HOUSE AMENDMENT Bill No. HB 35A CS
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 lines 169-1460, and insert:
16	Section 2. Subsections (17), (18), (19), (20), (21), (22),
17	(23), (24), (25), (26), and (27) of section 409.811, Florida
18	Statutes, are renumbered as subsections (18), (19), (20), (21),
19	(22), (23), (24), (25), (26), (27), and (28), respectively, and
20	a new subsection (17) is added to said section to read:
21	409.811 Definitions relating to Florida Kidcare Act.--As
22	used in ss. 409.810-409.820, the term:
23	(17) "Managed care plan" means a health maintenance
24	organization authorized pursuant to chapter 641 or a prepaid
25	health plan authorized pursuant to s. 409.912.
26	Section 3. Subsection (7) of section 409.8132, Florida
27	Statutes, is amended to read:
28	409.8132 Medikids program component.--
29	(7) ENROLLMENT.--Enrollment in the Medikids program
30	component may only occur during periodic open enrollment periods
31	as specified by the agency. An applicant may apply for
32	enrollment in the Medikids program component and proceed through
33	the eligibility determination process at any time throughout the
34	year. However, enrollment in Medikids shall not begin until the
35	next open enrollment period; and a child may not receive
36	services under the Medikids program until the child is enrolled
37	in a managed care plan as defined in s. 409.811 or inMediPass.
38	In addition, once determined eligible, an applicant may receive
39	choice counseling and select a managed care plan or MediPass.
40	The agency may initiate mandatory assignment for a Medikids
41	applicant who has not chosen a managed care plan or MediPass
42	provider after the applicant's voluntary choice period ends. An
43	applicant may select MediPass under the Medikids program
44	component only in counties that have fewer than two managed care
45	plans available to serve Medicaid recipients and only if the
46	federal Health Care Financing Administration determines that
47	MediPass constitutes "health insurance coverage" as defined in
48	Title XXI of the Social Security Act.
49	Section 4. Subsection (25) of section 409.901, Florida
50	Statutes, is amended to read:
51	409.901 Definitions; ss. 409.901-409.920.--As used in ss.
52	409.901-409.920, except as otherwise specifically provided, the
53	term:
54	(25) "Third party" means an individual, entity, or
55	program, excluding Medicaid, that is, may be, could be, should
56	be, or has been liable for all or part of the cost of medical
57	services related to any medical assistance providedcovered by
58	Medicaid. Third party includes a third-party administrator or
59	TPA and a pharmacy benefits manager or PBM.
60	Section 5. Subsection (2) of section 409.904, Florida
61	Statutes, is amended to read:
62	409.904 Optional payments for eligible persons.--The
63	agency may make payments for medical assistance and related
64	services on behalf of the following persons who are determined
65	to be eligible subject to the income, assets, and categorical
66	eligibility tests set forth in federal and state law. Payment on
67	behalf of these Medicaid eligible persons is subject to the
68	availability of moneys and any limitations established by the
69	General Appropriations Act or chapter 216.
70	(2) A caretaker relative or parent, a pregnant woman, a
71	child under age 19 who would otherwise qualify for Florida
72	Kidcare Medicaid, a child up to age 21 who would otherwise
73	qualify under s. 409.903(1), a person age 65 or over, or a blind
74	or disabled person, who would otherwise be eligible for Florida
75	Medicaid, except that the income or assets of such family or
76	person exceed established limitations. For a family or person in
77	one of these coverage groups, medical expenses are deductible
78	from income in accordance with federal requirements in order to
79	make a determination of eligibility. Expenses used to meet
80	spend-down liability are not reimbursable by Medicaid. Effective
81	May 1, 2003, When determining the eligibility of a pregnant
82	woman, a child, or an aged, blind, or disabled individual, $270
83	shall be deducted from the countable income of the filing unit.
84	When determining the eligibility of the parent or caretaker
85	relative as defined by Title XIX of the Social Security Act, the
86	additional income disregard of $270 does not apply.A family or
87	person eligible under the coverage known as the "medically
88	needy," is eligible to receive the same services as other
89	Medicaid recipients, with the exception of services in skilled
90	nursing facilities and intermediate care facilities for the
91	developmentally disabled.
92	Section 6. Subsections (1), (12), and (23) of section
93	409.906, Florida Statutes, are amended to read:
94	409.906 Optional Medicaid services.--Subject to specific
95	appropriations, the agency may make payments for services which
96	are optional to the state under Title XIX of the Social Security
97	Act and are furnished by Medicaid providers to recipients who
98	are determined to be eligible on the dates on which the services
99	were provided. Any optional service that is provided shall be
100	provided only when medically necessary and in accordance with
101	state and federal law. Optional services rendered by providers
102	in mobile units to Medicaid recipients may be restricted or
103	prohibited by the agency. Nothing in this section shall be
104	construed to prevent or limit the agency from adjusting fees,
105	reimbursement rates, lengths of stay, number of visits, or
106	number of services, or making any other adjustments necessary to
107	comply with the availability of moneys and any limitations or
108	directions provided for in the General Appropriations Act or
109	chapter 216. If necessary to safeguard the state's systems of
110	providing services to elderly and disabled persons and subject
111	to the notice and review provisions of s. 216.177, the Governor
112	may direct the Agency for Health Care Administration to amend
113	the Medicaid state plan to delete the optional Medicaid service
114	known as "Intermediate Care Facilities for the Developmentally
115	Disabled." Optional services may include:
116	(1) ADULT DENTAL SERVICES.--The agency may pay for
117	dentures, the procedures required to seat dentures, the repair
118	and reline of dentures, emergency dental procedures necessary to
119	alleviate pain or infection, and basic dental preventive
120	procedures provided by or under the direction of a licensed
121	dentist for a recipient who is age 65 or oldermedically
122	necessary, emergency dental procedures to alleviate pain or
123	infection. Emergency dental care shall be limited to emergency
124	oral examinations, necessary radiographs, extractions, and
125	incision and drainage of abscess, for a recipient who is age 21
126	or older. However, Medicaid will not provide reimbursement for
127	dental services provided in a mobile dental unit, except for a
128	mobile dental unit:
129	(a) Owned by, operated by, or having a contractual
130	agreement with the Department of Health and complying with
131	Medicaid's county health department clinic services program
132	specifications as a county health department clinic services
133	provider.
134	(b) Owned by, operated by, or having a contractual
135	arrangement with a federally qualified health center and
136	complying with Medicaid's federally qualified health center
137	specifications as a federally qualified health center provider.
138	(c) Rendering dental services to Medicaid recipients, 21
139	years of age and older, at nursing facilities.
