HB 0433 2003
1	CHAMBER ACTION
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6	The Committee on Appropriations recommends the following:
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8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to behavioral health; amending s. 20.19,
12	F.S.; requiring the Secretary of Children and Family
13	Services to appoint an assistant secretary for behavioral
14	health services; providing responsibilities of the
15	assistant secretary; providing for the appointment of a
16	Director of Mental Health Services; providing duties of
17	the director; providing for the appointment of a Director
18	of Substance Abuse Services; providing duties of the
19	director; creating s. 394.655, F.S.; providing for the
20	establishment of the Behavioral Health Services Board;
21	providing membership of the board; providing for powers
22	and duties and responsibilities of the board; providing
23	for an annual evaluation and report; providing for an
24	independent evaluation of substance abuse and mental
25	health programs by the Office of Program Policy Analysis
26	and Government Accountability and the Auditor General;
27	requiring a report; providing for the expiration of the
28	board; amending s. 409.912, F.S.; requiring the Agency for
29	Health Care Administration to seek federal approval to
30	contract with a single entity to provide comprehensive
31	behavioral health care services to Medicaid recipients;
32	requiring the agency and the Department of Children and
33	Family Services to execute a written agreement by a
34	specified date; requiring the agency to contract with
35	specified managed care entities to provide comprehensive
36	inpatient and outpatient mental health and substance abuse
37	services through capitated prepaid arrangements to
38	Medicaid recipients; providing requirements with respect
39	to such contracts; requiring the agency to submit a plan
40	for the full implementation of capitated prepaid
41	behavioral health care in all areas of the state;
42	providing plan requirements; excluding children residing
43	in specified residential programs of the Department of
44	Children and Family Services from the behavioral health
45	care prepaid health plan; allowing child welfare providers
46	to participate in the network for prepaid behavioral
47	health services; requiring the agency and the department
48	to develop a plan for implementing new Medicaid procedure
49	codes for specified services; providing plan requirements;
50	requiring approval of the plan by the Legislative Budget
51	Commission prior to implementation; amending s. 394.741,
52	F.S.; providing rights of the department and the agency to
53	monitor for a specified purpose; providing authority of
54	the department with respect to investigation of complaints
55	and monitoring of providers' compliance; requiring the
56	department to file a State Projects Compliance Supplement
57	for behavioral health care services; providing
58	requirements with respect to the monitoring of financial
59	operations of contractors; amending s. 394.9082, F.S.;
60	authorizing the department to contract with a single
61	managing entity or provider network for the delivery of
62	state-funded mental health services; requiring the
63	managing entity to coordinate its delivery of mental
64	health and substance abuse services with all prepaid
65	mental health plans in the region or the district;
66	providing contract requirements; correcting cross
67	references; amending s. 636.066, F.S.; providing that
68	payments made to a prepaid limited health services
69	organization by the Agency for Health Care Administration
70	under a contract to provide comprehensive behavioral
71	health care services to Medicaid recipients are not
72	subject to the insurance premium tax; requiring the agency
73	to provide the prepaid limited health services
74	organization with a specified certification letter;
75	amending ss. 409.908, 409.91196, 409.9122, 636.0145,
76	641.225, and 641.386, F.S.; correcting cross references;
77	providing an effective date.
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79	Be It Enacted by the Legislature of the State of Florida:
80
81	Section 1. Subsection (2) of section 20.19, Florida
82	Statutes, is amended to read:
83	20.19 Department of Children and Family Services.--There
84	is created a Department of Children and Family Services.
85	(2) SECRETARY OF CHILDREN AND FAMILY SERVICES; DEPUTY
86	SECRETARY.--
87	(a) The head of the department is the Secretary of
88	Children and Family Services. The secretary is appointed by the
89	Governor, subject to confirmation by the Senate. The secretary
90	serves at the pleasure of the Governor.
91	(b) The secretary shall appoint a deputy secretary who
92	shall act in the absence of the secretary. The deputy secretary
93	is directly responsible to the secretary, performs such duties
94	as are assigned by the secretary, and serves at the pleasure of
95	the secretary.
96	(c) The secretary shall appoint an assistant secretary for
97	behavioral health services to manage behavioral health services.
98	The assistant secretary for behavioral health services shall
99	have responsibility and authority for all of the programs,
100	services, functions, and duties included in chapters 394 and
101	397.
102	1. The secretary shall appoint a Director of Mental Health
103	Services and a Director of Substance Abuse Services.
104	2. The Director of Mental Health Services shall directly
105	administer all mental health programs, staff, budgets, duties,
106	and functions of the mental health program and shall be
107	responsible to the assistant secretary for behavioral health
108	services; the Director of Substance Abuse Services shall
109	directly administer all of the programs, staff, budgets, duties,
110	and functions of the substance abuse program and shall be
111	responsible to the assistant secretary for behavioral health
112	services.
