HB 6003

CS

CHAMBER ACTION

1	The Fiscal Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to Medicaid reform; providing legislative
7	findings and intent; providing waiver authority to the
8	Agency for Health Care Administration; providing for
9	implementation of demonstration projects; providing
10	definitions; identifying categorical groups for
11	eligibility under the waiver; establishing the choice
12	counseling process; requiring managed care plans to
13	include mandatory Medicaid services; requiring managed
14	care plans to provide a wellness and disease management
15	program, pharmacy benefits, and behavioral health care
16	benefits; requiring the agency to establish enhanced
17	benefit coverage and providing procedures therefor;
18	establishing flexible spending accounts and individual
19	development accounts; providing for the agency to
20	establish a catastrophic coverage fund or purchase stop-
21	loss coverage to cover certain services; providing for
22	cost sharing by recipients, and requirements; requiring a
23	managed care plan to have a certificate of operation from
24	the agency before operating under the waiver; providing
25	certification requirements; providing for reimbursement of
26	provider service networks; providing an exemption from
27	competitive bid requirements for provider service networks
28	under certain circumstances; providing for continuance of
29	contracts previously awarded for a specified period of
30	time; requiring the agency to have accountability and
31	quality assurance standards; requiring the agency to
32	establish a medical care database; providing data
33	collection requirements; requiring certain entities
34	certified to operate a managed care plan to comply with
35	ss. 641.3155 and 641.513, F.S.; providing for the agency
36	to develop a rate setting and risk adjustment system;
37	authorizing the agency to allow recipients to opt out of
38	Medicaid and purchase health care coverage through an
39	employer-sponsored insurer; requiring the agency to apply
40	and enforce certain provisions of law relating to Medicaid
41	fraud and abuse; providing penalties; providing for
42	integration of state funding to persons who are age 60 and
43	above; requiring the agency to provide a choice of managed
44	care plans to recipients; providing requirements for
45	managed care plans; requiring the agency to withhold
46	certain funding contingent upon the performance of a plan;
47	requiring the plan to rebate certain profits to the
48	agency; authorizing the agency to limit the number of
49	enrollees in a plan under certain circumstances; providing
50	for eligibility determination and choice counseling for
51	persons age 60 and above; providing for imposition of
52	liquidated damages; authorizing the agency to grant a
53	modification of certificate-of-need conditions to nursing
54	homes under certain circumstances; requiring integration
55	of Medicare and Medicaid services; providing legislative
56	intent; providing for awarding of funds for managed care
57	delivery system development, contingent upon an
58	appropriation; requiring the agency conduct a study of the
59	feasibility of establishing a Medicaid buy-in program for
60	individuals with disabilities; providing applicability;
61	granting rulemaking authority to the agency; requiring
62	legislative authority to implement the waiver; requiring
63	the Office of Program Policy Analysis and Government
64	Accountability to evaluate the Medicaid reform waiver and
65	issue reports; requiring the agency to submit status
66	reports; requiring the agency to contract for certain
67	evaluation comparisons; providing for future review and
68	repeal of the act; providing an effective date.
69
70	Be It Enacted by the Legislature of the State of Florida:
71
72	Section 1.  Medicaid reform.--
73	(1)  LEGISLATIVE FINDINGS AND INTENT.--
74	(a)  The Legislature finds that:
75	1.  The current Florida Medicaid program is a 3-decade-old
76	program that is no longer appropriate for 21st century health
77	care financing and delivery;
78	2.  Expenditures in the Florida Medicaid program are
79	growing at an unsustainable rate, limiting funding for other
80	essential state services;
81	3.  Caps on payments to providers have resulted in a fee
82	system which does not recognize the true cost of providing
83	Medicaid care and services to consumers;
84	4.  The current Medicaid health care financing system has
85	not given Medicaid providers the ability to respond to changes
86	and innovations in health care delivery resulting in restricted
87	access to needed care and services for recipients;
88	5.  Every Medicaid recipient deserves a "medical home"
89	which provides incentives for providers or consumers to maximize
90	wellness, prevention of disease, and early intervention and
91	assists in the avoidance of more costly and dangerous medical
92	conditions;
93	6.  The current Medicaid system locks recipients into
94	government-funded health care; does not maximize personal
95	responsibility and the use of private insurance mechanisms; does
96	not provide incentives and mechanisms for Medicaid recipients to
97	become gainfully employed and privately insured; does not serve
98	the needs of consumers in the state, health care providers, or
99	taxpayers; and is in need of meaningful reform; and
100	7.  The elderly and persons with disabilities are locked
101	into a system of supply-induced demand in which the services
102	that are provided to recipients are dictated by what government
103	funds rather than by the needs, abilities, and desires of
104	consumers.
105	(b)  It is, therefore, the intent of the Legislature that
106	the Agency for Health Care Administration and other entities
107	involved in the state's health care financing and delivery
108	system begin the process of reforming the state's system of
109	delivery of Medicaid services to bring more predictability to
110	budget growth, to incorporate free market incentives, and to
111	empower Medicaid consumers to make informed choices, direct
112	their own health care, and ensure appropriate care in an
113	appropriate setting.
114	(2)  WAIVER AUTHORITY.--Notwithstanding any other law to
115	the contrary, the Agency for Health Care Administration is
116	authorized to seek experimental, pilot, or demonstration project
117	waivers, pursuant to s. 1115 of the Social Security Act, to
118	reform the Florida Medicaid program pursuant to this section in
119	urban and rural demonstration sites. This waiver authority is
120	contingent upon federal approval to preserve the upper-payment-
121	limit funding mechanisms for hospitals and contingent upon
122	protection of the disproportionate share program authorized
123	pursuant to chapter 409, Florida Statutes. The agency is
124	directed to negotiate with the Centers for Medicare and Medicaid
125	Services to include in the approved waiver a methodology whereby
126	savings from the demonstration waiver may be used to increase
127	total upper-payment-limit and disproportionate share payments.
128	Any increased funds shall be reinvested in programs that provide
129	direct services to uninsured individuals in a cost-effective
130	manner and reduce reliance on hospital emergency care.
131	(3)  IMPLEMENTATION OF DEMONSTRATION PROJECTS.--The agency
132	shall include in the federal waiver request the authority to
133	establish managed care demonstration projects in at least one
134	urban and one rural area.
135	(4)  DEFINITIONS.--As used in this section, the term:
136	(a)  "Agency" means the Agency for Health Care
137	Administration.
138	(b)  "Enhanced benefit coverage" means additional health
139	care services or alternative health care coverage which can be
140	purchased by qualified recipients.