140	(d) Owned by, operated by, or having a contractual
141	agreement with a state-approved dental educational institution.
142	(12) CHILDREN'SHEARING SERVICES.--The agency may pay for
143	hearing and related services, including hearing evaluations,
144	hearing aid devices, dispensing of the hearing aid, and related
145	repairs, if provided to a recipient younger than 21 years of age
146	by a licensed hearing aid specialist, otolaryngologist,
147	otologist, audiologist, or physician.
148	(23) CHILDREN'SVISUAL SERVICES.--The agency may pay for
149	visual examinations, eyeglasses, and eyeglass repairs for a
150	recipient younger than 21 years of age, if they are prescribed
151	by a licensed physician specializing in diseases of the eye or
152	by a licensed optometrist.
153	Section 7. Paragraphs (c) and (d) are added to subsection
154	(1) of section 409.9081, Florida Statutes, to read:
155	409.9081 Copayments.--
156	(1) The agency shall require, subject to federal
157	regulations and limitations, each Medicaid recipient to pay at
158	the time of service a nominal copayment for the following
159	Medicaid services:
160	(c) Prescription drugs: a coinsurance equal to 5 percent
161	of the Medicaid cost of the prescription drug at the time of
162	purchase. The maximum coinsurance shall be $15 per prescription
163	drug purchased.
164	(d) Hospital outpatient services, emergency department: up
165	to $15 for each hospital outpatient emergency department
166	encounter that is for nonemergency purposes.
167	Section 8. Section 409.911, Florida Statutes, is amended
168	to read:
169	409.911 Disproportionate share program.--Subject to
170	specific allocations established within the General
171	Appropriations Act and any limitations established pursuant to
172	chapter 216, the agency shall distribute, pursuant to this
173	section, moneys to hospitals providing a disproportionate share
174	of Medicaid or charity care services by making quarterly
175	Medicaid payments as required. Notwithstanding the provisions of
176	s. 409.915, counties are exempt from contributing toward the
177	cost of this special reimbursement for hospitals serving a
178	disproportionate share of low-income patients.
179	(1) Definitions.--As used in this section, s. 409.9112,
180	and the Florida Hospital Uniform Reporting System manual:
181	(a) "Adjusted patient days" means the sum of acute care
182	patient days and intensive care patient days as reported to the
183	Agency for Health Care Administration, divided by the ratio of
184	inpatient revenues generated from acute, intensive, ambulatory,
185	and ancillary patient services to gross revenues.
186	(b) "Actual audited data" or "actual audited experience"
187	means data reported to the Agency for Health Care Administration
188	which has been audited in accordance with generally accepted
189	auditing standards by the agency or representatives under
190	contract with the agency.
191	(c) "Base Medicaid per diem" means the hospital's Medicaid
192	per diem rate initially established by the Agency for Health
193	Care Administration on January 1, 1999. The base Medicaid per
194	diem rate shall not include any additional per diem increases
195	received as a result of the disproportionate share distribution.
196	(c)(d)"Charity care" or "uncompensated charity care"
197	means that portion of hospital charges reported to the Agency
198	for Health Care Administration for which there is no
199	compensation, other than restricted or unrestricted revenues
200	provided to a hospital by local governments or tax districts
201	regardless of the method of payment, for care provided to a
202	patient whose family income for the 12 months preceding the
203	determination is less than or equal to 200 percent of the
204	federal poverty level, unless the amount of hospital charges due
205	from the patient exceeds 25 percent of the annual family income.
206	However, in no case shall the hospital charges for a patient
207	whose family income exceeds four times the federal poverty level
208	for a family of four be considered charity.
209	(d)(e)"Charity care days" means the sum of the deductions
210	from revenues for charity care minus 50 percent of restricted
211	and unrestricted revenues provided to a hospital by local
212	governments or tax districts, divided by gross revenues per
213	adjusted patient day.
214	(f) "Disproportionate share percentage" means a rate of
215	increase in the Medicaid per diem rate as calculated under this
216	section.
217	(e)(g)"Hospital" means a health care institution licensed
218	as a hospital pursuant to chapter 395, but does not include
219	ambulatory surgical centers.
220	(f)(h)"Medicaid days" means the number of actual days
221	attributable to Medicaid patients as determined by the Agency
222	for Health Care Administration.
223	(2) The Agency for Health Care Administration shall
224	utilize the following actual audited datacriteria to determine
225	the Medicaid days and charity care to be used in the calculation
226	of theif a hospital qualifies for adisproportionate share
227	payment:
228	(a) The Agency for Health Care Administration shall use
229	the average of the 1997, 1998, and 1999 audited data to
230	determine each hospital's Medicaid days and charity careA
231	hospital's total Medicaid days when combined with its total
232	charity care days must equal or exceed 7 percent of its total
233	adjusted patient days.
234	(b) In the event the Agency for Health Care Administration
235	does not have the prescribed 3 years of audited disproportionate
236	share data for a hospital, the Agency for Health Care
237	Administration shall use the average of the audited
238	disproportionate share data for the years availableA hospital's
239	total charity care days weighted by a factor of 4.5, plus its
240	total Medicaid days weighted by a factor of 1, shall be equal to
241	or greater than 10 percent of its total adjusted patient days.
242	(c) Additionally, In accordance with s. 1923(b) of the
243	Social Security Actthe seventh federal Omnibus Budget
244	Reconciliation Act, a hospital with a Medicaid inpatient
245	utilization rate greater than one standard deviation above the
246	statewide mean or a hospital with a low-income utilization rate
247	of 25 percent or greater shall qualify for reimbursement.
248	(3) In computing the disproportionate share rate:
249	(a) Per diem increases earned from disproportionate share
250	shall be applied to each hospital's base Medicaid per diem rate
251	and shall be capped at 170 percent.
252	(b) The agency shall use 1994 audited financial data for
253	the calculation of disproportionate share payments under this
254	section.
255	(c) If the total amount earned by all hospitals under this
256	section exceeds the amount appropriated, each hospital's share
257	shall be reduced on a pro rata basis so that the total dollars
258	distributed from the trust fund do not exceed the total amount
259	appropriated.
260	(d) The total amount calculated to be distributed under
261	this section shall be made in quarterly payments subsequent to
262	each quarter during the fiscal year.
