HB 0433 2003
1	CHAMBER ACTION
2
3
4
5
6	The Committee on Future of Florida's Families recommends the
7	following:
8
9	Committee Substitute
10	Remove the entire bill and insert:
11	A bill to be entitled
12	An act relating to behavioral health; amending s. 20.19,
13	F.S.; requiring the Secretary of Children and Family
14	Services to appoint an assistant secretary for behavioral
15	health; providing responsibilities of the assistant
16	secretary; providing for the appointment of a Director of
17	Mental Health Services; providing duties of the director;
18	providing for the appointment of a Director of Substance
19	Abuse Services; providing duties of the director; creating
20	s. 394.655, F.S.; providing for the establishment of the
21	Behavioral Health Advisory Board; providing membership of
22	the advisory board; providing duties of the advisory
23	board; amending s. 409.912, F.S.; requiring the Agency for
24	Health Care Administration to seek federal approval to
25	contract with a single entity to provide comprehensive
26	behavioral health care services to Medicaid recipients;
27	requiring the agency to submit a plan for fully
28	implementing capitated prepaid behavioral health care in
29	all regions of the state; providing for implementation of
30	the plan; authorizing the agency to adjust the capitation
31	rate under specified circumstances; requiring the agency
32	to develop policies and procedures that allow for
33	certification of local funds; requiring the agency to
34	implement new Medicaid procedure codes for specified
35	services; providing a requirement with respect to the
36	match requirements for such procedure codes; requiring the
37	Department of Children and Family Services to impose
38	specified requirements on its contractors in order to
39	certify local funds; authorizing the capping of local and
40	state mental health and substance abuse dollars certified
41	as state Medicaid match; providing for reduction of
42	certification of such funds under specified circumstances;
43	authorizing the agency to conduct a review of a local
44	provider who has applied to enroll as a Medicaid provider
45	under the certified match program; providing
46	responsibility of the department notwithstanding the
47	finding of a review; requiring the agency to develop a
48	reimbursement schedule specific to a local provider's
49	certified match program based on the federal
50	rehabilitative services option; requiring the agency and
51	the local provider to provide specified information and
52	documents to the Medicaid Fraud Control Unit of the
53	Department of Legal Affairs upon request; amending s.
54	394.741, F.S.; revising and providing additional
55	accreditation requirements for providers of behavioral
56	health care services; amending s. 394.9082, F.S.;
57	authorizing the department to contract with a single
58	managing entity or provider network for the delivery of
59	state-funded mental health services; requiring the
60	managing entity to coordinate its delivery of mental
61	health and substance abuse services with all prepaid
62	mental health plans in the region or the district;
63	providing contract requirements; correcting cross
64	references; amending s. 636.066, F.S.; providing that
65	payments made to a prepaid limited health services
66	organization by the Agency for Health Care Administration
67	under a contract to provide comprehensive behavioral
68	health care services to Medicaid recipients are not
69	subject to the insurance premium tax; requiring the agency
70	to provide the prepaid limited health services
71	organization with a specified certification letter;
72	amending s. 641.47, F.S.; expanding the definition of
73	"emergency medical condition" to include a specified
74	psychiatric condition; amending ss. 409.908, 409.91196,
75	409.9122, 636.0145, 641.225, and 641.386, F.S.; correcting
76	cross references; providing an effective date.
77
78	Be It Enacted by the Legislature of the State of Florida:
79
80	Section 1. Subsection (2) of section 20.19, Florida
81	Statutes, is amended to read:
82	20.19 Department of Children and Family Services.--There
83	is created a Department of Children and Family Services.
84	(2) SECRETARY OF CHILDREN AND FAMILY SERVICES; DEPUTY
85	SECRETARY.--
86	(a) The head of the department is the Secretary of
87	Children and Family Services. The secretary is appointed by the
88	Governor, subject to confirmation by the Senate. The secretary
89	serves at the pleasure of the Governor.
90	(b) The secretary shall appoint a deputy secretary who
91	shall act in the absence of the secretary. The deputy secretary
92	is directly responsible to the secretary, performs such duties
93	as are assigned by the secretary, and serves at the pleasure of
94	the secretary.
95	(c) The secretary shall appoint an assistant secretary for
96	behavioral health services to manage behavioral health services.
97	The assistant secretary for behavioral health services shall
98	have responsibility and authority for all of the programs,
99	services, functions, and duties included in chapters 394 and
100	397.
