Senate Bill sb1918
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Florida Senate - 2003 SB 1918
By Senator Peaden
2-1156-03 See HB 433
1 A bill to be entitled
2 An act relating to behavioral health; providing
3 legislative intent with respect to the
4 provision of mental health and substance abuse
5 services through the creation of an Agency for
6 Mental Health and Substance Abuse Services
7 within the Department of Children and Family
8 Services; defining "mental health and substance
9 abuse services" for purposes of the act;
10 creating part VI of ch. 394, F.S., entitled
11 "Agency for Mental Health and Substance Abuse
12 Services"; creating s. 394.95, F.S.; creating
13 the Agency for Mental Health and Substance
14 Abuse Services; providing the mission of the
15 agency; requiring the agency to develop a
16 strategic plan and collaborative agreements
17 with state agencies; providing for
18 responsibilities of the agency; providing that
19 the head of the agency shall be the director of
20 the Agency for Mental Health and Substance
21 Abuse Services; providing duties and
22 responsibilities of the director; providing for
23 a Division Director for Mental Health and a
24 Division Director for Substance Abuse;
25 providing duties and responsibilities of the
26 division directors; providing service structure
27 of the agency; providing for the appointment of
28 a statewide policy board by the Governor for
29 the purpose of making recommendations to the
30 director regarding policy, budget, and other
31 matters relating to the management of the
1
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 mental health and substance abuse systems
2 developed by the agency; providing for a
3 transition team to plan the transition of
4 responsibility for the provision of mental
5 health and substance abuse services from the
6 existing mental health and substance abuse
7 programs of the Department of Children and
8 Family Services to the Agency for Mental Health
9 and Substance Abuse Services; providing
10 membership of the transition team; requiring
11 the development of a transition plan;
12 prescribing plan components; providing for a
13 type two transfer of all powers, duties,
14 records, personnel, property, and unexpended
15 balances of appropriations, allocations, or
16 other funds of the mental health and substance
17 abuse programs of the Department of Children
18 and Family Services to the Agency for Mental
19 Health and Substance Abuse Services by a
20 specified date; providing for continuation of
21 administrative rules; providing for
22 continuation of judicial or administrative
23 proceedings; amending s. 394.741, F.S.;
24 revising and providing additional accreditation
25 requirements for providers of behavioral health
26 care services; amending s. 409.912, F.S.;
27 requiring the Agency for Health Care
28 Administration to seek federal approval to
29 contract with a single entity to provide
30 comprehensive behavioral health care services
31 to Medicaid recipients; requiring the agency to
2
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 contract with a single managed entity to
2 provide comprehensive inpatient and outpatient
3 mental health and substance abuse services
4 through capitated prepaid arrangements to
5 Medicaid recipients by a specified date;
6 requiring the agency to submit a plan for full
7 implementation of capitated prepaid behavioral
8 health care by a specified date; providing
9 implementation plan requirements and
10 procedures; reenacting s. 394.9082(4)(a), (b),
11 and (d), F.S., relating to the authority of the
12 Department of Children and Family Services and
13 the Agency for Health Care Administration to
14 contract for the provision or management of
15 behavioral health services with a managing
16 entity in specified geographic areas, to
17 incorporate the amendments to s. 409.912, F.S.,
18 in references thereto; reenacting s.
19 641.225(3)(b), F.S., relating to minimum
20 surplus requirements of specified health
21 maintenance organizations providing prepaid
22 capitated services, to incorporate the
23 amendments to s. 409.912, F.S., in references
24 thereto; reenacting s. 636.0145, F.S., relating
25 to license requirements for specified prepaid
26 limited health service organizations providing
27 comprehensive inpatient and outpatient mental
28 health care services to certain Medicaid
29 recipients through a capitated prepaid
30 arrangement pursuant to federal waiver, to
31 incorporate the amendments to s. 409.912, F.S.,
3
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 in references thereto; providing effective
2 dates.
