| 1 | Representative(s) Benson offered the following: |
| 2 |
|
| 3 | Amendment (with title amendment) |
| 4 | Remove line(s) 1042-1052 and insert: |
| 5 | Section 9. Section 409.9124, Florida Statutes, is amended |
| 6 | to read: |
| 7 | 409.9124 Managed care reimbursement.-- |
| 8 | (1) The agency shall develop and adopt by rule a |
| 9 | methodology for reimbursing managed care plans. |
| 10 | (1)(2) Final managed care rates shall be published |
| 11 | annually prior to September 1 of each year, based on methodology |
| 12 | that: |
| 13 | (a) Uses Medicaid's fee-for-service expenditures. |
| 14 | (b) Is certified as an actuarially sound computation of |
| 15 | Medicaid fee-for-service expenditures for comparable groups of |
| 16 | Medicaid recipients and includes all fee-for-service |
| 17 | expenditures, including those fee-for-service expenditures |
| 18 | attributable to recipients who are enrolled for a portion of a |
| 19 | year in a managed care plan or waiver program. |
| 20 | (c) Is compliant with applicable federal laws and |
| 21 | regulations, including, but not limited to, the requirements to |
| 22 | include an allowance for administrative expenses and to account |
| 23 | for all fee-for-service expenditures, including fee-for-service |
| 24 | expenditures for those groups enrolled for part of a year. |
| 25 | (2)(3) Each year prior to establishing new managed care |
| 26 | rates, the agency shall review all prior year adjustments for |
| 27 | changes in trend, and shall reduce or eliminate those |
| 28 | adjustments which are not reasonable and which reflect policies |
| 29 | or programs which are not in effect. In addition, the agency |
| 30 | shall apply only those policy reductions applicable to the |
| 31 | fiscal year for which the rates are being set, which can be |
| 32 | accurately estimated and verified by an independent actuary and |
| 33 | which have been implemented prior to or will be implemented |
| 34 | during the fiscal year. The agency shall pay rates at per- |
| 35 | member, per-month averages that equal, but do not exceed, the |
| 36 | amounts allowed for in the General Appropriations Act applicable |
| 37 | to the fiscal year for which the rates will be in effect. |
| 38 | (3)(4) The agency shall by rule prescribe those items of |
| 39 | financial information which each managed care plan shall report |
| 40 | to the agency, in the time periods prescribed by rule. In |
| 41 | prescribing items for reporting and definitions of terms, the |
| 42 | agency shall consult with the Office of Insurance Regulation of |
| 43 | the Financial Services Commission wherever possible. |
| 44 | (4)(5) The agency shall quarterly examine the financial |
| 45 | condition of each managed care plan, and its performance in |
| 46 | serving Medicaid patients, and shall utilize examinations |
| 47 | performed by the Office of Insurance Regulation wherever |
| 48 | possible. |
| 49 |
|
| 50 | ================ T I T L E A M E N D M E N T ============= |
| 51 | Remove line(s) 25-28 and insert: |
| 52 | s. 409.9124, F.S.; revising managed care rate methodology; |
| 53 | providing |