or denial of service, or fraudulent
 1941  enrollment. The agency shall develop criteria for good cause
 1942  disenrollment for chronically ill and disabled populations who
 1943  are assigned to managed care plans if more appropriate care is
 1944  available through the MediPass program. The agency must make a
 1945  determination as to whether cause exists. However, the agency
 1946  may require a recipient to use the managed care plan’s or
 1947  MediPass grievance process prior to the agency’s determination
 1948  of cause, except in cases in which immediate risk of permanent
 1949  damage to the recipient’s health is alleged. The grievance
 1950  process, when utilized, must be completed in time to permit the
 1951  recipient to disenroll by the first day of the second month
 1952  after the month the disenrollment request was made. If the
 1953  managed care plan or MediPass, as a result of the grievance
 1954  process, approves an enrollee’s request to disenroll, the agency
 1955  is not required to make a determination in the case. The agency
 1956  must make a determination and take final action on a recipient’s
 1957  request so that disenrollment occurs no later than the first day
 1958  of the second month after the month the request was made. If the
 1959  agency fails to act within the specified timeframe, the
 1960  recipient’s request to disenroll is deemed to be approved as of
 1961  the date agency action was required. Recipients who disagree
 1962  with the agency’s finding that cause does not exist for
 1963  disenrollment shall be advised of their right to pursue a
 1964  Medicaid fair hearing to dispute the agency’s finding.
 1965         (j) The agency shall apply for a federal waiver from the
 1966  Centers for Medicare and Medicaid Services to lock eligible
 1967  Medicaid recipients into a managed care plan or MediPass for 12
 1968  months after an open enrollment period. After 12 months’
 1969  enrollment, a recipient may select another managed care plan or
 1970  MediPass provider. However, nothing shall prevent a Medicaid
 1971  recipient from changing primary care providers within the
 1972  managed care plan or MediPass program during the 12-month
 1973  period.
 1974         (k) When a Medicaid recipient does not choose a managed
 1975  care plan or MediPass provider, the agency shall assign the
 1976  Medicaid recipient to a managed care plan, except in those
 1977  counties in which there are fewer than two managed care plans
 1978  accepting Medicaid enrollees, in which case assignment shall be
 1979  to a managed care plan or a MediPass provider. Medicaid
 1980  recipients in counties with fewer than two managed care plans
 1981  accepting Medicaid enrollees who are subject to mandatory
 1982  assignment but who fail to make a choice shall be assigned to
 1983  managed care plans until an enrollment of 35 percent in MediPass
 1984  and 65 percent in managed care plans, of all those eligible to
 1985  choose managed care, is achieved. Once that enrollment is
 1986  achieved, the assignments shall be divided in order to maintain
 1987  an enrollment in MediPass and managed care plans which is in a
 1988  35 percent and 65 percent proportion, respectively. For purposes
 1989  of this paragraph, when referring to assignment, the term
 1990  “managed care plans” includes exclusive provider organizations,
 1991  provider service networks, Children’s Medical Services Network,
 1992  minority physician networks, and pediatric emergency department
 1993  diversion programs authorized by this chapter or the General
 1994  Appropriations Act. When making assignments, the agency shall
 1995  take into account the following criteria:
 1996         1. A managed care plan has sufficient network capacity to
 1997  meet the need of members.
 1998         2. The managed care plan or MediPass has previously
 1999  enrolled the recipient as a member, or one of the managed care
 2000  plan’s primary care providers or MediPass providers has
 2001  previously provided health care to the recipient.
 2002         3. The agency has knowledge that the member has previously
 2003  expressed a preference for a particular managed care plan or
 2004  MediPass provider as indicated by Medicaid fee-for-service
 2005  claims data, but has failed to make a choice.
 2006         4. The managed care plan’s or MediPass primary care
 2007  providers are geographically accessible to the recipient’s
 2008  residence.
 2009         5. The agency has authority to make mandatory assignments
 2010  based on quality of service and performance of managed care
 2011  plans.
 2012         (l) Notwithstanding chapter 287, the agency may renew cost
 2013  effective contracts for choice counseling services once or more
 2014  for such periods as the agency may decide. However, all such
 2015  renewals may not combine to exceed a total period longer than
 2016  the term of the original contract.
 2017  
 2018  This subsection expires October 1, 2014.
 2019         (3) Notwithstanding s. 409.961, if a Medicaid recipient is
 2020  diagnosed with HIV/AIDS, the agency shall assign the recipient
 2021  to a managed care plan that is a health maintenance organization
 2022  authorized under chapter 641, that is under contract with the
 2023  agency as an HIV/AIDS specialty plan as of January 1, 2013, and
 2024  that offers a delivery system through a university-based
 2025  teaching and research-oriented organization that specializes in
 2026  providing health care services and treatment for individuals
 2027  diagnosed with HIV/AIDS. This subsection applies to recipients
 2028  who are subject to mandatory managed care enrollment and have
 2029  failed to choose a managed care option.