3
4 WHEREAS, mental health and substance abuse services are
5 delivered in many settings outside of the jurisdiction of the
6 Department of Children and Family Services, including
7 hospitals, clinics, jails, prisons, juvenile justice programs,
8 assisted living facilities, nursing homes, and other settings,
9 and
10 WHEREAS, each state agency that serves people with
11 mental health and substance abuse disorders has a planning,
12 quality assurance, and accountability function related to its
13 primary mission, and
14 WHEREAS, there is no single governmental agency
15 responsible for state strategy, policy, and leadership across
16 the state's combined behavioral health care system, and
17 WHEREAS, the Commission on Mental Health and Substance
18 Abuse reported in 2001 that the current system is complex,
19 fragmented, uncoordinated, and often ineffective, and
20 WHEREAS, the Commission on Mental Health and Substance
21 Abuse found that although significant cost associated with the
22 state's current approach to mental health and substance abuse
23 problems can be documented, programs are not organized
24 effectively at the state level, and
25 WHEREAS, multiple mental health and substance abuse
26 programs across agencies and departments present bureaucratic
27 barriers and often conflicting funding streams and regulations
28 that frustrate access for many Floridians needing care, and
29 WHEREAS, many states have combined mental health and
30 substance abuse services in a single unique agency because of
31
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 their common behavioral health-related treatment and service
2 orientation to individuals needing care, and
3 WHEREAS, the scope and complexity of the state's
4 behavioral health care system requires strong leadership to be
5 effective and efficient, NOW, THEREFORE,
6
7 Be It Enacted by the Legislature of the State of Florida:
8
9 Section 1. Legislative intent.--It is the intent of
10 the Legislature to provide mental health and substance abuse
11 services that are coordinated and consistent and reflect the
12 current state of knowledge regarding quality and effectiveness
13 by creating an agency dedicated to mental health and substance
14 abuse services. For purposes of this act, the term "mental
15 health and substance abuse services" means substance abuse
16 programs and functions under chapter 397, Florida Statutes,
17 mental health programs and functions under chapter 394,
18 Florida Statutes, and other related programs and functions
19 designated by statute.
20 Section 2. Effective October 1, 2004, part VI of
21 chapter 394, Florida Statutes, consisting of section 394.95,
22 is created to read:
23 PART VI
24 AGENCY FOR MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
25 394.95 Agency for Mental Health and Substance Abuse
26 Services.--There is created an Agency for Mental Health and
27 Substance Abuse Services within the Department of Children and
28 Family Services. The agency shall be a separate budget entity
29 and the director of the Agency for Mental Health and Substance
30 Abuse Services shall be the agency head for all purposes.
31 (1) MISSION.--
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (a) The mission of the Agency for Mental Health and
2 Substance Abuse Services shall be to:
3 1. Provide overall policy and programmatic leadership
4 for all mental health and substance abuse services funded by
5 or through the state.
6 2. Initiate and organize partnerships with local
7 communities to develop effective strategies for preventing or
8 reducing the negative consequences of mental illness and
9 substance abuse problems.
10 3. Provide a comprehensive and coordinated continuum
11 of effective mental health and substance abuse services to
12 help individuals suffering from these illnesses to achieve
13 their greatest potential for independent and productive
14 living.
15 (b) The agency shall develop a strategic plan for
16 fulfilling its mission and establish a set of measurable
17 goals, objectives, performance standards, and quality
18 assurance requirements to ensure that the agency is
19 accountable to the people of Florida.
20 (c) The agency shall develop effective collaborative
21 agreements with other state agencies to fulfill the intent of
22 this act and the mission of the agency.
23 (2) RESPONSIBILITIES.--The agency is responsible for:
24 (a) Establishing statewide policy for the provision of
25 mental health and substance abuse services to the citizens of
26 the state and developing strategies for the implementation of
27 such policy.
28 (b) Directing and managing the use of mental health
29 and substance abuse appropriations made pursuant to this
30 chapter and chapter 397, including those services funded
31 through the Medicaid program.
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (c) Ensuring the provision of all information required
2 by the Agency for Health Care Administration for the
3 accountability of Medicaid mental health and substance abuse
4 funding.