263	(3)(4)Hospitals that qualify for a disproportionate share
264	payment solely under paragraph (2)(c) shall have their payment
265	calculated in accordance with the following formulas:
266
267	DSHP = (HMD/TSMD) x $1 million
268	TAA = TA x (1/5.5)
269	DSHP = (HMD/TSMD) x TAA
270
271	Where:
272	TAA = total amount available.
273	TA = total appropriation.
274	DSHP = disproportionate share hospital payment.
275	HMD = hospital Medicaid days.
276	TSMD = total state Medicaid days.
277
278	(4) The following formulas shall be used to pay
279	disproportionate share dollars to public hospitals:
280	(a) For state mental health hospitals:
281
282	DSHP = (HMD/TMDMH) x TAAMH
283
284	The total amount available for the state mental health hospitals
285	shall be the difference between the federal cap for Institutions
286	for Mental Diseases and the amounts paid under the mental health
287	disproportionate share program.
288
289	Where:
290	DSHP = disproportionate share hospital payment.
291	HMD = hospital Medicaid days.
292	TMDMH = total Medicaid days for state mental health
293	hospitals.
294	TAAMH = total amount available for mental health hospitals.
295
296	(b) For nonstate government owned or operated hospitals
297	with 3,200 or more Medicaid days:
298
299	DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)] x TAAPH
300	TAAPH = TAA – TAAMH – 1,400,000
301
302	Where:
303	DSHP = disproportionate share hospital payments.
304	HCCD = hospital charity care dollars.
305	TCCD = total charity care dollars for public nonstate
306	hospitals.
307	HMD = hospital Medicaid days.
308	TMD = total Medicaid days for public nonstate hospitals.
309	TAAPH = total amount available for public hospitals.
310	TAA = total available appropriation.
311	TAAMH = total amount available for mental health hospitals.
312
313	(c) For nonstate government owned or operated hospitals
314	with less than 3,200 Medicaid days, a total of $400,000 shall be
315	distributed equally among these hospitals.
316	(5) The following formula shall be utilized by the agency
317	to determine the maximum disproportionate share rate to be used
318	to increase the Medicaid per diem rate for hospitals that
319	qualify pursuant to paragraphs (2)(a) and (b):
320	DSR = CCD MD
321	((---------) x 4.5) + (---------)
322	@_@2@_@
323	Where:
324	APD = adjusted patient days.
325	CCD = charity care days.
326	DSR = disproportionate share rate.
327	MD = Medicaid days.
328
329	(6)(a) To calculate the total amount earned by all
330	hospitals under this section, hospitals with a disproportionate
331	share rate less than 50 percent shall divide their Medicaid days
332	by four, and hospitals with a disproportionate share rate
333	greater than or equal to 50 percent and with greater than 40,000
334	Medicaid days shall multiply their Medicaid days by 1.5, and the
335	following formula shall be used by the agency to calculate the
336	total amount earned by all hospitals under this section:
337
338	TAE = BMPD x MD x DSP
339
340	Where:
341	TAE = total amount earned.
342	BMPD = base Medicaid per diem.
343	MD = Medicaid days.
344	DSP = disproportionate share percentage.
345
346	(5)(b)In no case shall total payments to a hospital under
347	this section, with the exception of public nonstate facilities
348	orstate facilities, exceed the total amount of uncompensated
349	charity care of the hospital, as determined by the agency
350	according to the most recent calendar year audited data
351	available at the beginning of each state fiscal year.
352	(7) The following criteria shall be used in determining
353	the disproportionate share percentage:
354	(a) If the disproportionate share rate is less than 10
355	percent, the disproportionate share percentage is zero and there
356	is no additional payment.
357	(b) If the disproportionate share rate is greater than or
358	equal to 10 percent, but less than 20 percent, then the
359	disproportionate share percentage is 1.8478498.
360	(c) If the disproportionate share rate is greater than or
361	equal to 20 percent, but less than 30 percent, then the
362	disproportionate share percentage is 3.4145488.
363	(d) If the disproportionate share rate is greater than or
364	equal to 30 percent, but less than 40 percent, then the
365	disproportionate share percentage is 6.3095734.
366	(e) If the disproportionate share rate is greater than or
367	equal to 40 percent, but less than 50 percent, then the
368	disproportionate share percentage is 11.6591440.
369	(f) If the disproportionate share rate is greater than or
370	equal to 50 percent, but less than 60 percent, then the
371	disproportionate share percentage is 73.5642254.
372	(g) If the disproportionate share rate is greater than or
373	equal to 60 percent but less than 72.5 percent, then the
374	disproportionate share percentage is 135.9356391.
375	(h) If the disproportionate share rate is greater than or
376	equal to 72.5 percent, then the disproportionate share
377	percentage is 170.
378	(8) The following formula shall be used by the agency to
379	calculate the total amount earned by all hospitals under this
380	section:
381
382	TAE = BMPD x MD x DSP
383
384	Where:
385	TAE = total amount earned.
386	BMPD = base Medicaid per diem.
387	MD = Medicaid days.
388	DSP = disproportionate share percentage.
389
390	(6)(9)The agency is authorized to receive funds from
391	local governments and other local political subdivisions for the
392	purpose of making payments, including federal matching funds,
393	through the Medicaid disproportionate share program. Funds
394	received from local governments for this purpose shall be
395	separately accounted for and shall not be commingled with other
396	state or local funds in any manner.
397	(7)(10)Payments made by the agency to hospitals eligible
398	to participate in this program shall be made in accordance with
399	federal rules and regulations.
400	(a) If the Federal Government prohibits, restricts, or
401	changes in any manner the methods by which funds are distributed
402	for this program, the agency shall not distribute any additional
403	funds and shall return all funds to the local government from
404	which the funds were received, except as provided in paragraph
405	(b).
406	(b) If the Federal Government imposes a restriction that
407	still permits a partial or different distribution, the agency
408	may continue to disburse funds to hospitals participating in the
409	disproportionate share program in a federally approved manner,
410	provided:
411	1. Each local government which contributes to the
412	disproportionate share program agrees to the new manner of
413	distribution as shown by a written document signed by the
414	governing authority of each local government; and
415	2. The Executive Office of the Governor, the Office of
416	Planning and Budgeting, the House of Representatives, and the
417	Senate are provided at least 7 days' prior notice of the
418	proposed change in the distribution, and do not disapprove such
419	change.
420	(c) No distribution shall be made under the alternative
421	method specified in paragraph (b) unless all parties agree or
422	unless all funds of those parties that disagree which are not
423	yet disbursed have been returned to those parties.
424	(8)(11)Notwithstanding the provisions of chapter 216, the
425	Executive Office of the Governor is hereby authorized to
426	establish sufficient trust fund authority to implement the
427	disproportionate share program.
