Amendment
Bill No. 0017

Amendment No. 627463

CHAMBER ACTION
Senate		House
.
.
.

---

---

1	Representative(s) Sands offered the following:
2
3	Amendment (with directory and title amendments)
4	Between line(s) 61 and 62 insert:
5	(4)  The agency may contract with:
6	(b)  An entity that is providing comprehensive behavioral
7	health care services to certain Medicaid recipients through a
8	capitated, prepaid arrangement pursuant to the federal waiver
9	provided for by s. 409.905(5). Such an entity must be licensed
10	under chapter 624, chapter 636, or chapter 641 and must possess
11	the clinical systems and operational competence to manage risk
12	and provide comprehensive behavioral health care to Medicaid
13	recipients. As used in this paragraph, the term "comprehensive
14	behavioral health care services" means covered mental health and
15	substance abuse treatment services that are available to
16	Medicaid recipients. The secretary of the Department of Children
17	and Family Services shall approve provisions of procurements
18	related to children in the department's care or custody prior to
19	enrolling such children in a prepaid behavioral health plan. Any
20	contract awarded under this paragraph must be competitively
21	procured. In developing the behavioral health care prepaid plan
22	procurement document, the agency shall ensure that the
23	procurement document requires the contractor to develop and
24	implement a plan to ensure compliance with s. 394.4574 related
25	to services provided to residents of licensed assisted living
26	facilities that hold a limited mental health license. Except as
27	provided in subparagraph 8., the agency shall seek federal
28	approval to contract with a single entity meeting these
29	requirements to provide comprehensive behavioral health care
30	services to all Medicaid recipients not enrolled in a managed
31	care plan in an AHCA area. Each entity must offer sufficient
32	choice of providers in its network to ensure recipient access to
33	care and the opportunity to select a provider with whom they are
34	satisfied. The network shall include all public mental health
35	hospitals. To ensure unimpaired access to behavioral health care
36	services by Medicaid recipients, all contracts issued pursuant
37	to this paragraph shall require 80 percent of the capitation
38	paid to the managed care plan, including health maintenance
39	organizations, to be expended for the provision of behavioral
40	health care services. In the event the managed care plan expends
41	less than 80 percent of the capitation paid pursuant to this
42	paragraph for the provision of behavioral health care services,
43	the difference shall be returned to the agency. The agency shall
44	provide the managed care plan with a certification letter
45	indicating the amount of capitation paid during each calendar
46	year for the provision of behavioral health care services
47	pursuant to this section. The agency may reimburse for substance
48	abuse treatment services on a fee-for-service basis until the
49	agency finds that adequate funds are available for capitated,
50	prepaid arrangements.
51	1.  By January 1, 2001, the agency shall modify the
52	contracts with the entities providing comprehensive inpatient
53	and outpatient mental health care services to Medicaid
54	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
55	Counties, to include substance abuse treatment services.
56	2.  By July 1, 2003, the agency and the Department of
57	Children and Family Services shall execute a written agreement
58	that requires collaboration and joint development of all policy,
59	budgets, procurement documents, contracts, and monitoring plans
60	that have an impact on the state and Medicaid community mental
61	health and targeted case management programs.
62	3.  Except as provided in subparagraph 8., by July 1, 2006,
63	the agency and the Department of Children and Family Services
64	shall contract with managed care entities in each AHCA area
65	except area 6 or arrange to provide comprehensive inpatient and
66	outpatient mental health and substance abuse services through
67	capitated prepaid arrangements to all Medicaid recipients who
68	are eligible to participate in such plans under federal law and
69	regulation. In AHCA areas where eligible individuals number less
70	than 150,000, the agency shall contract with a single managed
71	care plan to provide comprehensive behavioral health services to
72	all recipients who are not enrolled in a Medicaid health
73	maintenance organization. The agency may contract with more than
74	one comprehensive behavioral health provider to provide care to
75	recipients who are not enrolled in a Medicaid health maintenance
76	organization in AHCA areas where the eligible population exceeds
77	150,000. Contracts for comprehensive behavioral health providers
78	awarded pursuant to this section shall be competitively
79	procured. Both for-profit and not-for-profit corporations shall
80	be eligible to compete. Managed care plans contracting with the
81	agency under subsection (3) shall provide and receive payment