5 (d) Creating and contracting with comprehensive
6 service provider networks pursuant to s. 394.9082 using single
7 and uniform contracts, standards, and data-reporting
8 requirements to the maximum extent possible.
9 (e) Working with community-based provider networks on
10 the establishment of local service priorities and service
11 strategies.
12 (f) Developing and implementing uniform contracting
13 and payment systems which are consistent with s. 394.9082 for
14 all mental health and substance abuse funds under agency
15 control.
16 (g) Developing standards and performance expectations
17 for contractors.
18 (h) Utilizing efficient accountability mechanisms
19 which are data-based and which reflect state-of-the-art
20 industry practices.
21 (i) Delegating to the maximum extent possible on-site
22 monitoring to the community-based provider networks.
23 (j) Maintaining knowledge of emerging research
24 regarding effective and efficient prevention and treatment
25 approaches and systematically incorporating this research into
26 practice.
27 (k) Working with other state and local agencies
28 involved in the delivery of mental health and substance abuse
29 services to facilitate the use of the most current approaches
30 to prevention and treatment.
31
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (l) Collecting data and monitoring the status of the
2 entire publicly funded mental health and substance abuse
3 system.
4 (m) Monitoring and forecasting mental health and
5 substance abuse manpower needs and working with the
6 educational systems in the state to ensure that the state has
7 the personnel needed to continuously implement and improve its
8 services.
9 (n) Providing or arranging for administrative services
10 and information systems necessary to support the mission of
11 the agency.
12 (o) Developing and maintaining effective interagency
13 collaboration.
14 (p) Ensuring access of children and families in the
15 child protection system to needed and appropriate mental
16 health and substance abuse services.
17 (q) Operating a consumer advocacy function.
18 (r) Ensuring that all federal and state laws and
19 reporting requirements are met.
20 (s) Maximizing the use of federal and other nonstate
21 funds in the accomplishment of the agency's mission.
22 (3) DIRECTOR OF THE AGENCY FOR MENTAL HEALTH AND
23 SUBSTANCE ABUSE SERVICES.--
24 (a) The head of the agency is the director of the
25 Agency for Mental Health and Substance Abuse Services, who
26 shall be appointed by the Governor, with the concurrence of
27 the secretary of the Department of Children and Family
28 Services. The director shall serve at the pleasure of and
29 report to the Governor and shall have a responsibility to
30 coordinate activities with the secretary of the Department of
31 Children and Family Services.
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (b) The director shall ensure that mental health and
2 substance abuse services are implemented according to
3 legislative intent, state and federal laws, rules,
4 regulations, statewide program standards, and performance
5 objectives.
6 (c) The director shall negotiate an agreement with the
7 secretary of the Agency for Health Care Administration that
8 delegates responsibility for managing Medicaid mental health
9 and substance abuse services to the Agency for Mental Health
10 and Substance Services.
11 (d) The director shall have formal relationships with
12 the State University System and shall, to the extent
13 practicable, utilize the resources and expertise of the State
14 University System in pursuing its responsibilities.
15 (4) DIVISION DIRECTORS; MANAGEMENT STAFF.--
16 (a) The director shall appoint a Division Director for
17 Mental Health and a Division Director for Substance Abuse. The
18 division directors are directly responsible to the director
19 and serve at the pleasure of the director.
20 (b) The Division Director for Mental Health is
21 responsible for all mental health institutional programs and
22 for community mental health programs and services, including
23 those funded by Medicaid, and shall have line authority over
24 regional mental health agency staff.
25 (c) The Division Director for Substance Abuse shall be
26 responsible for all substance abuse prevention and treatment
27 services and shall have line authority over all regional
28 substance abuse agency staff.
29 (d) In order to facilitate the accomplishment of
30 agency service goals, the director shall, to the maximum
31
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 extent possible, assign administrative services staff to the
2 division directors.
3 (e) The director shall appoint a Director of Consumer
4 Affairs who shall have input into the policy, program, and
5 training and research priorities of the agency in addition to
6 handling consumer and other complaints.