428	Section 9. Subsections (1) and (2) of section 409.9112,
429	Florida Statutes, are amended to read:
430	409.9112 Disproportionate share program for regional
431	perinatal intensive care centers.--In addition to the payments
432	made under s. 409.911, the Agency for Health Care Administration
433	shall design and implement a system of making disproportionate
434	share payments to those hospitals that participate in the
435	regional perinatal intensive care center program established
436	pursuant to chapter 383. This system of payments shall conform
437	with federal requirements and shall distribute funds in each
438	fiscal year for which an appropriation is made by making
439	quarterly Medicaid payments. Notwithstanding the provisions of
440	s. 409.915, counties are exempt from contributing toward the
441	cost of this special reimbursement for hospitals serving a
442	disproportionate share of low-income patients.
443	(1) The following formula shall be used by the agency to
444	calculate the total amount earned for hospitals that participate
445	in the regional perinatal intensive care center program:
446
447	TAE = HDSP/THDSP
448
449	Where:
450	TAE = total amount earned by a regional perinatal intensive
451	care center.
452	HDSP = the prior state fiscal year regional perinatal
453	intensive care center disproportionate share payment to the
454	individual hospital.
455	THDSP = the prior state fiscal year total regional
456	perinatal intensive care center disproportionate share payments
457	to all hospitals.
458	(2) The total additional payment for hospitals that
459	participate in the regional perinatal intensive care center
460	program shall be calculated by the agency as follows:
461
462	TAP = TAE x TA
463
464	Where:
465	TAP = total additional payment for a regional perinatal
466	intensive care center.
467	TAE = total amount earned by a regional perinatal intensive
468	care center.
469	TA = total appropriation for the regional perinatal
470	intensive care center disproportionate share program.
471
472	TAE = DSR x BMPD x MD
473
474	Where:
475	TAE = total amount earned by a regional perinatal intensive
476	care center.
477	DSR = disproportionate share rate.
478	BMPD = base Medicaid per diem.
479	MD = Medicaid days.
480
481	(2) The total additional payment for hospitals that
482	participate in the regional perinatal intensive care center
483	program shall be calculated by the agency as follows:
484	TAP = TAE x TA
485	(---------------)
486	@_@5@_@
487	Where:
488	TAP = total additional payment for a regional perinatal
489	intensive care center.
490	TAE = total amount earned by a regional perinatal intensive
491	care center.
492	STAE = sum of total amount earned by each hospital that
493	participates in the regional perinatal intensive care center
494	program.
495	TA = total appropriation for the regional perinatal
496	intensive care disproportionate share program.
497	Section 10. Section 409.9117, Florida Statutes, is amended
498	to read:
499	409.9117 Primary care disproportionate share program.--
500	(1) If federal funds are available for disproportionate
501	share programs in addition to those otherwise provided by law,
502	there shall be created a primary care disproportionate share
503	program.
504	(2) The following formula shall be used by the agency to
505	calculate the total amount earned for hospitals that participate
506	in the primary care disproportionate share program:
507
508	TAE = HDSP/THDSP
509
510	Where:
511	TAE = total amount earned by a hospital participating in
512	the primary care disproportionate share program.
513	HDSP = the prior state fiscal year primary care
514	disproportionate share payment to the individual hospital.
515	THDSP = the prior state fiscal year to primary care
516	disproportionate share payments to all hospitals.
517	(3) The total additional payment for hospitals that
518	participate in the primary care disproportionate share program
519	shall be calculated by the agency as follows:
520
521	TAP = TAE x TA
522
523	Where:
524	TAP = total additional payment for a primary care hospital.
525	TAE = total amount earned by a primary care hospital.
526	TA = total appropriation for the primary care
527	disproportionate share program.
528	(4)(2)In the establishment and funding of this program,
529	the agency shall use the following criteria in addition to those
530	specified in s. 409.911.,Payments may not be made to a hospital
531	unless the hospital agrees to:
532	(a) Cooperate with a Medicaid prepaid health plan, if one
533	exists in the community.
534	(b) Ensure the availability of primary and specialty care
535	physicians to Medicaid recipients who are not enrolled in a
536	prepaid capitated arrangement and who are in need of access to
537	such physicians.
538	(c) Coordinate and provide primary care services free of
539	charge, except copayments, to all persons with incomes up to 100
540	percent of the federal poverty level who are not otherwise
541	covered by Medicaid or another program administered by a
542	governmental entity, and to provide such services based on a
543	sliding fee scale to all persons with incomes up to 200 percent
544	of the federal poverty level who are not otherwise covered by
545	Medicaid or another program administered by a governmental
546	entity, except that eligibility may be limited to persons who
547	reside within a more limited area, as agreed to by the agency
548	and the hospital.
549	(d) Contract with any federally qualified health center,
550	if one exists within the agreed geopolitical boundaries,
551	concerning the provision of primary care services, in order to
552	guarantee delivery of services in a nonduplicative fashion, and
553	to provide for referral arrangements, privileges, and
554	admissions, as appropriate. The hospital shall agree to provide
555	at an onsite or offsite facility primary care services within 24
556	hours to which all Medicaid recipients and persons eligible
557	under this paragraph who do not require emergency room services
558	are referred during normal daylight hours.
559	(e) Cooperate with the agency, the county, and other
560	entities to ensure the provision of certain public health
561	services, case management, referral and acceptance of patients,
562	and sharing of epidemiological data, as the agency and the
563	hospital find mutually necessary and desirable to promote and
564	protect the public health within the agreed geopolitical
565	boundaries.
566	(f) In cooperation with the county in which the hospital
567	resides, develop a low-cost, outpatient, prepaid health care
568	program to persons who are not eligible for the Medicaid
569	program, and who reside within the area.
570	(g) Provide inpatient services to residents within the
571	area who are not eligible for Medicaid or Medicare, and who do
572	not have private health insurance, regardless of ability to pay,
573	on the basis of available space, except that nothing shall
574	prevent the hospital from establishing bill collection programs
575	based on ability to pay.
576	(h) Work with the Florida Healthy Kids Corporation, the
577	Florida Health Care Purchasing Cooperative,and business health
578	coalitions, as appropriate, to develop a feasibility study and
579	plan to provide a low-cost comprehensive health insurance plan
580	to persons who reside within the area and who do not have access
581	to such a plan.
582	(i) Work with public health officials and other experts to
583	provide community health education and prevention activities
584	designed to promote healthy lifestyles and appropriate use of
585	health services.
586	(j) Work with the local health council to develop a plan
587	for promoting access to affordable health care services for all
588	persons who reside within the area, including, but not limited
589	to, public health services, primary care services, inpatient
590	services, and affordable health insurance generally.
