HOUSE AMENDMENT Bill No. HB 35A CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Harrell offered the following:
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14	Amendment (with directory amendment)
15	Remove lines 1112-1159, and insert:
16	(k) When a Medicaid recipient does not choose a managed
17	care plan or MediPass provider, the agency shall assign the
18	Medicaid recipient to a managed care plan, except in those
19	counties in which there are fewer than two managed care plans
20	accepting Medicaid enrollees, in which case assignment shall be
21	to a managed care plan or a MediPass provider. Medicaid
22	recipients in counties with fewer than two managed care plans
23	accepting Medicaid enrollees who are subject to mandatory
24	assignment but who fail to make a choice shall be assigned to
25	managed care plans until an enrollment of 4045percent in
26	MediPass and 6055percent in managed care plans is achieved.
27	Once that enrollment is achieved, the assignments shall be
28	divided in order to maintain an enrollment in MediPass and
29	managed care plans which is in a 4045 percent and 6055percent
30	proportion, respectively. In geographic areas where the agency
31	is contracting for the provision of comprehensive behavioral
32	health services through a capitated prepaid arrangement,
33	recipients who fail to make a choice shall be assigned equally
34	to MediPass or a managed care plan. For purposes of this
35	paragraph, when referring to assignment, the term "managed care
36	plans" includes exclusive provider organizations, provider
37	service networks, Children's Medical Services network, minority
38	physician networks, and pediatric emergency department diversion
39	programs authorized by this chapter or the General
40	Appropriations Act. When making assignments, the agency shall
41	take into account the following criteria:
42	1. A managed care plan has sufficient network capacity to
43	meet the need of members.
44	2. The managed care plan or MediPass has previously
45	enrolled the recipient as a member, or one of the managed care
46	plan's primary care providers or MediPass providers has
47	previously provided health care to the recipient.
48	3. The agency has knowledge that the member has previously
49	expressed a preference for a particular managed care plan or
50	MediPass provider as indicated by Medicaid fee-for-service
51	claims data, but has failed to make a choice.
52	4. The managed care plan's or MediPass primary care
53	providers are geographically accessible to the recipient's
54	residence.
55	5. The agency has authority to make mandatory assignments
56	based on quality of service and performance of managed care
57	plans.
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59	============= D I R E C T O R Y A M E N D M E N T =============
60	Remove line 1044, and insert:
61	Section 17. Paragraphs (f) and (k) of subsection (2)