HOUSE AMENDMENT Bill No. SB 22A
1	CHAMBER ACTION
2	Senate House
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12	Representative Green offered the following:
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14	Amendment (with title amendment)
15	Remove everything after the enacting clause, and insert:
16	Section 1. Effective upon this act becoming a law,
17	paragraph (d) of subsection (5) of section 400.179, Florida
18	Statutes, is amended to read:
19	400.179 Sale or transfer of ownership of a nursing
20	facility; liability for Medicaid underpayments and
21	overpayments.--
22	(5) Because any transfer of a nursing facility may expose
23	the fact that Medicaid may have underpaid or overpaid the
24	transferor, and because in most instances, any such underpayment
25	or overpayment can only be determined following a formal field
26	audit, the liabilities for any such underpayments or
27	overpayments shall be as follows:
28	(d) Where the transfer involves a facility that has been
29	leased by the transferor:
30	1. The transferee shall, as a condition to being issued a
31	license by the agency, acquire, maintain, and provide proof to
32	the agency of a bond with a term of 30 months, renewable
33	annually, in an amount not less than the total of 3 months
34	Medicaid payments to the facility computed on the basis of the
35	preceding 12-month average Medicaid payments to the facility.
36	2. A leasehold licensee may meet the requirements of
37	subparagraph 1. by payment of a nonrefundable fee, paid at
38	initial licensure, paid at the time of any subsequent change of
39	ownership, and paid at the time of any subsequent annual license
40	renewal, in the amount of 2 percent of the total of 3 months'
41	Medicaid payments to the facility computed on the basis of the
42	preceding 12-month average Medicaid payments to the facility. If
43	a preceding 12-month average is not available, projected
44	Medicaid payments may be used. The fee shall be deposited into
45	the Health Care Trust Fund and shall be accounted for separately
46	as a Medicaid nursing home overpayment account. These fees shall
47	be used at the sole discretion of the agency to repay nursing
48	home Medicaid overpayments. Payment of this fee shall not
49	release the licensee from any liability for any Medicaid
50	overpayments, nor shall payment bar the agency from seeking to
51	recoup overpayments from the licensee and any other liable
52	party. As a condition of exercising this lease bond alternative,
53	licensees paying this fee must maintain an existing lease bond
54	through the end of the 30-month term period of that bond. The
55	agency is herein granted specific authority to promulgate all
56	rules pertaining to the administration and management of this
57	account, including withdrawals from the account, subject to
58	federal review and approval. This subparagraph is repealed on
59	June 30, 2003.This provision shall take effect upon becoming
60	law and shall apply to any leasehold license application.
61	a. The financial viability of the Medicaid nursing home
62	overpayment account shall be determined by the agency through
63	annual review of the account balance and the amount of total
64	outstanding, unpaid Medicaid overpayments owing from leasehold
65	licensees to the agency as determined by final agency audits.
66	b. The agency, in consultation with the Florida Health
67	Care Association and the Florida Association of Homes for the
68	Aging, shall study and make recommendations on the minimum
69	amount to be held in reserve to protect against Medicaid
70	overpayments to leasehold licensees and on the issue of
71	successor liability for Medicaid overpayments upon sale or
72	transfer of ownership of a nursing facility. The agency shall
73	submit the findings and recommendations of the study to the
74	Governor, the President of the Senate, and the Speaker of the
75	House of Representatives by January 1, 2003.
76	3. The leasehold licensee may meet the bond requirement
77	through other arrangements acceptable to the agency. The agency
78	is herein granted specific authority to promulgate rules
79	pertaining to lease bond arrangements.
80	4. All existing nursing facility licensees, operating the
81	facility as a leasehold, shall acquire, maintain, and provide
82	proof to the agency of the 30-month bond required in
83	subparagraph 1., above, on and after July 1, 1993, for each
84	license renewal.
85	5. It shall be the responsibility of all nursing facility
86	operators, operating the facility as a leasehold, to renew the
87	30-month bond and to provide proof of such renewal to the agency
88	annually at the time of application for license renewal.
89	6. Any failure of the nursing facility operator to
90	acquire, maintain, renew annually, or provide proof to the
91	agency shall be grounds for the agency to deny, cancel, revoke,
92	or suspend the facility license to operate such facility and to
93	take any further action, including, but not limited to,
94	enjoining the facility, asserting a moratorium, or applying for
95	a receiver, deemed necessary to ensure compliance with this
96	section and to safeguard and protect the health, safety, and
97	welfare of the facility's residents. A lease agreement required
98	as a condition of bond financing or refinancing under s. 154.213
99	by a health facilities authority or required under s. 159.30 by
100	a county or municipality is not a leasehold for purposes of this
101	paragraph and is not subject to the bond requirement of this
102	paragraph.
103	Section 2. Subsections (17), (18), (19), (20), (21), (22),
104	(23), (24), (25), (26), and (27) of section 409.811, Florida
105	Statutes, are renumbered as subsections (18), (19), (20), (21),
106	(22), (23), (24), (25), (26), (27), and (28), respectively, and
107	a new subsection (17) is added to said section to read:
108	409.811 Definitions relating to Florida Kidcare Act.--As
109	used in ss. 409.810-409.820, the term:
110	(17) "Managed care plan" means a health maintenance
111	organization authorized pursuant to chapter 641 or a prepaid
112	health plan authorized pursuant to s. 409.912.
113	Section 3. Subsection (7) of section 409.8132, Florida
114	Statutes, is amended to read:
115	409.8132 Medikids program component.--
116	(7) ENROLLMENT.--Enrollment in the Medikids program
117	component may only occur during periodic open enrollment periods
118	as specified by the agency. An applicant may apply for
119	enrollment in the Medikids program component and proceed through
120	the eligibility determination process at any time throughout the
121	year. However, enrollment in Medikids shall not begin until the
122	next open enrollment period; and a child may not receive
123	services under the Medikids program until the child is enrolled
124	in a managed care plan as defined in s. 409.811 or inMediPass.
125	In addition, once determined eligible, an applicant may receive
126	choice counseling and select a managed care plan or MediPass.
127	The agency may initiate mandatory assignment for a Medikids
128	applicant who has not chosen a managed care plan or MediPass
129	provider after the applicant's voluntary choice period ends. An
130	applicant may select MediPass under the Medikids program
131	component only in counties that have fewer than two managed care
132	plans available to serve Medicaid recipients and only if the
133	federal Health Care Financing Administration determines that
134	MediPass constitutes "health insurance coverage" as defined in
135	Title XXI of the Social Security Act.
136	Section 4. Subsection (25) of section 409.901, Florida
137	Statutes, is amended to read:
138	409.901 Definitions; ss. 409.901-409.920.--As used in ss.