591
592	Any hospital that fails to comply with any of the provisions of
593	this subsection, or any other contractual condition, may not
594	receive payments under this section until full compliance is
595	achieved.
596	Section 11. Section 409.9119, Florida Statutes, is amended
597	to read:
598	409.9119 Disproportionate share program for specialty
599	hospitals for children.--In addition to the payments made under
600	s. 409.911, the Agency for Health Care Administration shall
601	develop and implement a system under which disproportionate
602	share payments are made to those hospitals that are licensed by
603	the state as specialty hospitals for children and were licensed
604	on January 1, 2000, as specialty hospitals for children. This
605	system of payments must conform to federal requirements and must
606	distribute funds in each fiscal year for which an appropriation
607	is made by making quarterly Medicaid payments. Notwithstanding
608	s. 409.915, counties are exempt from contributing toward the
609	cost of this special reimbursement for hospitals that serve a
610	disproportionate share of low-income patients. Payments are
611	subject to specific appropriations in the General Appropriations
612	Act.
613	(1) The agency shall use the following formula to
614	calculate the total amount earned for hospitals that participate
615	in the specialty hospital for children disproportionate share
616	program:
617
618	TAE = DSR x BMPD x MD
619
620	Where:
621	TAE = total amount earned by a specialty hospital for
622	children.
623	DSR = disproportionate share rate.
624	BMPD = base Medicaid per diem.
625	MD = Medicaid days.
626	(2) The agency shall calculate the total additional
627	payment for hospitals that participate in the specialty hospital
628	for children disproportionate share program as follows:
629	TAP = TAE x TA
630	(---------------)
631	STAE
632	Where:
633	TAP = total additional payment for a specialty hospital for
634	children.
635	TAE = total amount earned by a specialty hospital for
636	children.
637	TA = total appropriation for the specialty hospital for
638	children disproportionate share program.
639	STAE = sum of total amount earned by each hospital that
640	participates in the specialty hospital for children
641	disproportionate share program.
642
643	(3) A hospital may not receive any payments under this
644	section until it achieves full compliance with the applicable
645	rules of the agency. A hospital that is not in compliance for
646	two or more consecutive quarters may not receive its share of
647	the funds. Any forfeited funds must be distributed to the
648	remaining participating specialty hospitals for children that
649	are in compliance.
650	Section 12. Paragraph (d) of subsection (3) of section
651	409.912, Florida Statutes, is amended, and subsection (41) is
652	added to said section, to read:
653	409.912 Cost-effective purchasing of health care.--The
654	agency shall purchase goods and services for Medicaid recipients
655	in the most cost-effective manner consistent with the delivery
656	of quality medical care. The agency shall maximize the use of
657	prepaid per capita and prepaid aggregate fixed-sum basis
658	services when appropriate and other alternative service delivery
659	and reimbursement methodologies, including competitive bidding
660	pursuant to s. 287.057, designed to facilitate the cost-
661	effective purchase of a case-managed continuum of care. The
662	agency shall also require providers to minimize the exposure of
663	recipients to the need for acute inpatient, custodial, and other
664	institutional care and the inappropriate or unnecessary use of
665	high-cost services. The agency may establish prior authorization
666	requirements for certain populations of Medicaid beneficiaries,
667	certain drug classes, or particular drugs to prevent fraud,
668	abuse, overuse, and possible dangerous drug interactions. The
669	Pharmaceutical and Therapeutics Committee shall make
670	recommendations to the agency on drugs for which prior
671	authorization is required. The agency shall inform the
672	Pharmaceutical and Therapeutics Committee of its decisions
673	regarding drugs subject to prior authorization.
674	(3) The agency may contract with:
675	(d) A provider networkNo more than four provider service
676	networks for demonstration projects to test Medicaid direct
677	contracting. The demonstration projectsmay be reimbursed on a
678	fee-for-service or prepaid basis. A provider service network
679	which is reimbursed by the agency on a prepaid basis shall be
680	exempt from parts I and III of chapter 641, but must meet
681	appropriate financial reserve, quality assurance, and patient
682	rights requirements as established by the agency. The agency
683	shall award contracts on a competitive bid basis and shall
684	select bidders based upon price and quality of care. Medicaid
685	recipients assigned to a demonstration project shall be chosen
686	equally from those who would otherwise have been assigned to
687	prepaid plans and MediPass.The agency is authorized to seek
688	federal Medicaid waivers as necessary to implement the
689	provisions of this section. A demonstration project awarded
690	pursuant to this paragraph shall be for 4 years from the date of
691	implementation.
692	(41) The agency may contract on a prepaid or fixed-sum
693	basis with an appropriately licensed prepaid dental health plan
694	to provide Medicaid covered dental services to child or adult
695	Medicaid recipients.
696	Section 13. Paragraphs (f), (k), and (l) of subsection (2)
697	of section 409.9122, Florida Statutes, are amended to read:
698	409.9122 Mandatory Medicaid managed care enrollment;
699	programs and procedures.--
700	(2)
701	(f) When a Medicaid recipient does not choose a managed
702	care plan or MediPass provider, the agency shall assign the
703	Medicaid recipient to a managed care plan or MediPass provider.
704	Medicaid recipients who are subject to mandatory assignment but
705	who fail to make a choice shall be assigned to managed care
706	plans until an enrollment of 4045 percent in MediPass and 6055
707	percent in managed care plans is achieved. Once this enrollment
708	is achieved, the assignments shall be divided in order to
709	maintain an enrollment in MediPass and managed care plans which
710	is in a 4045 percent and 6055percent proportion,
711	respectively. Thereafter, assignment of Medicaid recipients who
712	fail to make a choice shall be based proportionally on the
713	preferences of recipients who have made a choice in the previous
714	period. Such proportions shall be revised at least quarterly to
715	reflect an update of the preferences of Medicaid recipients. The
716	agency shall disproportionately assign Medicaid-eligible
717	recipients who are required to but have failed to make a choice
718	of managed care plan or MediPass, including children, and who
719	are to be assigned to the MediPass program to children's
720	networks as described in s. 409.912(3)(g), Children's Medical
721	Services network as defined in s. 391.021, exclusive provider
722	organizations, provider service networks, minority physician
723	networks, and pediatric emergency department diversion programs
724	authorized by this chapter or the General Appropriations Act, in
725	such manner as the agency deems appropriate, until the agency
726	has determined that the networks and programs have sufficient
727	numbers to be economically operated. For purposes of this
728	paragraph, when referring to assignment, the term "managed care
729	plans" includes health maintenance organizations, exclusive
730	provider organizations, provider service networks, minority
731	physician networks, Children's Medical Services network, and
732	pediatric emergency department diversion programs authorized by
733	this chapter or the General Appropriations Act. Beginning July
734	1, 2002, the agency shall assign all children in families who
735	have not made a choice of a managed care plan or MediPass in the
736	required timeframe to a pediatric emergency room diversion
737	program described in s. 409.912(3)(g) that, as of July 1, 2002,
738	has executed a contract with the agency, until such network or
739	program has reached an enrollment of 15,000 children. Once that
740	minimum enrollment level has been reached, the agency shall
741	assign children who have not chosen a managed care plan or
742	MediPass to the network or program in a manner that maintains
743	the minimum enrollment in the network or program at not less
744	than 15,000 children. To the extent practicable, the agency
745	shall also assign all eligible children in the same family to
746	such network or program. When making assignments, the agency
747	shall take into account the following criteria:
748	1. A managed care plan has sufficient network capacity to
749	meet the need of members.
