HB 0035A 2003
1	A bill to be entitled
2	An act relating to health care; amending s. 400.179, F.S.;
3	retaining a fee against leasehold licensees to meet
4	bonding requirements to cover Medicaid underpayments and
5	overpayments; amending s. 409.811, F.S.; defining "Florida
6	Healthy Kids" and "Managed care plan" for purposes of the
7	Florida Kidcare Act; amending s. 409.813, F.S.; revising
8	provisions for components of the Florida Kidcare program;
9	amending s. 409.8132, F.S.; providing a cross reference;
10	creating s. 409.8133, F.S.; creating the Florida Healthy
11	Kids program component of the Florida Kidcare program;
12	providing for administration; providing an exemption from
13	insurance licensure; providing for benefits, eligibility,
14	and enrollment; amending s. 409.814, F.S.; revising
15	Florida Kidcare program eligibility provisions; amending
16	s. 409.818, F.S.; revising provisions for administration
17	of the Florida Kidcare Act; providing for the Florida
18	Healthy Kids program; revising premium assistance payment
19	requirements; amending s. 409.901, F.S.; revising the
20	definition of "third party" and "third-party benefit";
21	amending s. 409.904, F.S.; revising eligibility
22	requirements for certain optional payments for medical
23	assistance and related services; amending s. 409.906,
24	F.S.; revising requirements for payment of optional
25	Medicaid services; limiting provision of dental, hearing,
26	and visual services; amending s. 409.9081, F.S.; providing
27	coinsurance requirements for prescription drugs; providing
28	copayment requirements for hospital outpatient emergency
29	department services; amending s. 409.911, F.S.; revising
30	formulas for payment under the disproportionate share
31	program; revising definitions; providing for use of
32	audited data; amending s. 409.9112, F.S.; revising
33	formulas for payment under the disproportionate share
34	program for regional perinatal intensive care centers;
35	amending s. 409.9117, F.S.; revising formulas for payment
36	under the primary care disproportionate share program;
37	revising criteria for such payments; amending s. 409.9119,
38	F.S.; revising criteria for payment under the
39	disproportionate share program for specialty hospitals for
40	children; amending s. 409.912, F.S.; providing for the
41	Agency for Health Care Administration to contract with a
42	service network; deleting provisions for service network
43	demonstration projects; providing for contracting to
44	provide Medicaid covered dental services; amending s.
45	409.9122, F.S.; revising provisions for assignment to a
46	managed care plan by the agency; amending s. 409.913,
47	F.S.; providing for oversight of Medicaid by authorized
48	agents of the Agency for Health Care Administration;
49	amending s. 430.502, F.S.; requiring the Agency for Health
50	Care Administration and the Department of Health to seek
51	and implement a Medicaid home and community-based waiver
52	for persons with Alzheimer's disease; requiring the
53	development of waiver program standards; providing for
54	consultation with the presiding officers of the
55	Legislature; providing for a contingent future repeal of
56	such waiver program; amending s. 624.91, F.S.; revising
57	duties of the Florida Healthy Kids Corporation; removing a
58	provision for coordination of benefits; removing
59	provisions for contracting for administrative services and
60	insurance coverage; revising membership of the board of
61	directors of the corporation; amending s. 624.915, F.S.;
62	providing that excess funds of the Florida Healthy Kids
63	Corporation be remitted to the agency to be used for the
64	Florida Kidcare program; repealing s. 57, ch. 98-288, Laws
65	of Florida, relating to future review and repeal of the
66	"Florida Kidcare Act" based on specified changes in
67	federal policy; providing for construction of the act in
68	pari materia with laws enacted during the Regular Session
69	of the Legislature; providing effective dates.
70
71	Be It Enacted by the Legislature of the State of Florida:
72
73	Section 1. Effective upon this act becoming a law,
74	paragraph (d) of subsection (5) of section 400.179, Florida
75	Statutes, is amended to read:
76	400.179 Sale or transfer of ownership of a nursing
77	facility; liability for Medicaid underpayments and
78	overpayments.--
79	(5) Because any transfer of a nursing facility may expose
80	the fact that Medicaid may have underpaid or overpaid the
81	transferor, and because in most instances, any such underpayment
82	or overpayment can only be determined following a formal field
83	audit, the liabilities for any such underpayments or
84	overpayments shall be as follows:
85	(d) Where the transfer involves a facility that has been
86	leased by the transferor:
87	1. The transferee shall, as a condition to being issued a
88	license by the agency, acquire, maintain, and provide proof to
89	the agency of a bond with a term of 30 months, renewable
90	annually, in an amount not less than the total of 3 months
91	Medicaid payments to the facility computed on the basis of the
92	preceding 12-month average Medicaid payments to the facility.
93	2. A leasehold licensee may meet the requirements of
94	subparagraph 1. by payment of a nonrefundable fee, paid at
95	initial licensure, paid at the time of any subsequent change of
96	ownership, and paid at the time of any subsequent annual license
97	renewal, in the amount of 2 percent of the total of 3 months'
98	Medicaid payments to the facility computed on the basis of the
99	preceding 12-month average Medicaid payments to the facility. If
100	a preceding 12-month average is not available, projected
101	Medicaid payments may be used. The fee shall be deposited into
102	the Health Care Trust Fund and shall be accounted for separately
103	as a Medicaid nursing home overpayment account. These fees shall
104	be used at the sole discretion of the agency to repay nursing
105	home Medicaid overpayments. Payment of this fee shall not
106	release the licensee from any liability for any Medicaid
107	overpayments, nor shall payment bar the agency from seeking to
108	recoup overpayments from the licensee and any other liable
109	party. As a condition of exercising this lease bond alternative,
110	licensees paying this fee must maintain an existing lease bond
111	through the end of the 30-month term period of that bond. The
112	agency is herein granted specific authority to promulgate all
113	rules pertaining to the administration and management of this
114	account, including withdrawals from the account, subject to
115	federal review and approval. This subparagraph is repealed on
116	June 30, 2003.This provision shall take effect upon becoming
117	law and shall apply to any leasehold license application.
118	a. The financial viability of the Medicaid nursing home
119	overpayment account shall be determined by the agency through
120	annual review of the account balance and the amount of total
121	outstanding, unpaid Medicaid overpayments owing from leasehold
122	licensees to the agency as determined by final agency audits.
123	b. The agency, in consultation with the Florida Health
124	Care Association and the Florida Association of Homes for the
125	Aging, shall study and make recommendations on the minimum
126	amount to be held in reserve to protect against Medicaid
127	overpayments to leasehold licensees and on the issue of
128	successor liability for Medicaid overpayments upon sale or
129	transfer of ownership of a nursing facility. The agency shall
130	submit the findings and recommendations of the study to the
131	Governor, the President of the Senate, and the Speaker of the
132	House of Representatives by January 1, 2003.
133	3. The leasehold licensee may meet the bond requirement
134	through other arrangements acceptable to the agency. The agency
135	is herein granted specific authority to promulgate rules
136	pertaining to lease bond arrangements.
137	4. All existing nursing facility licensees, operating the
138	facility as a leasehold, shall acquire, maintain, and provide
139	proof to the agency of the 30-month bond required in
140	subparagraph 1., above, on and after July 1, 1993, for each
141	license renewal.
142	5. It shall be the responsibility of all nursing facility
143	operators, operating the facility as a leasehold, to renew the
144	30-month bond and to provide proof of such renewal to the agency
145	annually at the time of application for license renewal.
146	6. Any failure of the nursing facility operator to
147	acquire, maintain, renew annually, or provide proof to the
148	agency shall be grounds for the agency to deny, cancel, revoke,
149	or suspend the facility license to operate such facility and to
150	take any further action, including, but not limited to,
151	enjoining the facility, asserting a moratorium, or applying for
152	a receiver, deemed necessary to ensure compliance with this
153	section and to safeguard and protect the health, safety, and
154	welfare of the facility's residents. A lease agreement required
155	as a condition of bond financing or refinancing under s. 154.213
156	by a health facilities authority or required under s. 159.30 by
157	a county or municipality is not a leasehold for purposes of this
158	paragraph and is not subject to the bond requirement of this
159	paragraph.
160	Section 2. Subsections (14), (15), (16), (17), (18), (19),
161	(20), (21), (22), (23), (24), (25), (26), and (27) of section
162	409.811, Florida Statutes, are renumbered as subsections (15),
163	(16), (17), (19), (20), (21), (22), (23), (24), (25), (26),
164	(27), (28), and (29), respectively, and new subsections (14) and
165	(18) are added to said section to read:
166	409.811 Definitions relating to Florida Kidcare Act.--As
167	used in ss. 409.810-409.820, the term:
168	(14) "Florida Healthy Kids" means a component of the
169	Florida Kidcare program of medical assistance for children from
170	5 through 18 years of age with incomes or assets too high to
171	qualify for Medicaid.
172	(18) "Managed care plan" means a health maintenance
173	organization authorized pursuant to chapter 641 or a prepaid
174	health plan authorized pursuant to s. 409.912.