113	3. The assistant secretary shall serve at the pleasure of
114	the secretary.
115	(d) The secretary shall appoint the directors or executive
116	directors of any commission or council assigned to the
117	department. Directors and executive directors shall serve at the
118	pleasure of the secretary as provided for division directors in
119	s.
120	(e)(c)The secretary has the authority and responsibility
121	to ensure that the mission of the department is fulfilled in
122	accordance with state and federal laws, rules, and regulations.
123	Section 2. Section 394.655, Florida Statutes, is created
124	to read:
125	394.655 Behavioral Health Services Board; powers and
126	duties; composition.--
127	(1) The Behavioral Health Services Board shall be
128	comprised of 11 members. Each member shall be appointed for a
129	2-year term. No member shall be reappointed for more than two
130	subsequent terms. Five members shall be appointed by the
131	Governor, three members shall be appointed by the President of
132	the Senate, and three members shall be appointed by the Speaker
133	of the House of Representatives.
134	(a) Of the five members appointed by the Governor, three
135	must be prominent community leaders with an interest in
136	substance abuse and two must be prominent community leaders with
137	an interest in mental health.
138	(b) Of the three members appointed by the President of the
139	Senate, one must be a consumer of publicly-funded mental health
140	services or a family member of a consumer, one must be a
141	community leader who has an interest in substance abuse, and one
142	must be a community leader who an has interest in mental health.
143	(c) Of the three members appointed by the Speaker of the
144	House of Representatives, one must be a parent or a guardian of
145	a child receiving publicly-funded mental health or substance
146	abuse services and two shall be prominent community leaders, one
147	of whom is involved in the judiciary or criminal justice system
148	and one of whom is involved in child welfare community-based
149	care.
150	(2) The director of the Medicaid program, the Assistant
151	Secretary for Behavioral Health Services of the department, and
152	a representative of county government shall serve as ex officio
153	members of the board.
154	(3) Members of the board shall serve without compensation
155	but are entitled to reimbursement for travel and per diem
156	expenses pursuant to s. 112.061.
157	(4) Persons who derive their income from resources
158	controlled by the department or the agency are ineligible for
159	membership on the board.
160	(5) Subject to and consistent with direction set by the
161	Legislature, the board shall exercise the following
162	responsibilities:
163	(a) Request and review the collection and analysis of
164	needs assessment data as described in s. 394.82.
165	(b) Review the status of publicly funded mental health and
166	substance abuse systems and recommend to the secretary of the
167	department and the secretary of the agency policy designed to
168	improve coordination and effectiveness.
169	(c) Provide mechanisms for substance abuse and mental
170	health stakeholders, including consumers, family members,
171	providers, and advocates, to provide input concerning the
172	management of the system.
173	(d) Recommend priorities for service expansion to the
174	department and the agency.
175	(e) Prepare a proposed behavioral health legislative
176	budget request and submit the budget request to the secretary
177	with a copy to the Governor, the President of the Senate, and
178	the Speaker of the House of Representatives. The secretary
179	shall submit the department’s legislative budget request to the
180	Governor in accordance with s. 216.023.
181	(f) Review performance data prepared by the department and
182	the agency.
183	(g) Make policy recommendations to the secretary of the
184	department and the secretary of the agency concerning strategies
185	for improving the performance of the system.
186	(h) Review and forecast substance abuse and mental health
187	staffing needs and recommend to the secretary of the department
188	and the Commissioner of Education policies that continuously
189	improve the quality and availability of staff.
190	(6) The board shall work with the department and the
191	agency to ensure, to the maximum extent possible, that Medicaid
192	and department-funded services are delivered in a coordinated
193	manner using common service definitions, standards, and
194	accountability mechanisms.
195	(7) The memorandum shall include a description of how the
196	department will support the board and respond to its requests
197	for information.
198	(8) The board must annually evaluate and, in December of
199	each year, report to the Legislature and the Governor on the
200	status of the state’s publicly-funded substance abuse and mental
201	health systems. The board’s first report must be submitted in
202	December 2004. Each public sector agency that delivers, or
203	contracts for the provision of, substance abuse or mental health
204	services must cooperate with the board in the development of
205	this annual evaluation and report.