7 (f) The director shall appoint a Director of Services
8 Integration who shall advocate for services integration and
9 who shall be responsible for monitoring and reporting on the
10 agency's performance in integrating mental health and
11 substance abuse services in its own operations and integrating
12 mental health and substance abuse services in the operations
13 of other departments that deliver mental health and substance
14 abuse services.
15 (g) The director may appoint additional managers and
16 administrators that he or she determines are necessary for the
17 effective management of the agency.
18 (5) SERVICE STRUCTURE.--
19 (a) The agency is authorized to establish regional
20 offices which, if established, will be aligned with one or
21 more regions of the Agency for Health Care Administration.
22 (b) The agency is authorized to contract for mental
23 health and substance abuse services with comprehensive
24 community-based provider networks and shall use contracting
25 mechanisms to the maximum extent possible in accomplishing its
26 mission.
27 (6) STATEWIDE POLICY BOARD.--The Governor shall
28 appoint a statewide policy board composed of business and
29 community leaders who have an interest in mental health and
30 substance abuse services. The board shall make recommendations
31 to the director regarding organization, policy, budget, and
10
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 other matters relating to the management of the mental health
2 and substance abuse system.
3 Section 3. Transition team; Agency for Mental Health
4 and Substance Abuse Services creation plan.--
5 (1) By July 1, 2003, the Secretary of Children and
6 Family Services shall convene a transition team to plan the
7 transition of responsibility for the provision of mental
8 health and substance abuse services in the state from the
9 existing mental health and substance abuse programs of the
10 Department of Children and Family Services to the Agency for
11 Mental Health and Substance Abuse Services.
12 (2) The transition team shall be composed of the
13 following members:
14 (a) A member of the House of Representatives to be
15 appointed by the Speaker of the House of Representatives.
16 (b) A member of the Senate to be appointed by the
17 President of the Senate.
18 (c) The director of the Medicaid program for the
19 Agency for Health Care Administration.
20 (d) The secretary of the Department of Health.
21 (e) The Department of Children and Family Services
22 program office directors for mental health and substance
23 abuse.
24 (f) The Department of Children and Family Services
25 assistant secretary for programs.
26 (g) A representative of the Executive Office of the
27 Governor to be appointed by the Governor.
28 (h) A representative of the Statewide Drug Policy
29 Advisory Council to be appointed by the Governor.
30 (i) A representative of the Florida Council for
31 Behavioral Healthcare to be appointed by the Governor.
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (j) A representative of the Florida Alcohol and Drug
2 Abuse Association to be appointed by the Governor.
3 (k) Representatives of the State University System to
4 be appointed by the Governor.
5 (l) Representatives of other appropriate mental health
6 and substance abuse advocacy groups, including consumers and
7 family members, to be appointed by the Governor.
8 (3) The transition team shall develop a plan of
9 transition activities and functions with respect to the
10 creation of the Agency for Mental Health and Substance Abuse
11 Services. The transition plan shall be formulated anticipating
12 the use of Department of Children and Family Services and
13 Agency for Health Care Administration program and
14 administrative resources currently directly or indirectly
15 involved in managing and accounting for Department of Children
16 and Family Services and Medicaid mental health and substance
17 abuse services. The final plan shall anticipate a 10-percent
18 reduction in total administrative costs. The plan shall
19 address, at a minimum:
20 (a) Organizational structure.
21 (b) The transfer of responsibility for Medicaid mental
22 health and substance abuse services to the new agency and the
23 associated children's mental health and substance abuse
24 services requirements regarding integration with the child
25 protection system.
26 (c) Information and support systems.
27 (d) Policy and rules transfer.
28 (e) Necessary changes in statutes and rules.
29 (f) Administrative support functions.
30 (g) Standards and licensing requirements.
31 (h) Budget authority and positions.
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (i) Applicable federal requirements.
2 (j) Inventory and transfers of equipment and
3 structures.
4 (k) Building leases.