750	2. The managed care plan or MediPass has previously
751	enrolled the recipient as a member, or one of the managed care
752	plan's primary care providers or MediPass providers has
753	previously provided health care to the recipient.
754	3. The agency has knowledge that the member has previously
755	expressed a preference for a particular managed care plan or
756	MediPass provider as indicated by Medicaid fee-for-service
757	claims data, but has failed to make a choice.
758	4. The managed care plan's or MediPass primary care
759	providers are geographically accessible to the recipient's
760	residence.
761	5. The agency has authority to make mandatory assignments
762	based on quality of service and performance of managed care
763	plans.
764	(k) When a Medicaid recipient does not choose a managed
765	care plan or MediPass provider, the agency shall assign the
766	Medicaid recipient to a managed care plan, except in those
767	counties in which there are fewer than two managed care plans
768	accepting Medicaid enrollees, in which case assignment shall be
769	to a managed care plan or a MediPass provider. Medicaid
770	recipients in counties with fewer than two managed care plans
771	accepting Medicaid enrollees who are subject to mandatory
772	assignment but who fail to make a choice shall be assigned to
773	managed care plans until an enrollment of 45 percent in MediPass
774	and 55 percent in managed care plans is achieved. Once that
775	enrollment is achieved, the assignments shall be divided in
776	order to maintain an enrollment in MediPass and managed care
777	plans which is in a 45 percent and 55 percent proportion,
778	respectively. In geographic areas where the agency is
779	contracting for the provision of comprehensive behavioral health
780	services through a capitated prepaid arrangement, recipients who
781	fail to make a choice shall be assigned equally to MediPass or a
782	managed care plan. For purposes of this paragraph, when
783	referring to assignment, the term "managed care plans" includes
784	exclusive provider organizations, provider service networks,
785	Children's Medical Services network, minority physician
786	networks, and pediatric emergency department diversion programs
787	authorized by this chapter or the General Appropriations Act.
788	When making assignments, the agency shall take into account the
789	following criteria:
790	1. A managed care plan has sufficient network capacity to
791	meet the need of members.
792	2. The managed care plan or MediPass has previously
793	enrolled the recipient as a member, or one of the managed care
794	plan's primary care providers or MediPass providers has
795	previously provided health care to the recipient.
796	3. The agency has knowledge that the member has previously
797	expressed a preference for a particular managed care plan or
798	MediPass provider as indicated by Medicaid fee-for-service
799	claims data, but has failed to make a choice.
800	4. The managed care plan's or MediPass primary care
801	providers are geographically accessible to the recipient's
802	residence.
803	5. The agency has authority to make mandatory assignments
804	based on quality of service and performance of managed care
805	plans.
806	(k)(l)Notwithstanding the provisions of chapter 287, the
807	agency may, at its discretion, renew cost-effective contracts
808	for choice counseling services once or more for such periods as
809	the agency may decide. However, all such renewals may not
810	combine to exceed a total period longer than the term of the
811	original contract.
812	Section 14. Subsections (8) and (28) of section 409.913,
813	Florida Statutes, are amended to read:
814	409.913 Oversight of the integrity of the Medicaid
815	program.--The agency shall operate a program to oversee the
816	activities of Florida Medicaid recipients, and providers and
817	their representatives, to ensure that fraudulent and abusive
818	behavior and neglect of recipients occur to the minimum extent
819	possible, and to recover overpayments and impose sanctions as
820	appropriate. Beginning January 1, 2003, and each year
821	thereafter, the agency and the Medicaid Fraud Control Unit of
822	the Department of Legal Affairs shall submit a joint report to
823	the Legislature documenting the effectiveness of the state's
824	efforts to control Medicaid fraud and abuse and to recover
825	Medicaid overpayments during the previous fiscal year. The
826	report must describe the number of cases opened and investigated
827	each year; the sources of the cases opened; the disposition of
828	the cases closed each year; the amount of overpayments alleged
829	in preliminary and final audit letters; the number and amount of
830	fines or penalties imposed; any reductions in overpayment
831	amounts negotiated in settlement agreements or by other means;
832	the amount of final agency determinations of overpayments; the
833	amount deducted from federal claiming as a result of
834	overpayments; the amount of overpayments recovered each year;
835	the amount of cost of investigation recovered each year; the
836	average length of time to collect from the time the case was
837	opened until the overpayment is paid in full; the amount
838	determined as uncollectible and the portion of the uncollectible
839	amount subsequently reclaimed from the Federal Government; the
840	number of providers, by type, that are terminated from
841	participation in the Medicaid program as a result of fraud and
842	abuse; and all costs associated with discovering and prosecuting
843	cases of Medicaid overpayments and making recoveries in such
844	cases. The report must also document actions taken to prevent
845	overpayments and the number of providers prevented from
846	enrolling in or reenrolling in the Medicaid program as a result
847	of documented Medicaid fraud and abuse and must recommend
848	changes necessary to prevent or recover overpayments. For the
849	2001-2002 fiscal year, the agency shall prepare a report that
850	contains as much of this information as is available to it.
851	(8) A Medicaid provider shall retain medical,
852	professional, financial, and business records pertaining to
853	services and goods furnished to a Medicaid recipient and billed
854	to Medicaid for a period of 5 years after the date of furnishing
855	such services or goods. The agency and its duly authorized
856	agentsmay investigate, review, or analyze such records, which
857	must be made available during normal business hours. However,
858	24-hour notice must be provided if patient treatment would be
859	disrupted. The provider is responsible for furnishing to the
860	agency and its duly authorized agents, and keeping the agency
861	and its duly authorized agentsinformed of the location of, the
862	provider's Medicaid-related records. The authority of the agency
863	and its duly authorized agentsto obtain Medicaid-related
864	records from a provider is neither curtailed nor limited during
865	a period of litigation between the agency and the provider.