 2030         (4)(a) The agency shall establish quality-of-care standards
 2031  for managed care plans. These standards shall be based upon, but
 2032  are not limited to:
 2033         1. Compliance with the accreditation requirements as
 2034  provided in s. 641.512.
 2035         2. Compliance with Early and Periodic Screening, Diagnosis,
 2036  and Treatment screening requirements.
 2037         3. The percentage of voluntary disenrollments.
 2038         4. Immunization rates.
 2039         5. Standards of the National Committee for Quality
 2040  Assurance and other approved accrediting bodies.
 2041         6. Recommendations of other authoritative bodies.
 2042         7. Specific requirements of the Medicaid program, or
 2043  standards designed to specifically assist the unique needs of
 2044  Medicaid recipients.
 2045         8. Compliance with the health quality improvement system as
 2046  established by the agency, which incorporates standards and
 2047  guidelines developed by the Medicaid Bureau of the Health Care
 2048  Financing Administration as part of the quality assurance reform
 2049  initiative.
 2050         (b) For the MediPass program, the agency shall establish
 2051  standards which are based upon, but are not limited to:
 2052         1. Quality-of-care standards which are comparable to those
 2053  required of managed care plans.
 2054         2. Credentialing standards for MediPass providers.
 2055         3. Compliance with Early and Periodic Screening, Diagnosis,
 2056  and Treatment screening requirements.
 2057         4. Immunization rates.
 2058         5. Specific requirements of the Medicaid program, or
 2059  standards designed to specifically assist the unique needs of
 2060  Medicaid recipients.
 2061  
 2062  This subsection expires October 1, 2014.
 2063         (5)(a) Each female recipient may select as her primary care
 2064  provider an obstetrician/gynecologist who has agreed to
 2065  participate as a MediPass primary care case manager.
 2066         (b) The agency shall establish a complaints and grievance
 2067  process to assist Medicaid recipients enrolled in the MediPass
 2068  program to resolve complaints and grievances. The agency shall
 2069  investigate reports of quality-of-care grievances which remain
 2070  unresolved to the satisfaction of the enrollee.
 2071  
 2072  This subsection expires October 1, 2014.
 2073         (6)(a) The agency shall work cooperatively with the Social
 2074  Security Administration to identify beneficiaries who are
 2075  jointly eligible for Medicare and Medicaid and shall develop
 2076  cooperative programs to encourage these beneficiaries to enroll
 2077  in a Medicare participating health maintenance organization or
 2078  prepaid health plans.
 2079         (b) The agency shall work cooperatively with the Department
 2080  of Elderly Affairs to assess the potential cost-effectiveness of
 2081  providing MediPass to beneficiaries who are jointly eligible for
 2082  Medicare and Medicaid on a voluntary choice basis. If the agency
 2083  determines that enrollment of these beneficiaries in MediPass
 2084  has the potential for being cost-effective for the state, the
 2085  agency shall offer MediPass to these beneficiaries on a
 2086  voluntary choice basis in the counties where MediPass operates.
 2087  
 2088  This subsection expires October 1, 2014.
 2089         (7) MediPass enrolled recipients may receive up to 10
 2090  visits of reimbursable services by participating Medicaid
 2091  physicians licensed under chapter 460 and up to four visits of
 2092  reimbursable services by participating Medicaid physicians
 2093  licensed under chapter 461. Any further visits must be by prior
 2094  authorization by the MediPass primary care provider. However,
 2095  nothing in this subsection may be construed to increase the
 2096  total number of visits or the total amount of dollars per year
 2097  per person under current Medicaid rules, unless otherwise
 2098  provided for in the General Appropriations Act. This subsection
 2099  expires October 1, 2014.
 2100         (8)(a) The agency shall develop and implement a
 2101  comprehensive plan to ensure that recipients are adequately
 2102  informed of their choices and rights under all Medicaid managed
 2103  care programs and that Medicaid managed care programs meet
 2104  acceptable standards of quality in patient care, patient
 2105  satisfaction, and financial solvency.
 2106         (b) The agency shall provide adequate means for informing
 2107  patients of their choice and rights under a managed care plan at
 2108  the time of eligibility determination.
 2109         (c) The agency shall require managed care plans and
 2110  MediPass providers to demonstrate and document plans and
 2111  activities, as defined by rule, including outreach and followup,
 2112  undertaken to ensure that Medicaid recipients receive the health
 2113  care service to which they are entitled.