101	1. The secretary shall appoint a Director of Mental Health
102	Services and a Director of Substance Abuse Services.
103	2. The Director of Mental Health Services shall directly
104	administer all mental health programs, staff, budgets, duties,
105	and functions of the mental health program and shall be
106	responsible to the assistant secretary for behavioral health
107	services; the Director of Substance Abuse Services shall
108	directly administer all of the programs, staff, budgets, duties,
109	and functions of the substance abuse program and shall be
110	responsible to the assistant secretary for behavioral health
111	services.
112	3. The assistant secretary shall serve at the pleasure of
113	the secretary.
114	(d) The secretary shall appoint the directors or executive
115	directors of any commission or council assigned to the
116	department. Directors and executive directors shall serve at the
117	pleasure of the secretary as provided for division directors in
118	s. %_%0%_%
119	(e)(c)The secretary has the authority and responsibility
120	to ensure that the mission of the department is fulfilled in
121	accordance with state and federal laws, rules, and regulations.
122	Section 2. Section 394.655, Florida Statutes, is created
123	to read:
124	394.655 Behavioral Health Advisory Board; powers and
125	duties; composition.--
126	(1) The Behavioral Health Advisory Board shall be
127	comprised of 11 members. Each member shall be appointed for a 2-
128	year term. No member shall be reappointed for more than two
129	subsequent terms. Five members shall be appointed by the
130	Governor, three members shall be appointed by the President of
131	the Senate, and three members shall be appointed by the Speaker
132	of the House of Representatives.
133	(a) Of the five members appointed by the Governor, four
134	must be prominent community leaders, two of whom have experience
135	and interest in substance abuse, and two of whom have experience
136	and interest in mental health.
137	(b) Of the three members appointed by the President of the
138	Senate, one must be a consumer of publicly-funded mental health
139	services or the family member of a consumer, one must be an
140	expert in elder mental health, and one must be an expert in
141	elder substance abuse.
142	(c) Of the three members appointed by the Speaker of the
143	House of Representatives, one must represent the judiciary or
144	criminal justice system, one must have expertise in child
145	welfare, and one must have expertise in bio-ethics.
146	(2) The director of the Medicaid program and the secretary
147	of the Department of Elder Affairs shall serve as ex officio
148	members of the advisory board.
149	(3) Members of the advisory board shall serve without
150	compensation, but are entitled to reimbursement for travel and
151	per diem expenses pursuant to s. 112.061.
152	(4) Persons who derive their income from resources
153	controlled by the Department of Children and Family Services or
154	the Agency for Health Care Administration are ineligible for
155	membership on the advisory board.
156	(5) The advisory board shall prepare the behavioral health
157	budget request and the secretary shall submit the budget request
158	to the Governor.
159	(6) The advisory board shall work with the Assistant
160	Secretary of Behavioral Health to ensure that the behavioral
161	health care needs as identified in local needs assessments and
162	plans are met. The board shall work to enhance the understanding
163	of all persons of the efficacy of behavioral health services and
164	work to ensure that adequate resources are available.
165	Section 3. Subsections (1) and (2) of section 409.912,
166	Florida Statutes, are renumbered as subsections (2) and (3),
167	respectively, subsection (3) is renumbered as subsection (4) and
168	paragraphs (b) and (c) of said subsection are amended,
169	subsection (19) is renumbered as subsection (22) and paragraph
170	(c) of said subsection is amended, subsection (27) is renumbered
171	as subsection (30) and amended, present subsections (4) through
172	(18) are renumbered as subsections (7) through (21),
173	respectively, present subsections (20) through (26) are
174	renumbered as subsections (23) through (29), respectively,
175	present subsections (28) through (40) are renumbered as
176	subsections (31) through (43), respectively, and new subsections
177	(1), (5), and (6) are added to said section, to read:
178	409.912 Cost-effective purchasing of health care.--The
179	agency shall purchase goods and services for Medicaid recipients
180	in the most cost-effective manner consistent with the delivery
181	of quality medical care. The agency shall maximize the use of
182	prepaid per capita and prepaid aggregate fixed-sum basis
183	services when appropriate and other alternative service delivery
184	and reimbursement methodologies, including competitive bidding
185	pursuant to s. 287.057, designed to facilitate the cost-
186	effective purchase of a case-managed continuum of care. The
187	agency shall also require providers to minimize the exposure of
188	recipients to the need for acute inpatient, custodial, and other
189	institutional care and the inappropriate or unnecessary use of
190	high-cost services. The agency may establish prior authorization
191	requirements for certain populations of Medicaid beneficiaries,
192	certain drug classes, or particular drugs to prevent fraud,
193	abuse, overuse, and possible dangerous drug interactions. The
194	Pharmaceutical and Therapeutics Committee shall make
195	recommendations to the agency on drugs for which prior
196	authorization is required. The agency shall inform the
197	Pharmaceutical and Therapeutics Committee of its decisions
198	regarding drugs subject to prior authorization.