206	(9) This section shall expire on October 1, 2006, unless
207	reviewed and reenacted by the Legislature before that date. The
208	Office of Program Policy Analysis and Government Accountability
209	and the Auditor General shall conduct an independent evaluation
210	of the effectiveness of the substance abuse and mental health
211	programs. The evaluation must include, but need not be limited
212	to, the operation of the board and the organization of programs
213	within the department. A report that includes recommendations
214	relating to the continuation of the board and the organizational
215	arrangement of the programs must be submitted by the Executive
216	Office of the Governor to the President of the Senate and the
217	Speaker of the House of Representatives by January 1, 2006.
218	Section 3. Subsections (1) and (2) of section 409.912,
219	Florida Statutes, are renumbered as subsections (2) and (3),
220	respectively, subsection (3) is renumbered as subsection (4) and
221	paragraphs (b) and (c) of said subsection are amended,
222	subsection (19) is renumbered as subsection (21) and paragraph
223	(c) of said subsection is amended, subsection (27) is renumbered
224	as subsection (29) and amended, present subsections (4) through
225	(18) are renumbered as subsections (6) through (20),
226	respectively, present subsections (20) through (26) are
227	renumbered as subsections (22) through (28), respectively,
228	present subsections (28) through (40) are renumbered as
229	subsections (30) through (42), respectively, and new subsections
230	(1) and (5) are added to said section, to read:
231	409.912 Cost-effective purchasing of health care.--The
232	agency shall purchase goods and services for Medicaid recipients
233	in the most cost-effective manner consistent with the delivery
234	of quality medical care. The agency shall maximize the use of
235	prepaid per capita and prepaid aggregate fixed-sum basis
236	services when appropriate and other alternative service delivery
237	and reimbursement methodologies, including competitive bidding
238	pursuant to s. 287.057, designed to facilitate the cost-
239	effective purchase of a case-managed continuum of care. The
240	agency shall also require providers to minimize the exposure of
241	recipients to the need for acute inpatient, custodial, and other
242	institutional care and the inappropriate or unnecessary use of
243	high-cost services. The agency may establish prior authorization
244	requirements for certain populations of Medicaid beneficiaries,
245	certain drug classes, or particular drugs to prevent fraud,
246	abuse, overuse, and possible dangerous drug interactions. The
247	Pharmaceutical and Therapeutics Committee shall make
248	recommendations to the agency on drugs for which prior
249	authorization is required. The agency shall inform the
250	Pharmaceutical and Therapeutics Committee of its decisions
251	regarding drugs subject to prior authorization.
252	(1) The agency shall work with the Department of Children
253	and Family Services to ensure access of children and families in
254	the child protection system to needed and appropriate mental
255	health and substance abuse services.
256	(4)(3)The agency may contract with:
257	(b) An entity that is providing comprehensive behavioral
258	health care services to certain Medicaid recipients through a
259	capitated, prepaid arrangement pursuant to the federal waiver
260	provided for by s. 409.905(5). Such an entity must be licensed
261	under chapter 624, chapter 636, or chapter 641 and must possess
262	the clinical systems and operational competence to manage risk
263	and provide comprehensive behavioral health care to Medicaid
264	recipients. As used in this paragraph, the term "comprehensive
265	behavioral health care services" means covered mental health and
266	substance abuse treatment services that are available to
267	Medicaid recipients. The Secretary of the Department of Children
268	and Family Services shall approve provisions of procurements
269	related to children in the department's care or custody prior to
270	enrolling such children in a prepaid behavioral health plan. Any
271	contract awarded under this paragraph must be competitively
272	procured. In developing the behavioral health care prepaid plan
273	procurement document, the agency shall ensure that the
274	procurement document requires the contractor to develop and
275	implement a plan to ensure compliance with s. 394.4574 related
276	to services provided to residents of licensed assisted living
277	facilities that hold a limited mental health license. The
278	agency shall seek federal approval to contract with a single
279	entity meeting these requirements to provide comprehensive
280	behavioral health care services to all Medicaid recipients in a
281	group of districts or counties. Each entity must offer
282	sufficient choices of providers in its network to ensure
283	recipient access to care and the opportunity to select a
284	provider with whom the recipient is satisfied.The agency must
285	ensure that Medicaid recipients have available the choice of at
286	least two managed care plans for their behavioral health care
287	services.To ensure unimpaired access to behavioral health care
288	services by Medicaid recipients, all contracts issued pursuant
289	to this paragraph shall require 80 percent of the capitation
290	paid to the managed care plan, including health maintenance
291	organizations, to be expended for the provision of behavioral
292	health care services. In the event the managed care plan expends
293	less than 80 percent of the capitation paid pursuant to this
294	paragraph for the provision of behavioral health care services,
295	the difference shall be returned to the agency. The agency shall
296	provide the managed care plan with a certification letter
297	indicating the amount of capitation paid during each calendar
298	year for the provision of behavioral health care services
299	pursuant to this section. The agency may reimburse for
300	substance-abuse-treatment services on a fee-for-service basis
301	until the agency finds that adequate funds are available for
302	capitated, prepaid arrangements.