139	409.901-409.920, except as otherwise specifically provided, the
140	term:
141	(25) "Third party" means an individual, entity, or
142	program, excluding Medicaid, that is, may be, could be, should
143	be, or has been liable for all or part of the cost of medical
144	services related to any medical assistance providedcovered by
145	Medicaid. Third party includes a third-party administrator or
146	TPA and a pharmacy benefits manager or PBM.
147	Section 5. Subsection (2) of section 409.904, Florida
148	Statutes, as amended by section 1 of chapter 2003-9, Laws of
149	Florida, is amended to read:
150	409.904 Optional payments for eligible persons.--The
151	agency may make payments for medical assistance and related
152	services on behalf of the following persons who are determined
153	to be eligible subject to the income, assets, and categorical
154	eligibility tests set forth in federal and state law. Payment on
155	behalf of these Medicaid eligible persons is subject to the
156	availability of moneys and any limitations established by the
157	General Appropriations Act or chapter 216.
158	(2) A caretaker relative or parent, a pregnant woman, a
159	child under age 19 who would otherwise qualify for Florida
160	Kidcare Medicaid, a child up to age 21 who would otherwise
161	qualify under s. 409.903(1), a person age 65 or over, or a blind
162	or disabled person, who would otherwise be eligible for Florida
163	Medicaid, except that the income or assets of such family or
164	person exceed established limitations. For a family or person in
165	one of these coverage groups, medical expenses are deductible
166	from income in accordance with federal requirements in order to
167	make a determination of eligibility. Expenses used to meet
168	spend-down liability are not reimbursable by Medicaid. Effective
169	July 1, 2003, when determining the eligibility of a pregnant
170	woman, a child, or an aged, blind, or disabled individual, $270
171	shall be deducted from the countable income of the filing unit.
172	When determining the eligibility of the parent or caretaker
173	relative as defined by Title XIX of the Social Security Act, the
174	additional income disregard of $270 does not apply.A family or
175	person eligible under the coverage known as the "medically
176	needy," is eligible to receive the same services as other
177	Medicaid recipients, with the exception of services in skilled
178	nursing facilities and intermediate care facilities for the
179	developmentally disabled.
180	Section 6. Subsections (1), (12), and (23) of section
181	409.906, Florida Statutes, are amended to read:
182	409.906 Optional Medicaid services.--Subject to specific
183	appropriations, the agency may make payments for services which
184	are optional to the state under Title XIX of the Social Security
185	Act and are furnished by Medicaid providers to recipients who
186	are determined to be eligible on the dates on which the services
187	were provided. Any optional service that is provided shall be
188	provided only when medically necessary and in accordance with
189	state and federal law. Optional services rendered by providers
190	in mobile units to Medicaid recipients may be restricted or
191	prohibited by the agency. Nothing in this section shall be
192	construed to prevent or limit the agency from adjusting fees,
193	reimbursement rates, lengths of stay, number of visits, or
194	number of services, or making any other adjustments necessary to
195	comply with the availability of moneys and any limitations or
196	directions provided for in the General Appropriations Act or
197	chapter 216. If necessary to safeguard the state's systems of
198	providing services to elderly and disabled persons and subject
199	to the notice and review provisions of s. 216.177, the Governor
200	may direct the Agency for Health Care Administration to amend
201	the Medicaid state plan to delete the optional Medicaid service
202	known as "Intermediate Care Facilities for the Developmentally
203	Disabled." Optional services may include:
204	(1) ADULT DENTAL SERVICES.--The agency may pay for
205	dentures, the procedures required to seat dentures, the repair
206	and reline of dentures, emergency dental procedures necessary to
207	alleviate pain or infection, and basic dental preventive
208	procedures provided by or under the direction of a licensed
209	dentist for a recipient who is age 65 or oldermedically
210	necessary, emergency dental procedures to alleviate pain or
211	infection. Emergency dental care shall be limited to emergency
212	oral examinations, necessary radiographs, extractions, and
213	incision and drainage of abscess, for a recipient who is age 21
214	or older. However, Medicaid will not provide reimbursement for
215	dental services provided in a mobile dental unit, except for a
216	mobile dental unit:
217	(a) Owned by, operated by, or having a contractual
218	agreement with the Department of Health and complying with
219	Medicaid's county health department clinic services program
220	specifications as a county health department clinic services
221	provider.
222	(b) Owned by, operated by, or having a contractual
223	arrangement with a federally qualified health center and
224	complying with Medicaid's federally qualified health center
225	specifications as a federally qualified health center provider.
226	(c) Rendering dental services to Medicaid recipients, 21
227	years of age and older, at nursing facilities.
228	(d) Owned by, operated by, or having a contractual
229	agreement with a state-approved dental educational institution.
230	(12) CHILDREN'SHEARING SERVICES.--The agency may pay for
231	hearing and related services, including hearing evaluations,
232	hearing aid devices, dispensing of the hearing aid, and related
233	repairs, if provided to a recipient younger than 21 years of age
234	by a licensed hearing aid specialist, otolaryngologist,
235	otologist, audiologist, or physician.
236	(23) CHILDREN'SVISUAL SERVICES.--The agency may pay for
237	visual examinations, eyeglasses, and eyeglass repairs for a
238	recipient younger than 21 years of age, if they are prescribed
239	by a licensed physician specializing in diseases of the eye or
240	by a licensed optometrist.
241	Section 7. Paragraphs (c) and (d) are added to subsection
242	(1) of section 409.9081, Florida Statutes, to read:
243	409.9081 Copayments.--
244	(1) The agency shall require, subject to federal
245	regulations and limitations, each Medicaid recipient to pay at
246	the time of service a nominal copayment for the following
247	Medicaid services:
248	(c) Prescription drugs: a coinsurance equal to 5 percent
249	of the Medicaid cost of the prescription drug at the time of
250	purchase. The maximum coinsurance shall be $15 per prescription
251	drug purchased.
252	(d) Hospital outpatient services, emergency department: up
253	to $15 for each hospital outpatient emergency department
254	encounter that is for nonemergency purposes.
255	Section 8. Section 409.911, Florida Statutes, is amended
256	to read:
257	409.911 Disproportionate share program.--Subject to
258	specific allocations established within the General
259	Appropriations Act and any limitations established pursuant to
260	chapter 216, the agency shall distribute, pursuant to this
261	section, moneys to hospitals providing a disproportionate share
262	of Medicaid or charity care services by making quarterly
263	Medicaid payments as required. Notwithstanding the provisions of
264	s. 409.915, counties are exempt from contributing toward the
265	cost of this special reimbursement for hospitals serving a
266	disproportionate share of low-income patients.
267	(1) Definitions.--As used in this section, s. 409.9112,
268	and the Florida Hospital Uniform Reporting System manual:
269	(a) "Adjusted patient days" means the sum of acute care
270	patient days and intensive care patient days as reported to the
271	Agency for Health Care Administration, divided by the ratio of
272	inpatient revenues generated from acute, intensive, ambulatory,
273	and ancillary patient services to gross revenues.
274	(b) "Actual audited data" or "actual audited experience"
275	means data reported to the Agency for Health Care Administration
276	which has been audited in accordance with generally accepted
277	auditing standards by the agency or representatives under
278	contract with the agency.
279	(c) "Base Medicaid per diem" means the hospital's Medicaid
280	per diem rate initially established by the Agency for Health
281	Care Administration on January 1, 1999. The base Medicaid per
282	diem rate shall not include any additional per diem increases
283	received as a result of the disproportionate share distribution.
284	(c)(d)"Charity care" or "uncompensated charity care"
285	means that portion of hospital charges reported to the Agency
286	for Health Care Administration for which there is no
287	compensation, other than restricted or unrestricted revenues
288	provided to a hospital by local governments or tax districts
289	regardless of the method of payment, for care provided to a
290	patient whose family income for the 12 months preceding the
291	determination is less than or equal to 200 percent of the
292	federal poverty level, unless the amount of hospital charges due
293	from the patient exceeds 25 percent of the annual family income.