199	(1) The agency shall work with the Department of Children
200	and Family Services to ensure access of children and families in
201	the child protection system to needed and appropriate mental
202	health and substance abuse services.
203	(4)(3)The agency may contract with:
204	(b) An entity that is providing comprehensive behavioral
205	health care services to certain Medicaid recipients through a
206	capitated, prepaid arrangement pursuant to the federal waiver
207	provided for by s. 409.905(5). Such an entity must be licensed
208	under chapter 624, chapter 636, or chapter 641 and must possess
209	the clinical systems and operational competence to manage risk
210	and provide comprehensive behavioral health care to Medicaid
211	recipients. As used in this paragraph, the term "comprehensive
212	behavioral health care services" means covered mental health and
213	substance abuse treatment services that are available to
214	Medicaid recipients. The Secretary of the Department of Children
215	and Family Services shall approve provisions of procurements
216	related to children in the department's care or custody prior to
217	enrolling such children in a prepaid behavioral health plan. Any
218	contract awarded under this paragraph must be competitively
219	procured. In developing the behavioral health care prepaid plan
220	procurement document, the agency shall ensure that the
221	procurement document requires the contractor to develop and
222	implement a plan to ensure compliance with s. 394.4574 related
223	to services provided to residents of licensed assisted living
224	facilities that hold a limited mental health license. The
225	agency shall seek federal approval to contract with a single
226	entity meeting these requirements to provide comprehensive
227	behavioral health care services to all Medicaid recipients in a
228	group of districts or counties. Each entity must offer
229	sufficient choices of providers in its network to ensure
230	recipient access to care and the opportunity to select a
231	provider with whom the recipient is satisfied.The agency must
232	ensure that Medicaid recipients have available the choice of at
233	least two managed care plans for their behavioral health care
234	services.To ensure unimpaired access to behavioral health care
235	services by Medicaid recipients, all contracts issued pursuant
236	to this paragraph shall require 80 percent of the capitation
237	paid to the managed care plan, including health maintenance
238	organizations, to be expended for the provision of behavioral
239	health care services. In the event the managed care plan expends
240	less than 80 percent of the capitation paid pursuant to this
241	paragraph for the provision of behavioral health care services,
242	the difference shall be returned to the agency. The agency shall
243	provide the managed care plan with a certification letter
244	indicating the amount of capitation paid during each calendar
245	year for the provision of behavioral health care services
246	pursuant to this section. The agency may reimburse for
247	substance-abuse-treatment services on a fee-for-service basis
248	until the agency finds that adequate funds are available for
249	capitated, prepaid arrangements.
250	1. By January 1, 2001, the agency shall modify the
251	contracts with the entities providing comprehensive inpatient
252	and outpatient mental health care services to Medicaid
253	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
254	Counties, to include substance-abuse-treatment services.
255	2. By July 1, 2003, the agency and the Department of
256	Children and Family Services shall execute a written agreement
257	that requires collaboration and joint development of all
258	policies, budgets, procurement documents, contracts, and
259	monitoring plans that have an impact on the state and Medicaid
260	community mental health and targeted case management programs.
261	3. By October 1, 2003, the agency shall submit a plan to
262	the Governor, the President of the Senate, the Speaker of the
263	House of Representatives, and the chairs of the relevant
264	substantive committees of the Senate and the House of
265	Representatives for review and approval that provides for fully
266	implementing capitated prepaid behavioral health care in all
267	regions of the state.
268	a. Implementation shall begin in 2003 in those areas of
269	the state where the agency is able to establish a sound
270	capitation rate.
271	b. If the agency determines that the proposed capitation
272	rate is insufficient to attract providers or claims data does
273	not provide sufficient information for the development of an
274	actuarially sound rate, the agency may adjust the capitation
275	rate to ensure that care will be available.
276	c. Subject to any limitations provided for in the General
277	Appropriations Act, the agency, in compliance with appropriate
278	federal authorization, shall develop policies and procedures
279	that allow for certification of local funds.
280	2. By December 31, 2001, the agency shall contract with
281	entities providing comprehensive behavioral health care services
282	to Medicaid recipients through capitated, prepaid arrangements
283	in Charlotte, Collier, DeSoto, Escambia, Glades, Hendry, Lee,
284	Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota, and Walton
285	Counties. The agency may contract with entities providing
286	comprehensive behavioral health care services to Medicaid
287	recipients through capitated, prepaid arrangements in Alachua
288	County. The agency may determine if Sarasota County shall be
289	included as a separate catchment area or included in any other
290	agency geographic area.