141	(c)  "Flexible spending account" means an account that
142	encourages consumer ownership and management of resources
143	available for enhanced benefit coverage, wellness activities,
144	preventive services, and other services to improve the health of
145	the recipient.
146	(d)  "Individual development account" means a dedicated
147	savings account that is designed to encourage and enable a
148	recipient to build assets in order to purchase health-related
149	services or health-related products.
150	(e)  "Managed care plan" or "plan" means an entity
151	certified by the agency to accept a capitation payment,
152	including, but not limited to, a health maintenance organization
153	authorized under part I of chapter 641, Florida Statutes; an
154	entity under part II or part III of chapter 641, Florida
155	Statutes, or under chapter 627, chapter 636, chapter 391, or s.
156	409.912, Florida Statutes; a licensed mental health provider
157	under chapter 394, Florida Statutes; a licensed substance abuse
158	provider under chapter 397, Florida Statutes; a hospital under
159	chapter 395, Florida Statutes; a provider service network as
160	defined in this section; or a state-certified contractor as
161	defined in this section.
162	(f)  "Medicaid buy-in" means a program under s. 4733 of the
163	federal Balanced Budget Act of 1997 to provide Medicaid coverage
164	to certain working individuals with disabilities and pursuant to
165	the provisions of this section.
166	(g)  "Medicaid opt-out option" means a program that allows
167	a recipient to purchase health care insurance through an
168	employer-sponsored plan instead of through a Medicaid-certified
169	plan.
170	(h)  "Plan benefits" means the mandatory services specified
171	in s. 409.905, Florida Statutes; behavioral health services
172	specified in s. 409.906(8), Florida Statutes; pharmacy services
173	specified in s. 409.906(20), Florida Statutes; and other
174	services, including, but not limited to, Medicaid optional
175	services specified in s. 409.906, Florida Statutes, for which a
176	plan is receiving a risk adjusted capitation rate. Plans shall
177	provide coverage of all mandatory services, may vary in amount,
178	duration, and scope of benefits, and may cover optional services
179	to attract recipients and provide needed care. In all instances,
180	the agency shall ensure that plan benefits include those
181	services that are medically necessary, based on historical
182	Medicaid utilization.
183	(i)  "Provider service network" means an incorporated
184	network:
185	1.  Established or organized, and operated, by a health
186	care provider or group of affiliated health care providers;
187	2.  That provides a substantial proportion of the health
188	care items and services under a contract directly through the
189	provider or affiliated group;
190	3.  That may make arrangements with physicians, other
191	health care professionals, and health care institutions, to
192	assume all or part of the financial risk on a prospective basis
193	for the provision of basic health services; and
194	4.  Within which health care providers have a controlling
195	interest in the governing body of the provider service network
196	organization, as authorized by s. 409.912, Florida Statutes.
197	(j)  "Shall" means the agency must include the provision of
198	a subsection as delineated in this section in the waiver
199	application and implement the provision to the extent allowed in
200	the demonstration project sites by the Centers for Medicare and
201	Medicaid Services and as approved by the Legislature pursuant to
202	this section.
203	(k)  "State-certified contractor" means an entity not
204	authorized under part I, part II, or part III of chapter 641,
205	Florida Statutes, or under chapter 624, chapter 627, or chapter
206	636, Florida Statutes, qualified by the agency to be certified
207	as a managed care plan. The agency shall develop the standards
208	necessary to authorize an entity to become a state-certified
209	contractor.
210	(5)  ELIGIBILITY.--
211	(a)  The agency shall pursue waivers to reform Medicaid for
212	the following categorical groups:
213	1.  Temporary Assistance for Needy Families, consistent
214	with ss. 402 and 1931 of the Social Security Act and chapter
215	409, chapter 414, or chapter 445, Florida Statutes.
216	2.  Supplemental Security Income recipients as defined in
217	Title XVI of the Social Security Act, except for persons who are
218	dually eligible for Medicaid and Medicare, individuals 60 years
219	of age or older, individuals who have developmental
220	disabilities, and residents of institutions or nursing homes.
221	3.  All children covered pursuant to Title XIX of the
222	Social Security Act.
223	(b)  The agency may pursue any appropriate federal waiver
224	to reform Medicaid for the populations not identified by this
225	subsection, including Title XXI children, if authorized by the
226	Legislature.
227	(6)  CHOICE COUNSELING.--
228	(a)  At the time of eligibility determination, the agency
229	shall provide the recipient with all the Medicaid health care
230	options available in that community to assist the recipient in
231	choosing health care coverage. A condition of enrollment is the
232	choice of a plan. The recipient shall be able to choose a plan
233	within 30 days after the recipient is eligible unless the
234	recipient loses eligibility.
235	(b)  In the managed care demonstration projects, the
236	Medicaid recipients who are already enrolled in a managed care
237	plan shall remain with that plan until they lose eligibility.
238	The agency shall develop a method whereby newly eligible
239	Medicaid recipients, Medicaid recipients with renewed
240	eligibility, and Medipass enrollees shall enroll in managed care
241	plans certified pursuant to this section.
242	(c)  A Medicaid recipient receiving services under this
243	section is eligible for only emergency services until the
244	recipient enrolls in a managed care plan.
245	(d)  The agency shall ensure that the recipient is provided
246	with:
247	1.  A list and description of the benefits provided.
248	2.  Information about cost sharing.
249	3.  Plan performance data, if available.
250	4.  An explanation of benefit limitations.
251	5.  Contact information, including geographic locations and
252	transportation limitations.
253	6.  Any other information the agency determines would
254	facilitate a recipient's understanding of the plan or insurance
255	that would best meet his or her needs.
256	(e)  The agency shall ensure that there is a record of
257	recipient acknowledgment that choice counseling has been
258	provided.
259	(f)  To accommodate the needs of recipients, the agency
260	shall ensure that the choice counseling process and related
261	material are designed to provide counseling through face-to-face
262	interaction, by telephone, and in writing and through other
263	forms of relevant media. Materials shall be written at the
264	fourth-grade reading level and available in a language other
265	than English when 5 percent of the county speaks a language
266	other than English. Choice counseling shall also utilize
267	language lines and other services for impaired recipients, such
268	as TTD/TTY.
