HB 0433 2003
1	A bill to be entitled
2	An act relating to behavioral health; providing
3	legislative intent with respect to the provision of mental
4	health and substance abuse services through the creation
5	of an Agency for Mental Health and Substance Abuse
6	Services within the Department of Children and Family
7	Services; defining "mental health and substance abuse
8	services" for purposes of the act; creating part VI of ch.
9	394, F.S., entitled "Agency for Mental Health and
10	Substance Abuse Services"; creating s. 394.95, F.S.;
11	creating the Agency for Mental Health and Substance Abuse
12	Services; providing the mission of the agency; requiring
13	the agency to develop a strategic plan and collaborative
14	agreements with state agencies; providing for
15	responsibilities of the agency; providing that the head of
16	the agency shall be the director of the Agency for Mental
17	Health and Substance Abuse Services; providing duties and
18	responsibilities of the director; providing for a Division
19	Director for Mental Health and a Division Director for
20	Substance Abuse; providing duties and responsibilities of
21	the division directors; providing service structure of the
22	agency; providing for the appointment of a statewide
23	policy board by the Governor for the purpose of making
24	recommendations to the director regarding policy, budget,
25	and other matters relating to the management of the mental
26	health and substance abuse systems developed by the
27	agency; providing for a transition team to plan the
28	transition of responsibility for the provision of mental
29	health and substance abuse services from the existing
30	mental health and substance abuse programs of the
31	Department of Children and Family Services to the Agency
32	for Mental Health and Substance Abuse Services; providing
33	membership of the transition team; requiring the
34	development of a transition plan; prescribing plan
35	components; providing for a type two transfer of all
36	powers, duties, records, personnel, property, and
37	unexpended balances of appropriations, allocations, or
38	other funds of the mental health and substance abuse
39	programs of the Department of Children and Family Services
40	to the Agency for Mental Health and Substance Abuse
41	Services by a specified date; providing for continuation
42	of administrative rules; providing for continuation of
43	judicial or administrative proceedings; amending s.
44	394.741, F.S.; revising and providing additional
45	accreditation requirements for providers of behavioral
46	health care services; amending s. 409.912, F.S.; requiring
47	the Agency for Health Care Administration to seek federal
48	approval to contract with a single entity to provide
49	comprehensive behavioral health care services to Medicaid
50	recipients; requiring the agency to contract with a single
51	managed entity to provide comprehensive inpatient and
52	outpatient mental health and substance abuse services
53	through capitated prepaid arrangements to Medicaid
54	recipients by a specified date; requiring the agency to
55	submit a plan for full implementation of capitated prepaid
56	behavioral health care by a specified date; providing
57	implementation plan requirements and procedures;
58	reenacting s. 394.9082(4)(a), (b), and (d), F.S., relating
59	to the authority of the Department of Children and Family
60	Services and the Agency for Health Care Administration to
61	contract for the provision or management of behavioral
62	health services with a managing entity in specified
63	geographic areas, to incorporate the amendments to s.
64	409.912, F.S., in references thereto; reenacting s.
65	641.225(3)(b), F.S., relating to minimum surplus
66	requirements of specified health maintenance organizations
67	providing prepaid capitated services, to incorporate the
68	amendments to s. 409.912, F.S., in references thereto;
69	reenacting s. 636.0145, F.S., relating to license
70	requirements for specified prepaid limited health service
71	organizations providing comprehensive inpatient and
72	outpatient mental health care services to certain Medicaid
73	recipients through a capitated prepaid arrangement
74	pursuant to federal waiver, to incorporate the amendments
75	to s. 409.912, F.S., in references thereto; providing
76	effective dates.
