Amendment
Bill No. 6003

Amendment No. 350541

CHAMBER ACTION
Senate		House
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1	Representative(s) A. Gibson offered the following:
2
3	Amendment
4	Remove line(s) 182-311 and insert:
5	Medicaid utilization. Notwithstanding any other provision of
6	law, however, all plans shall be required to cover prenatal care
7	for pregnant women. The usage of this prenatal care coverage
8	cannot eliminate or reduce other coverage areas for enrollees as
9	designed within the plans.
10	(i)  "Provider service network" means an incorporated
11	network:
12	1.  Established or organized, and operated, by a health
13	care provider or group of affiliated health care providers;
14	2.  That provides a substantial proportion of the health
15	care items and services under a contract directly through the
16	provider or affiliated group;
17	3.  That may make arrangements with physicians, other
18	health care professionals, and health care institutions, to
19	assume all or part of the financial risk on a prospective basis
20	for the provision of basic health services; and
21	4.  Within which health care providers have a controlling
22	interest in the governing body of the provider service network
23	organization, as authorized by s. 409.912, Florida Statutes.
24	(j)  "Shall" means the agency must include the provision of
25	a subsection as delineated in this section in the waiver
26	application and implement the provision to the extent allowed in
27	the demonstration project sites by the Centers for Medicare and
28	Medicaid Services and as approved by the Legislature pursuant to
29	this section.
30	(k)  "State-certified contractor" means an entity not
31	authorized under part I, part II, or part III of chapter 641,
32	Florida Statutes, or under chapter 624, chapter 627, or chapter
33	636, Florida Statutes, qualified by the agency to be certified
34	as a managed care plan. The agency shall develop the standards
35	necessary to authorize an entity to become a state-certified
36	contractor.
37	(5)  ELIGIBILITY.--
38	(a)  The agency shall pursue waivers to reform Medicaid for
39	the following categorical groups:
40	1.  Temporary Assistance for Needy Families, consistent
41	with ss. 402 and 1931 of the Social Security Act and chapter
42	409, chapter 414, or chapter 445, Florida Statutes.
43	2.  Supplemental Security Income recipients as defined in
44	Title XVI of the Social Security Act, except for persons who are
45	dually eligible for Medicaid and Medicare, individuals 60 years
46	of age or older, individuals who have developmental
47	disabilities, and residents of institutions or nursing homes.
48	3.  All children covered pursuant to Title XIX of the
49	Social Security Act.
50	(b)  The agency may pursue any appropriate federal waiver
51	to reform Medicaid for the populations not identified by this
52	subsection, including Title XXI children, if authorized by the
53	Legislature.
54	(6)  CHOICE COUNSELING.--
55	(a)  At the time of eligibility determination, the agency
56	shall provide the recipient with all the Medicaid health care
57	options available in that community to assist the recipient in
58	choosing health care coverage. A condition of enrollment is the
59	choice of a plan. The recipient shall be able to choose a plan
60	within 30 days after the recipient is eligible unless the
61	recipient loses eligibility.
62	(b)  In the managed care demonstration projects, the
63	Medicaid recipients who are already enrolled in a managed care
64	plan shall remain with that plan until they lose eligibility.
65	The agency shall develop a method whereby newly eligible
66	Medicaid recipients, Medicaid recipients with renewed
67	eligibility, and Medipass enrollees shall enroll in managed care
68	plans certified pursuant to this section.
69	(c)  A Medicaid recipient receiving services under this
70	section is eligible for only emergency services until the
71	recipient enrolls in a managed care plan.
72	(d)  The agency shall ensure that the recipient is provided
73	with:
74	1.  A list and description of the benefits provided.
75	2.  Information about cost sharing.
76	3.  Plan performance data, if available.
77	4.  An explanation of benefit limitations.
78	5.  Contact information, including geographic locations and
79	transportation limitations.
80	6.  Any other information the agency determines would
81	facilitate a recipient's understanding of the plan or insurance
82	that would best meet his or her needs.
83	(e)  The agency shall ensure that there is a record of
84	recipient acknowledgment that choice counseling has been
85	provided.
86	(f)  To accommodate the needs of recipients, the agency
87	shall ensure that the choice counseling process and related
88	material are designed to provide counseling through face-to-face
89	interaction, by telephone, and in writing and through other
90	forms of relevant media. Materials shall be written at the
91	fourth-grade reading level and available in a language other
92	than English when 5 percent of the county speaks a language
93	other than English. Choice counseling shall also utilize
94	language lines and other services for impaired recipients, such
95	as TTD/TTY.
96	(g)  The agency shall require the entity performing choice
97	counseling to determine if the recipient has made a choice of a
98	plan or has opted out because of duress, threats, payment to the
99	recipient, or incentives promised to the recipient by a third
100	party. If the choice counseling entity determines that the
101	decision to choose a plan was unlawfully influenced or a plan
102	violated any of the provisions of s. 409.912(21), Florida
103	Statutes, the choice counseling entity shall immediately report
104	the violation to the agency's program integrity section for
105	investigation. Verification of choice counseling by the
106	recipient shall include a stipulation that the recipient
107	acknowledges the provisions of this subsection.
108	(h)  It is the intent of the Legislature, within the
109	authority of the waiver and within available resources, that the
110	agency promote health literacy and partner with the Department
111	of Health to provide information aimed to reduce minority health
112	disparities through outreach activities for Medicaid recipients.
113	(i)  The agency is authorized to contract with entities to
114	perform choice counseling and may establish standards and
115	performance contracts, including standards requiring the
116	contractor to hire choice counselors representative of the
117	state's diverse population and to train choice counselors in
118	working with culturally diverse populations.
119	(j)  The agency shall develop processes to ensure that
120	demonstration sites have sufficient levels of enrollment to
121	conduct a valid test of the managed care demonstration project
122	model within a 2-year timeframe.
123	(7)  PLANS.--
124	(a)  Plan benefits.--The agency shall develop a capitated
125	system of care that promotes choice and competition. Plan
126	benefits shall include the mandatory services delineated in
127	federal law and specified in s. 409.905, Florida Statutes;
128	behavioral health services specified in s. 409.906(8), Florida
129	Statutes; pharmacy services specified in s. 409.906(20), Florida
130	Statutes; and other services including, but not limited to,
131	Medicaid optional services specified in s. 409.906, Florida
132	Statutes, for which a plan is receiving a risk-adjusted
133	capitation rate. Plans shall provide coverage of all mandatory
134	services, may vary in amount, duration, and scope of benefits,
135	and may cover optional services to attract recipients and
136	provide needed care. In all instances, the agency shall ensure
137	that plan benefits include those services that are medically
138	necessary, based on historical Medicaid utilization.
139	Notwithstanding any other provision of law, however, all plans
140	shall be required to cover prenatal care for pregnant women. The
141	usage of this prenatal care coverage cannot eliminate or reduce
142	other coverage areas for enrollees as designed within the plans.

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