269	(g)  The agency shall require the entity performing choice
270	counseling to determine if the recipient has made a choice of a
271	plan or has opted out because of duress, threats, payment to the
272	recipient, or incentives promised to the recipient by a third
273	party. If the choice counseling entity determines that the
274	decision to choose a plan was unlawfully influenced or a plan
275	violated any of the provisions of s. 409.912(21), Florida
276	Statutes, the choice counseling entity shall immediately report
277	the violation to the agency's program integrity section for
278	investigation. Verification of choice counseling by the
279	recipient shall include a stipulation that the recipient
280	acknowledges the provisions of this subsection.
281	(h)  It is the intent of the Legislature, within the
282	authority of the waiver and within available resources, that the
283	agency promote health literacy and partner with the Department
284	of Health to provide information aimed to reduce minority health
285	disparities through outreach activities for Medicaid recipients.
286	(i)  The agency is authorized to contract with entities to
287	perform choice counseling and may establish standards and
288	performance contracts, including standards requiring the
289	contractor to hire choice counselors representative of the
290	state's diverse population and to train choice counselors in
291	working with culturally diverse populations.
292	(j)  The agency shall develop processes to ensure that
293	demonstration sites have sufficient levels of enrollment to
294	conduct a valid test of the managed care demonstration project
295	model within a 2-year timeframe.
296	(7)  PLANS.--
297	(a)  Plan benefits.--The agency shall develop a capitated
298	system of care that promotes choice and competition. Plan
299	benefits shall include the mandatory services delineated in
300	federal law and specified in s. 409.905, Florida Statutes;
301	behavioral health services specified in s. 409.906(8), Florida
302	Statutes; pharmacy services specified in s. 409.906(20), Florida
303	Statutes; and other services including, but not limited to,
304	Medicaid optional services specified in s. 409.906, Florida
305	Statutes, for which a plan is receiving a risk-adjusted
306	capitation rate. Plans shall provide coverage of all mandatory
307	services, may vary in amount, duration, and scope of benefits,
308	and may cover optional services to attract recipients and
309	provide needed care. In all instances, the agency shall ensure
310	that plan benefits include those services that are medically
311	necessary, based on historical Medicaid utilization.
312	(b)  Wellness and disease management.--
313	1.  The agency shall require plans to provide a wellness
314	disease management program for certain Medicaid recipients
315	participating in the waiver. The agency shall require plans to
316	develop disease management programs necessary to meet the needs
317	of the population they serve.
318	2.  The agency shall require a plan to develop appropriate
319	disease management protocols and develop procedures for
320	implementing those protocols, and determine the procedure for
321	providing disease management services to plan enrollees. The
322	agency is authorized to allow a plan to contract separately with
323	another entity for disease management services or provide
324	disease management services directly through the plan.
325	3.  The agency shall provide oversight to ensure that the
326	service network provides the contractually agreed upon level of
327	service.
328	4.  The agency may establish performance contracts that
329	reward a plan when measurable operational targets in both
330	participation and clinical outcomes are reached or exceeded by
331	the plan.
332	5.  The agency may establish performance contracts that
333	penalize a plan when measurable operational targets for both
334	participation and clinical outcomes are not reached by the plan.
335	6.  The agency shall develop oversight requirements and
336	procedures to ensure that plans utilize standardized methods and
337	clinical protocols for determining compliance with a wellness or
338	disease management plan.
339	(c)  Pharmacy benefits.--
340	1.  The agency shall require plans to provide pharmacy
341	benefits and include pharmacy benefits as part of the capitation
342	risk structure to enable a plan to coordinate and fully manage
343	all aspects of patient care as part of the plan or through a
344	pharmacy benefits manager.
345	2.  The agency may set standards for pharmacy benefits for
346	managed care plans and specify the therapeutic classes of
347	pharmacy benefits to enable a plan to coordinate and fully
348	manage all aspects of patient care as part of the plan or
349	through a pharmacy benefits manager.
350	3.  Each plan shall implement a pharmacy fraud, waste, and
351	abuse initiative that may include a surety bond or letter of
352	credit requirement for participating pharmacies, enhanced
353	provider auditing practices, the use of additional fraud and
354	abuse software, recipient management programs for recipients
355	inappropriately using their benefits, and other measures to
356	reduce provider and recipient fraud, waste, and abuse. The
357	initiative shall address enforcement efforts to reduce the
358	number and use of counterfeit prescriptions.
359	4.  The agency shall require plans to report incidences of
360	pharmacy fraud and abuse and establish procedures for receiving
361	and investigating fraud and abuse reports from plans in the
362	demonstration project sites. Plans must report instances of
363	fraud and abuse pursuant to chapter 641, Florida Statutes.
364	5.  The agency may facilitate the establishment of a
365	Florida managed care plan purchasing alliance. The purpose of
366	the alliance is to form agreements among participating plans to
367	purchase pharmaceuticals at a discount, to achieve rebates, or
368	to receive best market price adjustments. Participation in the
369	Florida managed care plan purchasing alliance shall be
370	voluntary.
371	(d)  Behavioral health care benefits.--
372	1.  The agency shall include behavioral health care
373	benefits as part of the capitation structure to enable a plan to
374	coordinate and fully manage all aspects of patient care.
375	2.  Managed care plans shall require their contracted
376	behavioral health providers to have a member's behavioral
377	treatment plan on file in the provider's medical record.
378	(8)  ENHANCED BENEFIT COVERAGE.--
379	(a)  The agency shall establish enhanced benefit coverage
380	and a methodology to fund the enhanced benefit coverage.
381	(b)  A recipient who complies with the objectives of a
382	wellness or disease management plan, as determined by the
383	agency, shall have access to the enhanced benefit coverage for
384	the purpose of purchasing or securing health-care services or
385	health-care products.
386	(c)  The agency shall establish flexible spending accounts
387	or similar accounts for recipients as approved in the waiver to
388	be administered by the agency or by a managed care plan. The
389	agency shall make deposits to a recipient's flexible spending
390	account contingent upon compliance with a wellness plan or a
391	disease management plan.
392	(d)  The purpose of the flexible spending accounts is to
393	allow waiver recipients to accumulate funds up to a maximum of
394	$1,000 for purposes of activities allowed by federal regulations
395	or as approved in the waiver.
396	(e)  The agency may allow a plan to establish additional
397	reward systems for compliance with a wellness or disease
398	management objective that are supplemental to the enhanced
399	benefit coverage.
400	(f)  The agency shall establish individual development
401	accounts or similar accounts for recipients as approved in the
402	waiver. The agency shall make deposits into a recipient's
403	individual development account contingent upon compliance with a
404	wellness or a disease management plan.