303	1. By January 1, 2001, the agency shall modify the
304	contracts with the entities providing comprehensive inpatient
305	and outpatient mental health care services to Medicaid
306	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
307	Counties, to include substance-abuse-treatment services.
308	2. By July 1, 2003, the agency and the Department of
309	Children and Family Services shall execute a written agreement
310	that requires collaboration and joint development of all
311	policies, budgets, procurement documents, contracts, and
312	monitoring plans that have an impact on the state and Medicaid
313	community mental health and targeted case management programs.
314	3. By July 1, 2006, the agency shall contract with managed
315	care entities in each AHCA area except area 6 to provide
316	comprehensive inpatient and outpatient mental health and
317	substance abuse services through capitated prepaid arrangements
318	to all Medicaid recipients for whom such plans are allowable
319	under federal law and regulation. In AHCA areas where eligible
320	individuals number less than 150,000, the agency shall contract
321	with a single managed care plan. The agency shall contract with
322	more than one plan in AHCA areas where the eligible population
323	exceeds 150,000. Contracts awarded pursuant to this section
324	shall be competitively procured. For profit and not-for-profit
325	corporations shall be eligible to compete.
326	4. By January 1, 2004, the agency and the department shall
327	submit a plan to the Governor, the President of the Senate, and
328	the Speaker of the House of Representatives for review and
329	approval that provides for the full implementation of capitated
330	prepaid behavioral health care in all areas of the state.
331
332	The plan shall include provisions which ensure that children and
333	families receiving foster care and other related services are
334	appropriately served and that these services assist the
335	community-based care lead agencies in meeting the goals and
336	outcomes of the child welfare system. The plan shall be
337	developed with the participation of community-based care lead
338	agencies, community alliances, sheriffs, and community providers
339	serving dependent children.
340	2. By December 31, 2001, the agency shall contract with
341	entities providing comprehensive behavioral health care services
342	to Medicaid recipients through capitated, prepaid arrangements
343	in Charlotte, Collier, DeSoto, Escambia, Glades, Hendry, Lee,
344	Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota, and Walton
345	Counties. The agency may contract with entities providing
346	comprehensive behavioral health care services to Medicaid
347	recipients through capitated, prepaid arrangements in Alachua
348	County. The agency may determine if Sarasota County shall be
349	included as a separate catchment area or included in any other
350	agency geographic area.
351	4.3. Children residing in a Department of Juvenile Justice
352	or Department of Children and Family Servicesresidential
353	program approved as a Medicaid behavioral health overlay
354	services provider shall not be included in a behavioral health
355	care prepaid health plan pursuant to this paragraph.
356	5.4.In converting to a prepaid system of delivery, the
357	agency shall in its procurement document require an entity
358	providing comprehensive behavioral health care services to
359	prevent the displacement of indigent care patients by enrollees
360	in the Medicaid prepaid health plan providing behavioral health
361	care services from facilities receiving state funding to provide
362	indigent behavioral health care, to facilities licensed under
363	chapter 395 which do not receive state funding for indigent
364	behavioral health care, or reimburse the unsubsidized facility
365	for the cost of behavioral health care provided to the displaced
366	indigent care patient.
367	6.5.Traditional community mental health providers under
368	contract with the Department of Children and Family Services
369	pursuant to part IV of chapter 394, child welfare providers
370	under contract with the Department of Children and Family
371	Services,and inpatient mental health providers licensed
372	pursuant to chapter 395 must be offered an opportunity to accept
373	or decline a contract to participate in any provider network for
374	prepaid behavioral health services.
375	(c) A federally qualified health center or an entity owned
376	by one or more federally qualified health centers or an entity
377	owned by other migrant and community health centers receiving
378	non-Medicaid financial support from the Federal Government to
379	provide health care services on a prepaid or fixed-sum basis to
380	recipients. Such prepaid health care services entity must be
381	licensed under parts I and III of chapter 641, but shall be
382	prohibited from serving Medicaid recipients on a prepaid basis,
383	until such licensure has been obtained. However, such an entity
384	is exempt from s. 641.225 if the entity meets the requirements
385	specified in subsections (16)(14) and (17)(15).
386	(5) By October 1, 2003, the agency and the department
387	shall, to the extent feasible, develop a plan for implementing
388	new Medicaid procedure codes for emergency and crisis care,
389	supportive residential services, and other services designed to
390	maximize the use of Medicaid funds for Medicaid-eligible
391	recipients. The agency shall include in the agreement developed
392	pursuant to subsection (4), a provision that ensures that the
393	match requirements for these new procedure codes are met by
394	certifying eligible general revenue or local funds that are
395	currently expended on these services by the department with
396	contracted alcohol, drug abuse, and mental health providers.
397	The plan must describe specific procedure codes to be
398	implemented, a projection of the number of procedures to be
399	delivered during fiscal year 2003-2004, and a financial analysis
400	which describes the certified match procedures and
401	accountability mechanisms, projects the earnings associated with
402	these procedures, and describes the sources of state match.