294	However, in no case shall the hospital charges for a patient
295	whose family income exceeds four times the federal poverty level
296	for a family of four be considered charity.
297	(d)(e)"Charity care days" means the sum of the deductions
298	from revenues for charity care minus 50 percent of restricted
299	and unrestricted revenues provided to a hospital by local
300	governments or tax districts, divided by gross revenues per
301	adjusted patient day.
302	(f) "Disproportionate share percentage" means a rate of
303	increase in the Medicaid per diem rate as calculated under this
304	section.
305	(e)(g)"Hospital" means a health care institution licensed
306	as a hospital pursuant to chapter 395, but does not include
307	ambulatory surgical centers.
308	(f)(h)"Medicaid days" means the number of actual days
309	attributable to Medicaid patients as determined by the Agency
310	for Health Care Administration.
311	(2) The Agency for Health Care Administration shall
312	utilize the following actual audited datacriteria to determine
313	the Medicaid days and charity care to be used in the calculation
314	of theif a hospital qualifies for adisproportionate share
315	payment:
316	(a) The Agency for Health Care Administration shall use
317	the average of the 1997, 1998, and 1999 audited data to
318	determine each hospital's Medicaid days and charity careA
319	hospital's total Medicaid days when combined with its total
320	charity care days must equal or exceed 7 percent of its total
321	adjusted patient days.
322	(b) In the event the Agency for Health Care Administration
323	does not have the prescribed 3 years of audited disproportionate
324	share data for a hospital, the Agency for Health Care
325	Administration shall use the average of the audited
326	disproportionate share data for the years availableA hospital's
327	total charity care days weighted by a factor of 4.5, plus its
328	total Medicaid days weighted by a factor of 1, shall be equal to
329	or greater than 10 percent of its total adjusted patient days.
330	(c) Additionally, In accordance with s. 1923(b) of the
331	Social Security Actthe seventh federal Omnibus Budget
332	Reconciliation Act, a hospital with a Medicaid inpatient
333	utilization rate greater than one standard deviation above the
334	statewide mean or a hospital with a low-income utilization rate
335	of 25 percent or greater shall qualify for reimbursement.
336	(3) In computing the disproportionate share rate:
337	(a) Per diem increases earned from disproportionate share
338	shall be applied to each hospital's base Medicaid per diem rate
339	and shall be capped at 170 percent.
340	(b) The agency shall use 1994 audited financial data for
341	the calculation of disproportionate share payments under this
342	section.
343	(c) If the total amount earned by all hospitals under this
344	section exceeds the amount appropriated, each hospital's share
345	shall be reduced on a pro rata basis so that the total dollars
346	distributed from the trust fund do not exceed the total amount
347	appropriated.
348	(d) The total amount calculated to be distributed under
349	this section shall be made in quarterly payments subsequent to
350	each quarter during the fiscal year.
351	(3)(4)Hospitals that qualify for a disproportionate share
352	payment solely under paragraph (2)(c) shall have their payment
353	calculated in accordance with the following formulas:
354
355	DSHP = (HMD/TSMD) x $1 million
356	TAA = TA x (1/5.5)
357	DSHP = (HMD/TSMD) x TAA
358
359	Where:
360	TAA = total amount available.
361	TA = total appropriation.
362	DSHP = disproportionate share hospital payment.
363	HMD = hospital Medicaid days.
364	TSMD = total state Medicaid days.
365
366	(4) The following formulas shall be used to pay
367	disproportionate share dollars to public hospitals:
368	(a) For state mental health hospitals:
369
370	DSHP = (HMD/TMDMH) x TAAMH
371
372	The total amount available for the state mental health hospitals
373	shall be the difference between the federal cap for Institutions
374	for Mental Diseases and the amounts paid under the mental health
375	disproportionate share program.
376
377	Where:
378	DSHP = disproportionate share hospital payment.
379	HMD = hospital Medicaid days.
380	TMDMH = total Medicaid days for state mental health
381	hospitals.
382	TAAMH = total amount available for mental health hospitals.
383
384	(b) For nonstate government owned or operated hospitals
385	with 3,200 or more Medicaid days:
386
387	DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)] x TAAPH
388	TAAPH = TAA – TAAMH – 1,400,000
389
390	Where:
391	DSHP = disproportionate share hospital payments.
392	HCCD = hospital charity care dollars.
393	TCCD = total charity care dollars for public nonstate
394	hospitals.
395	HMD = hospital Medicaid days.
396	TMD = total Medicaid days for public nonstate hospitals.
397	TAAPH = total amount available for public hospitals.
398	TAA = total available appropriation.
399	TAAMH = total amount available for mental health hospitals.
400
401	(c) For nonstate government owned or operated hospitals
402	with less than 3,200 Medicaid days, a total of $400,000 shall be
403	distributed equally among these hospitals.
404	(5) The following formula shall be utilized by the agency
405	to determine the maximum disproportionate share rate to be used
406	to increase the Medicaid per diem rate for hospitals that
407	qualify pursuant to paragraphs (2)(a) and (b):
408	DSR = CCD MD
409	((---------) x 4.5) + (---------)
410	@_@2@_@
411	Where:
412	APD = adjusted patient days.
413	CCD = charity care days.
414	DSR = disproportionate share rate.
415	MD = Medicaid days.
416
417	(6)(a) To calculate the total amount earned by all
418	hospitals under this section, hospitals with a disproportionate
419	share rate less than 50 percent shall divide their Medicaid days
420	by four, and hospitals with a disproportionate share rate
421	greater than or equal to 50 percent and with greater than 40,000
422	Medicaid days shall multiply their Medicaid days by 1.5, and the
423	following formula shall be used by the agency to calculate the
424	total amount earned by all hospitals under this section:
425
426	TAE = BMPD x MD x DSP
427
428	Where:
429	TAE = total amount earned.
430	BMPD = base Medicaid per diem.
431	MD = Medicaid days.
432	DSP = disproportionate share percentage.
433
434	(5)(b)In no case shall total payments to a hospital under
435	this section, with the exception of public nonstate facilities
436	orstate facilities, exceed the total amount of uncompensated
437	charity care of the hospital, as determined by the agency
438	according to the most recent calendar year audited data
439	available at the beginning of each state fiscal year.
440	(7) The following criteria shall be used in determining
441	the disproportionate share percentage:
442	(a) If the disproportionate share rate is less than 10
443	percent, the disproportionate share percentage is zero and there
444	is no additional payment.
445	(b) If the disproportionate share rate is greater than or
446	equal to 10 percent, but less than 20 percent, then the
447	disproportionate share percentage is 1.8478498.
448	(c) If the disproportionate share rate is greater than or
449	equal to 20 percent, but less than 30 percent, then the
450	disproportionate share percentage is 3.4145488.
451	(d) If the disproportionate share rate is greater than or
452	equal to 30 percent, but less than 40 percent, then the
453	disproportionate share percentage is 6.3095734.
454	(e) If the disproportionate share rate is greater than or
455	equal to 40 percent, but less than 50 percent, then the
456	disproportionate share percentage is 11.6591440.