405	(g)  The purpose of an individual development account is to
406	allow waiver recipients to accumulate funds up to a maximum of
407	$1,000 for purposes of activities allowed by federal regulations
408	or as approved in the waiver.
409	(h)  A recipient shall choose to participate in a flexible
410	spending account or an individual development account to
411	accumulate funds pursuant to the provisions of this section.
412	(i)  It is the intent of the Legislature that flexible
413	spending accounts and individual development accounts encourage
414	consumer management of resources for wellness activities,
415	preventive services, and other services to improve the health of
416	the recipient.
417	(j)  The agency shall develop standards and oversight
418	procedures to monitor access to enhanced services, the use of
419	flexible spending accounts, and the use of individual
420	development accounts during the eligibility period and up to 3
421	years after loss of eligibility as approved by the waiver.
422	(k)  It is the intent of the Legislature that the agency
423	may develop an electronic benefit transfer system for the
424	distribution of enhanced benefit funds earned by the recipient.
425	(9)  COST SHARING.--
426	(a)  For recipients enrolled in a Medicaid managed care
427	plan, the agency may continue cost-sharing requirements as
428	currently defined in s. 409.9081, Florida Statutes, or as
429	approved under a waiver granted by the federal Centers for
430	Medicare and Medicaid Services. Such approved cost-sharing
431	requirements may include provisions requiring recipients to pay:
432	1.  An enrollment fee;
433	2.  A deductible;
434	3.  Coinsurance or a portion of the plan premium; or
435	4.  For families with higher levels of income,
436	progressively higher percentages of the cost of the medical
437	assistance.
438	(b)  For recipients who opt out of Medicaid, cost sharing
439	shall be governed by the policy of the plan in which the
440	individual enrolls.
441	(c)  If the employer-sponsored coverage requires that the
442	cost-sharing provisions imposed under paragraph (a) include
443	requirements that recipients pay a portion of the plan premium,
444	the agency shall specify the manner in which the premium is
445	paid. The agency may require that the premium be paid to the
446	agency, an organization operating part of the medical assistance
447	program, or the managed care plan.
448	(d)  Cost-sharing provisions adopted under this section may
449	be determined based on the maximum level authorized under an
450	approved federal waiver.
451	(10)  CATASTROPHIC COVERAGE.--
452	(a)  All managed care plans shall provide coverage to the
453	extent required by the agency up to a per-recipient service
454	limitation threshold determined by the agency and within the
455	capitation rate set by the agency. This limitation threshold may
456	vary by eligibility group or other appropriate factors,
457	including, but not limited to, recipients with special needs and
458	recipients with certain disease states.
459	(b)  The agency shall establish a fund or purchase stop-
460	loss coverage from a plan under part I of chapter 641, Florida
461	Statutes, or a health insurer authorized under chapter 624,
462	Florida Statutes, for purposes of covering services in excess of
463	those covered by the managed care plan. The catastrophic
464	coverage fund or stop-loss coverage shall provide for payment of
465	medically necessary care for recipients who are enrolled in a
466	plan and whose care has exceeded the predetermined service
467	threshold. The agency may establish an aggregate maximum level
468	of coverage in the catastrophic fund or for the stop-loss
469	coverage.
470	(c)  The agency shall develop policies and procedures to
471	allow all plans to utilize the catastrophic coverage fund or
472	stop-loss coverage for a Medicaid recipient in the plan who has
473	reached the catastrophic coverage threshold.
474	(d)  The agency shall contract for an administrative
475	structure to manage the catastrophic coverage fund.
476	(11)  CERTIFICATION.--Before any entity may operate a
477	managed care plan under the waiver, it shall obtain a
478	certificate of operation from the agency.
479	(a)  Any entity operating under part I, part II, or part
480	III of chapter 641, Florida Statutes, or under chapter 627,
481	chapter 636, chapter 391, or s. 409.912, Florida Statutes; a
482	licensed mental health provider under chapter 394, Florida
483	Statutes; a licensed substance abuse provider under chapter 397,
484	Florida Statutes; a hospital under chapter 395, Florida
485	Statutes; a provider service network as defined in this section;
486	or a state-certified contractor as defined in this section shall
487	be in compliance with the requirements and standards developed
488	by the agency. For purposes of the waiver established under this
489	section, provider service networks shall be exempt from the
490	competitive bid requirements in s. 409.912, Florida Statutes.
491	The agency, in consultation with the Office of Insurance
492	Regulation, shall establish certification requirements. It is
493	the intent of the Legislature that, to the extent possible, any
494	project authorized by the state under this section include any
495	federally qualified health center, federally qualified rural
496	health clinic, county health department, or any other federally,
497	state, or locally funded entity that serves the geographic area
498	within the boundaries of that project. The certification process
499	shall, at a minimum, include all requirements in the current
500	Medicaid prepaid health plan contract and take into account the
501	following requirements:
502	1.  The entity has sufficient financial solvency to be
503	placed at risk for the basic plan benefits under ss. 409.905,
504	409.906(8), and 409.906(20), Florida Statutes, and other covered
505	services.
506	2.  Any plan benefit package shall be actuarially
507	equivalent to the premium calculated by the agency to ensure
508	that competing plan benefits are equivalent in value. In all
509	instances, the benefit package must provide services sufficient
510	to meet the needs of the target population based on historical
511	Medicaid utilization.
512	3.  The entity has sufficient service network capacity to
513	meet the needs of members under ss. 409.905, 409.906(8), and
514	409.906(20), Florida Statutes, and other covered services.
515	4.  The entity's primary care providers are geographically
516	accessible to the recipient.
517	5.  The entity has the capacity to provide a wellness or
518	disease management program.
519	6.  The entity shall provide for ambulance service in
520	accordance with ss. 409.908(13)(d) and 409.9128, Florida
521	Statutes.
522	7.  The entity has the infrastructure to manage financial
523	transactions, recordkeeping, data collection, and other
524	administrative functions.
525	8.  The entity, if not a fully indemnified insurance
526	program under chapter 624, chapter 627, chapter 636, or chapter
527	641, Florida Statutes, must meet the financial solvency
528	requirements under this section.
529	(b)  The agency has the authority to contract with entities
530	not otherwise licensed as an insurer or risk-bearing entity
531	under chapter 627 or chapter 641, Florida Statutes, as long as
532	these entities meet the certification standards of this section
533	and any additional standards as defined by the agency to qualify
534	as managed care plans under this section.
535	(c)  In certifying a risk-bearing entity and determining
536	the financial solvency of such an entity as a provider service
537	network, the following shall apply:
538	1.  The entity shall maintain a minimum surplus in an
539	amount that is the greater of $1 million or 1.5 percent of
540	projected annual premiums.