175	Section 3. Subsection (3) of section 409.813, Florida
176	Statutes, is amended to read:
177	409.813 Program components; entitlement and
178	nonentitlement.--The Florida Kidcare program includes health
179	benefits coverage provided to children through:
180	(3) The Florida Healthy Kids programCorporationas
181	created in s. 409.8133624.91;
182
183	Except for coverage under the Medicaid program, coverage under
184	the Florida Kidcare program is not an entitlement. No cause of
185	action shall arise against the state, the department, the
186	Department of Children and Family Services, or the agency for
187	failure to make health services available to any person under
188	ss. 409.810-409.820.
189	Section 4. Subsection (7) of section 409.8132, Florida
190	Statutes, is amended to read:
191	409.8132 Medikids program component.--
192	(7) ENROLLMENT.--Enrollment in the Medikids program
193	component may only occur during periodic open enrollment periods
194	as specified by the agency. An applicant may apply for
195	enrollment in the Medikids program component and proceed through
196	the eligibility determination process at any time throughout the
197	year. However, enrollment in Medikids shall not begin until the
198	next open enrollment period; and a child may not receive
199	services under the Medikids program until the child is enrolled
200	in a managed care plan as defined in s. 409.811 or inMediPass.
201	In addition, once determined eligible, an applicant may receive
202	choice counseling and select a managed care plan or MediPass.
203	The agency may initiate mandatory assignment for a Medikids
204	applicant who has not chosen a managed care plan or MediPass
205	provider after the applicant's voluntary choice period ends. An
206	applicant may select MediPass under the Medikids program
207	component only in counties that have fewer than two managed care
208	plans available to serve Medicaid recipients and only if the
209	federal Health Care Financing Administration determines that
210	MediPass constitutes "health insurance coverage" as defined in
211	Title XXI of the Social Security Act.
212	Section 5. Section 409.8133, Florida Statutes, is created
213	to read:
214	409.8133 Florida Healthy Kids program component.--
215	(1) PROGRAM COMPONENT CREATED; PURPOSE.--The Florida
216	Healthy Kids program component is created in the Agency for
217	Health Care Administration to provide health care services under
218	the Florida Kidcare program to eligible children using the
219	administrative structure and provider network of the Medicaid
220	program.
221	(2) ADMINISTRATION.--The Florida Healthy Kids program
222	shall be administered by the Agency for Health Care
223	Administration and the Florida Healthy Kids Corporation.
224	(a) The agency is designated as the state agency
225	authorized to make payments and contract for medical assistance
226	and related services for the Florida Healthy Kids program
227	component of the Florida Kidcare program. Payments shall be
228	made, subject to any limitations or directions in the General
229	Appropriations Act, only for covered services provided to
230	eligible children by qualified health care providers under the
231	Florida Kidcare program.
232	(b) The Florida Healthy Kids Corporation shall perform its
233	functions as authorized in s. 624.91, including eligibility
234	determinations for participation in the Florida Healthy Kids
235	program.
236	(3) INSURANCE LICENSURE NOT REQUIRED.--The Florida Healthy
237	Kids program component shall not be subject to the licensing
238	requirements of the Florida Insurance Code or rules of the
239	Office of Insurance Regulation.
240	(4) BENEFITS.--Benefits provided under the Florida Healthy
241	Kids program component shall be established by the board of
242	directors of the Florida Healthy Kids Corporation. The benefits
243	shall comply with s. 409.815.
244	(5) ELIGIBILITY.--
245	(a) A child who has attained the age of 5 years but who is
246	under the age of 19 years is eligible to enroll in the Florida
247	Healthy Kids program component of the Florida Kidcare program if
248	the child is a member of a family that has a family income which
249	exceeds the Medicaid applicable income level as specified in s.
250	409.903. A child who is eligible for the Florida Healthy Kids
251	program may elect to enroll in employer-sponsored group
252	coverage.
253	(b) The provisions of s. 409.814 shall be applicable to
254	the Florida Healthy Kids program.
255	(6) ENROLLMENT.--Enrollment in the Florida Healthy Kids
256	program component shall be done by the Florida Healthy Kids
257	Corporation in accordance with s. 624.91.
258	Section 6. Paragraph (b) of subsection (4) and paragraph
259	(c) of subsection (5) of section 409.814, Florida Statutes, are
260	amended to read:
261	409.814 Eligibility.--A child whose family income is equal
262	to or below 200 percent of the federal poverty level is eligible
263	for the Florida Kidcare program as provided in this section. In
264	determining the eligibility of such a child, an assets test is
265	not required. An applicant under 19 years of age who, based on a
266	complete application, appears to be eligible for the Medicaid
267	component of the Florida Kidcare program is presumed eligible
268	for coverage under Medicaid, subject to federal rules. A child
269	who has been deemed presumptively eligible for Medicaid shall
270	not be enrolled in a managed care plan until the child's full
271	eligibility determination for Medicaid has been completed. The
272	Florida Healthy Kids Corporation may, subject to compliance with
273	applicable requirements of the Agency for Health Care
274	Administration and the Department of Children and Family
275	Services, be designated as an entity to conduct presumptive
276	eligibility determinations. An applicant under 19 years of age
277	who, based on a complete application, appears to be eligible for
278	the Medikids, Florida Healthy Kids, or Children's Medical
279	Services network program component, who is screened as
280	ineligible for Medicaid and prior to the monthly verification of
281	the applicant's enrollment in Medicaid or of eligibility for
282	coverage under the state employee health benefit plan, may be
283	enrolled in and begin receiving coverage from the appropriate
284	program component on the first day of the month following the
285	receipt of a completed application. For enrollment in the
286	Children's Medical Services network, a complete application
287	includes the medical or behavioral health screening. If, after
288	verification, an individual is determined to be ineligible for
289	coverage, he or she must be disenrolled from the respective
290	Title XXI-funded Kidcare program component.
291	(4) The following children are not eligible to receive
292	premium assistance for health benefits coverage under ss.
293	409.810-409.820, except under Medicaid if the child would have
294	been eligible for Medicaid under s. 409.903 or s. 409.904 as of
295	June 1, 1997:
296	(b) A child who is covered under a group health benefit
297	plan or under other health insurance coverage, excluding
298	coverage provided under the Florida Healthy Kids program
299	Corporation as established under s. 409.8133624.91.
300	(5) A child whose family income is above 200 percent of
301	the federal poverty level or a child who is excluded under the
302	provisions of subsection (4) may participate in the Florida
303	Kidcare program, excluding the Medicaid program, but is subject
304	to the following provisions:
305	(c) The board of directors of the Florida Healthy Kids
306	Corporation is authorized to place limits on enrollment in the
307	Florida Healthy Kids program byofthese children in order to
308	avoid adverse selection. In addition, the board is authorized to
309	offer a reduced benefit package to these children in order to
310	limit program costs for such families. The number of children
311	participating in the Florida Healthy Kids program whose family
312	income exceeds 200 percent of the federal poverty level must not
313	exceed 10 percent of total enrollees in the Florida Healthy Kids
314	program.
315	Section 7. Paragraph (c) of subsection (1), paragraphs
316	(a), (c), and (g) of subsection (3), and subsections (4) and (5)
317	of section 409.818, Florida Statutes, are amended to read:
318	409.818 Administration.--In order to implement ss.
319	409.810-409.820, the following agencies shall have the following
320	duties:
321	(1) The Department of Children and Family Services shall:
322	(c) Inform program applicants about eligibility
323	determinations and provide information about eligibility of
324	applicants to Medicaid, Medikids, the Children's Medical
325	Services network, and the Florida Healthy Kids program
326	Corporation, and to insurers and their agents, through a
327	centralized coordinating office.
328	(3) The Agency for Health Care Administration, under the
329	authority granted in s. 409.914(1), shall:
330	(a) Calculate the premium assistance payment necessary to
331	comply with the premium and cost-sharing limitations specified
332	in s. 409.816. The premium assistance payment for each enrollee
333	in a health insurance plan participating in the Florida Healthy
334	Kids Corporation shall equal the premium agreed to by the agency
335	and the provider of servicesapproved by the Florida Healthy
336	Kids Corporation and the Department of Insurance pursuant to ss.
337	627.410 and 641.31, less any enrollee's share of the premium
338	established within the limitations specified in s. 409.816. The
339	premium assistance payment for each enrollee in an employer-
340	sponsored health insurance plan approved under ss. 409.810-
341	409.820 shall equal the premium for the plan adjusted for any
342	benchmark benefit plan actuarial equivalent benefit rider
343	approved by the Department of Insurance pursuant to ss. 627.410
344	and 641.31, less any enrollee's share of the premium established
345	within the limitations specified in s. 409.816. In calculating
346	the premium assistance payment levels for children with family
347	coverage, the agency shall set the premium assistance payment
348	levels for each child proportionately to the total cost of
349	family coverage.