403	This plan shall not be implemented in any part until approved by
404	the Legislative Budget Commission. If such approval has not
405	occurred by December 31, 2003, the plan shall be submitted for
406	consideration by the 2004 Legislature.
407	(21)(19)Any entity contracting with the agency pursuant
408	to this section to provide health care services to Medicaid
409	recipients is prohibited from engaging in any of the following
410	practices or activities:
411	(c) Granting or offering of any monetary or other valuable
412	consideration for enrollment, except as authorized by subsection
413	(23)(21).
414	(29)(27)The agency shall perform enrollments and
415	disenrollments for Medicaid recipients who are eligible for
416	MediPass or managed care plans. Notwithstanding the prohibition
417	contained in paragraph (20)(18)(f), managed care plans may
418	perform preenrollments of Medicaid recipients under the
419	supervision of the agency or its agents. For the purposes of
420	this section, "preenrollment" means the provision of marketing
421	and educational materials to a Medicaid recipient and assistance
422	in completing the application forms, but shall not include
423	actual enrollment into a managed care plan. An application for
424	enrollment shall not be deemed complete until the agency or its
425	agent verifies that the recipient made an informed, voluntary
426	choice. The agency, in cooperation with the Department of
427	Children and Family Services, may test new marketing initiatives
428	to inform Medicaid recipients about their managed care options
429	at selected sites. The agency shall report to the Legislature on
430	the effectiveness of such initiatives. The agency may contract
431	with a third party to perform managed care plan and MediPass
432	enrollment and disenrollment services for Medicaid recipients
433	and is authorized to adopt rules to implement such services. The
434	agency may adjust the capitation rate only to cover the costs of
435	a third-party enrollment and disenrollment contract, and for
436	agency supervision and management of the managed care plan
437	enrollment and disenrollment contract.
438	Section 4. Subsection (6) of section 394.741, Florida
439	Statutes, is amended, new subsections (7) and (8) are added to
440	said section, and present subsections (7) and (8) are renumbered
441	as subsections (9) and (10), respectively, to read:
442	394.741 Accreditation requirements for providers of
443	behavioral health care services.--
444	(6) The department or agency, by accepting the survey or
445	inspection of an accrediting organization, does not forfeit its
446	rights to monitor for the purpose of ensuring that services for
447	which the department has paid are provided. The department is
448	authorized to investigate complaints or suspected problems and
449	to monitor the provider’s compliance with negotiated terms and
450	conditions, including provisions relating to consent decrees
451	that are unique to a specific contract and are not statements of
452	general applicability. The department may monitor compliance
453	with federal and state statutes, federal regulations, or state
454	administrative rules, provided such monitoring does not
455	duplicate the review of accreditation standards or independent
456	audits pursuant to subsections (3) and (8)to perform
457	inspections at any time, including contract monitoring to ensure
458	that deliverables are provided in accordance with the contract.
459	(7) For the purposes of licensure and monitoring of
460	facilities under contract with the department, the department
461	shall rely only upon properly adopted and applicable federal and
462	state statutes and rules.
463	(8) The department shall file a State Projects Compliance
464	Supplement pursuant to s. 215.97 for behavioral health care
465	services. In monitoring the financial operations of its
466	contractors, the department shall rely upon certified public
467	accountant audits, if required. The department shall perform a
468	desk review of its contractors’ most recent independent audit
469	and may conduct onsite monitoring only of problems identified by
470	these audits, or by other sources of information documenting
471	problems with contractors’ financial management. Certified
472	public accountants employed by the department may conduct an on-
473	site test of the validity of a contractor’s independent audit
474	every third year.
475	(9)(7)The department and the agency shall report to the
476	Legislature by January 1, 2003, on the viability of mandating
477	all organizations under contract with the department for the
478	provision of behavioral health care services, or licensed by the
479	agency or department to be accredited. The department and the
480	agency shall also report to the Legislature by January 1, 2003,
481	on the viability of privatizing all licensure and monitoring
482	functions through an accrediting organization.
483	(10)(8)The accreditation requirements of this section
484	shall apply to contracted organizations that are already
485	accredited immediately upon becoming law.
486	Section 5. Paragraphs (a), (b), and (e) of subsection (4)
487	and subsection (5) of section 394.9082, Florida Statutes, are
488	amended to read:
489	394.9082 Behavioral health service delivery strategies.--
490	(4) CONTRACT FOR SERVICES.--
491	(a) The Department of Children and Family Services and the
492	Agency for Health Care Administration may contract for the
493	provision or management of behavioral health services with a
494	managing entity in at least two geographic areas. Both the
495	Department of Children and Family Services and the Agency for
496	Health Care Administration must contract with the same managing
497	entity in any distinct geographic area where the strategy
498	operates. This managing entity shall be accountable for the
499	delivery of behavioral health services specified by the
500	department and the agency for children, adolescents, and adults.