291	4.3.Children residing in a Department of Juvenile Justice
292	residential program approved as a Medicaid behavioral health
293	overlay services provider shall not be included in a behavioral
294	health care prepaid health plan pursuant to this paragraph.
295	5.4.In converting to a prepaid system of delivery, the
296	agency shall in its procurement document require an entity
297	providing comprehensive behavioral health care services to
298	prevent the displacement of indigent care patients by enrollees
299	in the Medicaid prepaid health plan providing behavioral health
300	care services from facilities receiving state funding to provide
301	indigent behavioral health care, to facilities licensed under
302	chapter 395 which do not receive state funding for indigent
303	behavioral health care, or reimburse the unsubsidized facility
304	for the cost of behavioral health care provided to the displaced
305	indigent care patient.
306	6.5.Traditional community mental health providers under
307	contract with the Department of Children and Family Services
308	pursuant to part IV of chapter 394 and inpatient mental health
309	providers licensed pursuant to chapter 395 must be offered an
310	opportunity to accept or decline a contract to participate in
311	any provider network for prepaid behavioral health services.
312	(c) A federally qualified health center or an entity owned
313	by one or more federally qualified health centers or an entity
314	owned by other migrant and community health centers receiving
315	non-Medicaid financial support from the Federal Government to
316	provide health care services on a prepaid or fixed-sum basis to
317	recipients. Such prepaid health care services entity must be
318	licensed under parts I and III of chapter 641, but shall be
319	prohibited from serving Medicaid recipients on a prepaid basis,
320	until such licensure has been obtained. However, such an entity
321	is exempt from s. 641.225 if the entity meets the requirements
322	specified in subsections (17)(14) and (18)(15).
323	(5) By October 1, 2003, the agency shall implement new
324	Medicaid procedure codes to the extent feasible, for emergency
325	and crisis care, supportive residential services, and other
326	services designed to maximize the use of Medicaid funds for
327	Medicaid eligible recipients. The agency shall include in the
328	agreement developed pursuant to subsection (4) a provision that
329	ensures that the match requirements for these new procedure
330	codes are met by certifying eligible general revenue or local
331	funds that are currently expended on these services by the
332	department with contracted alcohol, drug abuse, and mental
333	health providers.
334	(6) To certify local funds, the Department of Children and
335	Family Services shall require its contractors to verify the
336	Medicaid eligibility of each recipient served; develop and
337	maintain the financial and individual service plan records
338	needed to document the appropriate use of state and federal
339	Medicaid funds; comply with all state and federal Medicaid laws,
340	rules, regulations, and policies, including, but not limited to,
341	those related to the confidentiality of records and freedom of
342	choice of providers; and be responsible for reimbursing the cost
343	of any state or federal disallowance that results from failure
344	to comply with state or federal Medicaid laws, rules, or
345	regulations.
346	(a) Local and state mental health and substance abuse
347	dollars certified as state Medicaid match may be capped based on
348	the maximum amount of federal participation budgeted for this
349	purpose. Unless otherwise specifically provided for in the
350	General Appropriations Act, certification of such funds shall be
351	reduced proportionately to other voluntary Medicaid programs if
352	a cap is established by the federal Medicaid agency that reduces
353	federal Medicaid funding.
354	(b) Within 90 days after a local provider applies to
355	enroll as a Medicaid provider under the certified match program,
356	the agency may conduct a review to ensure that the provider has
357	the capability to comply with the requirements of this
358	subsection. A finding by the agency that a provider has the
359	capability to comply with the requirements of paragraph (a)
360	shall not relieve the Department of Children and Family Services
361	of its responsibility for correcting any deficiencies or for
362	reimbursing the cost of the state or federal disallowances
363	identified pursuant to any subsequent state or federal audits.
364	(c) The agency shall develop a reimbursement schedule
365	specific to the local provider's certified match program which
366	is based on the federal rehabilitative services option.
367	(d) The confidentiality of any information or documents
368	relating to this section held by the agency or the local
369	provider is waived and the agency and the local provider shall
370	provide any information or documents relating to this section to
371	the Medicaid Fraud Control Unit of the Department of Legal
372	Affairs upon request and pursuant to its authority under s.
373	409.920.
374	(19) Any entity contracting with the agency pursuant to
375	this section to provide health care services to Medicaid
376	recipients is prohibited from engaging in any of the following
377	practices or activities:
378	(c) Granting or offering of any monetary or other valuable
379	consideration for enrollment, except as authorized by subsection
380	(24)(21).