 2114  
 2115  This subsection expires October 1, 2014.
 2116         (9) The agency shall consult with Medicaid consumers and
 2117  their representatives on an ongoing basis regarding measurements
 2118  of patient satisfaction, procedures for resolving patient
 2119  grievances, standards for ensuring quality of care, mechanisms
 2120  for providing patient access to services, and policies affecting
 2121  patient care. This subsection expires October 1, 2014.
 2122         (10) The agency may extend eligibility for Medicaid
 2123  recipients enrolled in licensed and accredited health
 2124  maintenance organizations for the duration of the enrollment
 2125  period or for 6 months, whichever is earlier, provided the
 2126  agency certifies that such an offer will not increase state
 2127  expenditures. This subsection expires October 1, 2013.
 2128         (11) A managed care plan that has a Medicaid contract shall
 2129  at least annually review each primary care physician’s active
 2130  patient load and shall ensure that additional Medicaid
 2131  recipients are not assigned to physicians who have a total
 2132  active patient load of more than 3,000 patients. As used in this
 2133  subsection, the term “active patient” means a patient who is
 2134  seen by the same primary care physician, or by a physician
 2135  assistant or advanced registered nurse practitioner under the
 2136  supervision of the primary care physician, at least three times
 2137  within a calendar year. Each primary care physician shall
 2138  annually certify to the managed care plan whether or not his or
 2139  her patient load exceeds the limits established under this
 2140  subsection and the managed care plan shall accept such
 2141  certification on face value as compliance with this subsection.
 2142  The agency shall accept the managed care plan’s representations
 2143  that it is in compliance with this subsection based on the
 2144  certification of its primary care physicians, unless the agency
 2145  has an objective indication that access to primary care is being
 2146  compromised, such as receiving complaints or grievances relating
 2147  to access to care. If the agency determines that an objective
 2148  indication exists that access to primary care is being
 2149  compromised, it may verify the patient load certifications
 2150  submitted by the managed care plan’s primary care physicians and
 2151  that the managed care plan is not assigning Medicaid recipients
 2152  to primary care physicians who have an active patient load of
 2153  more than 3,000 patients. This subsection expires October 1,
 2154  2014.
 2155         (12) Effective July 1, 2003, the agency shall adjust the
 2156  enrollee assignment process of Medicaid managed prepaid health
 2157  plans for those Medicaid managed prepaid plans operating in
 2158  Miami-Dade County which have executed a contract with the agency
 2159  for a minimum of 8 consecutive years in order for the Medicaid
 2160  managed prepaid plan to maintain a minimum enrollment level of
 2161  15,000 members per month. When assigning enrollees pursuant to
 2162  this subsection, the agency shall give priority to providers
 2163  that initially qualified under this subsection until such
 2164  providers reach and maintain an enrollment level of 15,000
 2165  members per month. A prepaid health plan that has a statewide
 2166  Medicaid enrollment of 25,000 or more members is not eligible
 2167  for enrollee assignments under this subsection. This subsection
 2168  expires October 1, 2014.
 2169         (2)(13) The agency shall include in its calculation of the
 2170  hospital inpatient component of a Medicaid health maintenance
 2171  organization’s capitation rate any special payments, including,
 2172  but not limited to, upper payment limit or disproportionate
 2173  share hospital payments, made to qualifying hospitals through
 2174  the fee-for-service program. The agency may seek federal waiver
 2175  approval or state plan amendment as needed to implement this
 2176  adjustment.
 2177         (3)(14) The agency shall develop a process to enable any
 2178  recipient with access to employer-sponsored health care coverage
 2179  to opt out of all eligible plans in the Medicaid program and to
 2180  use Medicaid financial assistance to pay for the recipient’s
 2181  share of cost in any such employer-sponsored coverage.
 2182  Contingent on federal approval, the agency shall also enable
 2183  recipients with access to other insurance or related products
 2184  that provide access to health care services created pursuant to
 2185  state law, including any plan or product available pursuant to
 2186  the Florida Health Choices Program or any health exchange, to
 2187  opt out. The amount of financial assistance provided for each
 2188  recipient may not exceed the amount of the Medicaid premium that
 2189  would have been paid to a plan for that recipient.
 2190         (4)(15) The agency shall maintain and operate the Medicaid
 2191  Encounter Data System to collect, process, store, and report on
 2192  covered services provided to all Florida Medicaid recipients
 2193  enrolled in prepaid managed care plans.
 2194         (a) Prepaid managed care plans shall submit encounter data
 2195  electronically in a format that complies with the Health
 2196  Insurance Portability and Accountability Act provisions for
 2197  electronic claims and in accordance with deadlines established
 2198  by the agency. Prepaid managed care plans must certify that the
 2199  data reported is accurate and complete.
