HB 1397 2003
1	CHAMBER ACTION
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6	The Committee on Future of Florida's Families recommends the
7	following:
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9	Committee Substitute
10	Remove the entire bill and insert:
11	A bill to be entitled
12	An act relating to substance abuse services; amending s.
13	394.74, F.S.; authorizing the Department of Children and
14	Family Services to adopt by rule new payment methodologies
15	and to eliminate unit-based methodologies for mental
16	health and substance abuse services; authorizing the
17	department to adopt rules for local match based on new
18	methodologies; prohibiting changes to the ratio of state
19	to local matching resources or to the sources of local
20	match and prohibiting the increase in the amount of local
21	matching funds required; amending s. 394.9082, F.S.;
22	modifying the services for which a managing entity is
23	accountable; establishing data system requirements;
24	providing for establishment of a single managing entity
25	for the delivery of substance abuse services to child
26	protective services recipients in specified districts of
27	the department; providing for a contract; requiring
28	certain information to be kept; providing for reports to
29	the Governor and Legislature; providing an effective date.
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31	Be It Enacted by the Legislature of the State of Florida:
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33	Section 1. Paragraph (b) of subsection (2) of section
34	394.74, Florida Statutes, is amended to read:
35	394.74 Contracts for provision of local substance abuse
36	and mental health programs.--
37	(2)
38	(b) Notwithstanding s. 394.76(3)(a) and (c), the
39	department may use unit cost methods of payment in contracts for
40	purchasing mental health and substance abuse services. The unit
41	cost contracting system must account for those patient fees that
42	are paid on behalf of a specific client and those that are
43	earned and used by the provider for those services funded in
44	whole or in part by the department. The department is authorized
45	to implement through administrative rule fee-for-service,
46	prepaid case rate, or prepaid capitation contract methodologies
47	to purchase mental health and substance abuse services. Fee-for-
48	service, prepaid case rate, or prepaid capitation mechanisms may
49	not be implemented without the elimination of the unit cost
50	method of payment. Notwithstanding the provisions of s.
51	394.76(3), the department may adopt administrative rules that
52	account for local match in a manner that is consistent with fee-
53	for-service, prepaid case rate, and prepaid capitation contract
54	methodologies. Such provisions may not result in a change of the
55	ratio of state to local matching resources or in the sources of
56	local matching funds and may not increase the amount of required
57	local matching funds. It is the intent of the Legislature that
58	the provisions to account for local match be consistent with the
59	financial principles adopted for the payment of state funds.
60	Section 2. Paragraphs (a) and (d) of subsection (4) of
61	section 394.9082, Florida Statutes, are amended, present
62	subsection (8) is renumbered as subsection (9) and amended, and
63	a new subsection (8) is added to said section, to read:
64	394.9082 Behavioral health service delivery strategies.--
65	(4) CONTRACT FOR SERVICES.--
66	(a) The Department of Children and Family Services and the
67	Agency for Health Care Administration may contract for the
68	provision or management of behavioral health services with a
69	managing entity in at least two geographic areas. Both the
70	Department of Children and Family Services and the Agency for
71	Health Care Administration must contract with the same managing
72	entity in any distinct geographic area where the strategy
73	operates. This managing entity shall be accountable at a minimum
74	for the delivery of behavioral health services specified and
75	funded by the department and the agency for children,
76	adolescents, and adults. The geographic area must be of
77	sufficient size in population and have enough public funds for
78	behavioral health services to allow for flexibility and maximum
79	efficiency. Notwithstanding the provisions of s. 409.912(3)(b)1.
80	and 2., at least one service delivery strategy must be in one of
81	the service districts in the catchment area of G. Pierce Wood
82	Memorial Hospital.
83	(d) Under both strategies, the Department of Children and
84	Family Services and the Agency for Health Care Administration
85	may:
86	1. Establish benefit packages based on the level of
87	severity of illness and level of client functioning;
88	2. Align and integrate procedure codes, standards, or
89	other requirements if it is jointly determined that these
90	actions will simplify or improve client services and
91	efficiencies in service delivery;
92	3. Use prepaid per capita and prepaid aggregate fixed-sum
93	payment methodologies; and
94	4. Modify their current procedure codes to increase
95	clinical flexibility, encourage the use of the most effective
96	interventions, and support rehabilitative activities; and.