350	(c) Make premium assistance payments to health insurance
351	plans on a periodic basis. The agency may use its Medicaid
352	fiscal agent or a contracted third-party administrator in making
353	these payments. The agency may require health insurance plans
354	that participate in the Medikids program, the Florida Healthy
355	Kids program,or employer-sponsored group health insurance to
356	collect premium payments from an enrollee's family.
357	Participating health insurance plans shall report premium
358	payments collected on behalf of enrollees in the program to the
359	agency in accordance with a schedule established by the agency.
360	(g) Adopt rules necessary for calculating premium
361	assistance payment levels, calculating the program enrollment
362	ceiling, making premium assistance payments, monitoring access
363	and quality assurance standards, investigating and resolving
364	complaints and grievances, administering the Medikids program
365	and the Florida Healthy Kids program, and approving health
366	benefits coverage.
367
368	The agency is designated the lead state agency for Title XXI of
369	the Social Security Act for purposes of receipt of federal
370	funds, for reporting purposes, and for ensuring compliance with
371	federal and state regulations and rules.
372	(4) The Department of Insurance shall certify that health
373	benefits coverage plans that seek to provide services under the
374	Florida Kidcare program, except those offered through the
375	Florida Healthy Kids Corporation or theChildren's Medical
376	Services network, meet, exceed, or are actuarially equivalent to
377	the benchmark benefit plan and that health insurance plans will
378	be offered at an approved rate. In determining actuarial
379	equivalence of benefits coverage, the Department of Insurance
380	and health insurance plans must comply with the requirements of
381	s. 2103 of Title XXI of the Social Security Act. The department
382	shall adopt rules necessary for certifying health benefits
383	coverage plans.
384	(5) The Florida Healthy Kids Corporation shall perform
385	retain itsfunctions as authorized in s. 624.91, including
386	eligibility determination for participation in the Florida
387	Healthy Kids program.
388	Section 8. Subsections (25) and (26) of section 409.901,
389	Florida Statutes, are amended to read:
390	409.901 Definitions; ss. 409.901-409.920.--As used in ss.
391	409.901-409.920, except as otherwise specifically provided, the
392	term:
393	(25) "Third party" means an individual, entity, or
394	program, excluding Medicaid, that is, may be, could be, should
395	be, or has been liable for all or part of the cost of medical
396	services related to any medical assistance providedcovered by
397	Medicaid. Third party includes a third-party administrator or
398	TPA and a pharmacy benefits manager or PBM.
399	(26) "Third-party benefit" means any benefit that is or
400	may be available at any time through contract, court award,
401	judgment, settlement, agreement, or any arrangement between a
402	third party and any person or entity, including, without
403	limitation, a Medicaid recipient, a provider, another third
404	party, an insurer, or the agency, for any Medicaid-covered
405	injury, illness, goods, or services, including costs of medical
406	services related thereto, for personal injury or for death of
407	the recipient, but specifically excluding policies of life
408	insurance on the recipient, unless available under terms of the
409	policy to pay medical expenses prior to death. The term
410	includes, without limitation, collateral, as defined in this
411	section, health insurance, any benefit under a health
412	maintenance organization, Neurological Injury Compensation
413	Association funds,a preferred provider arrangement, a prepaid
414	health clinic, liability insurance, uninsured motorist insurance
415	or personal injury protection coverage, medical benefits under
416	workers' compensation, and any obligation under law or equity to
417	provide medical support.
418	Section 9. Subsection (2) of section 409.904, Florida
419	Statutes, is amended to read:
420	409.904 Optional payments for eligible persons.--The
421	agency may make payments for medical assistance and related
422	services on behalf of the following persons who are determined
423	to be eligible subject to the income, assets, and categorical
424	eligibility tests set forth in federal and state law. Payment on
425	behalf of these Medicaid eligible persons is subject to the
426	availability of moneys and any limitations established by the
427	General Appropriations Act or chapter 216.
428	(2) A caretaker relative or parent, a pregnant woman, a
429	child under age 19 who would otherwise qualify for Florida
430	Kidcare Medicaid, a child up to age 21 who would otherwise
431	qualify under s. 409.903(1), a person age 65 or over, or a blind
432	or disabled person, who would otherwise be eligible for Florida
433	Medicaid, except that the income or assets of such family or
434	person exceed established limitations. For a family or person in
435	one of these coverage groups, medical expenses are deductible
436	from income in accordance with federal requirements in order to
437	make a determination of eligibility. Expenses used to meet
438	spend-down liability are not reimbursable by Medicaid. Effective
439	May 1, 2003, When determining the eligibility of a pregnant
440	woman, a child, or an aged, blind, or disabled individual, $270
441	shall be deducted from the countable income of the filing unit.
442	When determining the eligibility of the parent or caretaker
443	relative as defined by Title XIX of the Social Security Act, the
444	additional income disregard of $270 does not apply.A family or
445	person eligible under the coverage known as the "medically
446	needy," is eligible to receive the same services as other
447	Medicaid recipients, with the exception of services in skilled
448	nursing facilities and intermediate care facilities for the
449	developmentally disabled.
450	Section 10. Subsections (1), (12), and (23) of section
451	409.906, Florida Statutes, are amended to read:
452	409.906 Optional Medicaid services.--Subject to specific
453	appropriations, the agency may make payments for services which
454	are optional to the state under Title XIX of the Social Security
455	Act and are furnished by Medicaid providers to recipients who
456	are determined to be eligible on the dates on which the services
457	were provided. Any optional service that is provided shall be
458	provided only when medically necessary and in accordance with
459	state and federal law. Optional services rendered by providers
460	in mobile units to Medicaid recipients may be restricted or
461	prohibited by the agency. Nothing in this section shall be
462	construed to prevent or limit the agency from adjusting fees,
463	reimbursement rates, lengths of stay, number of visits, or
464	number of services, or making any other adjustments necessary to
465	comply with the availability of moneys and any limitations or
466	directions provided for in the General Appropriations Act or
467	chapter 216. If necessary to safeguard the state's systems of
468	providing services to elderly and disabled persons and subject
469	to the notice and review provisions of s. 216.177, the Governor
470	may direct the Agency for Health Care Administration to amend
471	the Medicaid state plan to delete the optional Medicaid service
472	known as "Intermediate Care Facilities for the Developmentally
473	Disabled." Optional services may include:
474	(1) ADULT DENTAL SERVICES.--The agency may pay for
475	dentures, the procedures required to seat dentures, the repair
476	and reline of dentures, emergency dental procedures necessary to
477	alleviate pain or infection, and basic dental preventive
478	procedures provided by or under the direction of a licensed
479	dentist for a recipient who is age 65 or oldermedically
480	necessary, emergency dental procedures to alleviate pain or
481	infection. Emergency dental care shall be limited to emergency
482	oral examinations, necessary radiographs, extractions, and
483	incision and drainage of abscess, for a recipient who is age 21
484	or older. However, Medicaid will not provide reimbursement for
485	dental services provided in a mobile dental unit, except for a
486	mobile dental unit:
487	(a) Owned by, operated by, or having a contractual
488	agreement with the Department of Health and complying with
489	Medicaid's county health department clinic services program
490	specifications as a county health department clinic services
491	provider.
492	(b) Owned by, operated by, or having a contractual
493	arrangement with a federally qualified health center and
494	complying with Medicaid's federally qualified health center
495	specifications as a federally qualified health center provider.
496	(c) Rendering dental services to Medicaid recipients, 21
497	years of age and older, at nursing facilities.
498	(d) Owned by, operated by, or having a contractual
499	agreement with a state-approved dental educational institution.
500	(12) CHILDREN'SHEARING SERVICES.--The agency may pay for
501	hearing and related services, including hearing evaluations,
502	hearing aid devices, dispensing of the hearing aid, and related
503	repairs, if provided to a recipient younger than 21 years of age
504	by a licensed hearing aid specialist, otolaryngologist,
505	otologist, audiologist, or physician.
506	(23) CHILDREN'SVISUAL SERVICES.--The agency may pay for
507	visual examinations, eyeglasses, and eyeglass repairs for a
508	recipient younger than 21 years of age, if they are prescribed
509	by a licensed physician specializing in diseases of the eye or
510	by a licensed optometrist.
511	Section 11. Paragraphs (c) and (d) are added to subsection
512	(1) of section 409.9081, Florida Statutes, to read:
513	409.9081 Copayments.--
514	(1) The agency shall require, subject to federal
515	regulations and limitations, each Medicaid recipient to pay at
516	the time of service a nominal copayment for the following
517	Medicaid services:
518	(c) Prescription drugs: a coinsurance equal to 5 percent
519	of the Medicaid cost of the prescription drug at the time of
520	purchase. The maximum coinsurance shall be $15 per prescription
521	drug purchased.
522	(d) Hospital outpatient services, emergency department: up
523	to $15 for each hospital outpatient emergency department
524	encounter that is for nonemergency purposes.