457	(f) If the disproportionate share rate is greater than or
458	equal to 50 percent, but less than 60 percent, then the
459	disproportionate share percentage is 73.5642254.
460	(g) If the disproportionate share rate is greater than or
461	equal to 60 percent but less than 72.5 percent, then the
462	disproportionate share percentage is 135.9356391.
463	(h) If the disproportionate share rate is greater than or
464	equal to 72.5 percent, then the disproportionate share
465	percentage is 170.
466	(8) The following formula shall be used by the agency to
467	calculate the total amount earned by all hospitals under this
468	section:
469
470	TAE = BMPD x MD x DSP
471
472	Where:
473	TAE = total amount earned.
474	BMPD = base Medicaid per diem.
475	MD = Medicaid days.
476	DSP = disproportionate share percentage.
477
478	(6)(9)The agency is authorized to receive funds from
479	local governments and other local political subdivisions for the
480	purpose of making payments, including federal matching funds,
481	through the Medicaid disproportionate share program. Funds
482	received from local governments for this purpose shall be
483	separately accounted for and shall not be commingled with other
484	state or local funds in any manner.
485	(7)(10)Payments made by the agency to hospitals eligible
486	to participate in this program shall be made in accordance with
487	federal rules and regulations.
488	(a) If the Federal Government prohibits, restricts, or
489	changes in any manner the methods by which funds are distributed
490	for this program, the agency shall not distribute any additional
491	funds and shall return all funds to the local government from
492	which the funds were received, except as provided in paragraph
493	(b).
494	(b) If the Federal Government imposes a restriction that
495	still permits a partial or different distribution, the agency
496	may continue to disburse funds to hospitals participating in the
497	disproportionate share program in a federally approved manner,
498	provided:
499	1. Each local government which contributes to the
500	disproportionate share program agrees to the new manner of
501	distribution as shown by a written document signed by the
502	governing authority of each local government; and
503	2. The Executive Office of the Governor, the Office of
504	Planning and Budgeting, the House of Representatives, and the
505	Senate are provided at least 7 days' prior notice of the
506	proposed change in the distribution, and do not disapprove such
507	change.
508	(c) No distribution shall be made under the alternative
509	method specified in paragraph (b) unless all parties agree or
510	unless all funds of those parties that disagree which are not
511	yet disbursed have been returned to those parties.
512	(8)(11)Notwithstanding the provisions of chapter 216, the
513	Executive Office of the Governor is hereby authorized to
514	establish sufficient trust fund authority to implement the
515	disproportionate share program.
516	Section 9. Subsections (1) and (2) of section 409.9112,
517	Florida Statutes, are amended to read:
518	409.9112 Disproportionate share program for regional
519	perinatal intensive care centers.--In addition to the payments
520	made under s. 409.911, the Agency for Health Care Administration
521	shall design and implement a system of making disproportionate
522	share payments to those hospitals that participate in the
523	regional perinatal intensive care center program established
524	pursuant to chapter 383. This system of payments shall conform
525	with federal requirements and shall distribute funds in each
526	fiscal year for which an appropriation is made by making
527	quarterly Medicaid payments. Notwithstanding the provisions of
528	s. 409.915, counties are exempt from contributing toward the
529	cost of this special reimbursement for hospitals serving a
530	disproportionate share of low-income patients.
531	(1) The following formula shall be used by the agency to
532	calculate the total amount earned for hospitals that participate
533	in the regional perinatal intensive care center program:
534
535	TAE = HDSP/THDSP
536
537	Where:
538	TAE = total amount earned by a regional perinatal intensive
539	care center.
540	HDSP = the prior state fiscal year regional perinatal
541	intensive care center disproportionate share payment to the
542	individual hospital.
543	THDSP = the prior state fiscal year total regional
544	perinatal intensive care center disproportionate share payments
545	to all hospitals.
546	(2) The total additional payment for hospitals that
547	participate in the regional perinatal intensive care center
548	program shall be calculated by the agency as follows:
549
550	TAP = TAE x TA
551
552	Where:
553	TAP = total additional payment for a regional perinatal
554	intensive care center.
555	TAE = total amount earned by a regional perinatal intensive
556	care center.
557	TA = total appropriation for the regional perinatal
558	intensive care center disproportionate share program.
559
560	TAE = DSR x BMPD x MD
561
562	Where:
563	TAE = total amount earned by a regional perinatal intensive
564	care center.
565	DSR = disproportionate share rate.
566	BMPD = base Medicaid per diem.
567	MD = Medicaid days.
568
569	(2) The total additional payment for hospitals that
570	participate in the regional perinatal intensive care center
571	program shall be calculated by the agency as follows:
572	TAP = TAE x TA
573	(---------------)
574	@_@5@_@
575	Where:
576	TAP = total additional payment for a regional perinatal
577	intensive care center.
578	TAE = total amount earned by a regional perinatal intensive
579	care center.
580	STAE = sum of total amount earned by each hospital that
581	participates in the regional perinatal intensive care center
582	program.
583	TA = total appropriation for the regional perinatal
584	intensive care disproportionate share program.
585	Section 10. Section 409.9117, Florida Statutes, is amended
586	to read:
587	409.9117 Primary care disproportionate share program.--
588	(1) If federal funds are available for disproportionate
589	share programs in addition to those otherwise provided by law,
590	there shall be created a primary care disproportionate share
591	program.
592	(2) The following formula shall be used by the agency to
593	calculate the total amount earned for hospitals that participate
594	in the primary care disproportionate share program:
595
596	TAE = HDSP/THDSP
597
598	Where:
599	TAE = total amount earned by a hospital participating in
600	the primary care disproportionate share program.
601	HDSP = the prior state fiscal year primary care
602	disproportionate share payment to the individual hospital.
603	THDSP = the prior state fiscal year to primary care
604	disproportionate share payments to all hospitals.
605	(3) The total additional payment for hospitals that
606	participate in the primary care disproportionate share program
607	shall be calculated by the agency as follows:
608
609	TAP = TAE x TA
610
611	Where:
612	TAP = total additional payment for a primary care hospital.
613	TAE = total amount earned by a primary care hospital.
614	TA = total appropriation for the primary care
615	disproportionate share program.
616	(4)(2)In the establishment and funding of this program,
617	the agency shall use the following criteria in addition to those
618	specified in s. 409.911.,Payments may not be made to a hospital
619	unless the hospital agrees to:
620	(a) Cooperate with a Medicaid prepaid health plan, if one
621	exists in the community.
622	(b) Ensure the availability of primary and specialty care
623	physicians to Medicaid recipients who are not enrolled in a
624	prepaid capitated arrangement and who are in need of access to
625	such physicians.
626	(c) Coordinate and provide primary care services free of
627	charge, except copayments, to all persons with incomes up to 100
628	percent of the federal poverty level who are not otherwise
629	covered by Medicaid or another program administered by a
630	governmental entity, and to provide such services based on a
631	sliding fee scale to all persons with incomes up to 200 percent
632	of the federal poverty level who are not otherwise covered by
633	Medicaid or another program administered by a governmental
634	entity, except that eligibility may be limited to persons who
635	reside within a more limited area, as agreed to by the agency
636	and the hospital.