 2200         (b) The agency is responsible for validating the data
 2201  submitted by the plans. The agency shall develop methods and
 2202  protocols for ongoing analysis of the encounter data that
 2203  adjusts for differences in characteristics of prepaid plan
 2204  enrollees to allow comparison of service utilization among plans
 2205  and against expected levels of use. The analysis shall be used
 2206  to identify possible cases of systemic underutilization or
 2207  denials of claims and inappropriate service utilization such as
 2208  higher-than-expected emergency department encounters. The
 2209  analysis shall provide periodic feedback to the plans and enable
 2210  the agency to establish corrective action plans when necessary.
 2211  One of the focus areas for the analysis shall be the use of
 2212  prescription drugs.
 2213         (5)(16) The agency may establish a per-member, per-month
 2214  payment for Medicare Advantage Special Needs members that are
 2215  also eligible for Medicaid as a mechanism for meeting the
 2216  state’s cost-sharing obligation. The agency may also develop a
 2217  per-member, per-month payment only for Medicaid-covered services
 2218  for which the state is responsible. The agency shall develop a
 2219  mechanism to ensure that such per-member, per-month payment
 2220  enhances the value to the state and enrolled members by limiting
 2221  cost sharing, enhances the scope of Medicare supplemental
 2222  benefits that are equal to or greater than Medicaid coverage for
 2223  select services, and improves care coordination.
 2224         (6)(17) The agency shall establish, and managed care plans
 2225  shall use, a uniform method of accounting for and reporting
 2226  medical and nonmedical costs.
 2227         (a) Managed care plans shall submit financial data
 2228  electronically in a format that complies with the uniform
 2229  accounting procedures established by the agency. Managed care
 2230  plans must certify that the data reported is accurate and
 2231  complete.
 2232         (b) The agency is responsible for validating the financial
 2233  data submitted by the plans. The agency shall develop methods
 2234  and protocols for ongoing analysis of data that adjusts for
 2235  differences in characteristics of plan enrollees to allow
 2236  comparison among plans and against expected levels of
 2237  expenditures. The analysis shall be used to identify possible
 2238  cases of overspending on administrative costs or underspending
 2239  on medical services.
 2240         (7)(18) The agency shall establish and maintain an
 2241  information system to make encounter data, financial data, and
 2242  other measures of plan performance available to the public and
 2243  any interested party.
 2244         (a) Information submitted by the managed care plans shall
 2245  be available online as well as in other formats.
 2246         (b) Periodic agency reports shall be published that include
 2247  summary as well as plan specific measures of financial
 2248  performance and service utilization.
 2249         (c) Any release of the financial and encounter data
 2250  submitted by managed care plans shall ensure the confidentiality
 2251  of personal health information.
 2252         (8)(19) The agency may, on a case-by-case basis, exempt a
 2253  recipient from mandatory enrollment in a managed care plan when
 2254  the recipient has a unique, time-limited disease or condition
 2255  related circumstance and managed care enrollment will interfere
 2256  with ongoing care because the recipient’s provider does not
 2257  participate in the managed care plans available in the
 2258  recipient’s area.
 2259         (20) The agency shall contract with a single provider
 2260  service network to function as a managing entity for the
 2261  MediPass program in all counties with fewer than two prepaid
 2262  plans. The contractor shall be responsible for implementing
 2263  preauthorization procedures, case management programs, and
 2264  utilization management initiatives in order to improve care
 2265  coordination and patient outcomes while reducing costs. The
 2266  contractor may earn an administrative fee if the fee is less
 2267  than any savings as determined by the reconciliation process
 2268  under s. 409.912(4)(d)1. This subsection expires October 1,
 2269  2014, or upon full implementation of the managed medical
 2270  assistance program, whichever is sooner.
 2271         (21) Subject to federal approval, the agency shall contract
 2272  with a single provider service network to function as a third
 2273  party administrator and managing entity for the Medically Needy
 2274  program in all counties. The contractor shall provide care
 2275  coordination and utilization management in order to achieve more
 2276  cost-effective services for Medically Needy enrollees. To
 2277  facilitate the care management functions of the provider service
 2278  network, enrollment in the network shall be for a continuous 6
 2279  month period or until the end of the contract between the
 2280  provider service network and the agency, whichever is sooner.
 2281  Beginning the second month after the determination of
 2282  eligibility, the contractor may collect a monthly premium from
 2283  each Medically Needy recipient provided the premium does not
 2284  exceed the enrollee’s share of cost as determined by the
 2285  Department of Children and Families. The contractor must provide
 2286  a 90-day grace period before disenrolling a Medically Needy
 2287  recipient for failure to pay premiums. The contractor may earn
 2288  an administrative fee, if the fee is less than any savings
 2289  determined by the reconciliation process pursuant to s.
