Amendment
Bill No. 6003

Amendment No. 735915

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

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