Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 281672
CHAMBER ACTION
Senate House
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12/07/2005 12:26 PM .
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11 The Committee on Ways and Means (Atwater) recommended the
12 following amendment:
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14 Senate Amendment (with title amendment)
15 On page 41, between lines 13 and 14,
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17 insert:
18 Section 5. Paragraphs (f), (k), and (l) of subsection
19 (2) of section 409.9122, Florida Statutes, are amended to
20 read:
21 409.9122 Mandatory Medicaid managed care enrollment;
22 programs and procedures.--
23 (2)
24 (f) When an eligible Medicaid recipient does not
25 choose a managed care plan or MediPass provider, the agency
26 shall assign the Medicaid recipient to MediPass or a Medicaid
27 managed care plan according to the following provisions:
28 1. As of the effective date of this act, Medicaid
29 recipients who are subject to mandatory Medicaid managed care
30 enrollment but who fail to make a choice shall be assigned to
31 Medicaid managed care plans until not less than 70 percent of
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 281672
1 all Medicaid recipients eligible to choose any form of managed
2 care are enrolled in managed care plans.
3 2. For purposes of this paragraph, when referring to
4 assignment, the term "managed care plans" includes health
5 maintenance organizations, exclusive provider organizations,
6 provider service networks, minority physician networks, the
7 Children's Medical Services Network, and pediatric emergency
8 department diversion programs authorized by this chapter or
9 the General Appropriations Act.
10 3. In counties in which there are no managed care
11 plans accepting Medicaid enrollees, all assignment shall be to
12 a MediPass provider.
13 4. When assigning Medicaid recipients who fail to make
14 a choice, the agency shall take into account the following
15 criteria:
16 a. Network capacity is sufficient to meet the needs of
17 members.
18 b. The recipient has an enrollment history with a
19 managed care plan or a treatment history with one of the
20 primary care providers within a managed care plan.
21 c. The agency has knowledge that the member has
22 previously expressed a preference for a particular managed
23 care plan but has failed to make a choice.
24 d. Primary care providers and specialists are
25 geographically accessible to the recipient's residence.
26 (f) When a Medicaid recipient does not choose a
27 managed care plan or MediPass provider, the agency shall
28 assign the Medicaid recipient to a managed care plan or
29 MediPass provider. Medicaid recipients who are subject to
30 mandatory assignment but who fail to make a choice shall be
31 assigned to managed care plans until an enrollment of 40
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 281672
1 percent in MediPass and 60 percent in managed care plans is
2 achieved. Once this enrollment is achieved, the assignments
3 shall be divided in order to maintain an enrollment in
4 MediPass and managed care plans which is in a 40 percent and
5 60 percent proportion, respectively. Thereafter, assignment of
6 Medicaid recipients who fail to make a choice shall be based
7 proportionally on the preferences of recipients who have made
8 a choice in the previous period. Such proportions shall be
9 revised at least quarterly to reflect an update of the
10 preferences of Medicaid recipients. The agency shall
11 disproportionately assign Medicaid-eligible recipients who are
12 required to but have failed to make a choice of managed care
13 plan or MediPass, including children, and who are to be
14 assigned to the MediPass program to children's networks as
15 described in s. 409.912(4)(g), Children's Medical Services
16 Network as defined in s. 391.021, exclusive provider
17 organizations, provider service networks, minority physician
18 networks, and pediatric emergency department diversion
19 programs authorized by this chapter or the General
20 Appropriations Act, in such manner as the agency deems
21 appropriate, until the agency has determined that the networks
22 and programs have sufficient numbers to be economically
23 operated. For purposes of this paragraph, when referring to
24 assignment, the term "managed care plans" includes health
25 maintenance organizations, exclusive provider organizations,
26 provider service networks, minority physician networks,
27 Children's Medical Services Network, and pediatric emergency
28 department diversion programs authorized by this chapter or
29 the General Appropriations Act. When making assignments, the
30 agency shall take into account the following criteria:
31 1. A managed care plan has sufficient network capacity
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 281672
1 to meet the need of members.
2 2. The managed care plan or MediPass has previously
3 enrolled the recipient as a member, or one of the managed care
4 plan's primary care providers or MediPass providers has
5 previously provided health care to the recipient.
6 3. The agency has knowledge that the member has
7 previously expressed a preference for a particular managed
8 care plan or MediPass provider as indicated by Medicaid
9 fee-for-service claims data, but has failed to make a choice.
10 4. The managed care plan's or MediPass primary care
11 providers are geographically accessible to the recipient's
12 residence.
13 (k) When a Medicaid recipient does not choose a
14 managed care plan or MediPass provider, the agency shall
15 assign the Medicaid recipient to a managed care plan, except
16 in those counties in which there are fewer than two managed
17 care plans accepting Medicaid enrollees, in which case
18 assignment shall be to a managed care plan or a MediPass
19 provider. Medicaid recipients in counties with fewer than two
20 managed care plans accepting Medicaid enrollees who are
21 subject to mandatory assignment but who fail to make a choice
22 shall be assigned to managed care plans until an enrollment of
23 40 percent in MediPass and 60 percent in managed care plans is
24 achieved. Once that enrollment is achieved, the assignments
25 shall be divided in order to maintain an enrollment in
26 MediPass and managed care plans which is in a 40 percent and
27 60 percent proportion, respectively. In service areas 1 and 6
28 of the Agency for Health Care Administration where the agency
29 is contracting for the provision of comprehensive behavioral
30 health services through a capitated prepaid arrangement,
31 recipients who fail to make a choice shall be assigned equally
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 281672
1 to MediPass or a managed care plan. For purposes of this
2 paragraph, when referring to assignment, the term "managed
3 care plans" includes exclusive provider organizations,
4 provider service networks, Children's Medical Services
5 Network, minority physician networks, and pediatric emergency
6 department diversion programs authorized by this chapter or
7 the General Appropriations Act. When making assignments, the
8 agency shall take into account the following criteria:
9 1. A managed care plan has sufficient network capacity
10 to meet the need of members.
11 2. The managed care plan or MediPass has previously
12 enrolled the recipient as a member, or one of the managed care
13 plan's primary care providers or MediPass providers has
14 previously provided health care to the recipient.
15 3. The agency has knowledge that the member has
16 previously expressed a preference for a particular managed
17 care plan or MediPass provider as indicated by Medicaid
18 fee-for-service claims data, but has failed to make a choice.
19 4. The managed care plan's or MediPass primary care
20 providers are geographically accessible to the recipient's
21 residence.
22 5. The agency has authority to make mandatory
23 assignments based on quality of service and performance of
24 managed care plans.
25 (k)(l) Notwithstanding the provisions of chapter 287,
26 the agency may, at its discretion, renew cost-effective
27 contracts for choice counseling services once or more for such
28 periods as the agency may decide. However, all such renewals
29 may not combine to exceed a total period longer than the term
30 of the original contract.
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 281672
1 (Redesignate subsequent sections.)
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4 ================ T I T L E A M E N D M E N T ===============
5 And the title is amended as follows:
6 On page 3, line 10, after the first semicolon,
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8 insert:
9 amending s. 409.9122, F.S.; providing
10 requirements for the agency when an eligible
11 Medicaid recipient does not choose a managed
12 care plan or MediPass provider; defining the
13 term "managed care plans";
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