637	(d) Contract with any federally qualified health center,
638	if one exists within the agreed geopolitical boundaries,
639	concerning the provision of primary care services, in order to
640	guarantee delivery of services in a nonduplicative fashion, and
641	to provide for referral arrangements, privileges, and
642	admissions, as appropriate. The hospital shall agree to provide
643	at an onsite or offsite facility primary care services within 24
644	hours to which all Medicaid recipients and persons eligible
645	under this paragraph who do not require emergency room services
646	are referred during normal daylight hours.
647	(e) Cooperate with the agency, the county, and other
648	entities to ensure the provision of certain public health
649	services, case management, referral and acceptance of patients,
650	and sharing of epidemiological data, as the agency and the
651	hospital find mutually necessary and desirable to promote and
652	protect the public health within the agreed geopolitical
653	boundaries.
654	(f) In cooperation with the county in which the hospital
655	resides, develop a low-cost, outpatient, prepaid health care
656	program to persons who are not eligible for the Medicaid
657	program, and who reside within the area.
658	(g) Provide inpatient services to residents within the
659	area who are not eligible for Medicaid or Medicare, and who do
660	not have private health insurance, regardless of ability to pay,
661	on the basis of available space, except that nothing shall
662	prevent the hospital from establishing bill collection programs
663	based on ability to pay.
664	(h) Work with the Florida Healthy Kids Corporation, the
665	Florida Health Care Purchasing Cooperative,and business health
666	coalitions, as appropriate, to develop a feasibility study and
667	plan to provide a low-cost comprehensive health insurance plan
668	to persons who reside within the area and who do not have access
669	to such a plan.
670	(i) Work with public health officials and other experts to
671	provide community health education and prevention activities
672	designed to promote healthy lifestyles and appropriate use of
673	health services.
674	(j) Work with the local health council to develop a plan
675	for promoting access to affordable health care services for all
676	persons who reside within the area, including, but not limited
677	to, public health services, primary care services, inpatient
678	services, and affordable health insurance generally.
679
680	Any hospital that fails to comply with any of the provisions of
681	this subsection, or any other contractual condition, may not
682	receive payments under this section until full compliance is
683	achieved.
684	Section 11. Section 409.9119, Florida Statutes, is amended
685	to read:
686	409.9119 Disproportionate share program for specialty
687	hospitals for children.--In addition to the payments made under
688	s. 409.911, the Agency for Health Care Administration shall
689	develop and implement a system under which disproportionate
690	share payments are made to those hospitals that are licensed by
691	the state as specialty hospitals for children and were licensed
692	on January 1, 2000, as specialty hospitals for children. This
693	system of payments must conform to federal requirements and must
694	distribute funds in each fiscal year for which an appropriation
695	is made by making quarterly Medicaid payments. Notwithstanding
696	s. 409.915, counties are exempt from contributing toward the
697	cost of this special reimbursement for hospitals that serve a
698	disproportionate share of low-income patients. Payments are
699	subject to specific appropriations in the General Appropriations
700	Act.
701	(1) The agency shall use the following formula to
702	calculate the total amount earned for hospitals that participate
703	in the specialty hospital for children disproportionate share
704	program:
705
706	TAE = DSR x BMPD x MD
707
708	Where:
709	TAE = total amount earned by a specialty hospital for
710	children.
711	DSR = disproportionate share rate.
712	BMPD = base Medicaid per diem.
713	MD = Medicaid days.
714	(2) The agency shall calculate the total additional
715	payment for hospitals that participate in the specialty hospital
716	for children disproportionate share program as follows:
717	TAP = TAE x TA
718	(---------------)
719	STAE
720	Where:
721	TAP = total additional payment for a specialty hospital for
722	children.
723	TAE = total amount earned by a specialty hospital for
724	children.
725	TA = total appropriation for the specialty hospital for
726	children disproportionate share program.
727	STAE = sum of total amount earned by each hospital that
728	participates in the specialty hospital for children
729	disproportionate share program.
730
731	(3) A hospital may not receive any payments under this
732	section until it achieves full compliance with the applicable
733	rules of the agency. A hospital that is not in compliance for
734	two or more consecutive quarters may not receive its share of
735	the funds. Any forfeited funds must be distributed to the
736	remaining participating specialty hospitals for children that
737	are in compliance.
738	Section 12. Paragraph (d) of subsection (3) of section
739	409.912, Florida Statutes, is amended, and subsection (41) is
740	added to said section, to read:
741	409.912 Cost-effective purchasing of health care.--The
742	agency shall purchase goods and services for Medicaid recipients
743	in the most cost-effective manner consistent with the delivery
744	of quality medical care. The agency shall maximize the use of
745	prepaid per capita and prepaid aggregate fixed-sum basis
746	services when appropriate and other alternative service delivery
747	and reimbursement methodologies, including competitive bidding
748	pursuant to s. 287.057, designed to facilitate the cost-
749	effective purchase of a case-managed continuum of care. The
750	agency shall also require providers to minimize the exposure of
751	recipients to the need for acute inpatient, custodial, and other
752	institutional care and the inappropriate or unnecessary use of
753	high-cost services. The agency may establish prior authorization
754	requirements for certain populations of Medicaid beneficiaries,
755	certain drug classes, or particular drugs to prevent fraud,
756	abuse, overuse, and possible dangerous drug interactions. The
757	Pharmaceutical and Therapeutics Committee shall make
758	recommendations to the agency on drugs for which prior
759	authorization is required. The agency shall inform the
760	Pharmaceutical and Therapeutics Committee of its decisions
761	regarding drugs subject to prior authorization.
762	(3) The agency may contract with:
763	(d) A provider networkNo more than four provider service
764	networks for demonstration projects to test Medicaid direct
765	contracting. The demonstration projectsmay be reimbursed on a
766	fee-for-service or prepaid basis. A provider service network
767	which is reimbursed by the agency on a prepaid basis shall be
768	exempt from parts I and III of chapter 641, but must meet
769	appropriate financial reserve, quality assurance, and patient
770	rights requirements as established by the agency. The agency
771	shall award contracts on a competitive bid basis and shall
772	select bidders based upon price and quality of care. Medicaid
773	recipients assigned to a demonstration project shall be chosen
774	equally from those who would otherwise have been assigned to
775	prepaid plans and MediPass.The agency is authorized to seek
776	federal Medicaid waivers as necessary to implement the
777	provisions of this section. A demonstration project awarded
778	pursuant to this paragraph shall be for 4 years from the date of
779	implementation.