 2290  409.912(4)(d)1. Premium revenue collected from the recipients
 2291  shall be deducted from the contractor’s earned savings. This
 2292  subsection expires October 1, 2014, or upon full implementation
 2293  of the managed medical assistance program, whichever is sooner.
 2294         (9)(22) If required as a condition of a waiver, the agency
 2295  may calculate a medical loss ratio for managed care plans. The
 2296  calculation shall utilize uniform financial data collected from
 2297  all plans and shall be computed for each plan on a statewide
 2298  basis. The method for calculating the medical loss ratio shall
 2299  meet the following criteria:
 2300         (a) Except as provided in paragraphs (b) and (c),
 2301  expenditures shall be classified in a manner consistent with 45
 2302  C.F.R. part 158.
 2303         (b) Funds provided by plans to graduate medical education
 2304  institutions to underwrite the costs of residency positions
 2305  shall be classified as medical expenditures, provided the
 2306  funding is sufficient to sustain the positions for the number of
 2307  years necessary to complete the residency requirements and the
 2308  residency positions funded by the plans are active providers of
 2309  care to Medicaid and uninsured patients.
 2310         (c) Prior to final determination of the medical loss ratio
 2311  for any period, a plan may contribute to a designated state
 2312  trust fund for the purpose of supporting Medicaid and indigent
 2313  care and have the contribution counted as a medical expenditure
 2314  for the period.
 2315         Reviser’s note.—Amended to conform to the repeals of numerous
 2316         subunits pursuant to their own terms, effective at various
 2317         dates in 2013 and 2014.
 2318         Section 17. Subsection (15) of section 430.04, Florida
 2319  Statutes, is repealed.
 2320         Reviser’s note.—The cited subsection, which relates to
 2321         authorization of the Department of Elderly Affairs to
 2322         administer all Medicaid waivers and programs relating to
 2323         elders and their appropriations, expired pursuant to its
 2324         own terms, effective October 1, 2014.
 2325         Section 18. Subsections (10), (11), and (12) of section
 2326  430.502, Florida Statutes, are repealed.
 2327         Reviser’s note.—The cited subsections relate to seeking of a
 2328         federal waiver to implement a Medicaid home and community
 2329         based waiver targeted to persons with Alzheimer’s disease
 2330         to test the effectiveness of Alzheimer’s specific
 2331         interventions to delay or to avoid institutional placement.
 2332         Subsection (12) provides that authority to continue the
 2333         waiver program is automatically eliminated at the close of
 2334         the 2010 Regular Session of the Legislature unless further
 2335         action is taken to continue it before such time.
 2336         Section 19. Subsection (5) of section 443.131, Florida
 2337  Statutes, is repealed.
 2338         Reviser’s note.—The cited subsection, which relates to an
 2339         additional rate for interest on federal advances received
 2340         by the Unemployment Compensation Trust Fund, expired
 2341         pursuant to its own terms, effective July 1, 2014.
 2342         Section 20. Subsection (1) of section 576.061, Florida
 2343  Statutes, is amended to read:
 2344         576.061 Plant nutrient investigational allowances,
 2345  deficiencies, and penalties.—
 2346         (1) A commercial fertilizer is deemed deficient if the
 2347  analysis of any nutrient is below the guarantee by an amount
 2348  exceeding the investigational allowances. The department shall
 2349  adopt rules, which shall take effect on July 1, 2014, that
 2350  establish the investigational allowances used to determine
 2351  whether a fertilizer is deficient in plant food.
 2352         (a) Effective July 1, 2014, this paragraph and paragraphs
 2353  (b)-(f) are repealed. Until July 1, 2014, investigational
 2354  allowances shall be set as provided in paragraphs (b)-(f).
 2355         (b) Primary plant nutrients; investigational allowances.
 2356  
 2357  GuaranteedPercentTotalNitrogenPercentAvailablePhosphatePercentPotashPercent                       
 2358  
 2359  04 or less  0.49      0.67       0.41                                
 2360  05          0.51      0.67       0.43                                
 2361  06          0.52      0.67       0.47                                
 2362  07          0.54      0.68       0.53                                
 2363  08          0.55      0.68       0.60                                
 2364  09          0.57      0.68       0.65                                
 2365  10          0.58      0.69       0.70                                
 2366  12          0.61      0.69       0.79                                
 2367  14          0.63      0.70       0.87                                
 2368  16          0.67      0.70       0.94                                
 2369  18          0.70      0.71       1.01                                
 2370  20          0.73      0.72       1.08                                
 2371  22          0.75      0.72       1.15                                
 2372  24          0.78      0.73       1.21                                
 2373  26          0.81      0.73       1.27                                
 2374  28          0.83      0.74       1.33                                
 2375  30          0.86      0.75       1.39                                
 2376  32 or more  0.88      0.76       1.44                                
 2377  
 2378  For guarantees not listed, calculate the appropriate value by
 2379  interpolation.