525	Section 12. Section 409.911, Florida Statutes, is amended
526	to read:
527	409.911 Disproportionate share program.--Subject to
528	specific allocations established within the General
529	Appropriations Act and any limitations established pursuant to
530	chapter 216, the agency shall distribute, pursuant to this
531	section, moneys to hospitals providing a disproportionate share
532	of Medicaid or charity care services by making quarterly
533	Medicaid payments as required. Notwithstanding the provisions of
534	s. 409.915, counties are exempt from contributing toward the
535	cost of this special reimbursement for hospitals serving a
536	disproportionate share of low-income patients.
537	(1) Definitions.--As used in this section, s. 409.9112,
538	and the Florida Hospital Uniform Reporting System manual:
539	(a) "Adjusted patient days" means the sum of acute care
540	patient days and intensive care patient days as reported to the
541	Agency for Health Care Administration, divided by the ratio of
542	inpatient revenues generated from acute, intensive, ambulatory,
543	and ancillary patient services to gross revenues.
544	(b) "Actual audited data" or "actual audited experience"
545	means data reported to the Agency for Health Care Administration
546	which has been audited in accordance with generally accepted
547	auditing standards by the agency or representatives under
548	contract with the agency.
549	(c) "Base Medicaid per diem" means the hospital's Medicaid
550	per diem rate initially established by the Agency for Health
551	Care Administration on January 1, 1999. The base Medicaid per
552	diem rate shall not include any additional per diem increases
553	received as a result of the disproportionate share distribution.
554	(c)(d)"Charity care" or "uncompensated charity care"
555	means that portion of hospital charges reported to the Agency
556	for Health Care Administration for which there is no
557	compensation, other than restricted or unrestricted revenues
558	provided to a hospital by local governments or tax districts
559	regardless of the method of payment, for care provided to a
560	patient whose family income for the 12 months preceding the
561	determination is less than or equal to 200 percent of the
562	federal poverty level, unless the amount of hospital charges due
563	from the patient exceeds 25 percent of the annual family income.
564	However, in no case shall the hospital charges for a patient
565	whose family income exceeds four times the federal poverty level
566	for a family of four be considered charity.
567	(d)(e)"Charity care days" means the sum of the deductions
568	from revenues for charity care minus 50 percent of restricted
569	and unrestricted revenues provided to a hospital by local
570	governments or tax districts, divided by gross revenues per
571	adjusted patient day.
572	(f) "Disproportionate share percentage" means a rate of
573	increase in the Medicaid per diem rate as calculated under this
574	section.
575	(e)(g)"Hospital" means a health care institution licensed
576	as a hospital pursuant to chapter 395, but does not include
577	ambulatory surgical centers.
578	(f)(h)"Medicaid days" means the number of actual days
579	attributable to Medicaid patients as determined by the Agency
580	for Health Care Administration.
581	(2) The Agency for Health Care Administration shall
582	utilize the following actual audited datacriteria to determine
583	the Medicaid days and charity care to be used in the calculation
584	of theif a hospital qualifies for adisproportionate share
585	payment:
586	(a) The Agency for Health Care Administration shall use
587	the average of the 1997, 1998, and 1999 audited data to
588	determine each hospital's Medicaid days and charity careA
589	hospital's total Medicaid days when combined with its total
590	charity care days must equal or exceed 7 percent of its total
591	adjusted patient days.
592	(b) In the event the Agency for Health Care Administration
593	does not have the prescribed 3 years of audited disproportionate
594	share data for a hospital, the Agency for Health Care
595	Administration shall use the average of the audited
596	disproportionate share data for the years availableA hospital's
597	total charity care days weighted by a factor of 4.5, plus its
598	total Medicaid days weighted by a factor of 1, shall be equal to
599	or greater than 10 percent of its total adjusted patient days.
600	(c) Additionally, In accordance with s. 1923(b) of the
601	Social Security Actthe seventh federal Omnibus Budget
602	Reconciliation Act, a hospital with a Medicaid inpatient
603	utilization rate greater than one standard deviation above the
604	statewide mean or a hospital with a low-income utilization rate
605	of 25 percent or greater shall qualify for reimbursement.
606	(3) In computing the disproportionate share rate:
607	(a) Per diem increases earned from disproportionate share
608	shall be applied to each hospital's base Medicaid per diem rate
609	and shall be capped at 170 percent.
610	(b) The agency shall use 1994 audited financial data for
611	the calculation of disproportionate share payments under this
612	section.
613	(c) If the total amount earned by all hospitals under this
614	section exceeds the amount appropriated, each hospital's share
615	shall be reduced on a pro rata basis so that the total dollars
616	distributed from the trust fund do not exceed the total amount
617	appropriated.
618	(d) The total amount calculated to be distributed under
619	this section shall be made in quarterly payments subsequent to
620	each quarter during the fiscal year.
621	(3)(4)Hospitals that qualify for a disproportionate share
622	payment solely under paragraph (2)(c) shall have their payment
623	calculated in accordance with the following formulas:
624
625	DSHP = (HMD/TSMD) x $1 million
626	TAA = TA x (1/5.5)
627	DSHP = (HMD/TSMD) x TAA
628
629	Where:
630	TAA = total amount available.
631	TA = total appropriation.
632	DSHP = disproportionate share hospital payment.
633	HMD = hospital Medicaid days.
634	TSMD = total state Medicaid days.
635
636	(4) The following formulas shall be used to pay
637	disproportionate share dollars to public hospitals:
638	(a) For state mental health hospitals:
639
640	DSHP = (HMD/TMDMH) x TAAMH
641
642	The total amount available for the state mental health hospitals
643	shall be the difference between the federal cap for Institutions
644	for Mental Diseases and the amounts paid under the mental health
645	disproportionate share program.
646
647	Where:
648	DSHP = disproportionate share hospital payment.
649	HMD = hospital Medicaid days.
650	TMDMH = total Medicaid days for state mental health
651	hospitals.
652	TAAMH = total amount available for mental health hospitals.
653
654	(b) For nonstate government owned or operated hospitals
655	with 3,200 or more Medicaid days:
656
657	DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)] x TAAPH
658	TAAPH = TAA – TAAMH – 1,400,000
659
660	Where:
661	DSHP = disproportionate share hospital payments.
662	HCCD = hospital charity care dollars.
663	TCCD = total charity care dollars for public nonstate
664	hospitals.
665	HMD = hospital Medicaid days.
666	TMD = total Medicaid days for public nonstate hospitals.
667	TAAPH = total amount available for public hospitals.
668	TAA = total available appropriation.
669	TAAMH = total amount available for mental health hospitals.
670
671	(c) For nonstate government owned or operated hospitals
672	with less than 3,200 Medicaid days, a total of $400,000 shall be
673	distributed equally among these hospitals.
674	(5) The following formula shall be utilized by the agency
675	to determine the maximum disproportionate share rate to be used
676	to increase the Medicaid per diem rate for hospitals that
677	qualify pursuant to paragraphs (2)(a) and (b):
678	DSR = CCD MD
679	((---------) x 4.5) + (---------)
680	@_@2@_@
681	Where:
682	APD = adjusted patient days.
683	CCD = charity care days.
684	DSR = disproportionate share rate.
685	MD = Medicaid days.
686
687	(6)(a) To calculate the total amount earned by all
688	hospitals under this section, hospitals with a disproportionate
689	share rate less than 50 percent shall divide their Medicaid days
690	by four, and hospitals with a disproportionate share rate
691	greater than or equal to 50 percent and with greater than 40,000
692	Medicaid days shall multiply their Medicaid days by 1.5, and the
693	following formula shall be used by the agency to calculate the
694	total amount earned by all hospitals under this section:
695
696	TAE = BMPD x MD x DSP
697
698	Where:
699	TAE = total amount earned.
700	BMPD = base Medicaid per diem.
701	MD = Medicaid days.
702	DSP = disproportionate share percentage.
703
704	(5)(b)In no case shall total payments to a hospital under
705	this section, with the exception of public nonstate facilities
706	orstate facilities, exceed the total amount of uncompensated
707	charity care of the hospital, as determined by the agency
708	according to the most recent calendar year audited data
709	available at the beginning of each state fiscal year.
710	(7) The following criteria shall be used in determining
711	the disproportionate share percentage:
712	(a) If the disproportionate share rate is less than 10
713	percent, the disproportionate share percentage is zero and there
714	is no additional payment.
715	(b) If the disproportionate share rate is greater than or
716	equal to 10 percent, but less than 20 percent, then the
717	disproportionate share percentage is 1.8478498.
718	(c) If the disproportionate share rate is greater than or
719	equal to 20 percent, but less than 30 percent, then the
720	disproportionate share percentage is 3.4145488.
721	(d) If the disproportionate share rate is greater than or
722	equal to 30 percent, but less than 40 percent, then the
723	disproportionate share percentage is 6.3095734.
724	(e) If the disproportionate share rate is greater than or
725	equal to 40 percent, but less than 50 percent, then the
726	disproportionate share percentage is 11.6591440.