77
78	WHEREAS, mental health and substance abuse services are
79	delivered in many settings outside of the jurisdiction of the
80	Department of Children and Family Services, including hospitals,
81	clinics, jails, prisons, juvenile justice programs, assisted
82	living facilities, nursing homes, and other settings, and
83	WHEREAS, each state agency that serves people with mental
84	health and substance abuse disorders has a planning, quality
85	assurance, and accountability function related to its primary
86	mission, and
87	WHEREAS, there is no single governmental agency responsible
88	for state strategy, policy, and leadership across the state's
89	combined behavioral health care system, and
90	WHEREAS, the Commission on Mental Health and Substance
91	Abuse reported in 2001 that the current system is complex,
92	fragmented, uncoordinated, and often ineffective, and
93	WHEREAS, the Commission on Mental Health and Substance
94	Abuse found that although significant cost associated with the
95	state's current approach to mental health and substance abuse
96	problems can be documented, programs are not organized
97	effectively at the state level, and
98	WHEREAS, multiple mental health and substance abuse
99	programs across agencies and departments present bureaucratic
100	barriers and often conflicting funding streams and regulations
101	that frustrate access for many Floridians needing care, and
102	WHEREAS, many states have combined mental health and
103	substance abuse services in a single unique agency because of
104	their common behavioral health-related treatment and service
105	orientation to individuals needing care, and
106	WHEREAS, the scope and complexity of the state's behavioral
107	health care system requires strong leadership to be effective
108	and efficient, NOW, THEREFORE,
109
110	Be It Enacted by the Legislature of the State of Florida:
111
112	Section 1.Legislative intent.--It is the intent of the
113	Legislature to provide mental health and substance abuse
114	services that are coordinated and consistent and reflect the
115	current state of knowledge regarding quality and effectiveness
116	by creating an agency dedicated to mental health and substance
117	abuse services. For purposes of this act, the term "mental
118	health and substance abuse services" means substance abuse
119	programs and functions under chapter 397, Florida Statutes,
120	mental health programs and functions under chapter 394, Florida
121	Statutes, and other related programs and functions designated by
122	statute.
123	Section 2. Effective October 1, 2004, part VI of chapter
124	394, Florida Statutes, consisting of section 394.95, is created
125	to read:
126	PART VI
127	AGENCY FOR MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
128
129	394.95 Agency for Mental Health and Substance Abuse
130	Services.--There is created an Agency for Mental Health and
131	Substance Abuse Services within the Department of Children and
132	Family Services. The agency shall be a separate budget entity
133	and the director of the Agency for Mental Health and Substance
134	Abuse Services shall be the agency head for all purposes.
135	(1) MISSION.--
136	(a) The mission of the Agency for Mental Health and
137	Substance Abuse Services shall be to:
138	1. Provide overall policy and programmatic leadership for
139	all mental health and substance abuse services funded by or
140	through the state.
141	2. Initiate and organize partnerships with local
142	communities to develop effective strategies for preventing or
143	reducing the negative consequences of mental illness and
144	substance abuse problems.
145	3. Provide a comprehensive and coordinated continuum of
146	effective mental health and substance abuse services to help
147	individuals suffering from these illnesses to achieve their
148	greatest potential for independent and productive living.
149	(b) The agency shall develop a strategic plan for
150	fulfilling its mission and establish a set of measurable goals,
151	objectives, performance standards, and quality assurance
152	requirements to ensure that the agency is accountable to the
153	people of Florida.
154	(c) The agency shall develop effective collaborative
155	agreements with other state agencies to fulfill the intent of
156	this act and the mission of the agency.
157	(2) RESPONSIBILITIES.--The agency is responsible for:
158	(a) Establishing statewide policy for the provision of
159	mental health and substance abuse services to the citizens of
160	the state and developing strategies for the implementation of
161	such policy.
162	(b) Directing and managing the use of mental health and
163	substance abuse appropriations made pursuant to this chapter and
164	chapter 397, including those services funded through the
165	Medicaid program.
166	(c) Ensuring the provision of all information required by
167	the Agency for Health Care Administration for the accountability
168	of Medicaid mental health and substance abuse funding.
169	(d) Creating and contracting with comprehensive service
170	provider networks pursuant to s. 394.9082 using single and
171	uniform contracts, standards, and data-reporting requirements to
172	the maximum extent possible.
173	(e) Working with community-based provider networks on the
174	establishment of local service priorities and service
175	strategies.