780	(41) The agency may contract on a prepaid or fixed-sum
781	basis with an appropriately licensed prepaid dental health plan
782	to provide Medicaid covered dental services to child or adult
783	Medicaid recipients.
784	Section 13. Paragraphs (f) and (k) of subsection (2) of
785	section 409.9122, Florida Statutes, are amended to read:
786	409.9122 Mandatory Medicaid managed care enrollment;
787	programs and procedures.--
788	(2)
789	(f) When a Medicaid recipient does not choose a managed
790	care plan or MediPass provider, the agency shall assign the
791	Medicaid recipient to a managed care plan or MediPass provider.
792	Medicaid recipients who are subject to mandatory assignment but
793	who fail to make a choice shall be assigned to managed care
794	plans until an enrollment of 4045 percent in MediPass and 6055
795	percent in managed care plans is achieved. Once this enrollment
796	is achieved, the assignments shall be divided in order to
797	maintain an enrollment in MediPass and managed care plans which
798	is in a 4045 percent and 6055percent proportion,
799	respectively. Thereafter, assignment of Medicaid recipients who
800	fail to make a choice shall be based proportionally on the
801	preferences of recipients who have made a choice in the previous
802	period. Such proportions shall be revised at least quarterly to
803	reflect an update of the preferences of Medicaid recipients. The
804	agency shall disproportionately assign Medicaid-eligible
805	recipients who are required to but have failed to make a choice
806	of managed care plan or MediPass, including children, and who
807	are to be assigned to the MediPass program to children's
808	networks as described in s. 409.912(3)(g), Children's Medical
809	Services network as defined in s. 391.021, exclusive provider
810	organizations, provider service networks, minority physician
811	networks, and pediatric emergency department diversion programs
812	authorized by this chapter or the General Appropriations Act, in
813	such manner as the agency deems appropriate, until the agency
814	has determined that the networks and programs have sufficient
815	numbers to be economically operated. For purposes of this
816	paragraph, when referring to assignment, the term "managed care
817	plans" includes health maintenance organizations, exclusive
818	provider organizations, provider service networks, minority
819	physician networks, Children's Medical Services network, and
820	pediatric emergency department diversion programs authorized by
821	this chapter or the General Appropriations Act. Beginning July
822	1, 2002, the agency shall assign all children in families who
823	have not made a choice of a managed care plan or MediPass in the
824	required timeframe to a pediatric emergency room diversion
825	program described in s. 409.912(3)(g) that, as of July 1, 2002,
826	has executed a contract with the agency, until such network or
827	program has reached an enrollment of 15,000 children. Once that
828	minimum enrollment level has been reached, the agency shall
829	assign children who have not chosen a managed care plan or
830	MediPass to the network or program in a manner that maintains
831	the minimum enrollment in the network or program at not less
832	than 15,000 children. To the extent practicable, the agency
833	shall also assign all eligible children in the same family to
834	such network or program. When making assignments, the agency
835	shall take into account the following criteria:
836	1. A managed care plan has sufficient network capacity to
837	meet the need of members.
838	2. The managed care plan or MediPass has previously
839	enrolled the recipient as a member, or one of the managed care
840	plan's primary care providers or MediPass providers has
841	previously provided health care to the recipient.
842	3. The agency has knowledge that the member has previously
843	expressed a preference for a particular managed care plan or
844	MediPass provider as indicated by Medicaid fee-for-service
845	claims data, but has failed to make a choice.
846	4. The managed care plan's or MediPass primary care
847	providers are geographically accessible to the recipient's
848	residence.
849	5. The agency has authority to make mandatory assignments
850	based on quality of service and performance of managed care
851	plans.
852	(k) When a Medicaid recipient does not choose a managed
853	care plan or MediPass provider, the agency shall assign the
854	Medicaid recipient to a managed care plan, except in those
855	counties in which there are fewer than two managed care plans
856	accepting Medicaid enrollees, in which case assignment shall be
857	to a managed care plan or a MediPass provider. Medicaid
858	recipients in counties with fewer than two managed care plans
859	accepting Medicaid enrollees who are subject to mandatory
860	assignment but who fail to make a choice shall be assigned to
861	managed care plans until an enrollment of 4045percent in
862	MediPass and 6055percent in managed care plans is achieved.
863	Once that enrollment is achieved, the assignments shall be
864	divided in order to maintain an enrollment in MediPass and
865	managed care plans which is in a 4045 percent and 6055percent
866	proportion, respectively. In geographic areas where the agency
867	is contracting for the provision of comprehensive behavioral
868	health services through a capitated prepaid arrangement,
869	recipients who fail to make a choice shall be assigned equally
870	to MediPass or a managed care plan. For purposes of this
871	paragraph, when referring to assignment, the term "managed care
872	plans" includes exclusive provider organizations, provider
873	service networks, Children's Medical Services network, minority
874	physician networks, and pediatric emergency department diversion
875	programs authorized by this chapter or the General
876	Appropriations Act. When making assignments, the agency shall
877	take into account the following criteria:
878	1. A managed care plan has sufficient network capacity to
879	meet the need of members.
880	2. The managed care plan or MediPass has previously
881	enrolled the recipient as a member, or one of the managed care
882	plan's primary care providers or MediPass providers has
883	previously provided health care to the recipient.
884	3. The agency has knowledge that the member has previously
885	expressed a preference for a particular managed care plan or
886	MediPass provider as indicated by Medicaid fee-for-service
887	claims data, but has failed to make a choice.
888	4. The managed care plan's or MediPass primary care
889	providers are geographically accessible to the recipient's
890	residence.
891	5. The agency has authority to make mandatory assignments
892	based on quality of service and performance of managed care
893	plans.
894	Section 14. Subsections (8) and (28) of section 409.913,
895	Florida Statutes, are amended to read:
896	409.913 Oversight of the integrity of the Medicaid
897	program.--The agency shall operate a program to oversee the
898	activities of Florida Medicaid recipients, and providers and
899	their representatives, to ensure that fraudulent and abusive
900	behavior and neglect of recipients occur to the minimum extent
901	possible, and to recover overpayments and impose sanctions as
902	appropriate. Beginning January 1, 2003, and each year
903	thereafter, the agency and the Medicaid Fraud Control Unit of
904	the Department of Legal Affairs shall submit a joint report to
905	the Legislature documenting the effectiveness of the state's
906	efforts to control Medicaid fraud and abuse and to recover
907	Medicaid overpayments during the previous fiscal year. The
908	report must describe the number of cases opened and investigated
909	each year; the sources of the cases opened; the disposition of
910	the cases closed each year; the amount of overpayments alleged
911	in preliminary and final audit letters; the number and amount of
912	fines or penalties imposed; any reductions in overpayment
913	amounts negotiated in settlement agreements or by other means;
914	the amount of final agency determinations of overpayments; the
915	amount deducted from federal claiming as a result of
916	overpayments; the amount of overpayments recovered each year;
917	the amount of cost of investigation recovered each year; the
918	average length of time to collect from the time the case was
919	opened until the overpayment is paid in full; the amount
920	determined as uncollectible and the portion of the uncollectible
921	amount subsequently reclaimed from the Federal Government; the
922	number of providers, by type, that are terminated from
923	participation in the Medicaid program as a result of fraud and
924	abuse; and all costs associated with discovering and prosecuting
925	cases of Medicaid overpayments and making recoveries in such
926	cases. The report must also document actions taken to prevent
927	overpayments and the number of providers prevented from
928	enrolling in or reenrolling in the Medicaid program as a result
929	of documented Medicaid fraud and abuse and must recommend
930	changes necessary to prevent or recover overpayments. For the
931	2001-2002 fiscal year, the agency shall prepare a report that
932	contains as much of this information as is available to it.