727	(f) If the disproportionate share rate is greater than or
728	equal to 50 percent, but less than 60 percent, then the
729	disproportionate share percentage is 73.5642254.
730	(g) If the disproportionate share rate is greater than or
731	equal to 60 percent but less than 72.5 percent, then the
732	disproportionate share percentage is 135.9356391.
733	(h) If the disproportionate share rate is greater than or
734	equal to 72.5 percent, then the disproportionate share
735	percentage is 170.
736	(8) The following formula shall be used by the agency to
737	calculate the total amount earned by all hospitals under this
738	section:
739
740	TAE = BMPD x MD x DSP
741
742	Where:
743	TAE = total amount earned.
744	BMPD = base Medicaid per diem.
745	MD = Medicaid days.
746	DSP = disproportionate share percentage.
747
748	(6)(9)The agency is authorized to receive funds from
749	local governments and other local political subdivisions for the
750	purpose of making payments, including federal matching funds,
751	through the Medicaid disproportionate share program. Funds
752	received from local governments for this purpose shall be
753	separately accounted for and shall not be commingled with other
754	state or local funds in any manner.
755	(7)(10)Payments made by the agency to hospitals eligible
756	to participate in this program shall be made in accordance with
757	federal rules and regulations.
758	(a) If the Federal Government prohibits, restricts, or
759	changes in any manner the methods by which funds are distributed
760	for this program, the agency shall not distribute any additional
761	funds and shall return all funds to the local government from
762	which the funds were received, except as provided in paragraph
763	(b).
764	(b) If the Federal Government imposes a restriction that
765	still permits a partial or different distribution, the agency
766	may continue to disburse funds to hospitals participating in the
767	disproportionate share program in a federally approved manner,
768	provided:
769	1. Each local government which contributes to the
770	disproportionate share program agrees to the new manner of
771	distribution as shown by a written document signed by the
772	governing authority of each local government; and
773	2. The Executive Office of the Governor, the Office of
774	Planning and Budgeting, the House of Representatives, and the
775	Senate are provided at least 7 days' prior notice of the
776	proposed change in the distribution, and do not disapprove such
777	change.
778	(c) No distribution shall be made under the alternative
779	method specified in paragraph (b) unless all parties agree or
780	unless all funds of those parties that disagree which are not
781	yet disbursed have been returned to those parties.
782	(8)(11)Notwithstanding the provisions of chapter 216, the
783	Executive Office of the Governor is hereby authorized to
784	establish sufficient trust fund authority to implement the
785	disproportionate share program.
786	Section 13. Subsections (1) and (2) of section 409.9112,
787	Florida Statutes, are amended to read:
788	409.9112 Disproportionate share program for regional
789	perinatal intensive care centers.--In addition to the payments
790	made under s. 409.911, the Agency for Health Care Administration
791	shall design and implement a system of making disproportionate
792	share payments to those hospitals that participate in the
793	regional perinatal intensive care center program established
794	pursuant to chapter 383. This system of payments shall conform
795	with federal requirements and shall distribute funds in each
796	fiscal year for which an appropriation is made by making
797	quarterly Medicaid payments. Notwithstanding the provisions of
798	s. 409.915, counties are exempt from contributing toward the
799	cost of this special reimbursement for hospitals serving a
800	disproportionate share of low-income patients.
801	(1) The following formula shall be used by the agency to
802	calculate the total amount earned for hospitals that participate
803	in the regional perinatal intensive care center program:
804
805	TAE = HDSP/THDSP
806
807	Where:
808	TAE = total amount earned by a regional perinatal intensive
809	care center.
810	HDSP = the prior state fiscal year regional perinatal
811	intensive care center disproportionate share payment to the
812	individual hospital.
813	THDSP = the prior state fiscal year total regional
814	perinatal intensive care center disproportionate share payments
815	to all hospitals.
816	(2) The total additional payment for hospitals that
817	participate in the regional perinatal intensive care center
818	program shall be calculated by the agency as follows:
819
820	TAP = TAE x TA
821
822	Where:
823	TAP = total additional payment for a regional perinatal
824	intensive care center.
825	TAE = total amount earned by a regional perinatal intensive
826	care center.
827	TA = total appropriation for the regional perinatal
828	intensive care center disproportionate share program.
829
830	TAE = DSR x BMPD x MD
831
832	Where:
833	TAE = total amount earned by a regional perinatal intensive
834	care center.
835	DSR = disproportionate share rate.
836	BMPD = base Medicaid per diem.
837	MD = Medicaid days.
838
839	(2) The total additional payment for hospitals that
840	participate in the regional perinatal intensive care center
841	program shall be calculated by the agency as follows:
842	TAP = TAE x TA
843	(---------------)
844	@_@5@_@
845	Where:
846	TAP = total additional payment for a regional perinatal
847	intensive care center.
848	TAE = total amount earned by a regional perinatal intensive
849	care center.
850	STAE = sum of total amount earned by each hospital that
851	participates in the regional perinatal intensive care center
852	program.
853	TA = total appropriation for the regional perinatal
854	intensive care disproportionate share program.
855	Section 14. Section 409.9117, Florida Statutes, is amended
856	to read:
857	409.9117 Primary care disproportionate share program.--
858	(1) If federal funds are available for disproportionate
859	share programs in addition to those otherwise provided by law,
860	there shall be created a primary care disproportionate share
861	program.
862	(2) The following formula shall be used by the agency to
863	calculate the total amount earned for hospitals that participate
864	in the primary care disproportionate share program:
865
866	TAE = HDSP/THDSP
867
868	Where:
869	TAE = total amount earned by a hospital participating in
870	the primary care disproportionate share program.
871	HDSP = the prior state fiscal year primary care
872	disproportionate share payment to the individual hospital.
873	THDSP = the prior state fiscal year to primary care
874	disproportionate share payments to all hospitals.
875	(3) The total additional payment for hospitals that
876	participate in the primary care disproportionate share program
877	shall be calculated by the agency as follows:
878
879	TAP = TAE x TA
880
881	Where:
882	TAP = total additional payment for a primary care hospital.
883	TAE = total amount earned by a primary care hospital.
884	TA = total appropriation for the primary care
885	disproportionate share program.
886	(4)(2)In the establishment and funding of this program,
887	the agency shall use the following criteria in addition to those
888	specified in s. 409.911.,Payments may not be made to a hospital
889	unless the hospital agrees to:
890	(a) Cooperate with a Medicaid prepaid health plan, if one
891	exists in the community.
892	(b) Ensure the availability of primary and specialty care
893	physicians to Medicaid recipients who are not enrolled in a
894	prepaid capitated arrangement and who are in need of access to
895	such physicians.
896	(c) Coordinate and provide primary care services free of
897	charge, except copayments, to all persons with incomes up to 100
898	percent of the federal poverty level who are not otherwise
899	covered by Medicaid or another program administered by a
900	governmental entity, and to provide such services based on a
901	sliding fee scale to all persons with incomes up to 200 percent
902	of the federal poverty level who are not otherwise covered by
903	Medicaid or another program administered by a governmental
904	entity, except that eligibility may be limited to persons who
905	reside within a more limited area, as agreed to by the agency
906	and the hospital.
907	(d) Contract with any federally qualified health center,
908	if one exists within the agreed geopolitical boundaries,
909	concerning the provision of primary care services, in order to
910	guarantee delivery of services in a nonduplicative fashion, and
911	to provide for referral arrangements, privileges, and
912	admissions, as appropriate. The hospital shall agree to provide
913	at an onsite or offsite facility primary care services within 24
914	hours to which all Medicaid recipients and persons eligible
915	under this paragraph who do not require emergency room services
916	are referred during normal daylight hours.
917	(e) Cooperate with the agency, the county, and other
918	entities to ensure the provision of certain public health
919	services, case management, referral and acceptance of patients,
920	and sharing of epidemiological data, as the agency and the
921	hospital find mutually necessary and desirable to promote and
922	protect the public health within the agreed geopolitical
923	boundaries.
924	(f) In cooperation with the county in which the hospital
925	resides, develop a low-cost, outpatient, prepaid health care
926	program to persons who are not eligible for the Medicaid
927	program, and who reside within the area.
928	(g) Provide inpatient services to residents within the
929	area who are not eligible for Medicaid or Medicare, and who do
930	not have private health insurance, regardless of ability to pay,
931	on the basis of available space, except that nothing shall
932	prevent the hospital from establishing bill collection programs
933	based on ability to pay.
934	(h) Work with the Florida Healthy Kids Corporation, the
935	Florida Health Care Purchasing Cooperative,and business health
936	coalitions, as appropriate, to develop a feasibility study and
937	plan to provide a low-cost comprehensive health insurance plan
938	to persons who reside within the area and who do not have access
939	to such a plan.
940	(i) Work with public health officials and other experts to
941	provide community health education and prevention activities
942	designed to promote healthy lifestyles and appropriate use of
943	health services.