 2380         (c) Nitrogen investigational allowances.
 2381  
 2382  Nitrogen Breakdown         Investigational AllowancesPercent         
 2383  
 2384  Nitrate nitrogen                         0.40                        
 2385  Ammoniacal nitrogen                       0.40                        
 2386  Water soluble nitrogenor urea nitrogen                       0.40                        
 2387  Water insoluble nitrogen                       0.30                        
 2388  
 2389  
 2390  In no case may the investigational allowance exceed 50 percent
 2391  of the amount guaranteed.
 2392         (d) Secondary and micro plant nutrients, total or soluble.
 2393  
 2394  Element                 Investigational Allowances Percent           
 2395  
 2396  Calcium       0.2 unit + 5 percent of guarantee                      
 2397  Magnesium     0.2 unit + 5 percent of guarantee                      
 2398  Sulfur (free and combined)0.2 unit + 5 percent of guarantee                      
 2399  Boron         0.003 unit + 15 percent of guarantee                   
 2400  Cobalt        0.0001 unit + 30 percent of guarantee                  
 2401  Chlorine      0.005 unit + 10 percent of guarantee                   
 2402  Copper        0.005 unit + 10 percent of guarantee                   
 2403  Iron          0.005 unit + 10 percent of guarantee                   
 2404  Manganese     0.005 unit + 10 percent of guarantee                   
 2405  Molybdenum    0.0001 unit + 30 percent of guarantee                  
 2406  Sodium        0.005 unit + 10 percent of guarantee                   
 2407  Zinc          0.005 unit + 10 percent of guarantee                   
 2408  
 2409  
 2410  The maximum allowance for secondary and minor elements when
 2411  calculated in accordance with this section is 1 unit (1
 2412  percent). In no case, however, may the investigational allowance
 2413  exceed 50 percent of the amount guaranteed.
 2414         (e) Liming materials and gypsum.
 2415  
 2416  Range Percent            Investigational AllowancesPercent             
 2417  
 2418  0-10                                  0.30                           
 2419  Over 10-25                            0.40                           
 2420  Over 25                               0.50                           
 2421  
 2422         (f) Pesticides in fertilizer mixtures.—An investigational
 2423  allowance of 25 percent of the guarantee shall be allowed on all
 2424  pesticides when added to custom blend fertilizers.
 2425         Reviser’s note.—The cited paragraphs, which relate to
 2426         investigational allowances for fertilizer, were repealed
 2427         pursuant to their own terms, effective July 1, 2014.
 2428         Section 21. Section 624.351, Florida Statutes, is repealed.
 2429         Reviser’s note.—The cited section, which relates to the Medicaid
 2430         and Public Assistance Fraud Strike Force, was repealed
 2431         pursuant to its own terms, effective June 30, 2014.
 2432         Section 22. Section 624.352, Florida Statutes, is repealed.
 2433         Reviser’s note.—The cited section, which relates to interagency
 2434         agreements to detect and deter Medicaid and public
 2435         assistance fraud, was repealed pursuant to its own terms,
 2436         effective June 30, 2014.
 2437         Section 23. Subsection (7) of section 626.2815, Florida
 2438  Statutes, is repealed.
 2439         Reviser’s note.—The cited subsection, which relates to a
 2440         requirement that persons holding a license to solicit or
 2441         sell life insurance must complete a minimum of 3 hours in
 2442         continuing education on the subject of suitability in
 2443         annuity and life insurance transactions, was deleted from
 2444         s. 626.2815 by s. 11, ch. 2012-209, Laws of Florida,
 2445         effective October 1, 2014. Since the subsection was not
 2446         repealed by a “current session” of the Legislature, it may
 2447         be omitted from the 2015 Florida Statutes only through a
 2448         reviser’s bill duly enacted by the Legislature. See s.
 2449         11.242(5)(b) and (i).
 2450         Section 24. Paragraph (b) of subsection (4) of section
 2451  828.27, Florida Statutes, is amended to read:
 2452         828.27 Local animal control or cruelty ordinances;
 2453  penalty.—
 2454         (4)
 2455         (b)1. The governing body of a county or municipality may
 2456  impose and collect a surcharge of up to $5 upon each civil
 2457  penalty imposed for violation of an ordinance relating to animal
 2458  control or cruelty. The proceeds from such surcharges shall be
 2459  used to pay the costs of training for animal control officers.