541	2.  In lieu of the requirements in subparagraph 1., the
542	agency may consider the following:
543	a.  If the organization is a public entity, the agency may
544	take under advisement a statement from the public entity that a
545	county supports the managed care plan with the county's full
546	faith and credit. In order to qualify for the agency's
547	consideration, the county must own, operate, manage, administer,
548	or oversee the managed care plan, either partly or wholly,
549	through a county department or agency;
550	b.  The state guarantees the solvency of the organization;
551	c.  The organization is a federally qualified health center
552	or is controlled by one or more federally qualified health
553	centers and meets the solvency standards established by the
554	state for such organization pursuant to s. 409.912(4)(c),
555	Florida Statute; or
556	d.  The entity meets the solvency requirements for
557	federally approved provider-sponsored organizations as defined
558	in 42 C.F.R. ss. 422.380-422.390. However, if the provider
559	service network does not meet the solvency requirements of
560	either chapter 627 or chapter 641, Florida Statutes, the
561	provider service network is limited to the issuance of Medicaid
562	plans.
563	(d)  Each entity certified by the agency shall submit to
564	the agency any financial, programmatic, or patient-encounter
565	data or other information required by the agency to determine
566	the actual services provided and the cost of administering the
567	plan.
568	(e)  Notwithstanding the provisions of s. 409.912, Florida
569	Statutes, the agency shall extend the existing contract with a
570	hospital-based provider service network for a period not to
571	exceed 3 years.
572	(12)  ACCOUNTABILITY AND QUALITY ASSURANCE.--The agency
573	shall establish standards for plan compliance, including, but
574	not limited to, quality assurance and performance improvement
575	standards, peer or professional review standards, grievance
576	policies, and program integrity policies. The agency shall
577	develop a data reporting system, work with managed care plans to
578	establish reasonable patient-encounter reporting requirements,
579	and ensure that the data reported is accurate and complete.
580	(a)  In performing the duties required under this section,
581	the agency shall work with managed care plans to establish a
582	uniform system to measure, improve, and monitor the clinical and
583	functional outcomes of a recipient of Medicaid services. The
584	system may use financial, clinical, and other criteria based on
585	pharmacy, medical services, and other data related to the
586	provision of Medicaid services, including, but not limited to:
587	1.  Health Plan Employer Data and Information Set.
588	2.  Member satisfaction.
589	3.  Provider satisfaction.
590	4.  Report cards on plan performance and best practices.
591	5.  Quarterly reports on compliance with the prompt payment
592	of claims requirements of ss. 627.613, 641.3155, and 641.513,
593	Florida Statutes.
594	(b)  The agency shall require the managed care plans that
595	have contracted with the agency to establish a quality assurance
596	system that incorporates the provisions of s. 409.912(27),
597	Florida Statutes, and any standards, rules, and guidelines
598	developed by the agency.
599	(c)1.  The agency shall establish a medical care database
600	to compile data on health services rendered by health care
601	practitioners that provide services to patients enrolled in
602	managed care plans in the demonstration sites. The medical care
603	database shall:
604	a.  Collect for each type of patient encounter with a
605	health care practitioner or facility:
606	(I)  The demographic characteristics of the patient.
607	(II)  The principal, secondary, and tertiary diagnosis.
608	(III)  The procedure performed.
609	(IV)  The date and location where the procedure was
610	performed.
611	(V)  The payment for the procedure, if any.
612	(VI)  If applicable, the health care practitioner's
613	universal identification number.
614	(VII)  If the health care practitioner rendering the
615	service is a dependent practitioner, the modifiers appropriate
616	to indicate that the service was delivered by the dependent
617	practitioner.
618	b.  Collect appropriate information relating to
619	prescription drugs for each type of patient encounter.
620	c.  Collect appropriate information related to health care
621	costs, utilization, or resources from managed care plans
622	participating in the demonstration sites.
623	2.  To the extent practicable, when collecting the data
624	required under sub-subparagraph 1.a., the agency shall utilize
625	any standardized claim form or electronic transfer system being
626	used by health care practitioners, facilities, and payers.
627	3.  Health care practitioners and facilities in the
628	demonstration sites shall submit, and managed care plans
629	participating in the demonstration sites shall receive, claims
630	for payment and any other information reasonably related to the
631	medical care database electronically in a standard format as
632	required by the agency.
633	4.  The agency shall establish reasonable deadlines for
634	phasing in of electronic transmittal of claims.
635	5.  The plan shall ensure that the data reported is
636	accurate and complete.
637	(d)  The agency shall describe the evaluation methodology
638	and standards that will be used to assess the success of the
639	demonstration projects.
640	(13)  STATUTORY COMPLIANCE.--Any entity certified under
641	this section shall comply with ss. 627.613, 641.3155, and
642	641.513, Florida Statutes.
643	(14)  RATE SETTING AND RISK ADJUSTMENT.--The agency shall
644	develop an actuarially sound rate setting and risk adjustment
645	system for payment to managed care plans that:
646	(a)  Adjusts payment for differences in risk assumed by
647	managed care plans, based on a widely recognized clinical
648	diagnostic classification system or on categorical groups that
649	are established in consultation with the federal Centers for
650	Medicare and Medicaid Services.
651	(b)  Includes a phase-in of patient-encounter level data
652	reporting.
653	(c)  Includes criteria to adjust risk and validation of the
654	rates and risk adjustments.
655	(d)  Establishes rates in consultation with an actuary and
656	the federal Centers for Medicare and Medicaid Services and
657	supported by actuarial analysis.
658	(e)  Reimburses managed care demonstration projects on a
659	capitated basis, except for the first year of operation of a
660	provider service network. The agency shall develop contractual
661	arrangements with the provider service network for a fee-for-
662	service reimbursement methodology that does not exceed total
663	payments under the risk-adjusted capitation during the first
664	year of operation of a managed care demonstration project.
665	Contracts must, at a minimum, require provider service networks
666	to report patient-encounter data, reconcile costs to established
667	risk-adjusted capitation rates at specified periods, and specify
668	the method and process for settlement of cost differences at the
669	end of the contract period.
670	(15)  MEDICAID OPT-OUT OPTION.--
671	(a)  The agency shall allow recipients to purchase health
672	care coverage through an employer-sponsored health insurance
673	plan instead of through a Medicaid certified plan.
