| 1 | Representative Garcia offered the following: |
| 2 |
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| 3 | Amendment (with directory and title amendments) |
| 4 | Between lines 1794 and 1795 insert: |
| 5 | (f) When a Medicaid recipient does not choose a managed |
| 6 | care plan or MediPass provider, the agency shall assign the |
| 7 | Medicaid recipient to a managed care plan or MediPass provider. |
| 8 | Medicaid recipients who are subject to mandatory assignment but |
| 9 | who fail to make a choice shall be assigned to managed care |
| 10 | plans until an enrollment of 38 40 percent in MediPass and 62 60 |
| 11 | percent in managed care plans is achieved. Once this enrollment |
| 12 | is achieved, the assignments shall be divided in order to |
| 13 | maintain an enrollment in MediPass and managed care plans which |
| 14 | is in a 38 40 percent and 62 60 percent proportion, |
| 15 | respectively. Thereafter, assignment of Medicaid recipients who |
| 16 | fail to make a choice shall be based proportionally on the |
| 17 | preferences of recipients who have made a choice in the previous |
| 18 | period. Such proportions shall be revised at least quarterly to |
| 19 | reflect an update of the preferences of Medicaid recipients. The |
| 20 | agency shall disproportionately assign Medicaid-eligible |
| 21 | recipients who are required to but have failed to make a choice |
| 22 | of managed care plan or MediPass, including children, and who |
| 23 | are to be assigned to the MediPass program to children's |
| 24 | networks as described in s. 409.912(3)(g), Children's Medical |
| 25 | Services network as defined in s. 391.021, exclusive provider |
| 26 | organizations, provider service networks, minority physician |
| 27 | networks, and pediatric emergency department diversion programs |
| 28 | authorized by this chapter or the General Appropriations Act, in |
| 29 | such manner as the agency deems appropriate, until the agency |
| 30 | has determined that the networks and programs have sufficient |
| 31 | numbers to be economically operated. For purposes of this |
| 32 | paragraph, when referring to assignment, the term "managed care |
| 33 | plans" includes health maintenance organizations, exclusive |
| 34 | provider organizations, provider service networks, minority |
| 35 | physician networks, Children's Medical Services network, and |
| 36 | pediatric emergency department diversion programs authorized by |
| 37 | this chapter or the General Appropriations Act. When making |
| 38 | assignments, the agency shall take into account the following |
| 39 | criteria: |
| 40 | 1. A managed care plan has sufficient network capacity to |
| 41 | meet the need of members. |
| 42 | 2. The managed care plan or MediPass has previously |
| 43 | enrolled the recipient as a member, or one of the managed care |
| 44 | plan's primary care providers or MediPass providers has |
| 45 | previously provided health care to the recipient. |
| 46 | 3. The agency has knowledge that the member has previously |
| 47 | expressed a preference for a particular managed care plan or |
| 48 | MediPass provider as indicated by Medicaid fee-for-service |
| 49 | claims data, but has failed to make a choice. |
| 50 | 4. The managed care plan's or MediPass primary care |
| 51 | providers are geographically accessible to the recipient's |
| 52 | residence. |
| 53 | (k) When a Medicaid recipient does not choose a managed |
| 54 | care plan or MediPass provider, the agency shall assign the |
| 55 | Medicaid recipient to a managed care plan, except in those |
| 56 | counties in which there are fewer than two managed care plans |
| 57 | accepting Medicaid enrollees, in which case assignment shall be |
| 58 | to a managed care plan or a MediPass provider. Medicaid |
| 59 | recipients in counties with fewer than two managed care plans |
| 60 | accepting Medicaid enrollees who are subject to mandatory |
| 61 | assignment but who fail to make a choice shall be assigned to |
| 62 | managed care plans until an enrollment of 38 40 percent in |
| 63 | MediPass and 62 60 percent in managed care plans is achieved. |
| 64 | Once that enrollment is achieved, the assignments shall be |
| 65 | divided in order to maintain an enrollment in MediPass and |
| 66 | managed care plans which is in a 38 40 percent and 62 60 percent |
| 67 | proportion, respectively. In geographic areas where the agency |
| 68 | is contracting for the provision of comprehensive behavioral |
| 69 | health services through a capitated prepaid arrangement, |
| 70 | recipients who fail to make a choice shall be assigned equally |
| 71 | to MediPass or a managed care plan. For purposes of this |
| 72 | paragraph, when referring to assignment, the term "managed care |
| 73 | plans" includes exclusive provider organizations, provider |
| 74 | service networks, Children's Medical Services network, minority |
| 75 | physician networks, and pediatric emergency department diversion |
| 76 | programs authorized by this chapter or the General |
| 77 | Appropriations Act. When making assignments, the agency shall |
| 78 | take into account the following criteria: |
| 79 | 1. A managed care plan has sufficient network capacity to |
| 80 | meet the need of members. |
| 81 | 2. The managed care plan or MediPass has previously |
| 82 | enrolled the recipient as a member, or one of the managed care |
| 83 | plan's primary care providers or MediPass providers has |
| 84 | previously provided health care to the recipient. |
| 85 | 3. The agency has knowledge that the member has previously |
| 86 | expressed a preference for a particular managed care plan or |
| 87 | MediPass provider as indicated by Medicaid fee-for-service |
| 88 | claims data, but has failed to make a choice. |
| 89 | 4. The managed care plan's or MediPass primary care |
| 90 | providers are geographically accessible to the recipient's |
| 91 | residence. |
| 92 | 5. The agency has authority to make mandatory assignments |
| 93 | based on quality of service and performance of managed care |
| 94 | plans. |
| 95 |
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| 96 | =========== D I R E C T O R Y A M E N D M E N T ========== |
| 97 | Remove lines 1742 and 1743 and insert: |
| 98 | Section 10. Paragraphs (a), (f), and (k) of subsection (2) |
| 99 | of section 409.9122, Florida Statutes, are amended to read: |
| 100 |
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| 101 | ================ T I T L E A M E N D M E N T ============= |
| 102 | Between lines 30 and 31 insert: |
| 103 | revising prerequisites to mandatory assignment; |