944	(j) Work with the local health council to develop a plan
945	for promoting access to affordable health care services for all
946	persons who reside within the area, including, but not limited
947	to, public health services, primary care services, inpatient
948	services, and affordable health insurance generally.
949
950	Any hospital that fails to comply with any of the provisions of
951	this subsection, or any other contractual condition, may not
952	receive payments under this section until full compliance is
953	achieved.
954	Section 15. Section 409.9119, Florida Statutes, is amended
955	to read:
956	409.9119 Disproportionate share program for specialty
957	hospitals for children.--In addition to the payments made under
958	s. 409.911, the Agency for Health Care Administration shall
959	develop and implement a system under which disproportionate
960	share payments are made to those hospitals that are licensed by
961	the state as specialty hospitals for children and were licensed
962	on January 1, 2000, as specialty hospitals for children. This
963	system of payments must conform to federal requirements and must
964	distribute funds in each fiscal year for which an appropriation
965	is made by making quarterly Medicaid payments. Notwithstanding
966	s. 409.915, counties are exempt from contributing toward the
967	cost of this special reimbursement for hospitals that serve a
968	disproportionate share of low-income patients. Payments are
969	subject to specific appropriations in the General Appropriations
970	Act.
971	(1) The agency shall use the following formula to
972	calculate the total amount earned for hospitals that participate
973	in the specialty hospital for children disproportionate share
974	program:
975
976	TAE = DSR x BMPD x MD
977
978	Where:
979	TAE = total amount earned by a specialty hospital for
980	children.
981	DSR = disproportionate share rate.
982	BMPD = base Medicaid per diem.
983	MD = Medicaid days.
984	(2) The agency shall calculate the total additional
985	payment for hospitals that participate in the specialty hospital
986	for children disproportionate share program as follows:
987	TAP = TAE x TA
988	(---------------)
989	STAE
990	Where:
991	TAP = total additional payment for a specialty hospital for
992	children.
993	TAE = total amount earned by a specialty hospital for
994	children.
995	TA = total appropriation for the specialty hospital for
996	children disproportionate share program.
997	STAE = sum of total amount earned by each hospital that
998	participates in the specialty hospital for children
999	disproportionate share program.
1000
1001	(3) A hospital may not receive any payments under this
1002	section until it achieves full compliance with the applicable
1003	rules of the agency. A hospital that is not in compliance for
1004	two or more consecutive quarters may not receive its share of
1005	the funds. Any forfeited funds must be distributed to the
1006	remaining participating specialty hospitals for children that
1007	are in compliance.
1008	Section 16. Paragraph (d) of subsection (3) of section
1009	409.912, Florida Statutes, is amended, and subsection (41) is
1010	added to said section, to read:
1011	409.912 Cost-effective purchasing of health care.--The
1012	agency shall purchase goods and services for Medicaid recipients
1013	in the most cost-effective manner consistent with the delivery
1014	of quality medical care. The agency shall maximize the use of
1015	prepaid per capita and prepaid aggregate fixed-sum basis
1016	services when appropriate and other alternative service delivery
1017	and reimbursement methodologies, including competitive bidding
1018	pursuant to s. 287.057, designed to facilitate the cost-
1019	effective purchase of a case-managed continuum of care. The
1020	agency shall also require providers to minimize the exposure of
1021	recipients to the need for acute inpatient, custodial, and other
1022	institutional care and the inappropriate or unnecessary use of
1023	high-cost services. The agency may establish prior authorization
1024	requirements for certain populations of Medicaid beneficiaries,
1025	certain drug classes, or particular drugs to prevent fraud,
1026	abuse, overuse, and possible dangerous drug interactions. The
1027	Pharmaceutical and Therapeutics Committee shall make
1028	recommendations to the agency on drugs for which prior
1029	authorization is required. The agency shall inform the
1030	Pharmaceutical and Therapeutics Committee of its decisions
1031	regarding drugs subject to prior authorization.
1032	(3) The agency may contract with:
1033	(d) A provider networkNo more than four provider service
1034	networks for demonstration projects to test Medicaid direct
1035	contracting. The demonstration projectsmay be reimbursed on a
1036	fee-for-service or prepaid basis. A provider service network
1037	which is reimbursed by the agency on a prepaid basis shall be
1038	exempt from parts I and III of chapter 641, but must meet
1039	appropriate financial reserve, quality assurance, and patient
1040	rights requirements as established by the agency. The agency
1041	shall award contracts on a competitive bid basis and shall
1042	select bidders based upon price and quality of care. Medicaid
1043	recipients assigned to a demonstration project shall be chosen
1044	equally from those who would otherwise have been assigned to
1045	prepaid plans and MediPass.The agency is authorized to seek
1046	federal Medicaid waivers as necessary to implement the
1047	provisions of this section. A demonstration project awarded
1048	pursuant to this paragraph shall be for 4 years from the date of
1049	implementation.
1050	(41) The agency may contract on a prepaid or fixed-sum
1051	basis with an appropriately licensed prepaid dental health plan
1052	to provide Medicaid covered dental services to child or adult
1053	Medicaid recipients.
1054	Section 17. Paragraphs (f), (k), and (l) of subsection (2)
1055	of section 409.9122, Florida Statutes, are amended to read:
1056	409.9122 Mandatory Medicaid managed care enrollment;
1057	programs and procedures.--
1058	(2)
1059	(f) When a Medicaid recipient does not choose a managed
1060	care plan or MediPass provider, the agency shall assign the
1061	Medicaid recipient to a managed care plan or MediPass provider.
1062	Medicaid recipients who are subject to mandatory assignment but
1063	who fail to make a choice shall be assigned to managed care
1064	plans until an enrollment of 45 percent in MediPass and 55
1065	percent in managed care plans is achieved. Once this enrollment
1066	is achieved, the assignments shall be divided in order to
1067	maintain an enrollment in MediPass and managed care plans which
1068	is in a 45 percent and 55 percent proportion, respectively.
1069	Thereafter, assignment of Medicaid recipients who fail to make a
1070	choice shall be based proportionally on the preferences of
1071	recipients who have made a choice in the previous period. Such
1072	proportions shall be revised at least quarterly to reflect an
1073	update of the preferences of Medicaid recipients. The agency
1074	shall disproportionately assign Medicaid-eligible recipients to
1075	thewho are required to but have failed to make a choice of
1076	managed care plan or MediPass, including children, and who are
1077	to be assigned to the MediPass program to children's networks as
1078	described in s. 409.912(3)(g),Children's Medical Services
1079	network as defined in s. 391.021, exclusive provider
1080	organizations, provider service networks, minority physician
1081	networks, and pediatric emergency department diversion programs
1082	authorized by this chapter or the General Appropriations Act, in
1083	such manner as the agency deems appropriate, until the agency
1084	has determined that the networks and programs have sufficient
1085	numbers to be economically operated. For purposes of this
1086	paragraph, when referring to assignment, the term "managed care
1087	plans" includes health maintenance organizations, exclusive
1088	provider organizations, provider service networks, minority
1089	physician networks, Children's Medical Services network, and
1090	pediatric emergency department diversion programs authorized by
1091	this chapter or the General Appropriations Act. Beginning July
1092	1, 2002, the agency shall assign all children in families who
1093	have not made a choice of a managed care plan or MediPass in the
1094	required timeframe to a pediatric emergency room diversion
1095	program described in s. 409.912(3)(g) that, as of July 1, 2002,
1096	has executed a contract with the agency, until such network or
1097	program has reached an enrollment of 15,000 children. Once that
1098	minimum enrollment level has been reached, the agency shall
1099	assign children who have not chosen a managed care plan or
1100	MediPass to the network or program in a manner that maintains
1101	the minimum enrollment in the network or program at not less
1102	than 15,000 children. To the extent practicable, the agency
1103	shall also assign all eligible children in the same family to
1104	such network or program. When making assignments, the agency
1105	shall take into account the following criteria:
1106	1. A managed care plan has sufficient network capacity to
1107	meet the need of members.
1108	2. The managed care plan or MediPasshas previously
1109	enrolled the recipient as a member, or one of the managed care
1110	plan's primary care providers or MediPass providershas
1111	previously provided health care to the recipient.
1112	3. The agency has knowledge that the member has previously
1113	expressed a preference for a particular managed care plan or
1114	MediPass provideras indicated by Medicaid fee-for-service
1115	claims data, but has failed to make a choice.
1116	4. The managed care plan's or MediPassprimary care
1117	providers are geographically accessible to the recipient's
1118	residence.
1119	5. The agency has authority to make mandatory assignments
1120	based on quality of service and performance of managed care
1121	plans.