674	(b)  A recipient who chooses the Medicaid opt-out option
675	shall have an opportunity for a specified period of time, as
676	authorized under a waiver granted by the Centers for Medicare
677	and Medicaid Services, to select and enroll in a Medicaid
678	certified plan. If the recipient remains in the employer-
679	sponsored plan after the specified period, the recipient shall
680	remain in the opt-out program for at least 1 year or until the
681	recipient no longer has access to employer-sponsored coverage,
682	until the employer's open enrollment period for a person who
683	opts out in order to participate in employer-sponsored coverage,
684	or until the person is no longer eligible for Medicaid,
685	whichever time period is shorter.
686	(c)  Notwithstanding any other provision of this section,
687	coverage, cost sharing, and any other component of employer-
688	sponsored health insurance shall be governed by applicable state
689	and federal laws.
690	(16)  FRAUD AND ABUSE.--
691	(a)  To minimize the risk of Medicaid fraud and abuse, the
692	agency shall ensure that applicable provisions of chapters 409,
693	414, 626, 641, and 932, Florida Statutes, relating to Medicaid
694	fraud and abuse, are applied and enforced at the demonstration
695	project sites.
696	(b)  Providers shall have the necessary certification,
697	license and credentials as required by law and waiver
698	requirements.
699	(c)  The agency shall ensure that the plan is in compliance
700	with the provisions of s. 409.912(21) and (22), Florida
701	Statutes.
702	(d)  The agency shall require each plan to establish
703	program integrity functions and activities to reduce the
704	incidence of fraud and abuse. Plans must report instances of
705	fraud and abuse pursuant to chapter 641, Florida Statutes.
706	(e)  The plan shall have written administrative and
707	management arrangements or procedures, including a mandatory
708	compliance plan, that are designed to guard against fraud and
709	abuse. The plan shall designate a compliance officer with
710	sufficient experience in health care.
711	(f)1.  The agency shall require all contractors in the
712	managed care plan to report all instances of suspected fraud and
713	abuse. A failure to report instances of suspected fraud and
714	abuse is a violation of law and subject to the penalties
715	provided by law.
716	2.  An instance of fraud and abuse in the managed care
717	plan, including, but not limited to, defrauding the state health
718	care benefit program by misrepresentation of fact in reports,
719	claims, certifications, enrollment claims, demographic
720	statistics, and patient-encounter data; misrepresentation of the
721	qualifications of persons rendering health care and ancillary
722	services; bribery and false statements relating to the delivery
723	of health care; unfair and deceptive marketing practices; and
724	managed care false claims actions, is a violation of law and
725	subject to the penalties provided by law.
726	3.  The agency shall require that all contractors make all
727	files and relevant billing and claims data accessible to state
728	regulators and investigators and that all such data be linked
729	into a unified system for seamless reviews and investigations.
730	(17)  INTEGRATED MANAGED LONG-TERM CARE SERVICES.--
731	(a)  Contingent upon federal approval, the Agency for
732	Health Care Administration may revise or apply for waivers
733	pursuant to s. 1915 of the Social Security Act or apply for
734	experimental, pilot, or demonstration project waivers pursuant
735	to s. 1115 of the Social Security Act to reform Florida's
736	Medicaid program in order to integrate all state funding for
737	Medicaid services to persons who are 60 years of age or older
738	into a managed care delivery system. Rates shall be developed in
739	accordance with 42 C.F.R. s. 438.60, certified by an actuary,
740	and submitted for approval to the Centers for Medicare and
741	Medicaid Services. The funds to be integrated shall include:
742	1.  All Medicaid home and community-based waiver services
743	funds.
744	2.  All funds for all Medicaid services, including Medicaid
745	nursing home services.
746	3.  All funds paid for Medicare coinsurance and deductibles
747	for persons dually eligible for Medicaid and Medicare, for which
748	the state is responsible, but not to exceed the federal limits
749	of liability specified in the state plan.
750	(b)  When the agency integrates the funding for Medicaid
751	services for recipients 60 years of age or older into a managed
752	care delivery system under paragraph (a) in any area of the
753	state, the agency shall provide to recipients a choice of plans
754	which shall include:
755	1.  Entities licensed under chapter 627 or chapter 641,
756	Florida Statutes.
757	2.  Any other entity certified by the agency to accept a
758	capitation payment, including entities eligible to participate
759	in the nursing home diversion program, other qualified providers
760	as defined in s. 430.703(7), Florida Statutes, and community
761	care for the elderly lead agencies.
762	(c)  The agency may begin the integration of Medicaid
763	services for the elderly into a managed care delivery system.
764	(d)  When the agency integrates the funding for Medicaid
765	nursing home and community-based care services into a managed
766	care delivery system, the agency shall ensure that a plan, in
767	addition to other certification requirements:
768	1.  Allows an enrollee to select any provider with whom the
769	plan has a contract.
770	2.  Makes a good faith effort to develop contracts with
771	qualified providers currently under contract with the Department
772	of Elderly Affairs, area agencies on aging, or community care
773	for the elderly lead agencies.
774	3.  Secures subcontracts with providers of nursing home and
775	community-based long-term care services sufficient to ensure
776	access to and choice of providers.
777	4.  Develops and uses a service provider qualification
778	system that describes the quality-of-care standards that
779	providers of medical, health, and long-term care services must
780	meet in order to obtain a contract from the plan.
781	5.  Makes a good faith effort to develop contracts with all
782	qualified nursing homes located in the area that are served by
783	the plan, including those designated as Gold Seal.
784	6.  Ensures that a Medicaid recipient enrolled in a managed
785	care plan who is a resident of a facility licensed under chapter
786	400, Florida Statutes, and who does not choose to move to
787	another setting is allowed to remain in the facility in which he
788	or she is currently receiving care.
789	7.  Includes persons who are in nursing homes and who
790	convert from non-Medicaid payment sources to Medicaid. Plans
791	shall be at risk for serving persons who convert to Medicaid.
792	The agency shall ensure that persons who choose community
793	alternatives instead of nursing home care and who meet level of
794	care and financial eligibility standards continue to receive
795	Medicaid.
796	8.  Demonstrates a quality assurance system and a
797	performance improvement system that is satisfactory to the
798	agency.
799	9.  Develops a system to identify recipients who have
800	special health care needs such as polypharmacy, mental health
801	and substance abuse problems, falls, chronic pain, nutritional
802	deficits, or cognitive deficits or who are ventilator-dependent
803	in order to respond to and meet these needs.
804	10.  Ensures a multidisciplinary team approach to recipient
805	management that facilitates the sharing of information among
806	providers responsible for delivering care to a recipient.