933	(8) A Medicaid provider shall retain medical,
934	professional, financial, and business records pertaining to
935	services and goods furnished to a Medicaid recipient and billed
936	to Medicaid for a period of 5 years after the date of furnishing
937	such services or goods. The agency and its duly authorized
938	agentsmay investigate, review, or analyze such records, which
939	must be made available during normal business hours. However,
940	24-hour notice must be provided if patient treatment would be
941	disrupted. The provider is responsible for furnishing to the
942	agency and its duly authorized agents, and keeping the agency
943	and its duly authorized agentsinformed of the location of, the
944	provider's Medicaid-related records. The authority of the agency
945	and its duly authorized agentsto obtain Medicaid-related
946	records from a provider is neither curtailed nor limited during
947	a period of litigation between the agency and the provider.
948	(28) Notwithstanding other provisions of law, the agency
949	and its duly authorized agentsand the Medicaid Fraud Control
950	Unit of the Department of Legal Affairs may review a provider's
951	Medicaid-related records in order to determine the total output
952	of a provider's practice to reconcile quantities of goods or
953	services billed to Medicaid against quantities of goods or
954	services used in the provider's total practice.
955	Section 15. Subsections (7), (8), and (9) are added to
956	section 430.502, Florida Statutes, to read:
957	430.502 Alzheimer's disease; memory disorder clinics and
958	day care and respite care programs.--
959	(7) The Agency for Health Care Administration and the
960	department shall seek a federal waiver to implement a Medicaid
961	home and community-based waiver targeted to persons with
962	Alzheimer's disease to test the effectiveness of Alzheimer's
963	specific interventions to delay or to avoid institutional
964	placement.
965	(8) The department shall implement the waiver program
966	specified in subsection (7). The agency and the department shall
967	ensure that providers are selected that have a history of
968	successfully serving persons with Alzheimer's disease. The
969	department and the agency shall develop specialized standards
970	for providers and services tailored to persons in the early,
971	middle, and late stages of Alzheimer's disease and designate a
972	level of care determination process and standard that is most
973	appropriate to this population. The department and the agency
974	shall include in the waiver services designed to assist the
975	caregiver in continuing to provide in-home care. The department
976	shall implement this waiver program subject to a specific
977	appropriation or as provided in the General Appropriations Act.
978	The department and the agency shall submit their program design
979	to the President of the Senate and the Speaker of the House of
980	Representatives for consultation during the development process.
981	(9) Authority to continue the waiver program specified in
982	subsection (7) shall be automatically eliminated at the close of
983	the 2008 Regular Session of the Legislature unless further
984	legislative action is taken to continue it prior to such time.
985	Section 16. Paragraph (b) of subsection (4) and paragraph
986	(a) of subsection (5) of section 624.91, Florida Statutes, are
987	amended to read:
988	624.91 The Florida Healthy Kids Corporation Act.--
989	(4) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
990	(b) The Florida Healthy Kids Corporation shall:
991	1. Organize school children groups to facilitate the
992	provision of comprehensive health insurance coverage to
993	children.;
994	2. Arrange for the collection of any family, local
995	contributions, or employer payment or premium, in an amount to
996	be determined by the board of directors, to provide for payment
997	of premiums for comprehensive insurance coverage and for the
998	actual or estimated administrative expenses.;
999	3. Arrange for the collection of any voluntary
1000	contributions to provide for payment of premiums for children
1001	who are not eligible for medical assistance under Title XXI of
1002	the Social Security Act. Each fiscal year, the corporation shall
1003	establish a local match policy for the enrollment of non-Title-
1004	XXI-eligible children in the Healthy Kids program. By May 1 of
1005	each year, the corporation shall provide written notification of
1006	the amount to be remitted to the corporation for the following
1007	fiscal year under that policy. Local match sources may include,
1008	but are not limited to, funds provided by municipalities,
1009	counties, school boards, hospitals, health care providers,
1010	charitable organizations, special taxing districts, and private
1011	organizations. The minimum local match cash contributions
1012	required each fiscal year and local match credits shall be
1013	determined by the General Appropriations Act. The corporation
1014	shall calculate a county's local match rate based upon that
1015	county's percentage of the state's total non-Title-XXI
1016	expenditures as reported in the corporation's most recently
1017	audited financial statement. In awarding the local match
1018	credits, the corporation may consider factors including, but not
1019	limited to, population density, per capita income, and existing
1020	child-health-related expenditures and services.;
1021	4. Accept voluntary supplemental local match contributions
1022	that comply with the requirements of Title XXI of the Social
1023	Security Act for the purpose of providing additional coverage in
1024	contributing counties under Title XXI.;
1025	5. Establish the administrative and accounting procedures
1026	for the operation of the corporation.;
1027	6. Establish, with consultation from appropriate
1028	professional organizations, standards for preventive health
1029	services and providers and comprehensive insurance benefits
1030	appropriate to children; provided that such standards for rural
1031	areas shall not limit primary care providers to board-certified
1032	pediatricians.;
1033	7. Establish eligibility criteria which children must meet
1034	in order to participate in the program.;
1035	8. Establish procedures under which providers of local
1036	match to, applicants to and participants in the program may have
1037	grievances reviewed by an impartial body and reported to the
1038	board of directors of the corporation.;
1039	9. Establish participation criteria and, if appropriate,
1040	contract with an authorized insurer, health maintenance
1041	organization, or insurance administrator to provide
1042	administrative services to the corporation.;
1043	10. Establish enrollment criteria which shall include
1044	penalties or waiting periods of not fewer than 60 days for
1045	reinstatement of coverage upon voluntary cancellation for
1046	nonpayment of family premiums.;
1047	11. If a space is available, establish a special open
1048	enrollment period of 30 days' duration for any child who is
1049	enrolled in Medicaid or Medikids if such child loses Medicaid or
1050	Medikids eligibility and becomes eligible for the Florida
1051	Healthy Kids program.;
1052	12. Contract with authorized insurers or any provider of
1053	health care services, meeting standards established by the
1054	corporation, for the provision of comprehensive insurance
1055	coverage to participants.
1056	a.Such standards shall include criteria under which the
1057	corporation may contract with more than one provider of health
1058	care services in program sites. Health plans shall be selected
1059	through a competitive bid process that utilizes as the maximum
1060	payable rate the current Medicaid reimbursement being paid by
1061	the Agency for Health Care Administration to its managed care
1062	plans for the same age population, risk-adjusted for the Healthy
1063	Kids population and adjusted for enrollee demographics, services
1064	covered by the proposed rate, utilization, and inflation.
1065	Healthy Kids shall neither enter a contract nor renew a contract
1066	that has administrative costs greater than 15 percent.
1067	b. Enrollees shall be enrolled with the selected health
1068	plan or plans in their county. If no qualified bidder submits a
1069	proposal utilizing the rate, then enrollees in the Healthy Kids
1070	program may receive services through the Medikids program. If
1071	the corporation delivers services through the Medikids option,
1072	the corporation shall establish an appropriate level of reserves
1073	in which to pay claims. The amount of the reserves shall be
1074	appropriate for the number of enrollees accessing services
1075	through this option and will be actuarially reviewed for
1076	soundness and approved by the Department of Financial Services.
1077	c. Implementation of the process described in sub-
1078	subparagraphs a. and b. shall begin on July 1, 2003, or at
1079	renewal of each insurer's current contract, but shall be
1080	completed statewide no later than September 30, 2004. The term
1081	"renewal" includes contract options and option years.
1082	d. Dental services shall be provided to Healthy Kids
1083	enrollees using the administrative structure and provider
1084	network of the Medicaid programThe selection of health plans
1085	shall be based primarily on quality criteria established by the
1086	board.