1122	(k) When a Medicaid recipient does not choose a managed
1123	care plan or MediPass provider, the agency shall assign the
1124	Medicaid recipient to a managed care plan, except in those
1125	counties in which there are fewer than two managed care plans
1126	accepting Medicaid enrollees, in which case assignment shall be
1127	to a managed care plan or a MediPass provider. Medicaid
1128	recipients in counties with fewer than two managed care plans
1129	accepting Medicaid enrollees who are subject to mandatory
1130	assignment but who fail to make a choice shall be assigned to
1131	managed care plans until an enrollment of 45 percent in MediPass
1132	and 55 percent in managed care plans is achieved. Once that
1133	enrollment is achieved, the assignments shall be divided in
1134	order to maintain an enrollment in MediPass and managed care
1135	plans which is in a 45 percent and 55 percent proportion,
1136	respectively. In geographic areas where the agency is
1137	contracting for the provision of comprehensive behavioral health
1138	services through a capitated prepaid arrangement, recipients who
1139	fail to make a choice shall be assigned equally to MediPass or a
1140	managed care plan. For purposes of this paragraph, when
1141	referring to assignment, the term "managed care plans" includes
1142	exclusive provider organizations, provider service networks,
1143	Children's Medical Services network, minority physician
1144	networks, and pediatric emergency department diversion programs
1145	authorized by this chapter or the General Appropriations Act.
1146	When making assignments, the agency shall take into account the
1147	following criteria:
1148	1. A managed care plan has sufficient network capacity to
1149	meet the need of members.
1150	2. The managed care plan or MediPass has previously
1151	enrolled the recipient as a member, or one of the managed care
1152	plan's primary care providers or MediPass providers has
1153	previously provided health care to the recipient.
1154	3. The agency has knowledge that the member has previously
1155	expressed a preference for a particular managed care plan or
1156	MediPass provider as indicated by Medicaid fee-for-service
1157	claims data, but has failed to make a choice.
1158	4. The managed care plan's or MediPass primary care
1159	providers are geographically accessible to the recipient's
1160	residence.
1161	5. The agency has authority to make mandatory assignments
1162	based on quality of service and performance of managed care
1163	plans.
1164	(k)(l)Notwithstanding the provisions of chapter 287, the
1165	agency may, at its discretion, renew cost-effective contracts
1166	for choice counseling services once or more for such periods as
1167	the agency may decide. However, all such renewals may not
1168	combine to exceed a total period longer than the term of the
1169	original contract.
1170	Section 18. Subsections (8) and (28) of section 409.913,
1171	Florida Statutes, are amended to read:
1172	409.913 Oversight of the integrity of the Medicaid
1173	program.--The agency shall operate a program to oversee the
1174	activities of Florida Medicaid recipients, and providers and
1175	their representatives, to ensure that fraudulent and abusive
1176	behavior and neglect of recipients occur to the minimum extent
1177	possible, and to recover overpayments and impose sanctions as
1178	appropriate. Beginning January 1, 2003, and each year
1179	thereafter, the agency and the Medicaid Fraud Control Unit of
1180	the Department of Legal Affairs shall submit a joint report to
1181	the Legislature documenting the effectiveness of the state's
1182	efforts to control Medicaid fraud and abuse and to recover
1183	Medicaid overpayments during the previous fiscal year. The
1184	report must describe the number of cases opened and investigated
1185	each year; the sources of the cases opened; the disposition of
1186	the cases closed each year; the amount of overpayments alleged
1187	in preliminary and final audit letters; the number and amount of
1188	fines or penalties imposed; any reductions in overpayment
1189	amounts negotiated in settlement agreements or by other means;
1190	the amount of final agency determinations of overpayments; the
1191	amount deducted from federal claiming as a result of
1192	overpayments; the amount of overpayments recovered each year;
1193	the amount of cost of investigation recovered each year; the
1194	average length of time to collect from the time the case was
1195	opened until the overpayment is paid in full; the amount
1196	determined as uncollectible and the portion of the uncollectible
1197	amount subsequently reclaimed from the Federal Government; the
1198	number of providers, by type, that are terminated from
1199	participation in the Medicaid program as a result of fraud and
1200	abuse; and all costs associated with discovering and prosecuting
1201	cases of Medicaid overpayments and making recoveries in such
1202	cases. The report must also document actions taken to prevent
1203	overpayments and the number of providers prevented from
1204	enrolling in or reenrolling in the Medicaid program as a result
1205	of documented Medicaid fraud and abuse and must recommend
1206	changes necessary to prevent or recover overpayments. For the
1207	2001-2002 fiscal year, the agency shall prepare a report that
1208	contains as much of this information as is available to it.
1209	(8) A Medicaid provider shall retain medical,
1210	professional, financial, and business records pertaining to
1211	services and goods furnished to a Medicaid recipient and billed
1212	to Medicaid for a period of 5 years after the date of furnishing
1213	such services or goods. The agency and its duly authorized
1214	agentsmay investigate, review, or analyze such records, which
1215	must be made available during normal business hours. However,
1216	24-hour notice must be provided if patient treatment would be
1217	disrupted. The provider is responsible for furnishing to the
1218	agency and its duly authorized agents, and keeping the agency
1219	and its duly authorized agentsinformed of the location of, the
1220	provider's Medicaid-related records. The authority of the agency
1221	and its duly authorized agentsto obtain Medicaid-related
1222	records from a provider is neither curtailed nor limited during
1223	a period of litigation between the agency and the provider.
1224	(28) Notwithstanding other provisions of law, the agency
1225	and its duly authorized agentsand the Medicaid Fraud Control
1226	Unit of the Department of Legal Affairs may review a provider's
1227	Medicaid-related records in order to determine the total output
1228	of a provider's practice to reconcile quantities of goods or
1229	services billed to Medicaid against quantities of goods or
1230	services used in the provider's total practice.
1231	Section 19. Subsections (7), (8), and (9) are added to
1232	section 430.502, Florida Statutes, to read:
1233	430.502 Alzheimer's disease; memory disorder clinics and
1234	day care and respite care programs.--
1235	(7) The Agency for Health Care Administration and the
1236	department shall seek a federal waiver to implement a Medicaid
1237	home and community-based waiver targeted to persons with
1238	Alzheimer's disease to test the effectiveness of Alzheimer's
1239	specific interventions to delay or to avoid institutional
1240	placement.
1241	(8) The department shall implement the waiver program
1242	specified in subsection (7). The agency and the department shall
1243	ensure that providers are selected that have a history of
1244	successfully serving persons with Alzheimer's disease. The
1245	department and the agency shall develop specialized standards
1246	for providers and services tailored to persons in the early,
1247	middle, and late stages of Alzheimer's disease and designate a
1248	level of care determination process and standard that is most
1249	appropriate to this population. The department and the agency
1250	shall include in the waiver services designed to assist the
1251	caregiver in continuing to provide in-home care. The department
1252	shall implement this waiver program subject to a specific
1253	appropriation or as provided in the General Appropriations Act.
1254	The department and the agency shall submit their program design
1255	to the President of the Senate and the Speaker of the House of
1256	Representatives for consultation during the development process.
1257	(9) Authority to continue the waiver program specified in
1258	subsection (7) shall be automatically eliminated at the close of
1259	the 2008 Regular Session of the Legislature unless further
1260	legislative action is taken to continue it prior to such time.
1261	Section 20. Subsections (2) and (4) and paragraph (a) of
1262	subsection (5) of section 624.91, Florida Statutes, are amended
1263	to read:
1264	624.91 The Florida Healthy Kids Corporation Act.--
1265	(2) LEGISLATIVE INTENT.--
1266	(a) The Legislature finds that increased access to health
1267	care services could improve children's health and reduce the
1268	incidence and costs of childhood illness and disabilities among
1269	children in this state. Many children do not have comprehensive,
1270	affordable health care services available. It is the intent of
1271	the Legislature that the Florida Healthy Kids Corporation
1272	provide comprehensive health insurance coverage to such
1273	children. The corporation is encouraged to cooperate with any
1274	existing health service programs funded by the public or the
1275	private sector and to work cooperatively with the Florida
1276	Partnership for School Readiness.
1277	(b) It is the intent of the Legislature that the Florida
1278	Healthy Kids Corporation serve as an administrator forone of
1279	several providers of services to children eligible for medical
1280	assistance under Title XXI of the Social Security Act. Although
1281	the corporation may serve other children, the Legislature
1282	intends the primary recipients of services provided through the
1283	corporation be school-age children with a family income below
1284	200 percent of the federal poverty level, who do not qualify for
1285	Medicaid. It is also the intent of the Legislature that state
1286	and local government Florida Healthy Kids funds be used to
1287	continue and expand coverage, subject to specific appropriations
1288	in the General Appropriations Actwithin available
1289	appropriations, to children not eligible for federal matching
1290	funds under Title XXI.
1291	(4) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1292	(a) There is created the Florida Healthy Kids Corporation,
1293	a not-for-profit corporation.