807	11.  Ensures medical oversight of care plans and service
808	delivery, regular medical evaluation of care plans, and the
809	availability of medical consultation for care managers and
810	service coordinators.
811	12.  Develops, monitors, and enforces quality-of-care
812	requirements using existing Agency for Health Care
813	Administration survey and certification data, whenever possible,
814	to avoid duplication of survey or certification activities
815	between the plans and the agency.
816	13.  Ensures a system of care coordination that includes
817	educational and training standards for care managers and service
818	coordinators.
819	14.  Develops a business plan that demonstrates the ability
820	of the plan to organize and operate a risk-bearing entity.
821	15.  Furnishes evidence of liability insurance coverage or
822	a self-insurance plan that is determined by the Office of
823	Insurance Regulation to be adequate to respond to claims for
824	injuries arising out of the furnishing of health care.
825	16.  Complies with the prompt payment of claims
826	requirements of ss. 627.613, 641.3155, and 641.513, Florida
827	Statutes.
828	17.  Provides for a periodic review of its facilities, as
829	required by the agency, which does not duplicate other
830	requirements of federal or state law. The agency shall provide
831	provider survey results to the plan.
832	18.  Provides enrollees the ability, to the extent
833	possible, to choose care providers, including nursing home,
834	assisted living, and adult day care service providers affiliated
835	with a person's religious faith or denomination, nursing home
836	and assisted living facility providers that are part of a
837	retirement community in which an enrollee resides, and nursing
838	homes and assisted living facilities that are geographically
839	located as close as possible to an enrollee's family, friends,
840	and social support system.
841	(e)  In addition to other quality assurance standards
842	required by law or by rule or in an approved federal waiver, and
843	in consultation with the Department of Elderly Affairs and area
844	agencies on aging, the agency shall develop quality assurance
845	standards that are specific to the care needs of elderly
846	individuals and that measure enrollee outcomes and satisfaction
847	with care management, nursing home services, and other services
848	that are provided to recipients 60 years of age or older by
849	managed care plans pursuant to this section. The agency shall
850	contract with area agencies on aging to perform initial and
851	ongoing measurement of the appropriateness, effectiveness, and
852	quality of services that are provided to recipients age 60 years
853	of age or older by managed care plans and to collect and report
854	the resolution of enrollee grievances and complaints. The agency
855	and the department shall coordinate the quality measurement
856	activities performed by area agencies on aging with other
857	quality assurance activities required by this section in a
858	manner that promotes efficiency and avoids duplication.
859	(f)  If there is not a contractual relationship between a
860	nursing home provider and a plan in an area in which the
861	demonstration project operates, the nursing home shall cooperate
862	with the efforts of a plan to determine if a recipient would be
863	more appropriately served in a community setting, and payments
864	shall be made in accordance with Medicaid nursing home rates as
865	calculated in the Medicaid state plan.
866	(g)  The agency may develop innovative risk-sharing
867	agreements that limit the level of custodial nursing home risk
868	that the plan assumes, consistent with the intent of the
869	Legislature to reduce the use and cost of nursing home care.
870	Under risk-sharing agreements, the agency may reimburse the plan
871	or a nursing home for the cost of providing nursing home care
872	for Medicaid-eligible recipients who have been permanently
873	placed and remain in nursing home care.
874	(h)  The agency shall withhold a percentage of the
875	capitation rate that would otherwise have been paid to a plan in
876	order to create a quality reserve fund, which shall be annually
877	disbursed to those contracted plans that deliver high-quality
878	services, have a low rate of enrollee complaints, have
879	successful enrollee outcomes, are in compliance with quality
880	improvement standards, and demonstrate other indicators
881	determined by the agency to be consistent with high-quality
882	service delivery.
883	(i)  The agency shall implement a system of profit rebates
884	that require a plan to rebate a portion of the plan's profits
885	that exceed 3 percent. The portion of profit above 3 percent
886	that is to be rebated shall be determined by the agency on a
887	sliding scale; however, no profits above 15 percent may be
888	retained by the plan. Rebates shall be paid to the agency.
889	(j)  The agency may limit the number of persons enrolled in
890	a plan who are not nursing home facility residents but who would
891	be Medicaid eligible as defined under s. 409.904(3), Florida
892	Statutes, if served in an approved home or community-based
893	waiver program.
894	(k)  Except as otherwise provided in this section, the
895	Aging Resource Center, if available, shall be the entry point
896	for eligibility determination for persons 60 years of age or
897	older and shall provide choice counseling to assist recipients
898	in choosing a plan. If an Aging Resource Center is not operating
899	in an area or if the Aging Resource Center or area agency on
900	aging has a contractual relationship with or has any ownership
901	interest in a managed care plan, the agency may, in consultation
902	with the Department of Elderly Affairs, designate other entities
903	to perform these functions until an Aging Resource Center is
904	established and has the capacity to perform these functions.
905	(l)  In the event that a managed care plan does not meet
906	its obligations under its contract with the agency or under the
907	requirements of this section, the agency may impose liquidated
908	damages. Such liquidated damages shall be calculated by the
909	agency as reasonable estimates of the agency's financial loss
910	and are not to be used to penalize the plan. If the agency
911	imposes liquidated damages, the agency may collect those damages
912	by reducing the amount of any monthly premium payments otherwise
913	due to the plan by the amount of the damages. Liquidated damages
914	are forfeited and will not be subsequently paid to a plan upon
915	compliance or cure of default unless a determination is made
916	after appeal that the damages should not have been imposed.
917	(m)  In any area of the state in which the agency has
918	implemented a demonstration project pursuant to this section,
919	the agency may grant a modification of certificate-of-need
920	conditions related to Medicaid participation to a nursing home
921	that has experienced decreased Medicaid patient day utilization
922	due to a transition to a managed care delivery system.
923	(n)  Notwithstanding any other law to the contrary, the
924	agency shall ensure that, to the extent possible, Medicare and
925	Medicaid services are integrated. When possible, persons served
926	by the managed care delivery system who are eligible for
927	Medicare may choose to enroll in a Medicare managed health care
928	plan operated by the same entity that is placed at risk for
929	Medicaid services.
930	(o)  It is the intent of the Legislature that the agency
931	begin discussions with the federal Centers for Medicare and
932	Medicaid Services regarding the inclusion of Medicare in an
933	integrated long-term care system.