176	(f) Developing and implementing uniform contracting and
177	payment systems which are consistent with s. 394.9082 for all
178	mental health and substance abuse funds under agency control.
179	(g) Developing standards and performance expectations for
180	contractors.
181	(h) Utilizing efficient accountability mechanisms which
182	are data-based and which reflect state-of-the-art industry
183	practices.
184	(i) Delegating to the maximum extent possible on-site
185	monitoring to the community-based provider networks.
186	(j) Maintaining knowledge of emerging research regarding
187	effective and efficient prevention and treatment approaches and
188	systematically incorporating this research into practice.
189	(k) Working with other state and local agencies involved
190	in the delivery of mental health and substance abuse services to
191	facilitate the use of the most current approaches to prevention
192	and treatment.
193	(l) Collecting data and monitoring the status of the
194	entire publicly funded mental health and substance abuse system.
195	(m) Monitoring and forecasting mental health and substance
196	abuse manpower needs and working with the educational systems in
197	the state to ensure that the state has the personnel needed to
198	continuously implement and improve its services.
199	(n) Providing or arranging for administrative services and
200	information systems necessary to support the mission of the
201	agency.
202	(o) Developing and maintaining effective interagency
203	collaboration.
204	(p) Ensuring access of children and families in the child
205	protection system to needed and appropriate mental health and
206	substance abuse services.
207	(q) Operating a consumer advocacy function.
208	(r) Ensuring that all federal and state laws and reporting
209	requirements are met.
210	(s) Maximizing the use of federal and other nonstate funds
211	in the accomplishment of the agency's mission.
212	(3) DIRECTOR OF THE AGENCY FOR MENTAL HEALTH AND SUBSTANCE
213	ABUSE SERVICES.--
214	(a) The head of the agency is the director of the Agency
215	for Mental Health and Substance Abuse Services, who shall be
216	appointed by the Governor, with the concurrence of the secretary
217	of the Department of Children and Family Services. The director
218	shall serve at the pleasure of and report to the Governor and
219	shall have a responsibility to coordinate activities with the
220	secretary of the Department of Children and Family Services.
221	(b) The director shall ensure that mental health and
222	substance abuse services are implemented according to
223	legislative intent, state and federal laws, rules, regulations,
224	statewide program standards, and performance objectives.
225	(c) The director shall negotiate an agreement with the
226	secretary of the Agency for Health Care Administration that
227	delegates responsibility for managing Medicaid mental health and
228	substance abuse services to the Agency for Mental Health and
229	Substance Services.
230	(d) The director shall have formal relationships with the
231	State University System and shall, to the extent practicable,
232	utilize the resources and expertise of the State University
233	System in pursuing its responsibilities.
234	(4) DIVISION DIRECTORS; MANAGEMENT STAFF.--
235	(a) The director shall appoint a Division Director for
236	Mental Health and a Division Director for Substance Abuse. The
237	division directors are directly responsible to the director and
238	serve at the pleasure of the director.
239	(b) The Division Director for Mental Health is responsible
240	for all mental health institutional programs and for community
241	mental health programs and services, including those funded by
242	Medicaid, and shall have line authority over regional mental
243	health agency staff.
244	(c) The Division Director for Substance Abuse shall be
245	responsible for all substance abuse prevention and treatment
246	services and shall have line authority over all regional
247	substance abuse agency staff.
248	(d) In order to facilitate the accomplishment of agency
249	service goals, the director shall, to the maximum extent
250	possible, assign administrative services staff to the division
251	directors.
252	(e) The director shall appoint a Director of Consumer
253	Affairs who shall have input into the policy, program, and
254	training and research priorities of the agency in addition to
255	handling consumer and other complaints.
256	(f) The director shall appoint a Director of Services
257	Integration who shall advocate for services integration and who
258	shall be responsible for monitoring and reporting on the
259	agency's performance in integrating mental health and substance
260	abuse services in its own operations and integrating mental
261	health and substance abuse services in the operations of other
262	departments that deliver mental health and substance abuse
263	services.