381	(27) The agency shall perform enrollments and
382	disenrollments for Medicaid recipients who are eligible for
383	MediPass or managed care plans. Notwithstanding the prohibition
384	contained in paragraph (21)(18)(f), managed care plans may
385	perform preenrollments of Medicaid recipients under the
386	supervision of the agency or its agents. For the purposes of
387	this section, "preenrollment" means the provision of marketing
388	and educational materials to a Medicaid recipient and assistance
389	in completing the application forms, but shall not include
390	actual enrollment into a managed care plan. An application for
391	enrollment shall not be deemed complete until the agency or its
392	agent verifies that the recipient made an informed, voluntary
393	choice. The agency, in cooperation with the Department of
394	Children and Family Services, may test new marketing initiatives
395	to inform Medicaid recipients about their managed care options
396	at selected sites. The agency shall report to the Legislature on
397	the effectiveness of such initiatives. The agency may contract
398	with a third party to perform managed care plan and MediPass
399	enrollment and disenrollment services for Medicaid recipients
400	and is authorized to adopt rules to implement such services. The
401	agency may adjust the capitation rate only to cover the costs of
402	a third-party enrollment and disenrollment contract, and for
403	agency supervision and management of the managed care plan
404	enrollment and disenrollment contract.
405	Section 4. Subsection (6) of section 394.741, Florida
406	Statutes, is amended, a new subsection (7) is added to said
407	section, and subsections (7) and (8) are renumbered as
408	subsections (8) and (9), respectively, to read:
409	394.741 Accreditation requirements for providers of
410	behavioral health care services.--
411	(6) The department or agency, by accepting the survey or
412	inspection of an accrediting organization, does not forfeit its
413	rights to perform inspections at any time, including contract
414	monitoring to ensure that services that have been billed
415	deliverablesare provided in accordance with the contract.
416	(7) In monitoring the financial operations of its
417	contractors, the department shall perform an off-site desk
418	review of its contractors' most recent audit conducted by an
419	independent certified public accountant and only conduct on-site
420	monitoring of problems identified by such audit.
421	(8)(7)The department and the agency shall report to the
422	Legislature by January 1, 2003, on the viability of mandating
423	all organizations under contract with the department for the
424	provision of behavioral health care services, or licensed by the
425	agency or department to be accredited. The department and the
426	agency shall also report to the Legislature by January 1, 2003,
427	on the viability of privatizing all licensure and monitoring
428	functions through an accrediting organization.
429	(9)(8)The accreditation requirements of this section
430	shall apply to contracted organizations that are already
431	accredited immediately upon becoming law.
432	Section 5. Paragraphs (a), (b), and (e) of subsection (4)
433	and subsection (5) of section 394.9082, Florida Statutes, are
434	amended to read:
435	394.9082 Behavioral health service delivery strategies.--
436	(4) CONTRACT FOR SERVICES.--
437	(a) The Department of Children and Family Services and the
438	Agency for Health Care Administration may contract for the
439	provision or management of behavioral health services with a
440	managing entity in at least two geographic areas. Both the
441	Department of Children and Family Services and the Agency for
442	Health Care Administration must contract with the same managing
443	entity in any distinct geographic area where the strategy
444	operates. This managing entity shall be accountable for the
445	delivery of behavioral health services specified by the
446	department and the agency for children, adolescents, and adults.
447	The geographic area must be of sufficient size in population and
448	have enough public funds for behavioral health services to allow
449	for flexibility and maximum efficiency. Notwithstanding the
450	provisions of s. 409.912(4)(3)(b)1. and 2., at least one service
451	delivery strategy must be in one of the service districts in the
452	catchment area of G. Pierce Wood Memorial Hospital.
453	(b) Under one of the service delivery strategies, the
454	Department of Children and Family Services may contract with a
455	prepaid mental health plan that operates under s. 409.912 to be
456	the managing entity. Under this strategy, the Department of
457	Children and Family Services is not required to competitively
458	procure those services and, notwithstanding other provisions of
459	law, may employ prospective payment methodologies that the
460	department finds are necessary to improve client care or
461	institute more efficient practices. The Department of Children
462	and Family Services may employ in its contract any provision of
463	the current prepaid behavioral health care plan authorized under
464	s. 409.912(4)(3)(a) and (b), or any other provision necessary to
465	improve quality, access, continuity, and price. Any contracts
466	under this strategy in Area 6 of the Agency for Health Care
467	Administration or in the prototype region under s. 20.19(7) of
468	the Department of Children and Family Services may be entered
469	with the existing substance abuse treatment provider network if
470	an administrative services organization is part of its network.