1294	(b) The Florida Healthy Kids Corporation shall:
1295	1. Organize school children groups to facilitate the
1296	provision of comprehensive health insurance coverage to
1297	children.;
1298	2. Arrange for the collection for the Agency for Health
1299	Care Administrationof any family, local contributions, or
1300	employer payment or premium, in an amount to be determined by
1301	the board of directors, to provide for payment of premiums for
1302	comprehensive insurance coverage and for the actual or estimated
1303	administrative expenses.;
1304	3. Arrange for the collection of any voluntary
1305	contributions to provide for payment of premiums for coverage
1306	under the Florida Kidcare program forchildren who are not
1307	eligible for medical assistance under Title XXI of the Social
1308	Security Act for the Agency for Health Care Administration. Each
1309	fiscal year, the corporation shall establish a local match
1310	policy for the enrollment of non-Title-XXI-eligible children in
1311	the Healthy Kids program. By May 1 of each year, the corporation
1312	shall provide written notification of the amount to be remitted
1313	to the Agency for Health Care Administrationcorporationfor the
1314	following fiscal year under that policy. Local match sources may
1315	include, but are not limited to, funds provided by
1316	municipalities, counties, school boards, hospitals, health care
1317	providers, charitable organizations, special taxing districts,
1318	and private organizations. The minimum local match cash
1319	contributions required each fiscal year and local match credits
1320	shall be determined by the General Appropriations Act. The
1321	corporation shall calculate a county's local match rate based
1322	upon that county's percentage of the state's total non-Title-XXI
1323	expenditures as reported in the corporation's most recently
1324	audited financial statement. In awarding the local match
1325	credits, the corporation may consider factors including, but not
1326	limited to, population density, per capita income, and existing
1327	child-health-related expenditures and services.;
1328	4. Accept for the Agency for Health Care Administration
1329	voluntary supplemental local match contributions that comply
1330	with the requirements of Title XXI of the Social Security Act
1331	for the purpose of providing additional coverage in contributing
1332	counties under Title XXI that shall be remitted to the Agency
1333	for Health Care Administration within 1 week after receipt.;
1334	5. Establish the administrative and accounting procedures
1335	for the operation of the corporation.;
1336	6. Establish, with consultation from appropriate
1337	professional organizations, standards for preventive health
1338	services and providers and comprehensive insurance benefits
1339	appropriate to children; provided that such standards for rural
1340	areas shall not limit primary care providers to board-certified
1341	pediatricians.;
1342	7. Establish eligibility criteria which children must meet
1343	in order to participate in the program.;
1344	8. Establish procedures under which providers of local
1345	match to, applicants to and participants in the program may have
1346	grievances reviewed by an impartial body and reported to the
1347	board of directors of the corporation.;
1348	9. Establish participation criteria and, if appropriate,
1349	contract with an authorized insurer, health maintenance
1350	organization, or insurance administrator to provide
1351	administrative services to the corporation;
1352	9.10.Establish enrollment criteria which shall include
1353	penalties or waiting periods of not fewer than 60 days for
1354	reinstatement of coverage upon voluntary cancellation for
1355	nonpayment of family premiums.;
1356	10.11.If a space is available, establish a special open
1357	enrollment period of 30 days' duration for any child who is
1358	enrolled in Medicaid or Medikids if such child loses Medicaid or
1359	Medikids eligibility and becomes eligible for the Florida
1360	Healthy Kids program.;
1361	12. Contract with authorized insurers or any provider of
1362	health care services, meeting standards established by the
1363	corporation, for the provision of comprehensive insurance
1364	coverage to participants. Such standards shall include criteria
1365	under which the corporation may contract with more than one
1366	provider of health care services in program sites. Health plans
1367	shall be selected through a competitive bid process. The
1368	selection of health plans shall be based primarily on quality
1369	criteria established by the board. The health plan selection
1370	criteria and scoring system, and the scoring results, shall be
1371	available upon request for inspection after the bids have been
1372	awarded;
1373	11.13.Establish disenrollment criteria in the event local
1374	matching funds are insufficient to cover enrollments.;
1375	12.14.Develop and implement a plan to publicize the
1376	Florida Healthy Kids Corporation, the eligibility requirements
1377	of the program, and the procedures for enrollment in the program
1378	and to maintain public awareness of the corporation and the
1379	program.;
1380	13.15.Secure staff necessary to properly administer the
1381	corporation. Staff costs shall be funded from state and local
1382	matching funds and such other private or public funds as become
1383	available. The board of directors shall determine the number of
1384	staff members necessary to administer the corporation.;
1385	14.16.As appropriate, enter into contracts with local
1386	school boards or other agencies to provide onsite information,
1387	enrollment, and other services necessary to the operation of the
1388	corporation.;
1389	15.17.Provide a report annually to the Governor, Chief
1390	Financial Officer, Commissioner of Education, Senate President,
1391	Speaker of the House of Representatives, and Minority Leaders of
1392	the Senate and the House of Representatives.;
1393	16.18.Each fiscal year, establish a maximum number of
1394	participants, on a statewide basis, who may enroll in the
1395	program.; and
1396	17.19.Establish eligibility criteria, premium and cost-
1397	sharing requirements, and benefit packages which conform to the
1398	provisions of the Florida Kidcare program, as created in ss.
1399	409.810-409.820.
1400	(c) Coverage under the corporation's program is secondary
1401	to any other available private coverage held by the participant
1402	child or family member. The corporation may establish procedures
1403	for coordinating benefits under this program with benefits under
1404	other public and private coverage.
1405	(c)(d)The Florida Healthy Kids Corporation shall be a
1406	private corporation not for profit, organized pursuant to
1407	chapter 617, and shall have all powers necessary to carry out
1408	the purposes of this act, including, but not limited to, the
1409	power to receive and accept grants, loans, or advances of funds
1410	from any public or private agency and to receive and accept from
1411	any source contributions of money, property, labor, or any other
1412	thing of value, to be held, used, and applied for the purposes
1413	of this act.
1414	(5) BOARD OF DIRECTORS.--
1415	(a) The Florida Healthy Kids Corporation shall operate
1416	subject to the supervision and approval of a board of directors
1417	chaired by the Chief Financial Officer or her or his designee,
1418	and composed of 1014other members selected for 3-year terms of
1419	office as follows:
1420	1. The secretary of the Agency for Health Care
1421	Administration or her or his designee.One member appointed by
1422	the Commissioner of Education from among three persons nominated
1423	by the Florida Association of School Administrators;
1424	2. One member appointed by the Commissioner of Education
1425	from among three persons nominated by the Florida Association of
1426	School Boards;
1427	2.3.One member appointed by the Commissioner of Education
1428	from the Office of School Health Programs of the Florida
1429	Department of Education.;
1430	3.4.One member appointed by the Governor from among three
1431	members nominated by the Florida Pediatric Society.;
1432	4.5.One member, appointed by the Governor, who represents
1433	the Children's Medical Services Program.;
1434	5.6. One member appointed by the GovernorChief Financial
1435	Officerfrom among three members nominated by the Florida
1436	Hospital Association.;
1437	7. Two members, appointed by the Chief Financial Officer,
1438	who are representatives of authorized health care insurers or
1439	health maintenance organizations;
1440	6.8. One member, appointed by the Board of GovernorsChief
1441	Financial Officer, who is knowledgeable aboutrepresents the
1442	Institute for child health policy.;
1443	7.9.One member, appointed by the Governor, from among
1444	three members nominated by the Florida Academy of Family
1445	Physicians.;
1446	8.10.One member, appointed by the Governor, who
1447	represents the state Medicaid program.Agency for Health Care
1448	Administration;
1449	11. One member, appointed by the Chief Financial Officer,
1450	from among three members nominated by the Florida Association of
1451	Counties, representing rural counties;
1452	9.12.One member, appointed by the Governor, from among
1453	three members nominated by the Florida Association of Counties.,
1454	representing urban counties; and
1455	10.13.The State Health Officer or her or his designee.
1456	Section 21. Section 624.915, Florida Statutes, is amended
1457	to read:
1458	624.915 Florida Healthy Kids Corporation; operating
1459	fund.--The Florida Healthy Kids Corporation may establish and
1460	manage an operating fund for the purposes of addressing the
1461	corporation's unique cash-flow needs and facilitating the fiscal
1462	management of the corporation. The corporation may accumulate
1463	and maintain in the operating fund at any given time a cash
1464	balance reserve equal to no more than 25 percent of its
1465	annualized operating expenses. Excess funds shall be remitted to
1466	the Agency for Health Care Administration for use in funding the
1467	Florida Kidcare program.Upon dissolution of the corporation,
1468	any remaining cash balances of state funds shall revert to the
1469	General Revenue Fund, or such other state funds consistent with
1470	the appropriated funding, as provided by law.
1471	Section 22. Section 57 of chapter 98-288, Laws of Florida,
1472	is repealed.
1473	Section 23. If any law amended by this act was also
1474	amended by a law enacted at the 2003 Regular Session of the
1475	Legislature, such laws shall be construed as if they had been
1476	enacted at the same session of the Legislature, and full effect
1477	shall be given to each if possible.
1478	Section 24. Except as otherwise provided herein, this act
1479	shall take effect July 1, 2003.