264	(g) The director may appoint additional managers and
265	administrators that he or she determines are necessary for the
266	effective management of the agency.
267	(5) SERVICE STRUCTURE.--
268	(a) The agency is authorized to establish regional offices
269	which, if established, will be aligned with one or more regions
270	of the Agency for Health Care Administration.
271	(b) The agency is authorized to contract for mental health
272	and substance abuse services with comprehensive community-based
273	provider networks and shall use contracting mechanisms to the
274	maximum extent possible in accomplishing its mission.
275	(6) STATEWIDE POLICY BOARD.--The Governor shall appoint a
276	statewide policy board composed of business and community
277	leaders who have an interest in mental health and substance
278	abuse services. The board shall make recommendations to the
279	director regarding organization, policy, budget, and other
280	matters relating to the management of the mental health and
281	substance abuse system.
282	Section 3.Transition team; Agency for Mental Health and
283	Substance Abuse Services creation plan.--
284	(1) By July 1, 2003, the secretary of the Department of
285	Children and Family Services shall convene a transition team to
286	plan the transition of responsibility for the provision of
287	mental health and substance abuse services in the state from the
288	existing mental health and substance abuse programs of the
289	Department of Children and Family Services to the Agency for
290	Mental Health and Substance Abuse Services.
291	(2) The transition team shall be composed of the following
292	members:
293	(a) A member of the House of Representatives to be
294	appointed by the Speaker of the House of Representatives.
295	(b) A member of the Senate to be appointed by the
296	President of the Senate.
297	(c) The director of the Medicaid program for the Agency
298	for Health Care Administration.
299	(c) The secretary of the Department of Health.
300	(d) The Department of Children and Family Services program
301	office directors for mental health and substance abuse.
302	(e) The Department of Children and Family Services
303	assistant secretary for programs.
304	(f) A representative of the Executive Office of the
305	Governor to be appointed by the Governor.
306	(g) A representative of the Statewide Drug Policy Advisory
307	Council to be appointed by the Governor.
308	(h) A representative of the Florida Council for Behavioral
309	Healthcare to be appointed by the Governor.
310	(i) A representative of the Florida Alcohol and Drug Abuse
311	Association to be appointed by the Governor.
312	(j) Representatives of the State University System to be
313	appointed by the Governor.
314	(k) Representatives of other appropriate mental health and
315	substance abuse advocacy groups, including consumers and family
316	members, to be appointed by the Governor.
317	(3) The transition team shall develop a plan of transition
318	activities and functions with respect to the creation of the
319	Agency for Mental Health and Substance Abuse Services. The
320	transition plan shall be formulated anticipating the use of
321	Department of Children and Family Services and Agency for Health
322	Care Administration program and administrative resources
323	currently directly or indirectly involved in managing and
324	accounting for Department of Children and Family Services and
325	Medicaid mental health and substance abuse services. The final
326	plan shall anticipate a 10-percent reduction in total
327	administrative costs. The plan shall address, at a minimum:
328	(a) Organizational structure.
329	(b) The transfer of responsibility for Medicaid mental
330	health and substance abuse services to the new agency and the
331	associated children’s mental health and substance abuse services
332	requirements regarding integration with the child protection
333	system.
334	(c) Information and support systems.
335	(d) Policy and rules transfer.
336	(e) Necessary changes in statutes and rules.
337	(f) Administrative support functions.
338	(g) Standards and licensing requirements.
339	(h) Budget authority and positions.
340	(i) Applicable federal requirements.
341	(j) Inventory and transfers of equipment and structures.
342	(k) Building leases.
343	(l) Contracts and contract management.
344	(m) Other areas identified by the transition team as
345	relevant to the creation and function of the Agency for Mental
346	Health and Substance Abuse Services and the transfer of powers,
347	duties, records, personnel, property, and funds of the mental
348	health and substance abuse programs of the Department of
349	Children and Family Services to the agency.
350	(4) The transition plan shall be submitted to the
351	Governor, the President of the Senate, the Speaker of the House
352	of Representatives, the chairs of the Senate and House of
353	Representatives appropriations committees, and the chairs of
354	appropriate substantive committees of the Senate and the House
355	of Representatives by November 1, 2003.
