Senate Bill sb0622

    Florida Senate - 2005                                   SB 622

    By Senator Lynn





    7-565-05

  1                      A bill to be entitled

  2         An act relating to community mental health

  3         services as optional Medicaid services;

  4         amending s. 409.906, F.S.; eliminating

  5         authorization for the Agency for Health Care

  6         Administration to operate a behavioral health

  7         utilization management program; eliminating the

  8         agency's authorization to implement certain

  9         reimbursement and use-management reforms;

10         providing an effective date.

11  

12  Be It Enacted by the Legislature of the State of Florida:

13  

14         Section 1.  Paragraphs (a) and (b) of subsection (8) of

15  section 409.906, Florida Statutes, are amended to read:

16         409.906  Optional Medicaid services.--Subject to

17  specific appropriations, the agency may make payments for

18  services which are optional to the state under Title XIX of

19  the Social Security Act and are furnished by Medicaid

20  providers to recipients who are determined to be eligible on

21  the dates on which the services were provided. Any optional

22  service that is provided shall be provided only when medically

23  necessary and in accordance with state and federal law.

24  Optional services rendered by providers in mobile units to

25  Medicaid recipients may be restricted or prohibited by the

26  agency. Nothing in this section shall be construed to prevent

27  or limit the agency from adjusting fees, reimbursement rates,

28  lengths of stay, number of visits, or number of services, or

29  making any other adjustments necessary to comply with the

30  availability of moneys and any limitations or directions

31  provided for in the General Appropriations Act or chapter 216.

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






    Florida Senate - 2005                                   SB 622
    7-565-05




 1  If necessary to safeguard the state's systems of providing

 2  services to elderly and disabled persons and subject to the

 3  notice and review provisions of s. 216.177, the Governor may

 4  direct the Agency for Health Care Administration to amend the

 5  Medicaid state plan to delete the optional Medicaid service

 6  known as "Intermediate Care Facilities for the Developmentally

 7  Disabled." Optional services may include:

 8         (8)  COMMUNITY MENTAL HEALTH SERVICES.--

 9         (a)  The agency may pay for rehabilitative services

10  provided to a recipient by a mental health or substance abuse

11  provider under contract with the agency or the Department of

12  Children and Family Services to provide such services.  Those

13  services which are psychiatric in nature shall be rendered or

14  recommended by a psychiatrist, and those services which are

15  medical in nature shall be rendered or recommended by a

16  physician or psychiatrist. The agency must develop a provider

17  enrollment process for community mental health providers which

18  bases provider enrollment on an assessment of service need.

19  The provider enrollment process shall be designed to control

20  costs, prevent fraud and abuse, consider provider expertise

21  and capacity, and assess provider success in managing

22  utilization of care and measuring treatment outcomes.

23  Providers will be selected through a competitive procurement

24  or selective contracting process. In addition to other

25  community mental health providers, the agency shall consider

26  for enrollment mental health programs licensed under chapter

27  395 and group practices licensed under chapter 458, chapter

28  459, chapter 490, or chapter 491. The agency is also

29  authorized to continue operation of its behavioral health

30  utilization management program and may develop new services if

31  these actions are necessary to ensure savings from the

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






    Florida Senate - 2005                                   SB 622
    7-565-05




 1  implementation of the utilization management system. The

 2  agency shall coordinate the implementation of this enrollment

 3  process with the Department of Children and Family Services

 4  and the Department of Juvenile Justice. The agency is

 5  authorized to utilize diagnostic criteria in setting

 6  reimbursement rates, to preauthorize certain high-cost or

 7  highly utilized services, to limit or eliminate coverage for

 8  certain services, or to make any other adjustments necessary

 9  to comply with any limitations or directions provided for in

10  the General Appropriations Act.

11         (b)  The agency is authorized to implement

12  reimbursement and use management reforms in order to comply

13  with any limitations or directions in the General

14  Appropriations Act, which may include, but are not limited to:

15  prior authorization of treatment and service plans; prior

16  authorization of services; enhanced use review programs for

17  highly used services; and limits on services for those

18  determined to be abusing their benefit coverages.

19         Section 2.  This act shall take effect July 1, 2005.

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22                          SENATE SUMMARY

23    Eliminates utilization management controls for Medicaid
      community mental health services.
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CODING: Words stricken are deletions; words underlined are additions.