 2460         2. In addition to the uses set forth in subparagraph 1., a
 2461  county, as defined in s. 125.011, may use the proceeds specified
 2462  in that subparagraph and any carryover or fund balance from such
 2463  proceeds for animal shelter operating expenses. This
 2464  subparagraph expires July 1, 2014.
 2465         Reviser’s note.—Amended to delete subparagraph (4)(b)2., which
 2466         expired pursuant to its own terms, effective July 1, 2014.
 2467         Section 25. Paragraph (e) of subsection (9) of section
 2468  1002.32, Florida Statutes, is amended to read:
 2469         1002.32 Developmental research (laboratory) schools.—
 2470         (9) FUNDING.—Funding for a lab school, including a charter
 2471  lab school, shall be provided as follows:
 2472         (e)1. Each lab school shall receive funds for capital
 2473  improvement purposes in an amount determined as follows:
 2474  multiply the maximum allowable nonvoted discretionary millage
 2475  for capital improvements pursuant to s. 1011.71(2) by 96 percent
 2476  of the current year’s taxable value for school purposes for the
 2477  district in which each lab school is located; divide the result
 2478  by the total full-time equivalent membership of the district;
 2479  and multiply the result by the full-time equivalent membership
 2480  of the lab school. The amount obtained shall be discretionary
 2481  capital improvement funds and shall be appropriated from state
 2482  funds in the General Appropriations Act to the Lab School
 2483  Educational Facility Trust Fund.
 2484         2. Notwithstanding the provisions of subparagraph 1., for
 2485  the 2013-2014 fiscal year, funds appropriated for capital
 2486  improvement purposes shall be divided between lab schools based
 2487  on full-time equivalent student membership. This subparagraph
 2488  expires July 1, 2014.
 2489         Reviser’s note.—Amended to delete subparagraph (9)(e)2., which
 2490         expired pursuant to its own terms, effective July 1, 2014.
 2491         Section 26. Subsection (4) of section 409.91195, Florida
 2492  Statutes, is amended to read:
 2493         409.91195 Medicaid Pharmaceutical and Therapeutics
 2494  Committee.—There is created a Medicaid Pharmaceutical and
 2495  Therapeutics Committee within the agency for the purpose of
 2496  developing a Medicaid preferred drug list.
 2497         (4) Upon recommendation of the committee, the agency shall
 2498  adopt a preferred drug list as described in s. 409.912(8)
 2499  409.912(37). To the extent feasible, the committee shall review
 2500  all drug classes included on the preferred drug list every 12
 2501  months, and may recommend additions to and deletions from the
 2502  preferred drug list, such that the preferred drug list provides
 2503  for medically appropriate drug therapies for Medicaid patients
 2504  which achieve cost savings contained in the General
 2505  Appropriations Act.
 2506         Reviser’s note.—Amended to conform to the redesignation of
 2507         subunits of s. 409.912 by this act.
 2508         Section 27. Subsection (1) of section 409.91196, Florida
 2509  Statutes, is amended to read:
 2510         409.91196 Supplemental rebate agreements; public records
 2511  and public meetings exemption.—
 2512         (1) The rebate amount, percent of rebate, manufacturer’s
 2513  pricing, and supplemental rebate, and other trade secrets as
 2514  defined in s. 688.002 that the agency has identified for use in
 2515  negotiations, held by the Agency for Health Care Administration
 2516  under s. 409.912(8)(a)7. 409.912(37)(a)7. are confidential and
 2517  exempt from s. 119.07(1) and s. 24(a), Art. I of the State
 2518  Constitution.
 2519         Reviser’s note.—Amended to conform to the redesignation of
 2520         subunits of s. 409.912 by this act.
 2521         Section 28. Subsections (1), (6), (12), and (13) of section
 2522  409.962, Florida Statutes, are amended to read:
 2523         409.962 Definitions.—As used in this part, except as
 2524  otherwise specifically provided, the term:
 2525         (1) “Accountable care organization” means an entity
 2526  qualified as an accountable care organization in accordance with
 2527  federal regulations, and which meets the requirements of a
 2528  provider service network as described in s. 409.912(2)
 2529  409.912(4)(d).
 2530         (6) “Eligible plan” means a health insurer authorized under
 2531  chapter 624, an exclusive provider organization authorized under
 2532  chapter 627, a health maintenance organization authorized under
 2533  chapter 641, or a provider service network authorized under s.