5 (l) Contracts and contract management.
6 (m) Other areas identified by the transition team as
7 relevant to the creation and function of the Agency for Mental
8 Health and Substance Abuse Services and the transfer of
9 powers, duties, records, personnel, property, and funds of the
10 mental health and substance abuse programs of the Department
11 of Children and Family Services to the agency.
12 (4) The transition plan shall be submitted to the
13 Governor, the President of the Senate, the Speaker of the
14 House of Representatives, the chairs of the Senate and House
15 of Representatives appropriations committees, and the chairs
16 of appropriate substantive committees of the Senate and the
17 House of Representatives by November 1, 2003.
18 (5) Members of the transition team shall serve without
19 compensation, but are entitled to receive reimbursement for
20 per diem and travel expenses as provided in section 112.061,
21 Florida Statutes.
22 Section 4. Transfer of programs.--
23 (1)(a) Effective October 1, 2004, all powers, duties,
24 records, personnel, property, and unexpended balances of
25 appropriations, allocations, or other funds of the mental
26 health and substance abuse programs of the Department of
27 Children and Family Services or its successor as designated by
28 law are transferred by a type two transfer, as defined in
29 section 20.06, Florida Statutes, to the Agency for Mental
30 Health and Substance Abuse Services within the Department of
31
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 Children and Family Services, as created by this act,
2 including:
3 1. The unexpended, indirect cost balances from the
4 General Revenue Fund and from applicable trust funds from
5 appropriate budget entities supporting administrative
6 infrastructure and positions for mental health and substance
7 abuse programs and functions within the Department of Children
8 and Family Services.
9 2. Mental health and substance abuse program positions
10 within the Department of Children and Family Services and the
11 Agency for Health Care Administration or their successors as
12 designated by law.
13 (b) The Department of Children and Family Services and
14 the Agency for Health Care Administration or their successors
15 as designated by law shall transfer all tangible property,
16 office furnishings and supplies, pro rata shares of fixed
17 capital funds for centrally managed projects, acquisition of
18 motor vehicles, and operating capital outlay for the 2004-2005
19 fiscal year to the Agency for Mental Health and Substance
20 Abuse Services.
21 (c) Pursuant to section 216.181, Florida Statutes, the
22 Executive Office of the Governor may provide for flexibility
23 in salary rates which is necessary to support the Agency for
24 Mental Health and Substance Abuse Services, and may establish
25 positions at a rate in excess of 10 percent above the minimum,
26 to the extent that annualized moneys for salaries are
27 available.
28 (d) The Department of Children and Family Services and
29 the Agency for Health Care Administration or their successors
30 as designated by law shall provide administrative support and
31
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 staff for the Agency for Mental Health and Substance Abuse
2 Services until December 31, 2005.
3 (2) All applicable administrative rules of the
4 Department of Children and Family Services and the Agency for
5 Health Care Administration or their successors as designated
6 by law which are in effect on October 1, 2004, shall remain in
7 effect as rules of the Agency for Mental Health and Substance
8 Abuse Services until they are specifically changed in the
9 manner provided by law.
10 (3) This act does not affect the validity of any
11 judicial or administrative proceeding pending on October 1,
12 2004, and the Agency for Mental Health and Substance Abuse
13 Services within the Department of Children and Family Services
14 is substituted as a real party in interest with respect to any
15 proceeding pending on that date which involves the mental
16 health or substance abuse programs of the Department of
17 Children and Family Services or its successor as designated by
18 law.
19 Section 5. Subsection (6) of section 394.741, Florida
20 Statutes, is amended, present subsection (7) is renumbered as
21 subsection (9), and new subsections (7) and (8) are added to
22 that section, to read:
23 394.741 Accreditation requirements for providers of
24 behavioral health care services.--
25 (6) The department or agency, by accepting the survey
26 or inspection of an accrediting organization, does not forfeit
27 its rights to perform inspections at any time, including
28 contract monitoring to ensure that services that have been
29 billed deliverables are provided in accordance with the
30 contract.
