HB 1535

1
A bill to be entitled
2An act relating to specialty behavioral health care
3providers; amending s. 394.4574, F.S.; authorizing the
4Agency for Health Care Administration to establish a
5demonstration project in certain counties in order to
6determine the benefits of developing a specialty
7behavioral health care provider to deliver behavioral
8health services to persons who reside in an assisted
9living facility that holds a limited mental health
10license; authorizing the agency to create an advisory
11committee; providing for membership, duties, and purpose
12of the committee; defining the term "specialty behavioral
13health care provider"; providing the requirements for the
14specialty behavioral health care provider demonstration
15project; providing that certain specialty behavioral
16health care providers may seek and develop cooperative
17agreements with administrators of certain assisted living
18facilities; authorizing the agency to seek federal waivers
19to implement an alternative prepaid behavioral health care
20plan under certain conditions; authorizing the agency to
21implement the demonstration project and the advisory
22committee to complete work; providing for an independent
23evaluation; requiring that a report be submitted to the
24Legislature; authorizing the agency to seek a waiver or
25approval for an amendment to a waiver for the purpose of
26addressing needs of individuals who reside in certain
27assisted living facilities; requiring the agency to
28establish a workgroup for the purpose of preparing an
29amendment to a waiver; providing requirements for the
30amendment; requiring the Office of Program Policy Analysis
31and Government Accountability to conduct an evaluation;
32requiring the agency to implement the waiver amendment;
33prohibiting the waiver amendment from increasing costs to
34the Medicaid program; providing an effective date.
35
36Be It Enacted by the Legislature of the State of Florida:
37
38     Section 1.  Subsections (4), (5), (6), (7), (8), (9), and
39(10) are added to section 394.4574, Florida Statutes, to read:
40     394.4574  Department responsibilities for a mental health
41resident who resides in an assisted living facility that holds a
42limited mental health license.--
43     (4)  The Agency for Health Care Administration may
44establish a demonstration project within Duval, Nassau, Pasco,
45Pinellas, Lee, Volusia, Putnam, Charlotte, Hillsborough, Dade,
46Broward, Brevard, Orange, Santa Rosa, Collier, and Palm Beach
47Counties for the purpose of developing evidence-based practices
48in the delivery of state-funded behavioral health care services
49and support through the use of specialty behavioral health care
50providers to persons who reside in assisted living facilities
51that hold a limited mental health license.
52     (5)(a)  The agency may create an advisory committee to make
53recommendations to the Agency for Health Care Administration and
54the Department of Children and Family Services for the
55demonstration project that may be developed by the Agency for
56Health Care Administration, in consultation with the Department
57of Children and Families Services. The advisory committee shall
58solicit input from stakeholders, residents, facility
59administrators, and advocates relative to standards, criteria,
60and the array of services that will be included.
61     (b)  The members of the advisory committee shall include
62local community partners, including residents, advocates,
63private and publicly funded behavioral health care providers,
64representatives of the Agency for Health Care Administration and
65the Department of Children and Family Services, and facility
66administrators selected by the agency. Other representatives may
67include the following:
68     1.  One person who is a member of the Florida Psychiatric
69Society, selected by the society;
70     2.  One person who is a member of the Florida Council for
71Behavioral Health, selected by the council;
72     3.  One person who is a member of the National Alliance for
73the Mentally Ill, selected by the state affiliate;
74     4.  One person who is a member of the Florida Assisted
75Living Affiliation, selected by the affiliation; and
76     5.  One person who is a member of the local advocacy
77council, selected by the local council.
78
79Each member or representative on the advisory committee must
80serve at his or her own expense.
81     (c)  The advisory committee shall establish goals, elect a
82chairperson, and be governed by the latest edition of Roberts
83Rules of Order. The chairperson within district 4 shall direct
84the work of the advisory committee and may appoint subcommittees
85as deemed appropriate by the chairperson. In addition, the
86chairperson shall be responsible for ensuring that minutes of
87meetings are kept and community input is solicited. The meetings
88shall convene upon the call of the chairperson.
