House Bill 1129e1

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                                   CS/HB 1129, First Engrossed/ntc



  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.

11

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, is amended to read:

16         409.912  Cost-effective purchasing of health care.--The

17  agency shall purchase goods and services for Medicaid

18  recipients in the most cost-effective manner consistent with

19  the delivery of quality medical care.  The agency shall

20  maximize the use of prepaid per capita and prepaid aggregate

21  fixed-sum basis services when appropriate and other

22  alternative service delivery and reimbursement methodologies,

23  including competitive bidding pursuant to s. 287.057, designed

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

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

26  minimize the exposure of recipients to the need for acute

27  inpatient, custodial, and other institutional care and the

28  inappropriate or unnecessary use of high-cost services.

29         (3)  The agency may contract with:

30         (b)1.a.  An entity that is providing comprehensive

31  behavioral inpatient and outpatient mental health care


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                                   CS/HB 1129, First Engrossed/ntc



  1  services and is licensed under chapter 624, chapter 636, or

  2  chapter 641. Unless otherwise authorized by law, the agency

  3  shall limit such contract to services provided to certain

  4  Medicaid recipients in Baker, Clay, Dade, Duval, Escambia,

  5  Hillsborough, Highlands, Hardee, Manatee, Nassau, Okaloosa,

  6  Pinellas, and Polk, Santa Rosa, St. Johns, and Walton

  7  Counties, through a capitated, prepaid arrangement pursuant to

  8  the federal waiver provided for by s. 409.905(5). Such an

  9  entity must become licensed under chapter 624, chapter 636, or

10  chapter 641 by December 31, 1998, and is exempt from the

11  provisions of part I of chapter 641 until then. However, if

12  the entity assumes risk, the Department of Insurance shall

13  develop appropriate regulatory requirements by rule under the

14  insurance code before the entity becomes operational.

15         b.  In any county in which the agency seeks to

16  implement its authority to award contracts as provided in this

17  subparagraph that has a Medicaid population in excess of

18  300,000, the agency shall award one contract for every 100,000

19  Medicaid recipients.

20         c.  An entity that is providing comprehensive

21  behavioral health care services to certain Medicaid recipients

22  through an administrative services organization agreement.

23  Such an entity must possess the clinical systems and

24  operational competence to provide comprehensive health care to

25  Medicaid recipients. As used in this paragraph, the term

26  "comprehensive behavioral health care services" means covered

27  mental health and substance abuse treatment services that are

28  available to Mediciad recipients. Any contract awarded under

29  this paragraph must be competitively procured. The agency must

30  ensure that Medicaid recipients have available the choice of

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                                   CS/HB 1129, First Engrossed/ntc



  1  at least two managed care plans for their behavioral health

  2  care services.

  3         d.  The agency shall set as part of the competitive

  4  procurement an allowable medical/loss ratio to limit

  5  administrative costs and shall use industry standards, which

  6  shall be adjusted based upon size of the plan.

  7         e.  In developing the behavioral health care prepaid

  8  plan procurement document, the agency shall consult and

  9  coordinate with the Department of Children and Family Services

10  and the Department of Juvenile Justice. The Department of

11  Children and Family Services shall approve the sections of the

12  behavioral health care prepaid plan procurement document that

13  relate to children in the care and custody of the Department

14  of Children and Family Services and the families of such

15  children. The Department of Juvenile Justice shall approve the

16  sections of the behavioral health care prepaid plan

17  procurement document that relate to children in the care and

18  custody of the Department of Juvenile Justice and the families

19  of such children.

20         f.  In any county that has a provider service network

21  as authorized in this section, which provides behavioral

22  health care services and is in operation as of October 1,

23  2000, the agency shall not include those recipients served by

24  the provider service network in the behavioral health prepaid

25  plan, pursuant to this paragraph.

26         2.  As used in this paragraph:

27         a.  "Behavioral health care" includes mental health and

28  substance abuse services.

29         b.  "District" means any district of the Department of

30  Children and Family Services.

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                                   CS/HB 1129, First Engrossed/ntc



  1         c.  "Therapeutic or supportive foster care homes" means

  2  any foster care program operated by a Medicaid community

  3  mental health provider which is a licensed residential child

  4  caring or child placing agency as defined in s. 409.175.

