House Bill 2087
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Florida House of Representatives - 1999 HB 2087
By the Committee on Children & Families and Representative
Murman
1 A bill to be entitled
2 An act relating to Medicaid managed health
3 care; amending s. 409.912, F.S.; authorizing
4 the Agency for Health Care Administration to
5 contract with entities providing behavioral
6 health care services to certain Medicaid
7 recipients in certain counties under certain
8 circumstances; providing requirements;
9 providing limitations; providing definitions;
10 providing an effective date.
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12 Be It Enacted by the Legislature of the State of Florida:
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14 Section 1. Paragraph (b) of subsection (3) of section
15 409.912, Florida Statutes, 1998 Supplement, is amended to
16 read:
17 409.912 Cost-effective purchasing of health care.--The
18 agency shall purchase goods and services for Medicaid
19 recipients in the most cost-effective manner consistent with
20 the delivery of quality medical care. The agency shall
21 maximize the use of prepaid per capita and prepaid aggregate
22 fixed-sum basis services when appropriate and other
23 alternative service delivery and reimbursement methodologies,
24 including competitive bidding pursuant to s. 287.057, designed
25 to facilitate the cost-effective purchase of a case-managed
26 continuum of care. The agency shall also require providers to
27 minimize the exposure of recipients to the need for acute
28 inpatient, custodial, and other institutional care and the
29 inappropriate or unnecessary use of high-cost services.
30 (3) The agency may contract with:
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Florida House of Representatives - 1999 HB 2087
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1 (b)1.a. An entity that is providing comprehensive
2 behavioral inpatient and outpatient mental health care
3 services to certain Medicaid recipients in Hillsborough,
4 Highlands, Hardee, Manatee, and Polk, Escambia, Santa Rosa,
5 Okaloosa, Walton, Baker, Nassau, Duval, Clay, St. Johns,
6 Hamilton Suwannee, Lafayette, Dixie, Columbia, Gilchrist,
7 Levy, Union, Bradford, Alachua, Pasco, Pinellas, and Dade
8 Counties, through a capitated, prepaid arrangement pursuant to
9 the federal waiver provided for by s. 409.905(5). Such an
10 entity must become licensed under chapter 624, chapter 636, or
11 chapter 641 by December 31, 1998, and is exempt from the
12 provisions of part I of chapter 641 until then. However, if
13 the entity assumes risk, the Department of Insurance shall
14 develop appropriate regulatory requirements by rule under the
15 insurance code before the entity becomes operational.
16 b. In counties in which the agency seeks to implement
17 its authority to award contracts as provided in this
18 paragraph, which counties have a Medicaid population which
19 exceeds 300,000, the agency shall award one contract for every
20 100,000 Medicaid recipients.
21 c. Total administrative cost for contracts under this
22 paragraph, including administrative costs associated with
23 subcontracts or subcapitation, shall be capped at 10 percent
24 of the flat monthly payment per enrollee or the capitation
25 rate.
26 d. In counties which have a provider service network
27 in operation as of October 1, 1999, and authorized by
28 paragraph (d), the agency shall not include those recipients
29 served by such provider service network in the behavioral
30 health project pursuant to this paragraph.
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Florida House of Representatives - 1999 HB 2087
602-136A-99
1 e. The agency shall not initiate procurement for a
2 prepaid plan not in operation on July 1, 1999, unless the
3 agency has ensured the readiness of affected communities and
4 adequacy of community based providers to successfully
5 implement a prepaid plan. The agency shall work cooperatively
6 with the Department of Children and Family Services at both
7 the local and state levels to plan for implementation of any
8 prepaid plan and shall ensure that procurements address the
9 critical needs of populations which are also served by the
10 department. The agency shall ensure that behavioral health
11 services provided under the prepaid plan are coordinated with
12 ongoing programs funded by the Department of Children and
13 Family Services and shall ensure that Medicaid costs are not
14 shifted onto programs funded by the department.
15 2. As used in this paragraph:
16 a. "Behavioral health care" includes mental health and
17 substance abuse services.
18 b. "District" means any district of the Department of
19 Children and Family Services.
20 3. The agency shall consult and coordinate with the
21 Department of Children and Family Services and the Department
22 of Juvenile Justice regarding plans to expand behavioral
23 managed care projects to each county or district through a
24 request-for-proposal procurement process, phased in over a
25 3-year period.
26 4. Plans must be county or district specific and
27 developed with local community participation, including, but
28 not limited to, input from community-based mental health,
29 substance abuse, child welfare, delinquency providers that are
30 currently under contract with the agency or departments to
31 furnish nonresidential and residential services.
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Florida House of Representatives - 1999 HB 2087
602-136A-99
1 5. Children receiving residential and nonresidential
2 services from the Department of Juvenile Justice or its
3 providers and children receiving residential and
4 nonresidential services from the Department of Children and
5 Family Services or its providers shall not be included in a
6 behavioral health care contract pursuant to this paragraph.
7 6. The plan must ensure that conversion to a capitated
8 system of delivery will not result in the displacement of
9 indigent care patients from facilities receiving state funding
10 to provide indigent behavioral health care to facilities
11 licensed under chapter 395 which do not receive state
12 subsidies unless the unsubsidized facilities are reimbursed
13 for the cost of all treatment, including medical treatment
14 which is a precondition to admission into a subsidized
15 facility. The agency and departments shall further ensure that
16 facilities licensed under chapter 395 are included in the
17 development of the county or district plans.
18 7. Plans to expand must be submitted by November 1,
19 2000, to the appropriate fiscal and substantive committees of
20 the House of Representatives and the Senate. Authority to
21 expand behavioral managed care projects to other counties or
22 districts shall be granted by the Legislature.
23 8. With respect to any county or district in which
24 expansion of behavioral managed care projects cannot be
25 accomplished within the 3-year timeframe, the plan must
26 clearly state the reasons the timeframe cannot be met and the
27 efforts that should be made to address the obstacles, which
28 may include alternatives to behavioral managed care.
29 9. Traditional inpatient mental health providers
30 licensed pursuant to chapter 395 must be included in any
31 subcontract for inpatient behavioral health service.
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Florida House of Representatives - 1999 HB 2087
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1 Section 2. This act shall take effect October 1, 1999.
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4 HOUSE SUMMARY
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Authorizes the Agency for Health Care Administration to
6 contract with entities providing behavioral health care
services to certain Medicaid recipients in specified
7 counties through a capitated, prepaid arrangement
pursuant to a federal waiver. Provides contract
8 requirements and limitations. See bill for details.
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