471	In Area 6 of the Agency for Health Care Administration or in the
472	prototype region of the Department of Children and Family
473	Services, the Department of Children and Family Services and the
474	Agency for Health Care Administration may employ alternative
475	service delivery and financing methodologies, which may include
476	prospective payment for certain population groups. The
477	population groups that are to be provided these substance abuse
478	services would include at a minimum: individuals and families
479	receiving family safety services; Medicaid-eligible children,
480	adolescents, and adults who are substance-abuse-impaired; or
481	current recipients and persons at risk of needing cash
482	assistance under Florida's welfare reform initiatives.
483	(e) The cost of the managing entity contract shall be
484	funded through a combination of funds from the Department of
485	Children and Family Services and the Agency for Health Care
486	Administration. To operate the managing entity, the Department
487	of Children and Family Services and the Agency for Health Care
488	Administration may not expend more than 10 percent of the annual
489	appropriations for mental health and substance abuse treatment
490	services prorated to the geographic areas and must include all
491	behavioral health Medicaid funds, including psychiatric
492	inpatient funds. This restriction does not apply to a prepaid
493	behavioral health plan that is authorized under s.
494	409.912(4)(3)(a) and (b).
495	(5) STATEWIDE ACTIONS.--If Medicaid appropriations for
496	Community Mental Health Services or Mental Health Targeted Case
497	Management are reduced in fiscal year 2001-2002,The agency and
498	the department shall jointly develop and implement strategies
499	that reduce service costs in a manner that mitigates the impact
500	on persons in need of those services. The agency and department
501	may employ any methodologies on a regional or statewide basis
502	necessary to achieve the reduction, including but not limited to
503	use of case rates, prepaid per capita contracts, utilization
504	management, expanded use of care management, use of waivers from
505	the Centers for Medicare and Medicaid ServicesHealth Care
506	Financing Administrationto maximize federal matching of current
507	local and state funding, modification or creation of additional
508	procedure codes, and certification of match or other management
509	techniques. The department may contract with a single managing
510	entity or provider network that shall be responsible for
511	delivering state-funded mental health services. The managing
512	entity shall coordinate its delivery of mental health and
513	substance abuse services with all prepaid mental health plans in
514	the region or the district. The department may include in its
515	contract with the managing entity data management and data
516	reporting requirements, and clinical, program management, and
517	administrative functions. Before the department contracts for
518	these functions with the provider network, the department shall
519	determine that the entity has the capacity and capability to
520	assume these functions. The roles and responsibilities of each
521	party must be clearly delineated in the contract.
522	Section 6. Subsection (2) of section 636.066, Florida
523	Statutes, is amended to read:
524	636.066 Taxes imposed.--
525	(2) Beginning January 1, 1994, the tax shall be imposed on
526	all premiums, contributions, and assessments for limited health
527	services. Payments made to a prepaid limited health services
528	organization by the Agency for Health Care Administration under
529	a contract entered into pursuant to s. 409.912(4)(b) for
530	comprehensive behavioral health care services that specifies a
531	minimum loss ratio do not constitute premiums, contributions, or
532	assessments for limited health services and are not subject to
533	the premium tax under s. 624.509. The Agency for Health Care
534	Administration shall provide the prepaid limited health services
535	organization with a certification letter indicating the amount
536	of premiums, capitation, and assessments it has paid during each
537	calendar year for such comprehensive behavioral health services.
538	Section 7. Subsection (7) of section 641.47, Florida
539	Statutes, is amended to read:
540	641.47 Definitions.--As used in this part, the term:
541	(7) “Emergency medical condition” means:
542	(a) A medical condition manifesting itself by acute
543	symptoms of sufficient severity, which may include severe pain
544	or other acute symptoms, such that the absence of immediate
545	medical attention could reasonably be expected to result in any
546	of the following:
547	1. Serious jeopardy to the health of a patient, including
548	a pregnant woman or a fetus.
549	2. Serious impairment to bodily functions.
550	3. Serious dysfunction of any bodily organ or part.
551	(b) With respect to a pregnant woman:
552	1. That there is inadequate time to effect safe transfer
553	to another hospital prior to delivery;
554	2. That a transfer may pose a threat to the health and
555	safety of the patient or fetus; or
556	3. That there is evidence of the onset and persistence of
557	uterine contractions or rupture of the membranes.
558	(c) A psychiatric condition manifested by acute symptoms
559	of psychiatric disturbance or substance abuse by a person in a
560	designated receiving facility under a court ex parte order for
561	examination or placed by an authorized party for involuntary
562	examination in accordance with s. 394.463.
563	Section 8. Subsection (4) of section 409.908, Florida
564	Statutes, is amended to read:
565	409.908 Reimbursement of Medicaid providers.--Subject to
566	specific appropriations, the agency shall reimburse Medicaid
567	providers, in accordance with state and federal law, according
568	to methodologies set forth in the rules of the agency and in
569	policy manuals and handbooks incorporated by reference therein.