82	for the same comprehensive behavioral health benefits as
83	provided in AHCA rules, including handbooks incorporated by
84	reference. Existing provider service networks shall be permitted
85	to continue their programs for a period of no less than 3 years
86	and shall include mental health care and substance abuse
87	services as part of the services offered by the network.
88	Notwithstanding the provisions of this section, county
89	governments may participate as provider service networks.
90	4.  By October 1, 2003, the agency and the department shall
91	submit a plan to the Governor, the President of the Senate, and
92	the Speaker of the House of Representatives which provides for
93	the full implementation of capitated prepaid behavioral health
94	care in all areas of the state.
95	a.  Implementation shall begin in 2003 in those AHCA areas
96	of the state where the agency is able to establish sufficient
97	capitation rates.
98	b.  If the agency determines that the proposed capitation
99	rate in any area is insufficient to provide appropriate
100	services, the agency may adjust the capitation rate to ensure
101	that care will be available. The agency and the department may
102	use existing general revenue to address any additional required
103	match but may not over-obligate existing funds on an annualized
104	basis.
105	c.  Subject to any limitations provided for in the General
106	Appropriations Act, the agency, in compliance with appropriate
107	federal authorization, shall develop policies and procedures
108	that allow for certification of local and state funds.
109	5.  Children residing in a statewide inpatient psychiatric
110	program, or in a Department of Juvenile Justice or a Department
111	of Children and Family Services residential program approved as
112	a Medicaid behavioral health overlay services provider shall not
113	be included in a behavioral health care prepaid health plan or
114	any other Medicaid managed care plan pursuant to this paragraph.
115	6.  In converting to a prepaid system of delivery, the
116	agency shall in its procurement document require an entity
117	providing only comprehensive behavioral health care services to
118	prevent the displacement of indigent care patients by enrollees
119	in the Medicaid prepaid health plan providing behavioral health
120	care services from facilities receiving state funding to provide
121	indigent behavioral health care, to facilities licensed under
122	chapter 395 which do not receive state funding for indigent
123	behavioral health care, or reimburse the unsubsidized facility
124	for the cost of behavioral health care provided to the displaced
125	indigent care patient.
126	7.  Traditional community mental health providers under
127	contract with the Department of Children and Family Services
128	pursuant to part IV of chapter 394, child welfare providers
129	under contract with the Department of Children and Family
130	Services in areas 1 and 6, and inpatient mental health providers
131	licensed pursuant to chapter 395 must be offered an opportunity
132	to accept or decline a contract to participate in any provider
133	network for prepaid behavioral health services.
134	8.  For fiscal year 2004-2005, all Medicaid eligible
135	children, except children in areas 1 and 6, whose cases are open
136	for child welfare services in the HomeSafeNet system, shall be
137	enrolled in MediPass or in Medicaid fee-for-service and all
138	their behavioral health care services including inpatient,
139	outpatient psychiatric, community mental health, and case
140	management shall be reimbursed on a fee-for-service basis.
141	Beginning July 1, 2005, such children, who are open for child
142	welfare services in the HomeSafeNet system, shall receive their
143	behavioral health care services through a specialty prepaid plan
144	operated by community-based lead agencies either through a
145	single agency or formal agreements among several agencies. The
146	specialty prepaid plan must result in savings to the state
147	comparable to savings achieved in other Medicaid managed care
148	and prepaid programs. Such plan must provide mechanisms to
149	maximize state and local revenues. The specialty prepaid plan
150	shall be developed by the agency and the Department of Children
151	and Family Services. The agency is authorized to seek any
152	federal waivers to implement this initiative.
153
154	=========== D I R E C T O R Y  A M E N D M E N T ==========
155	Remove line(s) 15 and 16 and insert:
156	Section 1.  Paragraph (b) of subsection (4) of section
157	409.912, Florida Statutes, is amended, and subsection (50) is
158	added to said section, to read:
159
160	================ T I T L E  A M E N D M E N T =============
161	Remove line(s) 3 and insert:
162
163	409.912, F.S.; authorizing existing provider service networks to
164	continue their programs for a specified period of time;
165	including mental health and substance abuse services;
166	authorizing county governments to participate as networks;
167	requiring the Agency for Health Care

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