 2534  409.912(2) 409.912(4)(d) or an accountable care organization
 2535  authorized under federal law. For purposes of the managed
 2536  medical assistance program, the term also includes the
 2537  Children’s Medical Services Network authorized under chapter 391
 2538  and entities qualified under 42 C.F.R. part 422 as Medicare
 2539  Advantage Preferred Provider Organizations, Medicare Advantage
 2540  Provider-sponsored Organizations, Medicare Advantage Health
 2541  Maintenance Organizations, Medicare Advantage Coordinated Care
 2542  Plans, and Medicare Advantage Special Needs Plans, and the
 2543  Program of All-inclusive Care for the Elderly.
 2544         (12) “Prepaid plan” means a managed care plan that is
 2545  licensed or certified as a risk-bearing entity, or qualified
 2546  pursuant to s. 409.912(2) 409.912(4)(d), in the state and is
 2547  paid a prospective per-member, per-month payment by the agency.
 2548         (13) “Provider service network” means an entity qualified
 2549  pursuant to s. 409.912(2) 409.912(4)(d) of which a controlling
 2550  interest is owned by a health care provider, or group of
 2551  affiliated providers, or a public agency or entity that delivers
 2552  health services. Health care providers include Florida-licensed
 2553  health care professionals or licensed health care facilities,
 2554  federally qualified health care centers, and home health care
 2555  agencies.
 2556         Reviser’s note.—Amended to conform to the redesignation of
 2557         subunits of s. 409.912 by this act.
 2558         Section 29. Section 636.0145, Florida Statutes, is amended
 2559  to read:
 2560         636.0145 Certain entities contracting with Medicaid.
 2561  Notwithstanding the requirements of s. 409.912(4)(b), An entity
 2562  that is providing comprehensive inpatient and outpatient mental
 2563  health care services to certain Medicaid recipients in
 2564  Hillsborough, Highlands, Hardee, Manatee, and Polk Counties
 2565  through a capitated, prepaid arrangement pursuant to the federal
 2566  waiver provided for in s. 409.905(5) must become licensed under
 2567  this chapter by December 31, 1998. Any entity licensed under
 2568  this chapter which provides services solely to Medicaid
 2569  recipients under a contract with Medicaid is exempt from ss.
 2570  636.017, 636.018, 636.022, 636.028, 636.034, and 636.066(1).
 2571         Reviser’s note.—Amended to conform to the deletion of s.
 2572         409.912(4)(b) by this act to conform to its expiration
 2573         pursuant to its own terms, effective October 1, 2014.
 2574         Section 30. Subsection (22) of section 641.19, Florida
 2575  Statutes, is amended to read:
 2576         641.19 Definitions.—As used in this part, the term:
 2577         (22) “Provider service network” means a network authorized
 2578  under s. 409.912(2) 409.912(4)(d), reimbursed on a prepaid
 2579  basis, operated by a health care provider or group of affiliated
 2580  health care providers, and which directly provides health care
 2581  services under a Medicare, Medicaid, or Healthy Kids contract.
 2582         Reviser’s note.—Amended to conform to the redesignation of
 2583         subunits of s. 409.912 by this act.
 2584         Section 31. Subsection (3) of section 641.225, Florida
 2585  Statutes, is amended to read:
 2586         641.225 Surplus requirements.—
 2587         (3)(a) An entity providing prepaid capitated services which
 2588  is authorized under s. 409.912(4)(a) and which applies for a
 2589  certificate of authority is subject to the minimum surplus
 2590  requirements set forth in subsection (1), unless the entity is
 2591  backed by the full faith and credit of the county in which it is
 2592  located.
 2593         (b) An entity providing prepaid capitated services which is
 2594  authorized under s. 409.912(4)(b) or (c), and which applies for
 2595  a certificate of authority is subject to the minimum surplus
 2596  requirements set forth in s. 409.912.
 2597         Reviser’s note.—Amended to conform to the expiration of
 2598         paragraphs (4)(a)-(c) of s. 409.912 pursuant to their own
 2599         terms, effective October 1, 2014, and confirmation of the
 2600         expiration by this act.
 2601         Section 32. Subsection (4) of section 641.386, Florida
 2602  Statutes, is amended to read:
 2603         641.386 Agent licensing and appointment required;
 2604  exceptions.—
 2605         (4) All agents and health maintenance organizations shall
 2606  comply with and be subject to the applicable provisions of ss.
 2607  641.309 and 409.912(5) 409.912(20), and all companies and
 2608  entities appointing agents shall comply with s. 626.451, when
 2609  marketing for any health maintenance organization licensed
 2610  pursuant to this part, including those organizations under
 2611  contract with the Agency for Health Care Administration to
 2612  provide health care services to Medicaid recipients or any
 2613  private entity providing health care services to Medicaid
 2614  recipients pursuant to a prepaid health plan contract with the
 2615  Agency for Health Care Administration.
 2616         Reviser’s note.—Amended to conform to the redesignation of
 2617         subunits of s. 409.912 by this act.
 2618         Section 33. This act shall take effect on the 60th day
 2619  after adjournment sine die of the session of the Legislature in
 2620  which enacted.