501	The geographic area must be of sufficient size in population and
502	have enough public funds for behavioral health services to allow
503	for flexibility and maximum efficiency. Notwithstanding the
504	provisions of s. 409.912(4)(3)(b)1. and 2., at least one service
505	delivery strategy must be in one of the service districts in the
506	catchment area of G. Pierce Wood Memorial Hospital.
507	(b) Under one of the service delivery strategies, the
508	Department of Children and Family Services may contract with a
509	prepaid mental health plan that operates under s. 409.912 to be
510	the managing entity. Under this strategy, the Department of
511	Children and Family Services is not required to competitively
512	procure those services and, notwithstanding other provisions of
513	law, may employ prospective payment methodologies that the
514	department finds are necessary to improve client care or
515	institute more efficient practices. The Department of Children
516	and Family Services may employ in its contract any provision of
517	the current prepaid behavioral health care plan authorized under
518	s. 409.912(4)(3)(a) and (b), or any other provision necessary to
519	improve quality, access, continuity, and price. Any contracts
520	under this strategy in Area 6 of the Agency for Health Care
521	Administration or in the prototype region under s. 20.19(7) of
522	the Department of Children and Family Services may be entered
523	with the existing substance abuse treatment provider network if
524	an administrative services organization is part of its network.
525	In Area 6 of the Agency for Health Care Administration or in the
526	prototype region of the Department of Children and Family
527	Services, the Department of Children and Family Services and the
528	Agency for Health Care Administration may employ alternative
529	service delivery and financing methodologies, which may include
530	prospective payment for certain population groups. The
531	population groups that are to be provided these substance abuse
532	services would include at a minimum: individuals and families
533	receiving family safety services; Medicaid-eligible children,
534	adolescents, and adults who are substance-abuse-impaired; or
535	current recipients and persons at risk of needing cash
536	assistance under Florida's welfare reform initiatives.
537	(e) The cost of the managing entity contract shall be
538	funded through a combination of funds from the Department of
539	Children and Family Services and the Agency for Health Care
540	Administration. To operate the managing entity, the Department
541	of Children and Family Services and the Agency for Health Care
542	Administration may not expend more than 10 percent of the annual
543	appropriations for mental health and substance abuse treatment
544	services prorated to the geographic areas and must include all
545	behavioral health Medicaid funds, including psychiatric
546	inpatient funds. This restriction does not apply to a prepaid
547	behavioral health plan that is authorized under s.
548	409.912(4)(3)(a) and(b).
549	(5) STATEWIDE ACTIONS.--If Medicaid appropriations for
550	Community Mental Health Services or Mental Health Targeted Case
551	Management are reduced in fiscal year 2001-2002,The agency and
552	the department shall jointly develop and implement strategies
553	that reduce service costs in a manner that mitigates the impact
554	on persons in need of those services. The agency and department
555	may employ any methodologies on a regional or statewide basis
556	necessary to achieve the reduction, including but not limited to
557	use of case rates, prepaid per capita contracts, utilization
558	management, expanded use of care management, use of waivers from
559	the Centers for Medicare and Medicaid ServicesHealth Care
560	Financing Administrationto maximize federal matching of current
561	local and state funding, modification or creation of additional
562	procedure codes, and certification of match or other management
563	techniques. The department may contract with a single managing
564	entity or provider network that shall be responsible for
565	delivering state-funded mental health services. The managing
566	entity shall coordinate its delivery of mental health and
567	substance abuse services with all prepaid mental health plans in
568	the region or the district. The department may include in its
569	contract with the managing entity data management and data
570	reporting requirements, and clinical, program management, and
571	administrative functions. Before the department contracts for
572	these functions with the provider network, the department shall
573	determine that the entity has the capacity and capability to
574	assume these functions. The roles and responsibilities of each
575	party must be clearly delineated in the contract.
576	Section 6. Subsection (2) of section 636.066, Florida
577	Statutes, is amended to read:
578	636.066 Taxes imposed.--
579	(2) Beginning January 1, 1994, the tax shall be imposed on
580	all premiums, contributions, and assessments for limited health
581	services. Payments made to a prepaid limited health services
582	organization by the Agency for Health Care Administration under
583	a contract entered into pursuant to s. 409.912(4)(b) for
584	comprehensive behavioral health care services that specifies a
585	minimum loss ratio do not constitute premiums, contributions, or
586	assessments for limited health services and are not subject to
587	the premium tax under s. 624.509. The Agency for Health Care
588	Administration shall provide the prepaid limited health services
589	organization with a certification letter indicating the amount
590	of premiums, capitation, and assessments it has paid during each
591	calendar year for such comprehensive behavioral health services.