356	(5) Members of the transition team shall serve without
357	compensation, but are entitled to receive reimbursement for per
358	diem and travel expenses as provided in s. 112.061, Florida
359	Statutes.
360	Section 4.Transfer of programs.--
361	(1)(a) Effective October 1, 2004, all powers, duties,
362	records, personnel, property, and unexpended balances of
363	appropriations, allocations, or other funds of the mental health
364	and substance abuse programs of the Department of Children and
365	Family Services or its successor as designated by law are
366	transferred by a type two transfer, as defined in s. 20.06,
367	Florida Statutes, to the Agency for Mental Health and Substance
368	Abuse Services within the Department of Children and Family
369	Services, as created by this act, including:
370	1. The unexpended, indirect cost balances from the General
371	Revenue Fund and from applicable trust funds from appropriate
372	budget entities supporting administrative infrastructure and
373	positions for mental health and substance abuse programs and
374	functions within the Department of Children and Family Services.
375	2. Mental health and substance abuse program positions
376	within the Department of Children and Family Services and the
377	Agency for Health Care Administration or their successors as
378	designated by law.
379	(b) The Department of Children and Family Services and the
380	Agency for Health Care Administration or their successors as
381	designated by law shall transfer all tangible property, office
382	furnishings and supplies, pro rata shares of fixed capital funds
383	for centrally managed projects, acquisition of motor vehicles,
384	and operating capital outlay for the 2004-2005 fiscal year to
385	the Agency for Mental Health and Substance Abuse Services.
386	(c) Pursuant to s. 216.181, Florida Statutes, the
387	Executive Office of the Governor may provide for flexibility in
388	salary rates which is necessary to support the Agency for Mental
389	Health and Substance Abuse Services, and may establish positions
390	at a rate in excess of 10 percent above the minimum, to the
391	extent that annualized moneys for salaries are available.
392	(d) The Department of Children and Family Services and the
393	Agency for Health Care Administration or their successors as
394	designated by law shall provide administrative support and staff
395	for the Agency for Mental Health and Substance Abuse Services
396	until December 31, 2005.
397	(2) All applicable administrative rules of the Department
398	of Children and Family Services and the Agency for Health Care
399	Administration or their successors as designated by law which
400	are in effect on October 1, 2004, shall remain in effect as
401	rules of the Agency for Mental Health and Substance Abuse
402	Services until they are specifically changed in the manner
403	provided by law.
404	(3) This act does not affect the validity of any judicial
405	or administrative proceeding pending on October 1, 2004, and the
406	Agency for Mental Health and Substance Abuse Services within the
407	Department of Children and Family Services is substituted as a
408	real party in interest with respect to any proceeding pending on
409	that date which involves the mental health or substance abuse
410	programs of the Department of Children and Family Services or
411	its successor as designated by law.
412	Section 5. Subsection (6) of section 394.741, Florida
413	Statutes, is amended, present subsection (7) is renumbered as
414	subsection (9), and new subsections (7) and (8) are added to
415	said section, to read:
416	394.741 Accreditation requirements for providers of
417	behavioral health care services.--
418	(6) The department or agency, by accepting the survey or
419	inspection of an accrediting organization, does not forfeit its
420	rights to perform inspections at any time, including contract
421	monitoring to ensure thatservices that have been billed
422	deliverablesare provided in accordance with the contract.
423	(7) The department or agency shall not monitor
424	organizations under contract with the department or find such
425	organizations out of compliance with requirements for which
426	there are no specific federal or state regulations.
427	(8) The department shall file a State Projects Compliance
428	Supplement for behavioral health care services pursuant to s.
429	215.97. If monitoring the financial operations of its
430	contractors, the department shall perform an off-site desk
431	review of its contractors' most recent independent CPA audit and
432	only conduct on-site monitoring of problems identified by such
433	audit.
