HB 1237

1	A bill to be entitled
2	An act relating to community mental health services as
3	optional Medicaid services; amending s. 409.906, F.S.;
4	eliminating authorization for the Agency for Health Care
5	Administration to operate a behavioral health utilization
6	management program; eliminating the agency's authorization
7	to implement certain reimbursement and use management
8	reforms; providing an effective date.
9
10	Be It Enacted by the Legislature of the State of Florida:
11
12	Section 1.  Subsection (8) of section 409.906, Florida
13	Statutes, is amended to read:
14	409.906  Optional Medicaid services.--Subject to specific
15	appropriations, the agency may make payments for services which
16	are optional to the state under Title XIX of the Social Security
17	Act and are furnished by Medicaid providers to recipients who
18	are determined to be eligible on the dates on which the services
19	were provided. Any optional service that is provided shall be
20	provided only when medically necessary and in accordance with
21	state and federal law. Optional services rendered by providers
22	in mobile units to Medicaid recipients may be restricted or
23	prohibited by the agency. Nothing in this section shall be
24	construed to prevent or limit the agency from adjusting fees,
25	reimbursement rates, lengths of stay, number of visits, or
26	number of services, or making any other adjustments necessary to
27	comply with the availability of moneys and any limitations or
28	directions provided for in the General Appropriations Act or
29	chapter 216. If necessary to safeguard the state's systems of
30	providing services to elderly and disabled persons and subject
31	to the notice and review provisions of s. 216.177, the Governor
32	may direct the Agency for Health Care Administration to amend
33	the Medicaid state plan to delete the optional Medicaid service
34	known as "Intermediate Care Facilities for the Developmentally
35	Disabled." Optional services may include:
36	(8)  COMMUNITY MENTAL HEALTH SERVICES.--
37	(a)  The agency may pay for rehabilitative services
38	provided to a recipient by a mental health or substance abuse
39	provider under contract with the agency or the Department of
40	Children and Family Services to provide such services.  Those
41	services which are psychiatric in nature shall be rendered or
42	recommended by a psychiatrist, and those services which are
43	medical in nature shall be rendered or recommended by a
44	physician or psychiatrist. The agency must develop a provider
45	enrollment process for community mental health providers which
46	bases provider enrollment on an assessment of service need. The
47	provider enrollment process shall be designed to control costs,
48	prevent fraud and abuse, consider provider expertise and
49	capacity, and assess provider success in managing utilization of
50	care and measuring treatment outcomes. Providers will be
51	selected through a competitive procurement or selective
52	contracting process. In addition to other community mental
53	health providers, the agency shall consider for enrollment
54	mental health programs licensed under chapter 395 and group
55	practices licensed under chapter 458, chapter 459, chapter 490,
56	or chapter 491. The agency is also authorized to continue
57	operation of its behavioral health utilization management
58	program and may develop new services if these actions are
59	necessary to ensure savings from the implementation of the
60	utilization management system. The agency shall coordinate the
61	implementation of this enrollment process with the Department of
62	Children and Family Services and the Department of Juvenile
63	Justice. The agency is authorized to utilize diagnostic criteria
64	in setting reimbursement rates, to preauthorize certain high-
65	cost or highly utilized services, to limit or eliminate coverage
66	for certain services, or to make any other adjustments necessary
67	to comply with any limitations or directions provided for in the
68	General Appropriations Act.
69	(b)  The agency is authorized to implement reimbursement
70	and use management reforms in order to comply with any
71	limitations or directions in the General Appropriations Act,
72	which may include, but are not limited to: prior authorization
73	of treatment and service plans; prior authorization of services;
74	enhanced use review programs for highly used services; and
75	limits on services for those determined to be abusing their
76	benefit coverages.
77	Section 2.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.