  5         d.  "Specialized therapeutic foster care" means any

  6  foster care program provided under the Medicaid community

  7  mental health program service entitled specialized therapeutic

  8  foster care.

  9         3.  Children residing in a Department of Juvenile

10  Justice residential program approved as a Medicaid behavioral

11  health overlay services provider shall not be included in a

12  behavioral health care prepaid plan pursuant to this

13  paragraph.

14         4.  When implementing the behavioral health care

15  prepaid program in Baker, Clay, Dade, Duval, Nassau, or St.

16  Johns Counties, the agency shall not include the following:

17         a.  Dependent children placed by the Department of

18  Children and Family Services or a licensed child placing

19  agency into a licensed residential group care facility which

20  is operated by a Medicaid community mental health provider.

21         b.  Dependent children of the department receiving

22  therapeutic or supportive foster home care.

23         c.  Services to children in the care or custody of the

24  department while they are in an emergency shelter.

25         d.  Children served under the community mental health

26  program specialized therapeutic foster care.

27         5.  When implementing the behavioral health care

28  prepaid program in Baker, Clay, Dade, Duval, Nassau, or St.

29  Johns Counties, the agency shall require that any existing

30  licensed child caring or child placing agency that is also a

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                                   CS/HB 1129, First Engrossed/ntc



  1  Medicaid community mental health program provider be part of

  2  the provider network.

  3         6.  The agency and the department shall approve

  4  behavioral health care criteria and protocols for services

  5  provided to children referred from the child protection team

  6  for followup services.

  7         7.  In each the behavioral health care prepaid plan,

  8  substance abuse services shall be reimbursed on a

  9  fee-for-service basis from state Medicaid funds until such

10  time as the agency determines that adequate funds are

11  available for prepaid methods. The agency shall ensure that

12  any contractors for prepaid behavioral health services shall

13  propose practical methods of integrating mental health and

14  substance abuse services, including opportunities for

15  community-based substance abuse agencies to become partners in

16  the provider networks established at a district or area level,

17  and to participate in the development of protocols for

18  substance abuse services.

19         8.  In developing the behavioral health care prepaid

20  plan procurement document, the agency shall ensure that

21  conversion to a prepaid system of delivery shall not result in

22  the displacement of indigent care patients from facilities

23  receiving state funding to provide indigent behavioral health

24  care to facilities licensed under chapter 395 which do not

25  receive state subsidies unless the unsubsidized facilities are

26  reimbursed for the costs of all treatment, including medical

27  treatment which is a precondition to admission into a

28  subsidized facility. Traditional community mental health

29  providers, under contract with the Department of Children and

30  Family Services pursuant to part IV of chapter 394, and

31  inpatient mental health providers licensed pursuant to chapter


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                                   CS/HB 1129, First Engrossed/ntc



  1  395 must be included in any provider network for prepaid

  2  behavioral health services.

  3         9.  The agency shall notify the Legislature of the

  4  status and plans to expand the behavioral managed care

  5  projects to those counties designated in this paragraph by

  6  October 1, 2001. With respect to any county or district in

  7  which expansion of behavioral managed care projects cannot be

  8  accomplished within the 3-year timeframe, the plan must

  9  clearly state the reasons the timeframe cannot be met and the

10  efforts that should be made to address the obstacles, which

11  may include alternatives to behavioral managed care. The plan

12  must also address the status of services to children and their

13  families in the care and custody of the department and

14  Juvenile Justice. The plan must address how the services for

15  those children and families will be integrated into the

16  comprehensive behavioral health care program or how services

17  will be provided using alternative methods over the 3-year

18  phase-in.

19         10.  For counties not specifically designated in this

20  paragraph, a local planning process shall be completed prior

21  to the agency expanding behavioral managed care projects to

22  other areas. The planning process shall be completed with

23  local community participation, including, but not limited to,

24  input from community-based mental health, substance abuse,

25  child welfare, and delinquency providers currently under

26  contract with the Department of Children and Family Services,

27  Department of Juvenile Justice, or the agency. Facilities

28  licensed under chapter 395 shall be included in the local

29  planning process.

30         Section 2.  This act shall take effect October 1, 2000.

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