434	(9)(7)The department and the agency shall report to the
435	Legislature by January 1, 2003, on the viability of mandating
436	all organizations under contract with the department for the
437	provision of behavioral health care services, or licensed by the
438	agency or department to be accredited. The department and the
439	agency shall also report to the Legislature by January 1, 2003,
440	on the viability of privatizing all licensure and monitoring
441	functions through an accrediting organization.
442	Section 6. Paragraph (b) of subsection (3) of section
443	409.912, Florida Statutes, is amended to read:
444	409.912 Cost-effective purchasing of health care.--The
445	agency shall purchase goods and services for Medicaid recipients
446	in the most cost-effective manner consistent with the delivery
447	of quality medical care. The agency shall maximize the use of
448	prepaid per capita and prepaid aggregate fixed-sum basis
449	services when appropriate and other alternative service delivery
450	and reimbursement methodologies, including competitive bidding
451	pursuant to s. 287.057, designed to facilitate the cost-
452	effective purchase of a case-managed continuum of care. The
453	agency shall also require providers to minimize the exposure of
454	recipients to the need for acute inpatient, custodial, and other
455	institutional care and the inappropriate or unnecessary use of
456	high-cost services. The agency may establish prior authorization
457	requirements for certain populations of Medicaid beneficiaries,
458	certain drug classes, or particular drugs to prevent fraud,
459	abuse, overuse, and possible dangerous drug interactions. The
460	Pharmaceutical and Therapeutics Committee shall make
461	recommendations to the agency on drugs for which prior
462	authorization is required. The agency shall inform the
463	Pharmaceutical and Therapeutics Committee of its decisions
464	regarding drugs subject to prior authorization.
465	(3) The agency may contract with:
466	(b) An entity that is providing comprehensive behavioral
467	health care services to certain Medicaid recipients through a
468	capitated, prepaid arrangement pursuant to the federal waiver
469	provided for by s. 409.905(5). Such an entity must be licensed
470	under chapter 624, chapter 636, or chapter 641 and must possess
471	the clinical systems and operational competence to manage risk
472	and provide comprehensive behavioral health care to Medicaid
473	recipients. As used in this paragraph, the term "comprehensive
474	behavioral health care services" means covered mental health and
475	substance abuse treatment services that are available to
476	Medicaid recipients. The secretary of the Department of Children
477	and Family Services shall approve provisions of procurements
478	related to children in the department's care or custody prior to
479	enrolling such children in a prepaid behavioral health plan. Any
480	contract awarded under this paragraph must be competitively
481	procured. In developing the behavioral health care prepaid plan
482	procurement document, the agency shall ensure that the
483	procurement document requires the contractor to develop and
484	implement a plan to ensure compliance with s. 394.4574 related
485	to services provided to residents of licensed assisted living
486	facilities that hold a limited mental health license.The agency
487	shall seek federal approval to contract with a single entity
488	meeting these requirements in each region or combination of
489	regions to provide comprehensive behavioral health care services
490	to all Medicaid recipients residing in the region. These
491	entities must offer sufficient choice of providers to ensure
492	recipient access and satisfaction.The agency must ensure that
493	Medicaid recipients have available the choice of at least two
494	managed care plans for their behavioral health care services.To
495	ensure unimpaired access to behavioral health care services by
496	Medicaid recipients, all contracts issued pursuant to this
497	paragraph shall require 80 percent of the capitation paid to the
498	managed care plan, including health maintenance organizations,
499	to be expended for the provision of behavioral health care
500	services. In the event the managed care plan expends less than
501	80 percent of the capitation paid pursuant to this paragraph for
502	the provision of behavioral health care services, the difference
503	shall be returned to the agency. The agency shall provide the
504	managed care plan with a certification letter indicating the
505	amount of capitation paid during each calendar year for the
506	provision of behavioral health care services pursuant to this
507	section. The agency may reimburse for substance-abuse-treatment
508	services on a fee-for-service basis until the agency finds that
509	adequate funds are available for capitated, prepaid
510	arrangements.