570	These methodologies may include fee schedules, reimbursement
571	methods based on cost reporting, negotiated fees, competitive
572	bidding pursuant to s. 287.057, and other mechanisms the agency
573	considers efficient and effective for purchasing services or
574	goods on behalf of recipients. If a provider is reimbursed based
575	on cost reporting and submits a cost report late and that cost
576	report would have been used to set a lower reimbursement rate
577	for a rate semester, then the provider's rate for that semester
578	shall be retroactively calculated using the new cost report, and
579	full payment at the recalculated rate shall be affected
580	retroactively. Medicare-granted extensions for filing cost
581	reports, if applicable, shall also apply to Medicaid cost
582	reports. Payment for Medicaid compensable services made on
583	behalf of Medicaid eligible persons is subject to the
584	availability of moneys and any limitations or directions
585	provided for in the General Appropriations Act or chapter 216.
586	Further, nothing in this section shall be construed to prevent
587	or limit the agency from adjusting fees, reimbursement rates,
588	lengths of stay, number of visits, or number of services, or
589	making any other adjustments necessary to comply with the
590	availability of moneys and any limitations or directions
591	provided for in the General Appropriations Act, provided the
592	adjustment is consistent with legislative intent.
593	(4) Subject to any limitations or directions provided for
594	in the General Appropriations Act, alternative health plans,
595	health maintenance organizations, and prepaid health plans shall
596	be reimbursed a fixed, prepaid amount negotiated, or
597	competitively bid pursuant to s. 287.057, by the agency and
598	prospectively paid to the provider monthly for each Medicaid
599	recipient enrolled. The amount may not exceed the average amount
600	the agency determines it would have paid, based on claims
601	experience, for recipients in the same or similar category of
602	eligibility. The agency shall calculate capitation rates on a
603	regional basis and, beginning September 1, 1995, shall include
604	age-band differentials in such calculations. Effective July 1,
605	2001, the cost of exempting statutory teaching hospitals,
606	specialty hospitals, and community hospital education program
607	hospitals from reimbursement ceilings and the cost of special
608	Medicaid payments shall not be included in premiums paid to
609	health maintenance organizations or prepaid health care plans.
610	Each rate semester, the agency shall calculate and publish a
611	Medicaid hospital rate schedule that does not reflect either
612	special Medicaid payments or the elimination of rate
613	reimbursement ceilings, to be used by hospitals and Medicaid
614	health maintenance organizations, in order to determine the
615	Medicaid rate referred to in ss. 409.912(20)(17), 409.9128(5),
616	and 641.513(6).
617	Section 9. Subsections (1) and (2) of section 409.91196,
618	Florida Statutes, are amended to read:
619	409.91196 Supplemental rebate agreements; confidentiality
620	of records and meetings.--
621	(1) Trade secrets, rebate amount, percent of rebate,
622	manufacturer's pricing, and supplemental rebates which are
623	contained in records of the Agency for Health Care
624	Administration and its agents with respect to supplemental
625	rebate negotiations and which are prepared pursuant to a
626	supplemental rebate agreement under s. 409.912(40)(37)(a)7. are
627	confidential and exempt from s. 119.07 and s. 24(a), Art. I of
628	the State Constitution.
629	(2) Those portions of meetings of the Medicaid
630	Pharmaceutical and Therapeutics Committee at which trade
631	secrets, rebate amount, percent of rebate, manufacturer's
632	pricing, and supplemental rebates are disclosed for discussion
633	or negotiation of a supplemental rebate agreement under s.
634	409.912(40)(37)(a)7. are exempt from s. 286.011 and s. 24(b),
635	Art. I of the State Constitution.
636	Section 10. Paragraph (f) of subsection (2) of section
637	409.9122, Florida Statutes, is amended to read:
638	409.9122 Mandatory Medicaid managed care enrollment;
639	programs and procedures.--
640	(2)
641	(f) When a Medicaid recipient does not choose a managed
642	care plan or MediPass provider, the agency shall assign the
643	Medicaid recipient to a managed care plan or MediPass provider.
644	Medicaid recipients who are subject to mandatory assignment but
645	who fail to make a choice shall be assigned to managed care
646	plans until an enrollment of 45 percent in MediPass and 55
647	percent in managed care plans is achieved. Once this enrollment
648	is achieved, the assignments shall be divided in order to
649	maintain an enrollment in MediPass and managed care plans which
650	is in a 45 percent and 55 percent proportion, respectively.