89     (6)(a)  For the purposes of this demonstration project, the
90term "specialty behavioral health care provider" means a public
91or private behavioral health care entity, provider, or
92organization or coalition of providers which holds a contract
93with the Department of Children and Family Services and can
94offer a full array of state-funded behavioral health care
95services to residents who live in state-licensed assisted living
96facilities that hold a limited mental health license in the
97counties of Duval, Nassau, Pasco, Pinellas, Lee, Volusia,
98Putnam, Charlotte, Hillsborough, Dade, Broward, Brevard, Orange,
99Santa Rosa, Collier, or Palm Beach. The services that are
100provided on a fee-for-service basis shall be provided directly
101by the specialty behavioral health care provider. For the
102purpose of this demonstration project, the Department of
103Children and Family Services shall allow private providers the
104opportunity to seek a contract with the department in order to
105compete and provide state-funded behavioral health care
106services.
107     (b)  In constructing the requirements for the specialty
108behavioral health care provider demonstration project, the
109Agency for Health Care Administration and the Department of
110Children and Family Services shall ensure that the providers
111develop and implement a plan to ensure the provision of the
112services and requirements referenced under this section. The
113demonstration project shall include requirements for intensive
114case-management services, provisions for on-call case managers,
115and vocational support services and shall include a requirement
116for the development of evidence-based models and practices in
117the delivery of community-based behavioral health care services
118which include strategies for reducing the use of state-funded
119inpatient psychiatric care. These models should demonstrate new
120approaches and allow for maximum input from consumers, family
121members, and facility administrators. Services provided under
122the demonstration project shall be provided on a fee-for-service
123basis for residents who are not eligible for Medicaid and must
124be cost neutral for the Agency for Health Care Administration
125and for the Department of Children and Family Services. The
126Agency for Health Care Administration, in consultation with the
127Department of Children and Family Services, shall use a request-
128for-information process for the purpose of procurement and to
129ensure competition and choice.
130     (c)  For Medicaid-eligible residents who live in assisted
131living facilities that hold a limited mental health license in
132the counties of Duval, Nassau, Pasco, Pinellas, Lee, Volusia,
133Putnam, Charlotte, Hillsborough, Dade, Broward, Brevard, Orange,
134Santa Rosa, Collier, or Palm Beach and are enrolled in the
135MediPass program under a fee-for-service arrangement for the
136provision of Medicaid-funded behavioral health care services,
137the Department of Children and Family Services and the Agency
138for Health Care Administration shall allow any behavioral health
139care provider in the counties referenced under this section
140which meets the eligibility requirements for this demonstration
141project to become a specialty behavioral health care provider,
142including a nonprofit or private behavioral health care
143provider, organization, or entity or coalition of providers.
144     (d)  Each eligible specialty behavioral health care
145provider that is qualified under the requirements of the
146demonstration project may seek and develop cooperative
147agreements with administrators of assisted living facilities
148that hold a limited mental health license in the counties of
149Duval, Nassau, Pasco, Pinellas, Lee, Volusia, Putnam, Charlotte,
150Hillsborough, Dade, Broward, Brevard, Orange, Santa Rosa,
151Collier, or Palm Beach. The cooperative agreement shall be for a
152minimum of 1 year during the course of the demonstration project
153and shall be binding on both parties for the duration of the
154agreement. The cooperative agreement must include provisions
155that promote the development of evidence-based practices and
156models as outlined in the procurement document for the project.
157For the purposes of this demonstration project, the provisions
158of the cooperative agreement shall be focused on improving the
159coordination of services, improved communication, detailed
160protocols that relate to the supervision of the clinical needs
161of the residents, and all other provisions required by law.