1087
1088	The health plan selection criteria and scoring system, and the
1089	scoring results, shall be available upon request for inspection
1090	after the bids have been awarded.;
1091	13. Establish disenrollment criteria in the event local
1092	matching funds are insufficient to cover enrollments.;
1093	14. Develop and implement a plan to publicize the Florida
1094	Healthy Kids Corporation, the eligibility requirements of the
1095	program, and the procedures for enrollment in the program and to
1096	maintain public awareness of the corporation and the program.;
1097	15. Secure staff necessary to properly administer the
1098	corporation. Staff costs shall be funded from state and local
1099	matching funds and such other private or public funds as become
1100	available. The board of directors shall determine the number of
1101	staff members necessary to administer the corporation.;
1102	16. As appropriate, enter into contracts with local school
1103	boards or other agencies to provide onsite information,
1104	enrollment, and other services necessary to the operation of the
1105	corporation.;
1106	17. Provide a report annually to the Governor, Chief
1107	Financial Officer, Commissioner of Education, Senate President,
1108	Speaker of the House of Representatives, and Minority Leaders of
1109	the Senate and the House of Representatives.;
1110	18. Each fiscal year, establish a maximum number of
1111	participants, on a statewide basis, who may enroll in the
1112	program.; and
1113	19. Establish eligibility criteria, premium and cost-
1114	sharing requirements, and benefit packages which conform to the
1115	provisions of the Florida Kidcare program, as created in ss.
1116	409.810-409.820.
1117	(5) BOARD OF DIRECTORS.--
1118	(a) The Florida Healthy Kids Corporation shall operate
1119	subject to the supervision and approval of a board of directors
1120	chaired by the Chief Financial Officer or her or his designee,
1121	and composed of 614other members selected for 3-year terms of
1122	office as follows:
1123	1. One member, appointed by the Chief Financial Officer,
1124	who represents the Office of Insurance Regulation.Commissioner
1125	of Education from among three persons nominated by the Florida
1126	Association of School Administrators;
1127	2. One member appointed by the Commissioner of Education
1128	from among three persons nominated by the Florida Association of
1129	School Boards;
1130	3. One member appointed by the Commissioner of Education
1131	from the Office of School Health Programs of the Florida
1132	Department of Education;
1133	4. One member appointed by the Governor from among three
1134	members nominated by the Florida Pediatric Society;
1135	2.5.One member, appointed by the Governor, who represents
1136	the Children's Medical Services Program and the Department of
1137	Health.;
1138	6. One member appointed by the Chief Financial Officer
1139	from among three members nominated by the Florida Hospital
1140	Association;
1141	7. Two members, appointed by the Chief Financial Officer,
1142	who are representatives of authorized health care insurers or
1143	health maintenance organizations;
1144	3.8.One member, appointed by the Chief Financial Officer,
1145	who represents the Institute for Child Health Policy.;
1146	9. One member, appointed by the Governor, from among three
1147	members nominated by the Florida Academy of Family Physicians;
1148	4.10.One member, appointed by the Governor, who
1149	represents the Agency for Health Care Administration.;
1150	5.11.One member, appointed by the Chief Financial
1151	Officer, from among three members nominated by the Florida
1152	Association of Counties, representing rural counties.;
1153	6.12.One member, appointed by the Governor, from among
1154	three members nominated by the Florida Association of Counties,
1155	representing urban counties.; and
1156	13. The State Health Officer or her or his designee.
1157	Section 17. The provisions of this act which would require
1158	changes to the contracts in existence on June 30, 2003, between
1159	the Florida Healthy Kids Corporation and its contracted
1160	providers shall be applied to such contracts upon the renewal of
1161	the contracts, but no later than September 30, 2004. The term
1162	"renewal" includes contract options and option years.
1163	Section 18. Section 57 of chapter 98-288, Laws of Florida,
1164	is repealed.
1165	Section 19. If any law amended by this act was also
1166	amended by a law enacted at the 2003 Regular Session of the
1167	Legislature, such laws shall be construed as if they had been
1168	enacted at the same session of the Legislature, and full effect
1169	shall be given to each if possible.
1170	Section 20. Except as otherwise provided herein, this act
1171	shall take effect July 1, 2003.
1172
1173	================= T I T L E A M E N D M E N T =================
1174	Remove the entire title, and insert:
1175	A bill to be entitled
1176	An act relating to health care; amending s. 400.179, F.S.;
1177	retaining a fee against leasehold licensees to meet
1178	bonding requirements to cover Medicaid underpayments and
1179	overpayments; amending s. 409.811, F.S.; defining "managed
1180	care plan" for purposes of the Florida Kidcare Act;
1181	amending s. 409.8132, F.S.; providing a cross reference;
1182	amending s. 409.901, F.S.; revising the definition of
1183	"third party"; amending s. 409.904, F.S.; revising
1184	eligibility requirements for certain optional payments for
1185	medical assistance and related services; amending s.
1186	409.906, F.S.; revising requirements for payment of
1187	optional Medicaid services; limiting provision of dental,
1188	hearing, and visual services; amending s. 409.9081, F.S.;
1189	providing coinsurance requirements for prescription drugs;
1190	providing copayment requirements for hospital outpatient
1191	emergency department services; amending s. 409.911, F.S.;
1192	revising formulas for payment under the disproportionate
1193	share program; revising definitions; providing for use of
1194	audited data; amending s. 409.9112, F.S.; revising
1195	formulas for payment under the disproportionate share
1196	program for regional perinatal intensive care centers;
1197	amending s. 409.9117, F.S.; revising formulas for payment
1198	under the primary care disproportionate share program;
1199	revising criteria for such payments; amending s. 409.9119,
1200	F.S.; revising criteria for payment under the
1201	disproportionate share program for specialty hospitals for
1202	children; amending s. 409.912, F.S.; providing for the
1203	Agency for Health Care Administration to contract with a
1204	service network; deleting provisions for service network
1205	demonstration projects; providing for contracting to
1206	provide Medicaid covered dental services; amending s.
1207	409.9122, F.S.; revising provisions for assignment to a
1208	managed care plan by the agency; amending s. 409.913,
1209	F.S.; providing for oversight of Medicaid by authorized
1210	agents of the Agency for Health Care Administration;
1211	amending s. 430.502, F.S.; requiring the Agency for Health
1212	Care Administration and the Department of Elderly Affairs
1213	to seek and implement a Medicaid home and community-based
1214	waiver for persons with Alzheimer's disease; requiring the
1215	development of waiver program standards; providing for
1216	consultation with the presiding officers of the
1217	Legislature; providing for a contingent future repeal of
1218	such waiver program; amending s. 624.91, F.S.; revising
1219	duties of the Florida Healthy Kids Corporation; revising
1220	membership of the board of directors of the corporation;
1221	providing for application of the act to existing contracts
1222	between the Florida Healthy Kids Corporation and its
1223	contracted providers; repealing s. 57, ch. 98-288, Laws of
1224	Florida, relating to future review and repeal of the
1225	"Florida Kidcare Act" based on specified changes in
1226	federal policy; providing for construction of the act in
1227	pari materia with laws enacted during the Regular Session
1228	of the Legislature; providing effective dates.