651	Thereafter, assignment of Medicaid recipients who fail to make a
652	choice shall be based proportionally on the preferences of
653	recipients who have made a choice in the previous period. Such
654	proportions shall be revised at least quarterly to reflect an
655	update of the preferences of Medicaid recipients. The agency
656	shall disproportionately assign Medicaid-eligible recipients who
657	are required to but have failed to make a choice of managed care
658	plan or MediPass, including children, and who are to be assigned
659	to the MediPass program to children's networks as described in
660	s. 409.912(4)(3)(g), Children's Medical Services network as
661	defined in s. 391.021, exclusive provider organizations,
662	provider service networks, minority physician networks, and
663	pediatric emergency department diversion programs authorized by
664	this chapter or the General Appropriations Act, in such manner
665	as the agency deems appropriate, until the agency has determined
666	that the networks and programs have sufficient numbers to be
667	economically operated. For purposes of this paragraph, when
668	referring to assignment, the term "managed care plans" includes
669	health maintenance organizations, exclusive provider
670	organizations, provider service networks, minority physician
671	networks, Children's Medical Services network, and pediatric
672	emergency department diversion programs authorized by this
673	chapter or the General Appropriations Act. Beginning July 1,
674	2002, the agency shall assign all children in families who have
675	not made a choice of a managed care plan or MediPass in the
676	required timeframe to a pediatric emergency room diversion
677	program described in s. 409.912(4)(3)(g) that, as of July 1,
678	2002, has executed a contract with the agency, until such
679	network or program has reached an enrollment of 15,000 children.
680	Once that minimum enrollment level has been reached, the agency
681	shall assign children who have not chosen a managed care plan or
682	MediPass to the network or program in a manner that maintains
683	the minimum enrollment in the network or program at not less
684	than 15,000 children. To the extent practicable, the agency
685	shall also assign all eligible children in the same family to
686	such network or program. When making assignments, the agency
687	shall take into account the following criteria:
688	1. A managed care plan has sufficient network capacity to
689	meet the need of members.
690	2. The managed care plan or MediPass has previously
691	enrolled the recipient as a member, or one of the managed care
692	plan's primary care providers or MediPass providers has
693	previously provided health care to the recipient.
694	3. The agency has knowledge that the member has previously
695	expressed a preference for a particular managed care plan or
696	MediPass provider as indicated by Medicaid fee-for-service
697	claims data, but has failed to make a choice.
698	4. The managed care plan's or MediPass primary care
699	providers are geographically accessible to the recipient's
700	residence.
701	Section 11. Section 636.0145, Florida Statutes, is amended
702	to read:
703	636.0145 Certain entities contracting with
704	Medicaid.--Notwithstanding the requirements of s.
705	409.912(4)(3)(b), an entity that is providing comprehensive
706	inpatient and outpatient mental health care services to certain
707	Medicaid recipients in Hillsborough, Highlands, Hardee, Manatee,
708	and Polk Counties through a capitated, prepaid arrangement
709	pursuant to the federal waiver provided for in s. 409.905(5)
710	must become licensed under chapter 636 by December 31, 1998. Any
711	entity licensed under this chapter which provides services
712	solely to Medicaid recipients under a contract with Medicaid
713	shall be exempt from ss. 636.017, 636.018, 636.022, 636.028, and
714	636.034.
715	Section 12. Subsection (3) of section 641.225, Florida
716	Statutes, is amended to read:
717	641.225 Surplus requirements.--
718	(3)(a) An entity providing prepaid capitated services
719	which is authorized under s. 409.912(4)(3)(a) and which applies
720	for a certificate of authority is subject to the minimum surplus
721	requirements set forth in subsection (1), unless the entity is
722	backed by the full faith and credit of the county in which it is
723	located.
724	(b) An entity providing prepaid capitated services which
725	is authorized under s. 409.912(4)(3)(b) or (c), and which
726	applies for a certificate of authority is subject to the minimum
727	surplus requirements set forth in s. 409.912.
728	Section 13. Subsection (4) of section 641.386, Florida
729	Statutes, is amended to read:
730	641.386 Agent licensing and appointment required;
731	exceptions.--
732	(4) All agents and health maintenance organizations shall
733	comply with and be subject to the applicable provisions of ss.
734	641.309 and 409.912(22)(19), and all companies and entities
735	appointing agents shall comply with s. 626.451, when marketing
736	for any health maintenance organization licensed pursuant to
737	this part, including those organizations under contract with the
738	Agency for Health Care Administration to provide health care
739	services to Medicaid recipients or any private entity providing
740	health care services to Medicaid recipients pursuant to a
741	prepaid health plan contract with the Agency for Health Care
742	Administration.
743	Section 14. This act shall take effect upon becoming a
744	law.