592	Section 7. Subsection (4) of section 409.908, Florida
593	Statutes, is amended to read:
594	409.908 Reimbursement of Medicaid providers.--Subject to
595	specific appropriations, the agency shall reimburse Medicaid
596	providers, in accordance with state and federal law, according
597	to methodologies set forth in the rules of the agency and in
598	policy manuals and handbooks incorporated by reference therein.
599	These methodologies may include fee schedules, reimbursement
600	methods based on cost reporting, negotiated fees, competitive
601	bidding pursuant to s. 287.057, and other mechanisms the agency
602	considers efficient and effective for purchasing services or
603	goods on behalf of recipients. If a provider is reimbursed based
604	on cost reporting and submits a cost report late and that cost
605	report would have been used to set a lower reimbursement rate
606	for a rate semester, then the provider's rate for that semester
607	shall be retroactively calculated using the new cost report, and
608	full payment at the recalculated rate shall be affected
609	retroactively. Medicare-granted extensions for filing cost
610	reports, if applicable, shall also apply to Medicaid cost
611	reports. Payment for Medicaid compensable services made on
612	behalf of Medicaid eligible persons is subject to the
613	availability of moneys and any limitations or directions
614	provided for in the General Appropriations Act or chapter 216.
615	Further, nothing in this section shall be construed to prevent
616	or limit the agency from adjusting fees, reimbursement rates,
617	lengths of stay, number of visits, or number of services, or
618	making any other adjustments necessary to comply with the
619	availability of moneys and any limitations or directions
620	provided for in the General Appropriations Act, provided the
621	adjustment is consistent with legislative intent.
622	(4) Subject to any limitations or directions provided for
623	in the General Appropriations Act, alternative health plans,
624	health maintenance organizations, and prepaid health plans shall
625	be reimbursed a fixed, prepaid amount negotiated, or
626	competitively bid pursuant to s. 287.057, by the agency and
627	prospectively paid to the provider monthly for each Medicaid
628	recipient enrolled. The amount may not exceed the average amount
629	the agency determines it would have paid, based on claims
630	experience, for recipients in the same or similar category of
631	eligibility. The agency shall calculate capitation rates on a
632	regional basis and, beginning September 1, 1995, shall include
633	age-band differentials in such calculations. Effective July 1,
634	2001, the cost of exempting statutory teaching hospitals,
635	specialty hospitals, and community hospital education program
636	hospitals from reimbursement ceilings and the cost of special
637	Medicaid payments shall not be included in premiums paid to
638	health maintenance organizations or prepaid health care plans.
639	Each rate semester, the agency shall calculate and publish a
640	Medicaid hospital rate schedule that does not reflect either
641	special Medicaid payments or the elimination of rate
642	reimbursement ceilings, to be used by hospitals and Medicaid
643	health maintenance organizations, in order to determine the
644	Medicaid rate referred to in ss. 409.912(19)(17), 409.9128(5),
645	and 641.513(6).
646	Section 8. Subsections (1) and (2) of section 409.91196,
647	Florida Statutes, are amended to read:
648	409.91196 Supplemental rebate agreements; confidentiality
649	of records and meetings.--
650	(1) Trade secrets, rebate amount, percent of rebate,
651	manufacturer's pricing, and supplemental rebates which are
652	contained in records of the Agency for Health Care
653	Administration and its agents with respect to supplemental
654	rebate negotiations and which are prepared pursuant to a
655	supplemental rebate agreement under s. 409.912(39)(37)(a)7. are
656	confidential and exempt from s. 119.07 and s. 24(a), Art. I of
657	the State Constitution.
658	(2) Those portions of meetings of the Medicaid
659	Pharmaceutical and Therapeutics Committee at which trade
660	secrets, rebate amount, percent of rebate, manufacturer's
661	pricing, and supplemental rebates are disclosed for discussion
662	or negotiation of a supplemental rebate agreement under s.
663	409.912(39)(37)(a)7. are exempt from s. 286.011 and s. 24(b),
664	Art. I of the State Constitution.
665	Section 9. Paragraph (f) of subsection (2) of section
666	409.9122, Florida Statutes, is amended to read:
667	409.9122 Mandatory Medicaid managed care enrollment;
668	programs and procedures.--
669	(2)
670	(f) When a Medicaid recipient does not choose a managed
671	care plan or MediPass provider, the agency shall assign the
672	Medicaid recipient to a managed care plan or MediPass provider.
673	Medicaid recipients who are subject to mandatory assignment but
674	who fail to make a choice shall be assigned to managed care
675	plans until an enrollment of 45 percent in MediPass and 55
676	percent in managed care plans is achieved. Once this enrollment
677	is achieved, the assignments shall be divided in order to
678	maintain an enrollment in MediPass and managed care plans which
679	is in a 45 percent and 55 percent proportion, respectively.
