CODING: Words stricken are deletions; words underlined are additions.





                                                  SENATE AMENDMENT

    Bill No. CS/HB 1129, 2nd Eng.

    Amendment No.    

                            CHAMBER ACTION
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11  Senator Silver moved the following amendment:

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13         Senate Amendment (with title amendment) 

14         Delete everything after the enacting clause

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16  and insert:

17         Section 1.  Paragraph (b) of subsection (3) of section

18  409.912, Florida Statutes, is amended, and paragraph (e) is

19  added to that subsection, to read:

20         409.912  Cost-effective purchasing of health care.--The

21  agency shall purchase goods and services for Medicaid

22  recipients in the most cost-effective manner consistent with

23  the delivery of quality medical care.  The agency shall

24  maximize the use of prepaid per capita and prepaid aggregate

25  fixed-sum basis services when appropriate and other

26  alternative service delivery and reimbursement methodologies,

27  including competitive bidding pursuant to s. 287.057, designed

28  to facilitate the cost-effective purchase of a case-managed

29  continuum of care. The agency shall also require providers to

30  minimize the exposure of recipients to the need for acute

31  inpatient, custodial, and other institutional care and the

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 1129, 2nd Eng.

    Amendment No.    





 1  inappropriate or unnecessary use of high-cost services.

 2         (3)  The agency may contract with:

 3         (b)  An entity that is providing comprehensive

 4  behavioral inpatient and outpatient mental health care

 5  services to certain Medicaid recipients in Hillsborough,

 6  Highlands, Hardee, Manatee, and Polk Counties, through a

 7  capitated, prepaid arrangement pursuant to the federal waiver

 8  provided for by s. 409.905(5). Such an entity must be become

 9  licensed under chapter 624, chapter 636, or chapter 641 and

10  must possess the clinical systems and operational competence

11  to manage risk and provide comprehensive behavioral health

12  care to Medicaid recipients. As used in this paragraph, the

13  term "comprehensive behavioral health care services" means

14  covered mental health and substance abuse treatment services

15  that are available to Medicaid recipients. The Secretary of

16  the Department of Children and Families shall approve

17  provisions of procurements related to children in the

18  department's care or custody prior to enrolling such children

19  in a prepaid behavioral health plan. Any contract awarded

20  under this paragraph must be competitively procured. In

21  developing the behavioral health care prepaid plan procurement

22  document, the agency shall ensure that the procurement

23  document requires the contractor to develop and implement a

24  plan to ensure compliance with s. 394.4574 related to services

25  provided to residents of licensed assisted living facilities

26  that hold a limited mental health license. The agency must

27  ensure that Medicaid recipients have available the choice of

28  at least two managed care plans for their behavioral health

29  care services. The agency may reimburse for

30  substance-abuse-treatment services on a fee-for-service basis

31  until the agency finds that adequate funds are available for

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 1129, 2nd Eng.

    Amendment No.    





 1  capitated, prepaid arrangements.

 2         1.  By January 1, 2001, the agency shall modify the

 3  contracts with the entities providing comprehensive inpatient

 4  and outpatient mental health care services to Medicaid

 5  recipients in Hillsborough, Highlands, Hardee, Manatee, and

 6  Polk Counties, to include substance-abuse-treatment services.

 7         2.  By December 31, 2001, the agency shall contract

 8  with entities providing comprehensive behavioral health care

 9  services to Medicaid recipients through capitated, prepaid

10  arrangements in Charlotte, Collier, DeSoto, Escambia, Glades,

11  Hendry, Lee, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota,

12  and Walton Counties. The agency may contract with entities

13  providing comprehensive behavioral health care services to

14  Medicaid recipients through capitated, prepaid arrangements in

15  Alachua County. The agency may determine if Sarasota County

16  shall be included as a separate catchment area or included in

17  any other agency geographic area.

18         3.  Children residing in a Department of Juvenile

19  Justice residential program approved as a Medicaid behavioral

20  health overlay services provider shall not be included in a

21  behavioral health care prepaid health plan pursuant to this

22  paragraph.

23         4.  In converting to a prepaid system of delivery, the

24  agency shall in its procurement document require an entity

25  providing comprehensive behavioral health care services to

26  prevent the displacement of indigent care patients by

27  enrollees in the Medicaid prepaid health plan providing

28  behavioral health care services from facilities receiving

29  state funding to provide indigent behavioral health care, to

30  facilities licensed under chapter 395 which do not receive

31  state funding for indigent behavioral health care, or

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 1129, 2nd Eng.

    Amendment No.    





 1  reimburse the unsubsidized facility for the cost of behavioral

 2  health care provided to the displaced indigent care patient.

 3         5.  Traditional community mental health providers under

 4  contract with the Department of Children and Families pursuant

 5  to Part IV of chapter 394 and inpatient mental health

 6  providers licensed pursuant to chapter 395, must be offered an

 7  opportunity to accept or decline a contract to participate in

 8  any provider network for prepaid behavioral health services.

 9  by December 31, 1998, and is exempt from the provisions of

10  part I of chapter 641 until then. However, if the entity

11  assumes risk, the Department of Insurance shall develop

12  appropriate regulatory requirements by rule under the

13  insurance code before the entity becomes operational.

14         (e)  An entity that provides comprehensive behavioral

15  health care services to certain Medicaid recipients through an

16  administrative services organization agreement. Such an entity

17  must possess the clinical systems and operational competence

18  to provide comprehensive health care to Medicaid recipients.

19  As used in this paragraph, the term "comprehensive behavioral

20  health care services" means covered mental health and

21  substance abuse treatment services that are available to

22  Medicaid recipients. Any contract awarded under this paragraph

23  must be competitively procured. The agency must ensure that

24  Medicaid recipients have available the choice of at least two

25  managed care plans for their behavioral health care services.

26         Section 2.  This act shall take effect July 1, 2000.

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

30  And the title is amended as follows:

31         Delete everything before the enacting clause

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 1129, 2nd Eng.

    Amendment No.    





 1  and insert:

 2                      A bill to be entitled

 3         An act relating to Medicaid managed behavioral

 4         health care; amending s. 409.912, F.S.;

 5         authorizing the Agency for Health Care

 6         Administration to contract for prepaid

 7         behavioral health care services for Medicaid

 8         recipients in specified counties; providing

 9         requirements for the agency in developing

10         procurement procedures; authorizing the agency

11         to contract for the provision of certain

12         services in Alachua County and authorizing it

13         to make certain determinations regarding

14         Sarasota County; prohibiting the inclusion of

15         certain children in such services; requiring

16         the agency to require certain providers to

17         prevent the displacement of certain indigent

18         care patients; providing for certain

19         traditional mental health providers to be

20         offered a contract to participate in such

21         prepaid services plans; defining the term

22         "comprehensive behavioral health care

23         services"; providing deadlines for entering

24         such contracts; deleting provisions requiring

25         the Department of Insurance to develop certain

26         requirements for entities that provide mental

27         health care services; authorizing the Agency

28         for Health Care Administration to contract for

29         mental health and substance abuse treatment

30         services for Medicaid recipients through an

31         administrative services organization agreement;

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 1129, 2nd Eng.

    Amendment No.    





 1         providing requirements for procurement and

 2         availability of such services; providing an

 3         effective date.

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