97	5. Establish or develop data management and reporting
98	systems that promote efficient use of data by the service
99	delivery system. Data management and reporting systems must
100	address the management and clinical care needs of the service
101	providers and managing entities and provide information needed
102	by the department for required state and federal reporting. In
103	order to develop and test the application of new data systems, a
104	strategy implementation area is not required to provide
105	information that matches all current statewide reporting
106	requirements if the strategy's data systems include client
107	demographic, admission, discharge, enrollment, service events,
108	performance outcome information, and functional assessment.
109	(8) EXPANSION IN DISTRICTS 4 AND 12.--The department shall
110	work with community agencies to establish a single managing
111	entity for districts 4 and 12 accountable for the delivery of
112	substance abuse services to child protective services recipients
113	in the two districts. The purpose of this strategy is to enhance
114	the coordination of substance abuse services with community-
115	based care agencies and the department. The department shall
116	work with affected stakeholders to develop and implement a plan
117	that allows the phase-in of services beginning with the delivery
118	of substance abuse services, with phase-in of subsequent
119	substance abuse services agreed upon by the managing entity and
120	authorized by the department, providing the necessary technical
121	assistance to ensure provider and district readiness for
122	implementation. When a single managing entity is established and
123	meets readiness requirements, the department may enter into a
124	noncompetitive contract with the entity. The department shall
125	maintain detailed information on the methodology used for
126	selection and a justification for the selection. Performance
127	objectives shall be developed which ensure that services that
128	are delivered directly affect and complement the child's
129	permanency plan. During the initial planning and implementation
130	phase of this project, the requirements in subsections (6)
131	and(7) are waived. Considering the critical substance abuse
132	problems experienced by many families in the child protection
133	system, the department shall initiate the implementation of the
134	substance abuse delivery component of this program without delay
135	and furnish status reports to the appropriate substantive
136	committees of the Senate and the House of Representatives no
137	later than February 29, 2004, and February 28, 2005. The
138	integration of all services agreed upon by the managing entity
139	and authorized by the department must be completed within 2
140	years after project initiation. Ongoing monitoring and
141	evaluation of this strategy shall be conducted in accordance
142	with subsection (9).
143	(9)(8)MONITORING AND EVALUATION.--The Department of
144	Children and Family Services and the Agency for Health Care
145	Administration shall provide routine monitoring and oversight of
146	and technical assistance to the managing entities. The Louis de
147	la Parte Florida Mental Health Institute shall conduct an
148	ongoing formative evaluation of each strategy to identify the
149	most effective methods and techniques used to manage, integrate,
150	and deliver behavioral health services. The entity conducting
151	the evaluation shall report to the Department of Children and
152	Family Services, the Agency for Health Care Administration, the
153	Executive Office of the Governor, and the Legislature every 12
154	months regarding the status of the implementation of the service
155	delivery strategies. The report must include a summary of
156	activities that have occurred during the past 12 months of
157	implementation and any problems or obstacles that prevented, or
158	may prevent in the future, the managing entity from achieving
159	performance goals and measures. The first status report is due
160	January 1, 2002. After the service delivery strategies have been
161	operational for 1 year, the status report must include an
162	analysis of administrative costs and the status of the
163	achievement of performance outcomes. By December 31, 2006, the
164	Louis de la Parte Florida Mental Health Institute, as a part of
165	the ongoing formative evaluation of each strategy, must conduct
166	a study of the strategies established in Districts 1, 4, 8, and
167	12 under this section, and must include an assessment of best
168	practice models in other states. The study must address
169	programmatic outcomes that include, but are not limited to:
170	timeliness of service delivery, effectiveness of treatment
171	services, cost effectiveness of selected models, and customer
172	satisfaction with services. Based upon the results of this
173	study, the department and the Agency for Health Care
174	Administration, in consultation with the managing entities, must
175	provide a report to the Executive Office of the Governor, the
176	President of the Senate, and the Speaker of the House of
177	Representatives. This report must contain recommendations for
178	the statewide implementation of successful strategies, including
179	any modifications to the strategies; the identification and
180	prioritization of strategies to be implemented; and timeframes
181	for statewide completion that include target dates to complete
182	milestones as well as a date for full statewide implementation
183	Upon receiving the annual report from the evaluator, the
184	Department of Children and Family Services and the Agency for
185	Health Care Administration shall jointly make any
186	recommendations to the Executive Office of the Governor
187	regarding changes in the service delivery strategies or in the
188	implementation of the strategies, including timeframes.
189	Section 3. This act shall take effect upon becoming a law.