680	Thereafter, assignment of Medicaid recipients who fail to make a
681	choice shall be based proportionally on the preferences of
682	recipients who have made a choice in the previous period. Such
683	proportions shall be revised at least quarterly to reflect an
684	update of the preferences of Medicaid recipients. The agency
685	shall disproportionately assign Medicaid-eligible recipients who
686	are required to but have failed to make a choice of managed care
687	plan or MediPass, including children, and who are to be assigned
688	to the MediPass program to children's networks as described in
689	s. 409.912(4)(3)(g), Children's Medical Services network as
690	defined in s. 391.021, exclusive provider organizations,
691	provider service networks, minority physician networks, and
692	pediatric emergency department diversion programs authorized by
693	this chapter or the General Appropriations Act, in such manner
694	as the agency deems appropriate, until the agency has determined
695	that the networks and programs have sufficient numbers to be
696	economically operated. For purposes of this paragraph, when
697	referring to assignment, the term "managed care plans" includes
698	health maintenance organizations, exclusive provider
699	organizations, provider service networks, minority physician
700	networks, Children's Medical Services network, and pediatric
701	emergency department diversion programs authorized by this
702	chapter or the General Appropriations Act. Beginning July 1,
703	2002, the agency shall assign all children in families who have
704	not made a choice of a managed care plan or MediPass in the
705	required timeframe to a pediatric emergency room diversion
706	program described in s. 409.912(4)(3)(g) that, as of July 1,
707	2002, has executed a contract with the agency, until such
708	network or program has reached an enrollment of 15,000 children.
709	Once that minimum enrollment level has been reached, the agency
710	shall assign children who have not chosen a managed care plan or
711	MediPass to the network or program in a manner that maintains
712	the minimum enrollment in the network or program at not less
713	than 15,000 children. To the extent practicable, the agency
714	shall also assign all eligible children in the same family to
715	such network or program. When making assignments, the agency
716	shall take into account the following criteria:
717	1. A managed care plan has sufficient network capacity to
718	meet the need of members.
719	2. The managed care plan or MediPass has previously
720	enrolled the recipient as a member, or one of the managed care
721	plan's primary care providers or MediPass providers has
722	previously provided health care to the recipient.
723	3. The agency has knowledge that the member has previously
724	expressed a preference for a particular managed care plan or
725	MediPass provider as indicated by Medicaid fee-for-service
726	claims data, but has failed to make a choice.
727	4. The managed care plan's or MediPass primary care
728	providers are geographically accessible to the recipient's
729	residence.
730	Section 10. Section 636.0145, Florida Statutes, is amended
731	to read:
732	636.0145 Certain entities contracting with Medicaid.--
733	Notwithstanding the requirements of s. 409.912(4)(3)(b), an
734	entity that is providing comprehensive inpatient and outpatient
735	mental health care services to certain Medicaid recipients in
736	Hillsborough, Highlands, Hardee, Manatee, and Polk Counties
737	through a capitated, prepaid arrangement pursuant to the federal
738	waiver provided for in s. 409.905(5) must become licensed under
739	chapter 636 by December 31, 1998. Any entity licensed under this
740	chapter which provides services solely to Medicaid recipients
741	under a contract with Medicaid shall be exempt from ss. 636.017,
742	636.018, 636.022, 636.028, and 636.034.
743	Section 11. Subsection (3) of section 641.225, Florida
744	Statutes, is amended to read:
745	641.225 Surplus requirements.--
746	(3)(a) An entity providing prepaid capitated services
747	which is authorized under s. 409.912(4)(3)(a) and which applies
748	for a certificate of authority is subject to the minimum surplus
749	requirements set forth in subsection (1), unless the entity is
750	backed by the full faith and credit of the county in which it is
751	located.
752	(b) An entity providing prepaid capitated services which
753	is authorized under s. 409.912(4)(3)(b) or (c), and which
754	applies for a certificate of authority is subject to the minimum
755	surplus requirements set forth in s. 409.912.
756	Section 12. Subsection (4) of section 641.386, Florida
757	Statutes, is amended to read:
758	641.386 Agent licensing and appointment required;
759	exceptions.--
760	(4) All agents and health maintenance organizations shall
761	comply with and be subject to the applicable provisions of ss.
762	641.309 and 409.912(21)(19), and all companies and entities
763	appointing agents shall comply with s. 626.451, when marketing
764	for any health maintenance organization licensed pursuant to
765	this part, including those organizations under contract with the
766	Agency for Health Care Administration to provide health care
767	services to Medicaid recipients or any private entity providing
768	health care services to Medicaid recipients pursuant to a
769	prepaid health plan contract with the Agency for Health Care
770	Administration.
771	Section 13. This act shall take effect upon becoming a
772	law.