934	(18)  FUNDING DEVELOPMENT COSTS OF ESSENTIAL COMMUNITY
935	PROVIDERS.--It is the intent of the Legislature to facilitate
936	the development of managed care delivery systems by networks of
937	essential community providers, including current community care
938	for the elderly lead agencies and other networks as defined in
939	this section. To allow the assumption of responsibility and
940	financial risk for managing a recipient through the entire
941	continuum of Medicaid services, the agency shall, subject to
942	appropriations included in the General Appropriations Act, award
943	up to $500,000 per applicant for the purpose of funding managed
944	care delivery system development costs. The terms of repayment
945	may not extend beyond 6 years after the date when the funding
946	begins and must include payment in full with a rate of interest
947	equal to or greater than the federal funds rate. The agency
948	shall establish a grant application process for awards.
949	(19)  MEDICAID BUY-IN.--The agency shall conduct a study to
950	determine the feasibility of establishing a Medicaid buy-in
951	program for disabled individuals. The study shall consider the
952	following:
953	(a)  Income and eligibility requirements, including a
954	minimum work requirement.
955	(b)  Premiums or other cost-sharing charges based on
956	income.
957	(c)  Continuation of benefits for individuals who become
958	involuntarily unemployed.
959	(d)  Recommendations for administration of the program,
960	including, but not limited to, premium collection and sliding
961	scale premiums.
962	(20)  APPLICABILITY.--
963	(a)  The provisions of this section apply only to the
964	demonstration project sites approved by the Legislature.
965	(b)  The Legislature authorizes the Agency for Health Care
966	Administration to apply and enforce any provision of law not
967	referenced in this section to ensure the safety, quality, and
968	integrity of the waiver.
969	(c)  In any circumstance when the provisions of chapter
970	409, Florida Statutes, conflict with this section, this section
971	shall prevail.
972	(21)  RULEMAKING.--The Agency for Health Care
973	Administration is authorized to adopt rules in consultation with
974	the appropriate state agencies to implement the provisions of
975	this section.
976	(22)  IMPLEMENTATION.--
977	(a)  This section does not authorize the agency to
978	implement any provision of s. 1115 of the Social Security Act
979	experimental, pilot, or demonstration project waiver to reform
980	the state Medicaid program.
981	(b)  The agency shall develop and submit for approval
982	applications for waivers of applicable federal laws and
983	regulations as necessary to implement the managed care
984	demonstration project as defined in this section. The agency
985	shall post all waiver applications under this section on its
986	Internet website 30 days before submitting the applications to
987	the United States Centers for Medicare and Medicaid Services.
988	Notwithstanding s. 409.912(11), Florida Statutes, all waiver
989	applications shall be submitted to the select committees on
990	Medicaid reform of the Senate and the House of Representatives
991	to be approved for submission. All waivers submitted to and
992	approved by the United States Centers for Medicare and Medicaid
993	Services under this section must be submitted to the select
994	committees on Medicaid reform of the Senate and the House of
995	Representatives in order to obtain authority for implementation
996	as required by s. 409.912(11), Florida Statutes, before program
997	implementation. The select committees on Medicaid reform shall
998	recommend whether to approve the implementation of the waivers
999	to the Legislature or to the Legislative Budget Commission if
1000	the Legislature is not in regular or special session.
1001	Integration of Medicaid services to the elderly may be
1002	implemented pursuant to subsection (17).
1003	(23)  EVALUATION.--
1004	(a)  Two years after the implementation of the waiver and
1005	again 5 years after the implementation of the waiver, the Office
1006	of Program Policy Analysis and Government Accountability, shall
1007	conduct an evaluation study and analyze the impact of the
1008	Medicaid reform waiver pursuant to this section to the extent
1009	allowed in the waiver demonstration sites by the Centers for
1010	Medicare and Medicaid Services and implemented as approved by
1011	the Legislature pursuant to this section. The Office of Program
1012	Policy Analysis and Government Accountability shall consult with
1013	appropriate legislative committees to select provisions of the
1014	waiver to evaluate from among the following:
1015	1.  Demographic characteristics of the recipient of the
1016	waiver.
1017	2.  Plan types and service networks.
1018	3.  Health benefit coverage.
1019	4.  Choice counseling.
1020	5.  Disease management.
1021	6.  Pharmacy benefits.
1022	7.  Behavioral health benefits.
1023	8.  Service utilization.
1024	9.  Catastrophic coverage.
1025	10.  Enhanced benefits.
1026	11.  Medicaid opt-out option.
1027	12.  Quality assurance and accountability.
1028	13.  Fraud and abuse.
1029	14.  Cost and cost benefit of the waiver.
1030	15.  Impact of the waiver on the agency.
1031	16.  Positive impact of plans on health disparities among
1032	minorities.
1033	(b)  The Office of Program Policy Analysis and Government
1034	Accountability shall submit the evaluation study report to the
1035	agency and shall submit quarterly reports to the Governor, the
1036	President of the Senate, the Speaker of the House of
1037	Representatives, and the appropriate committees or councils of
1038	the Senate and the House of Representatives.
1039	(c)  One year after implementation of the integrated
1040	managed long-term care plan, the agency shall contract with an
1041	entity experienced in evaluating managed long-term care plans in
1042	another state to evaluate, at a minimum, demonstrated cost
1043	savings realized and expected, consumer satisfaction, the range
1044	of services being provided under the program, and rate-setting
1045	methodology.
1046	(d)  The agency shall submit, every 6 months after the date
1047	of waiver implementation, a status report describing the
1048	progress made on the implementation of the waiver and
1049	identification of any issues or problems to the Governor's
1050	Office of Planning and Budgeting and the appropriate committees
1051	or councils of the Senate and the House of Representatives.
1052	(e)  The agency shall provide to the appropriate committees
1053	or councils of the Senate and House of Representatives copies of
1054	any report or evaluation regarding the waiver that is submitted
1055	to the Center for Medicare and Medicaid Services.
1056	(f)  The agency shall contract for an evaluation comparison
1057	of the waiver demonstration projects with the Medipass fee-for-
1058	service program including, at a minimum:
1059	1.  Administrative or organizational structure of the
1060	service delivery system.
1061	2.  Covered services and service utilization patterns of
1062	mandatory, optional, and other services.
1063	3.  Clinical or health outcomes.
1064	4.  Cost analysis, cost avoidance, and cost benefit.
1065	(24)  REVIEW AND REPEAL.--This section shall stand repealed
1066	on July 1, 2010, unless reviewed and saved from repeal through
1067	reenactment by the Legislature.
1068	Section 2.  This act shall take effect July 1, 2005.

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