31
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 (7) The department or agency shall not monitor
2 organizations under contract with the department or find such
3 organizations out of compliance with requirements for which
4 there are no specific federal or state regulations.
5 (8) The department shall file a State Projects
6 Compliance Supplement for behavioral health care services
7 pursuant to s. 215.97. If monitoring the financial operations
8 of its contractors, the department shall perform an off-site
9 desk review of its contractors' most recent independent CPA
10 audit and only conduct on-site monitoring of problems
11 identified by such audit.
12 (9)(7) The department and the agency shall report to
13 the Legislature by January 1, 2003, on the viability of
14 mandating all organizations under contract with the department
15 for the provision of behavioral health care services, or
16 licensed by the agency or department to be accredited. The
17 department and the agency shall also report to the Legislature
18 by January 1, 2003, on the viability of privatizing all
19 licensure and monitoring functions through an accrediting
20 organization.
21 Section 6. Paragraph (b) of subsection (3) of section
22 409.912, Florida Statutes, is amended to read:
23 409.912 Cost-effective purchasing of health care.--The
24 agency shall purchase goods and services for Medicaid
25 recipients in the most cost-effective manner consistent with
26 the delivery of quality medical care. The agency shall
27 maximize the use of prepaid per capita and prepaid aggregate
28 fixed-sum basis services when appropriate and other
29 alternative service delivery and reimbursement methodologies,
30 including competitive bidding pursuant to s. 287.057, designed
31 to facilitate the cost-effective purchase of a case-managed
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Florida Senate - 2003 SB 1918
2-1156-03 See HB 433
1 continuum of care. The agency shall also require providers to
2 minimize the exposure of recipients to the need for acute
3 inpatient, custodial, and other institutional care and the
4 inappropriate or unnecessary use of high-cost services. The
5 agency may establish prior authorization requirements for
6 certain populations of Medicaid beneficiaries, certain drug
7 classes, or particular drugs to prevent fraud, abuse, overuse,
8 and possible dangerous drug interactions. The Pharmaceutical
9 and Therapeutics Committee shall make recommendations to the
10 agency on drugs for which prior authorization is required. The
11 agency shall inform the Pharmaceutical and Therapeutics
12 Committee of its decisions regarding drugs subject to prior
13 authorization.
14 (3) The agency may contract with:
15 (b) An entity that is providing comprehensive
16 behavioral health care services to certain Medicaid recipients
17 through a capitated, prepaid arrangement pursuant to the
18 federal waiver provided for by s. 409.905(5). Such an entity
19 must be licensed under chapter 624, chapter 636, or chapter
20 641 and must possess the clinical systems and operational
21 competence to manage risk and provide comprehensive behavioral
22 health care to Medicaid recipients. As used in this paragraph,
23 the term "comprehensive behavioral health care services" means
24 covered mental health and substance abuse treatment services
25 that are available to Medicaid recipients. The secretary of
26 the Department of Children and Family Services shall approve
27 provisions of procurements related to children in the
28 department's care or custody prior to enrolling such children
29 in a prepaid behavioral health plan. Any contract awarded
30 under this paragraph must be competitively procured. In
31 developing the behavioral health care prepaid plan procurement
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Florida Senate - 2003 SB 1918
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1 document, the agency shall ensure that the procurement
2 document requires the contractor to develop and implement a
3 plan to ensure compliance with s. 394.4574 related to services
4 provided to residents of licensed assisted living facilities
5 that hold a limited mental health license. The agency shall
6 seek federal approval to contract with a single entity meeting
7 these requirements in each region or combination of regions to
8 provide comprehensive behavioral health care services to all
9 Medicaid recipients residing in the region. These entities
10 must offer sufficient choice of providers to ensure recipient
11 access and satisfaction. The agency must ensure that Medicaid
12 recipients have available the choice of at least two managed
13 care plans for their behavioral health care services. To
14 ensure unimpaired access to behavioral health care services by
15 Medicaid recipients, all contracts issued pursuant to this
16 paragraph shall require 80 percent of the capitation paid to
17 the managed care plan, including health maintenance
18 organizations, to be expended for the provision of behavioral
19 health care services. In the event the managed care plan
20 expends less than 80 percent of the capitation paid pursuant
21 to this paragraph for the provision of behavioral health care
22 services, the difference shall be returned to the agency. The
23 agency shall provide the managed care plan with a
24 certification letter indicating the amount of capitation paid
25 during each calendar year for the provision of behavioral
26 health care services pursuant to this section. The agency may
27 reimburse for substance-abuse-treatment services on a
28 fee-for-service basis until the agency finds that adequate
29 funds are available for capitated, prepaid arrangements.