866	(28) Notwithstanding other provisions of law, the agency
867	and its duly authorized agentsand the Medicaid Fraud Control
868	Unit of the Department of Legal Affairs may review a provider's
869	Medicaid-related records in order to determine the total output
870	of a provider's practice to reconcile quantities of goods or
871	services billed to Medicaid against quantities of goods or
872	services used in the provider's total practice.
873	Section 15. Subsections (7), (8), and (9) are added to
874	section 430.502, Florida Statutes, to read:
875	430.502 Alzheimer's disease; memory disorder clinics and
876	day care and respite care programs.--
877	(7) The Agency for Health Care Administration and the
878	department shall seek a federal waiver to implement a Medicaid
879	home and community-based waiver targeted to persons with
880	Alzheimer's disease to test the effectiveness of Alzheimer's
881	specific interventions to delay or to avoid institutional
882	placement.
883	(8) The department shall implement the waiver program
884	specified in subsection (7). The agency and the department shall
885	ensure that providers are selected that have a history of
886	successfully serving persons with Alzheimer's disease. The
887	department and the agency shall develop specialized standards
888	for providers and services tailored to persons in the early,
889	middle, and late stages of Alzheimer's disease and designate a
890	level of care determination process and standard that is most
891	appropriate to this population. The department and the agency
892	shall include in the waiver services designed to assist the
893	caregiver in continuing to provide in-home care. The department
894	shall implement this waiver program subject to a specific
895	appropriation or as provided in the General Appropriations Act.
896	The department and the agency shall submit their program design
897	to the President of the Senate and the Speaker of the House of
898	Representatives for consultation during the development process.
899	(9) Authority to continue the waiver program specified in
900	subsection (7) shall be automatically eliminated at the close of
901	the 2008 Regular Session of the Legislature unless further
902	legislative action is taken to continue it prior to such time.
903	Section 16. Paragraph (b) of subsection (4) and paragraph
904	(a) of subsection (5) of section 624.91, Florida Statutes, are
905	amended to read:
906	624.91 The Florida Healthy Kids Corporation Act.--
907	(4) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
908	(b) The Florida Healthy Kids Corporation shall:
909	1. Organize school children groups to facilitate the
910	provision of comprehensive health insurance coverage to
911	children.;
912	2. Arrange for the collection of any family, local
913	contributions, or employer payment or premium, in an amount to
914	be determined by the board of directors, to provide for payment
915	of premiums for comprehensive insurance coverage and for the
916	actual or estimated administrative expenses.;
917	3. Arrange for the collection of any voluntary
918	contributions to provide for payment of premiums for children
919	who are not eligible for medical assistance under Title XXI of
920	the Social Security Act. Each fiscal year, the corporation shall
921	establish a local match policy for the enrollment of non-Title-
922	XXI-eligible children in the Healthy Kids program. By May 1 of
923	each year, the corporation shall provide written notification of
924	the amount to be remitted to the corporation for the following
925	fiscal year under that policy. Local match sources may include,
926	but are not limited to, funds provided by municipalities,
927	counties, school boards, hospitals, health care providers,
928	charitable organizations, special taxing districts, and private
929	organizations. The minimum local match cash contributions
930	required each fiscal year and local match credits shall be
931	determined by the General Appropriations Act. The corporation
932	shall calculate a county's local match rate based upon that
933	county's percentage of the state's total non-Title-XXI
934	expenditures as reported in the corporation's most recently
935	audited financial statement. In awarding the local match
936	credits, the corporation may consider factors including, but not
937	limited to, population density, per capita income, and existing
938	child-health-related expenditures and services.;
939	4. Accept voluntary supplemental local match contributions
940	that comply with the requirements of Title XXI of the Social
941	Security Act for the purpose of providing additional coverage in
942	contributing counties under Title XXI.;
943	5. Establish the administrative and accounting procedures
944	for the operation of the corporation.;
945	6. Establish, with consultation from appropriate
946	professional organizations, standards for preventive health
947	services and providers and comprehensive insurance benefits
948	appropriate to children; provided that such standards for rural
949	areas shall not limit primary care providers to board-certified
950	pediatricians.;
951	7. Establish eligibility criteria which children must meet
952	in order to participate in the program.;
953	8. Establish procedures under which providers of local
954	match to, applicants to and participants in the program may have
955	grievances reviewed by an impartial body and reported to the
956	board of directors of the corporation.;
957	9. Establish participation criteria and, if appropriate,
958	contract with an authorized insurer, health maintenance
959	organization, or insurance administrator to provide
960	administrative services to the corporation.;
961	10. Establish enrollment criteria which shall include
962	penalties or waiting periods of not fewer than 60 days for
963	reinstatement of coverage upon voluntary cancellation for
964	nonpayment of family premiums.;
965	11. If a space is available, establish a special open
966	enrollment period of 30 days' duration for any child who is
967	enrolled in Medicaid or Medikids if such child loses Medicaid or
968	Medikids eligibility and becomes eligible for the Florida
969	Healthy Kids program.;
970	12. Contract with authorized insurers or any provider of
971	health care services, meeting standards established by the
972	corporation, for the provision of comprehensive insurance
973	coverage to participants.
974	a.Such standards shall include criteria under which the
975	corporation may contract with more than one provider of health
976	care services in program sites. Health plans shall be selected
977	through a competitive bid process that utilizes as the maximum
978	payable rate the current Medicaid reimbursement being paid by
979	the Agency for Health Care Administration to its managed care
980	plans for the same age population, risk-adjusted for the Healthy
981	Kids population and adjusted for enrollee demographics, services
982	covered by the proposed rate, utilization, and inflation.
983	Healthy Kids shall neither enter a contract nor renew a contract
984	that has administrative costs greater than 15 percent.
985	b. Enrollees shall be enrolled with the selected health
986	plan or plans in their county. If no qualified bidder submits a
987	proposal utilizing the rate, then enrollees in the Healthy Kids
988	program may receive services through the Medikids program. If
989	the corporation delivers services through the Medikids option,
990	the corporation shall establish an appropriate level of reserves
991	in which to pay claims. The amount of the reserves shall be
992	appropriate for the number of enrollees accessing services
993	through this option and will be actuarially reviewed for
994	soundness and approved by the Department of Financial Services.
995	c. Implementation of the process described in sub-
996	subparagraphs a. and b. shall begin on July 1, 2003, or at
997	renewal of each insurer's current contract, but shall be
998	completed statewide no later than September 30, 2004. The term
999	"renewal" includes contract options and option years.