511	1. By January 1, 2001, the agency shall modify the
512	contracts with the entities providing comprehensive inpatient
513	and outpatient mental health care services to Medicaid
514	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
515	Counties, to include substance-abuse-treatment services.
516	2.The agency shall contract by July 1, 2007, with a
517	single managed care entity in each region, or combination of
518	regions, to provide comprehensive inpatient and outpatient
519	mental health and substance abuse services through capitated
520	prepaid arrangements to all Medicaid recipients for whom such
521	plans are allowable under federal law and regulations.
522	3. By March 1, 2004, the agency shall submit a plan for
523	fully implementing capitated prepaid behavioral health care in
524	all regions of the state.
525	a. Implementation shall be targeted for fiscal years 2003-
526	2004 and 2004-2005 in each region or combination of regions
527	where historical expenditures for mental health and substance
528	abuse services are actuarially sound and adequate to sustain a
529	managed care plan, and where communities are prepared.
530	b. The agency shall work with the Department of Children
531	and Family Services to implement strategies to maximize the
532	utilization of Medicaid behavioral health care services
533	delivered to Medicaid recipients. Alcohol, drug abuse, and
534	mental health funds appropriated to the Department of Children
535	and Family Services and other state or county funds shall, to
536	the extent possible, be used to match additional federal
537	Medicaid funds, provided that no transfer of funds to the Agency
538	for Health Care Administration is required.
539	c. The agency shall establish capitation rates based on
540	actuarial methods for each region or combination of regions
541	where historical fee-for-service expenditures do not produce
542	actuarially sound capitation rates. The rate-setting
543	methodology shall consider the impact of a lack of a health care
544	infrastructure in these areas of the state and the variations in
545	access to services produced by these and other factors.
546	Contracts shall not be finalized in these areas until adequate
547	capitation rates are established and approved by the agency.By
548	December 31, 2001, the agency shall contract with entities
549	providing comprehensive behavioral health care services to
550	Medicaid recipients through capitated, prepaid arrangements in
551	Charlotte, Collier, DeSoto, Escambia, Glades, Hendry, Lee,
552	Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota, and Walton
553	Counties. The agency may contract with entities providing
554	comprehensive behavioral health care services to Medicaid
555	recipients through capitated, prepaid arrangements in Alachua
556	County. The agency may determine if Sarasota County shall be
557	included as a separate catchment area or included in any other
558	agency geographic area.
559	4.3.Children residing in a Department of Juvenile Justice
560	residential program approved as a Medicaid behavioral health
561	overlay services provider shall not be included in a behavioral
562	health care prepaid health plan pursuant to this paragraph.
563	5.4.In converting to a prepaid system of delivery, the
564	agency shall in its procurement document require an entity
565	providing comprehensive behavioral health care services to
566	prevent the displacement of indigent care patients by enrollees
567	in the Medicaid prepaid health plan providing behavioral health
568	care services from facilities receiving state funding to provide
569	indigent behavioral health care, to facilities licensed under
570	chapter 395 which do not receive state funding for indigent
571	behavioral health care, or reimburse the unsubsidized facility
572	for the cost of behavioral health care provided to the displaced
573	indigent care patient.
574	6.5.Traditional community mental health providers under
575	contract with the Department of Children and Family Services
576	pursuant to part IV of chapter 394 and inpatient mental health
577	providers licensed pursuant to chapter 395 must be offered an
578	opportunity to accept or decline a contract to participate in
579	any provider network for prepaid behavioral health services.
580	Section 7. For the purpose of incorporating the amendments
581	to section 409.912, Florida Statutes, in references thereto, the
582	sections or subdivisions of Florida Statutes set forth below are
583	reenacted to read:
584	394.9082 Behavioral health service delivery strategies.--
585	(4) CONTRACT FOR SERVICES.--
586	(a) The Department of Children and Family Services and the
587	Agency for Health Care Administration may contract for the
588	provision or management of behavioral health services with a
589	managing entity in at least two geographic areas. Both the
590	Department of Children and Family Services and the Agency for
591	Health Care Administration must contract with the same managing
592	entity in any distinct geographic area where the strategy
593	operates. This managing entity shall be accountable for the
594	delivery of behavioral health services specified by the
595	department and the agency for children, adolescents, and adults.