30 1. By January 1, 2001, the agency shall modify the
31 contracts with the entities providing comprehensive inpatient
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Florida Senate - 2003 SB 1918
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1 and outpatient mental health care services to Medicaid
2 recipients in Hillsborough, Highlands, Hardee, Manatee, and
3 Polk Counties, to include substance-abuse-treatment services.
4 2. The agency shall contract by July 1, 2007, with a
5 single managed care entity in each region, or combination of
6 regions, to provide comprehensive inpatient and outpatient
7 mental health and substance abuse services through capitated
8 prepaid arrangements to all Medicaid recipients for whom such
9 plans are allowable under federal law and regulations.
10 3. By March 1, 2004, the agency shall submit a plan
11 for fully implementing capitated prepaid behavioral health
12 care in all regions of the state.
13 a. Implementation shall be targeted for fiscal years
14 2003-2004 and 2004-2005 in each region or combination of
15 regions where historical expenditures for mental health and
16 substance abuse services are actuarially sound and adequate to
17 sustain a managed care plan, and where communities are
18 prepared.
19 b. The agency shall work with the Department of
20 Children and Family Services to implement strategies to
21 maximize the utilization of Medicaid behavioral health care
22 services delivered to Medicaid recipients. Alcohol, drug
23 abuse, and mental health funds appropriated to the Department
24 of Children and Family Services and other state or county
25 funds shall, to the extent possible, be used to match
26 additional federal Medicaid funds, provided that no transfer
27 of funds to the Agency for Health Care Administration is
28 required.
29 c. The agency shall establish capitation rates based
30 on actuarial methods for each region or combination of regions
31 where historical fee-for-service expenditures do not produce
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Florida Senate - 2003 SB 1918
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1 actuarially sound capitation rates. The rate-setting
2 methodology shall consider the impact of a lack of a health
3 care infrastructure in these areas of the state and the
4 variations in access to services produced by these and other
5 factors. Contracts shall not be finalized in these areas until
6 adequate capitation rates are established and approved by the
7 agency. By December 31, 2001, the agency shall contract with
8 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 4.3. 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 5.4. In converting to a prepaid system of delivery,
24 the 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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1 reimburse the unsubsidized facility for the cost of behavioral
2 health care provided to the displaced indigent care patient.
3 6.5. Traditional community mental health providers
4 under contract with the Department of Children and Family
5 Services pursuant to part IV of chapter 394 and inpatient
6 mental health providers licensed pursuant to chapter 395 must
7 be offered an opportunity to accept or decline a contract to
8 participate in any provider network for prepaid behavioral
9 health services.
10 Section 7. For the purpose of incorporating the
11 amendments to section 409.912, Florida Statutes, in references
12 thereto, the sections or subdivisions of Florida Statutes set
13 forth below are reenacted to read:
14 394.9082 Behavioral health service delivery
15 strategies.--
16 (4) CONTRACT FOR SERVICES.--
17 (a) The Department of Children and Family Services and
18 the Agency for Health Care Administration may contract for the
19 provision or management of behavioral health services with a
20 managing entity in at least two geographic areas. Both the
21 Department of Children and Family Services and the Agency for
22 Health Care Administration must contract with the same
23 managing entity in any distinct geographic area where the
24 strategy operates. This managing entity shall be accountable
25 for the delivery of behavioral health services specified by
26 the department and the agency for children, adolescents, and
27 adults. The geographic area must be of sufficient size in
28 population and have enough public funds for behavioral health
29 services to allow for flexibility and maximum efficiency.