1000	d. Dental services shall be provided to Healthy Kids
1001	enrollees using the administrative structure and provider
1002	network of the Medicaid programThe selection of health plans
1003	shall be based primarily on quality criteria established by the
1004	board.
1005
1006	The health plan selection criteria and scoring system, and the
1007	scoring results, shall be available upon request for inspection
1008	after the bids have been awarded.;
1009	13. Establish disenrollment criteria in the event local
1010	matching funds are insufficient to cover enrollments.;
1011	14. Develop and implement a plan to publicize the Florida
1012	Healthy Kids Corporation, the eligibility requirements of the
1013	program, and the procedures for enrollment in the program and to
1014	maintain public awareness of the corporation and the program.;
1015	15. Secure staff necessary to properly administer the
1016	corporation. Staff costs shall be funded from state and local
1017	matching funds and such other private or public funds as become
1018	available. The board of directors shall determine the number of
1019	staff members necessary to administer the corporation.;
1020	16. As appropriate, enter into contracts with local school
1021	boards or other agencies to provide onsite information,
1022	enrollment, and other services necessary to the operation of the
1023	corporation.;
1024	17. Provide a report annually to the Governor, Chief
1025	Financial Officer, Commissioner of Education, Senate President,
1026	Speaker of the House of Representatives, and Minority Leaders of
1027	the Senate and the House of Representatives.;
1028	18. Each fiscal year, establish a maximum number of
1029	participants, on a statewide basis, who may enroll in the
1030	program.; and
1031	19. Establish eligibility criteria, premium and cost-
1032	sharing requirements, and benefit packages which conform to the
1033	provisions of the Florida Kidcare program, as created in ss.
1034	409.810-409.820.
1035	(5) BOARD OF DIRECTORS.--
1036	(a) The Florida Healthy Kids Corporation shall operate
1037	subject to the supervision and approval of a board of directors
1038	chaired by the Chief Financial Officer or her or his designee,
1039	and composed of 614other members selected for 3-year terms of
1040	office as follows:
1041	1. One member, appointed by the Chief Financial Officer,
1042	who represents the Office of Insurance Regulation.Commissioner
1043	of Education from among three persons nominated by the Florida
1044	Association of School Administrators;
1045	2. One member appointed by the Commissioner of Education
1046	from among three persons nominated by the Florida Association of
1047	School Boards;
1048	3. One member appointed by the Commissioner of Education
1049	from the Office of School Health Programs of the Florida
1050	Department of Education;
1051	4. One member appointed by the Governor from among three
1052	members nominated by the Florida Pediatric Society;
1053	2.5.One member, appointed by the Governor, who represents
1054	the Children's Medical Services Program and the Department of
1055	Health.;
1056	6. One member appointed by the Chief Financial Officer
1057	from among three members nominated by the Florida Hospital
1058	Association;
1059	7. Two members, appointed by the Chief Financial Officer,
1060	who are representatives of authorized health care insurers or
1061	health maintenance organizations;
1062	3.8.One member, appointed by the Chief Financial Officer,
1063	who represents the Institute for Child Health Policy.;
1064	9. One member, appointed by the Governor, from among three
1065	members nominated by the Florida Academy of Family Physicians;
1066	4.10.One member, appointed by the Governor, who
1067	represents the Agency for Health Care Administration.;
1068	5.11.One member, appointed by the Chief Financial
1069	Officer, from among three members nominated by the Florida
1070	Association of Counties, representing rural counties.;
1071	6.12.One member, appointed by the Governor, from among
1072	three members nominated by the Florida Association of Counties,
1073	representing urban counties.; and
1074	13. The State Health Officer or her or his designee.
1075	Section 17. The provisions of this act which would require
1076	changes to the contracts in existence on June 30, 2003, between
1077	the Florida Healthy Kids Corporation and its contracted
1078	providers shall be applied to such contracts upon the renewal of
1079	the contracts, but no later than September 30, 2004. The term
1080	"renewal" includes contract options and option years.
1081
1082	================= T I T L E A M E N D M E N T =================
1083	Remove lines 14-72, and insert:
1084	overpayments; amending s. 409.811, F.S.; defining "managed
1085	care plan" for purposes of the Florida Kidcare Act;
1086	amending s. 409.8132, F.S.; providing a cross reference;
1087	amending s. 409.901, F.S.; revising the definition of
1088	"third party"; amending s. 409.904, F.S.; revising
1089	eligibility requirements for certain optional payments for
1090	medical assistance and related services; amending s.
1091	409.906, F.S.; revising requirements for payment of
1092	optional Medicaid services; limiting provision of dental,
1093	hearing, and visual services; amending s. 409.9081, F.S.;
1094	providing coinsurance requirements for prescription drugs;
1095	providing copayment requirements for hospital outpatient
1096	emergency department services; amending s. 409.911, F.S.;
1097	revising formulas for payment under the disproportionate
1098	share program; revising definitions; providing for use of
1099	audited data; amending s. 409.9112, F.S.; revising
1100	formulas for payment under the disproportionate share
1101	program for regional perinatal intensive care centers;
1102	amending s. 409.9117, F.S.; revising formulas for payment
1103	under the primary care disproportionate share program;
1104	revising criteria for such payments; amending s. 409.9119,
1105	F.S.; revising criteria for payment under the
1106	disproportionate share program for specialty hospitals for
1107	children; amending s. 409.912, F.S.; providing for the
1108	Agency for Health Care Administration to contract with a
1109	service network; deleting provisions for service network
1110	demonstration projects; providing for contracting to
1111	provide Medicaid covered dental services; amending s.
1112	409.9122, F.S.; revising provisions for assignment to a
1113	managed care plan by the agency; amending s. 409.913,
1114	F.S.; providing for oversight of Medicaid by authorized
1115	agents of the Agency for Health Care Administration;
1116	amending s. 430.502, F.S.; requiring the Agency for Health
1117	Care Administration and the Department of Health to seek
1118	and implement a Medicaid home and community-based waiver
1119	for persons with Alzheimer's disease; requiring the
1120	development of waiver program standards; providing for
1121	consultation with the presiding officers of the
1122	Legislature; providing for a contingent future repeal of
1123	such waiver program; amending s. 624.91, F.S.; revising
1124	duties of the Florida Healthy Kids Corporation; revising
1125	membership of the board of directors of the corporation;
1126	providing for application of the act to existing contracts
1127	between the Florida Healthy Kids Corporation and its
1128	contracted providers;
1129