596	The geographic area must be of sufficient size in population and
597	have enough public funds for behavioral health services to allow
598	for flexibility and maximum efficiency. Notwithstanding the
599	provisions of s. 409.912(3)(b)1. and 2., at least one service
600	delivery strategy must be in one of the service districts in the
601	catchment area of G. Pierce Wood Memorial Hospital.
602	(b) Under one of the service delivery strategies, the
603	Department of Children and Family Services may contract with a
604	prepaid mental health plan that operates under s. 409.912 to be
605	the managing entity. Under this strategy, the Department of
606	Children and Family Services is not required to competitively
607	procure those services and, notwithstanding other provisions of
608	law, may employ prospective payment methodologies that the
609	department finds are necessary to improve client care or
610	institute more efficient practices. The Department of Children
611	and Family Services may employ in its contract any provision of
612	the current prepaid behavioral health care plan authorized under
613	s. 409.912(3)(a) and (b), or any other provision necessary to
614	improve quality, access, continuity, and price. Any contracts
615	under this strategy in Area 6 of the Agency for Health Care
616	Administration or in the prototype region under s. 20.19(7) of
617	the Department of Children and Family Services may be entered
618	with the existing substance abuse treatment provider network if
619	an administrative services organization is part of its network.
620	In Area 6 of the Agency for Health Care Administration or in the
621	prototype region of the Department of Children and Family
622	Services, the Department of Children and Family Services and the
623	Agency for Health Care Administration may employ alternative
624	service delivery and financing methodologies, which may include
625	prospective payment for certain population groups. The
626	population groups that are to be provided these substance abuse
627	services would include at a minimum: individuals and families
628	receiving family safety services; Medicaid-eligible children,
629	adolescents, and adults who are substance-abuse-impaired; or
630	current recipients and persons at risk of needing cash
631	assistance under Florida's welfare reform initiatives.
632	(d) Under both strategies, the Department of Children and
633	Family Services and the Agency for Health Care Administration
634	may:
635	1. Establish benefit packages based on the level of
636	severity of illness and level of client functioning;
637	2. Align and integrate procedure codes, standards, or
638	other requirements if it is jointly determined that these
639	actions will simplify or improve client services and
640	efficiencies in service delivery;
641	3. Use prepaid per capita and prepaid aggregate fixed-sum
642	payment methodologies; and
643	4. Modify their current procedure codes to increase
644	clinical flexibility, encourage the use of the most effective
645	interventions, and support rehabilitative activities.
646	Section 8. For the purpose of incorporating the amendments
647	to section 409.912, Florida Statutes, in references thereto, the
648	sections or subdivisions of Florida Statutes set forth below are
649	reenacted to read:
650	641.225 Surplus requirements.--
651	(3)
652	(b) An entity providing prepaid capitated services which
653	is authorized under s. 409.912(3)(b) or (c), and which applies
654	for a certificate of authority is subject to the minimum surplus
655	requirements set forth in s. 409.912.
656	Section 9. For the purpose of incorporating the amendments
657	to section 409.912, Florida Statutes, in references thereto, the
658	sections or subdivisions of Florida Statutes set forth below are
659	reenacted to read:
660	636.0145 Certain entities contracting with
661	Medicaid.--Notwithstanding the requirements of s. 409.912(3)(b),
662	an entity that is providing comprehensive inpatient and
663	outpatient mental health care services to certain Medicaid
664	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
665	Counties through a capitated, prepaid arrangement pursuant to
666	the federal waiver provided for in s. 409.905(5) must become
667	licensed under chapter 636 by December 31, 1998. Any entity
668	licensed under this chapter which provides services solely to
669	Medicaid recipients under a contract with Medicaid shall be
670	exempt from ss. 636.017, 636.018, 636.022, 636.028, and 636.034.
671	Section 10. Except as otherwise provided herein, this act
672	shall take effect upon becoming a law.
673