30 Notwithstanding the provisions of s. 409.912(3)(b)1. and 2.,
31 at least one service delivery strategy must be in one of the
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1 service districts in the catchment area of G. Pierce Wood
2 Memorial Hospital.
3 (b) Under one of the service delivery strategies, the
4 Department of Children and Family Services may contract with a
5 prepaid mental health plan that operates under s. 409.912 to
6 be the managing entity. Under this strategy, the Department of
7 Children and Family Services is not required to competitively
8 procure those services and, notwithstanding other provisions
9 of law, may employ prospective payment methodologies that the
10 department finds are necessary to improve client care or
11 institute more efficient practices. The Department of Children
12 and Family Services may employ in its contract any provision
13 of the current prepaid behavioral health care plan authorized
14 under s. 409.912(3)(a) and (b), or any other provision
15 necessary to improve quality, access, continuity, and price.
16 Any contracts under this strategy in Area 6 of the Agency for
17 Health Care Administration or in the prototype region under s.
18 20.19(7) of the Department of Children and Family Services may
19 be entered with the existing substance abuse treatment
20 provider network if an administrative services organization is
21 part of its network. In Area 6 of the Agency for Health Care
22 Administration or in the prototype region of the Department of
23 Children and Family Services, the Department of Children and
24 Family Services and the Agency for Health Care Administration
25 may employ alternative service delivery and financing
26 methodologies, which may include prospective payment for
27 certain population groups. The population groups that are to
28 be provided these substance abuse services would include at a
29 minimum: individuals and families receiving family safety
30 services; Medicaid-eligible children, adolescents, and adults
31 who are substance-abuse-impaired; or current recipients and
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1 persons at risk of needing cash assistance under Florida's
2 welfare reform initiatives.
3 (d) Under both strategies, the Department of Children
4 and Family Services and the Agency for Health Care
5 Administration may:
6 1. Establish benefit packages based on the level of
7 severity of illness and level of client functioning;
8 2. Align and integrate procedure codes, standards, or
9 other requirements if it is jointly determined that these
10 actions will simplify or improve client services and
11 efficiencies in service delivery;
12 3. Use prepaid per capita and prepaid aggregate
13 fixed-sum payment methodologies; and
14 4. Modify their current procedure codes to increase
15 clinical flexibility, encourage the use of the most effective
16 interventions, and support rehabilitative activities.
17 Section 8. For the purpose of incorporating the
18 amendments to section 409.912, Florida Statutes, in references
19 thereto, the sections or subdivisions of Florida Statutes set
20 forth below are reenacted to read:
21 641.225 Surplus requirements.--
22 (3)
23 (b) An entity providing prepaid capitated services
24 which is authorized under s. 409.912(3)(b) or (c), and which
25 applies for a certificate of authority is subject to the
26 minimum surplus requirements set forth in s. 409.912.
27 Section 9. For the purpose of incorporating the
28 amendments to section 409.912, Florida Statutes, in references
29 thereto, the sections or subdivisions of Florida Statutes set
30 forth below are reenacted to read:
31
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1 636.0145 Certain entities contracting with
2 Medicaid.--Notwithstanding the requirements of s.
3 409.912(3)(b), an entity that is providing comprehensive
4 inpatient and outpatient mental health care services to
5 certain Medicaid recipients in Hillsborough, Highlands,
6 Hardee, Manatee, and Polk Counties through a capitated,
7 prepaid arrangement pursuant to the federal waiver provided
8 for in s. 409.905(5) must become licensed under chapter 636 by
9 December 31, 1998. Any entity licensed under this chapter
10 which provides services solely to Medicaid recipients under a
11 contract with Medicaid shall be exempt from ss. 636.017,
12 636.018, 636.022, 636.028, and 636.034.
13 Section 10. Except as otherwise provided herein, this
14 act shall take effect upon becoming a law.
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