162     (7)  If the Agency for Health Care Administration
163implements a prepaid behavioral health care plan in the counties
164of Duval, Nassau, Pasco, Pinellas, Lee, Volusia, Putnam,
165Charlotte, Hillsborough, Dade, Broward, Brevard, Orange, Santa
166Rosa, Collier, or Palm Beach, the Agency for Health Care
167Administration may seek federal waivers to implement an
168alternative prepaid behavioral health care plan in the counties
169of Duval, Nassau, Pasco, Pinellas, Lee, Volusia, Putnam,
170Charlotte, Hillsborough, Dade, Broward, Brevard, Orange, Santa
171Rosa, Collier, or Palm Beach in order to demonstrate innovation
172and develop evidence-based practices that will improve the
173coordination, satisfaction, and delivery of all state-funded
174behavioral health care services to residents who reside in
175assisted living facilities that hold a limited mental health
176license. The Agency for Health Care Administration, in
177developing the alternative prepaid program for persons who
178reside in assisted living facilities that hold a limited mental
179health license in the counties of Duval, Nassau, Pasco,
180Pinellas, Lee, Volusia, Putnam, Charlotte, Hillsborough, Dade,
181Broward, Brevard, Orange, Santa Rosa, Collier, or Palm Beach,
182shall include provisions that ensure that the demonstration
183capitation rate is based on no more than 90 percent of the
184historic service utilization from the fee-for-service base,
185shall include all outpatient state-funded behavioral health care
186services and inpatient psychiatric services, and shall exempt
187medications. The Department of Children and Family Services
188shall calculate a rate for the non-Medicaid residents served in
189the demonstration area and shall ensure that the capitation rate
190does not result in the displacement of residents and is
191consistent with each resident's right of access to adequate and
192appropriate health care under s. 400.428.
193     (8)  The demonstration project may be implemented by the
194Agency for Health Care Administration at the direction of the
195Secretary of Health Care Administration. When the secretary
196authorizes implementation of the demonstration project, the
197project shall continue for at least 3 years following the date
198of implementation. The advisory committee shall complete its
199work at the end of the 3-year period.
200     (9)  The Office of Program Policy Analysis and Government
201Accountability shall conduct an evaluation of the demonstration
202project at the end of the first year and a review at the end of
203the 3-year period. The evaluation must assess the recidivism of
204residents from each assisted living facility that holds a
205limited mental health license to the inpatient hospital setting,
206improvements in resident behavioral health outcomes, resident
207satisfaction with care, improvements in program competencies and
208linkages, increased tenure of case-management relationships with
209residents, and implementation of meaningful plans of recovery.
210Following the evaluation and review, the office shall prepare a
211report and submit a copy to the President of the Senate and the
212Speaker of the House of Representatives in a timely manner.
213     (10)  The Agency for Health Care Administration may seek
214the necessary federal waivers or approval to amend a current
215waiver for the purpose of addressing the needs of individuals
216who reside in an assisted living facility that holds a limited
217mental health license. The agency shall establish a workgroup to
218assist in the preparation and development of the amendment to
219the waiver to provide input and information relevant to the
220completion and successful submission of an amendment. The
221amendment must address the needs of certain individuals that
222reside in state-licensed assisted living facilities that hold a
223limited mental health license. The amendment must provide for a
224mechanism by which those individuals having increased medical
225needs who are under the age of 65 and meet certain criteria
226would be eligible based on the availability of funding for
227additional services that would enable those individuals to
228remain as residents in an assisted living facility that holds a
229limited mental health license. The Office of Program Policy
230Analysis and Government Accountability shall conduct an
231evaluation of the waiver amendment after the first year of
232implementation. The evaluation shall assess whether the
233amendment to the waiver and the services provided have reduced,
234delayed, or otherwise improved the ability of the assisted
235living facility to retrain individuals who otherwise would have
236been homeless or placed in an institutional setting. The agency
237shall implement the waiver and serve 400 individuals who meet
238the criteria and reside in an assisted living facility that
239holds a limited mental health license in the counties of Duval,
240Nassau, Pasco, Putnam, Volusia, Dade, Charlotte, Santa Rosa,
241Collier, Palm Beach, or Lee. The agency shall implement the
242waiver amendment upon approval from appropriate federal agencies
243and access to available funding. The waiver amendment may not
244increase costs to the Medicaid program and must demonstrate
245savings.
246     Section 2.  This act shall take effect July 1, 2005.


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