House Bill 0009

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    Florida House of Representatives - 2000                   HB 9

        By 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.

11

12  Be It Enacted by the Legislature of the State of Florida:

13

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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  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  and Polk, Santa Rosa, St. Johns, and Walton Counties, through

  7  a capitated, prepaid arrangement pursuant to the federal

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

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

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

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

12  assumes risk, the Department of Insurance shall develop

13  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.  The agency shall set as part of the competitive

21  procurement an allowable medical/loss ratio to limit

22  administrative costs and shall use industry standards, which

23  shall be adjusted based upon size of the plan.

24         d.  In developing the behavioral health care prepaid

25  plan procurement document, the agency shall consult and

26  coordinate with the Department of Children and Family Services

27  and the Department of Juvenile Justice. The Department of

28  Children and Family Services shall approve the sections of the

29  behavioral health care prepaid plan procurement document that

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

31  of Children and Family Services and the families of such

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  1  children. The Department of Juvenile Justice shall approve the

  2  sections of the behavioral health care prepaid plan

  3  procurement document that relate to children in the care and

  4  custody of the Department of Juvenile Justice and the families

  5  of such children.

  6         e.  In any county that has a provider service network

  7  as authorized in this section, which provides behavioral

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

  9  2000, the agency shall not include those recipients served by

10  the provider service network in the behavioral health prepaid

11  plan, pursuant to this paragraph.

12         2.  As used in this paragraph:

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

14  substance abuse services.

15         b  "District" means any district of the Department of

16  Children and Family Services.

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

18  any foster care program operated by a Medicaid community

19  mental health provider which is a licensed residential child

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

21         d.  "Specialized therapeutic foster care" means any

22  foster care program provided under the Medicaid community

23  mental health program service entitled specialized therapeutic

24  foster care.

25         3.  Children residing in a Department of Juvenile

26  Justice residential program approved as a Medicaid behavioral

27  health overlay services provider shall not be included in a

28  behavioral health care prepaid plan pursuant to this

29  paragraph.

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  1         4.  When implementing the behavioral health care

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

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

  4         a.  Dependent children placed by the Department of

  5  Children and Family Services or a licensed child placing

  6  agency into a licensed residential group care facility which

  7  is operated by a Medicaid community mental health provider.

  8         b.  Dependent children of the department receiving

  9  therapeutic or supportive foster home care.

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

11  department while they are in an emergency shelter.

12         d.  Children served under the community mental health

13  program specialized therapeutic foster care.

14         5.  When implementing the behavioral health care

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

16  Johns Counties, the agency shall require that any existing

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

18  Medicaid community mental health program provider be part of

19  the provider network.

20         6.  The agency and the department shall approve

21  behavioral health care criteria and protocols for services

22  provided to children referred from the child protection team

23  for followup services.

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

25  substance abuse services shall be reimbursed on a

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

27  time as the agency determines that adequate funds are

28  available for prepaid methods. The agency shall ensure that

29  any contractors for prepaid behavioral health services shall

30  propose practical methods of integrating mental health and

31  substance abuse services, including opportunities for

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    Florida House of Representatives - 2000                   HB 9

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  1  community-based substance abuse agencies to become partners in

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

  3  and to participate in the development of protocols for

  4  substance abuse services.

  5         8.  In developing the behavioral health care prepaid

  6  plan procurement document, the agency shall ensure that

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

  8  the displacement of indigent care patients from facilities

  9  receiving state funding to provide indigent behavioral health

10  care to facilities licensed under chapter 395 which do not

11  receive state subsidies unless the unsubsidized facilities are

12  reimbursed for the costs of all treatment, including medical

13  treatment which is a precondition to admission into a

14  subsidized facility. Traditional inpatient mental health

15  providers licensed pursuant to chapter 395 must be included in

16  any provider network for prepaid behavioral health services.

17         9.  The agency shall notify the Legislature of the

18  status and plans to expand the behavioral managed care

19  projects to those counties designated in this paragraph by

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

21  which expansion of behavioral managed care projects cannot be

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

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

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

25  may include alternatives to behavioral managed care. The plan

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

27  families in the care and custody of the department and

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

29  those children and families will be integrated into the

30  comprehensive behavioral health care program or how services

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

  2  phase-in.

  3         10.  For counties not specifically designated in this

  4  paragraph, a local planning process shall be completed prior

  5  to the agency expanding behavioral managed care projects to

  6  other areas. The planning process shall be completed with

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

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

  9  child welfare, and delinquency providers currently under

10  contract with the Department of Children and Family Services,

11  Department of Juvenile Justice, or the agency. Facilities

12  licensed under chapter 395 shall be included in the local

13  planning process.

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

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16            *****************************************

17                          HOUSE SUMMARY

18
      Substantively identical to HB 2087, Second Engrossed,
19    which passed the House during the 1999 Regular Session.

20
      Authorizes the Agency for Health Care Administration to
21    contract with entities providing behavioral health care
      services to certain Medicaid recipients in specified
22    counties through a capitated, prepaid arrangement
      pursuant to a federal waiver. Provides contract
23    requirements and limitations. See bill for details.

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