HB 0003B

CS

CHAMBER ACTION

1	The Health & Families 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; amending s. 641.2261, F.S.;
7	revising the applicability of solvency requirements to
8	include Medicaid provider service networks and updating a
9	reference; amending s. 409.911, F.S.; renaming the
10	Medicaid Disproportionate Share Council; providing for
11	appointment of council members; providing responsibilities
12	of the council; providing for future legislative review
13	and repeal of the council; amending s. 409.912, F.S.;
14	providing an exception from certain contract procurement
15	requirements for specified Medicaid managed care pilot
16	programs and Medicaid health maintenance organizations;
17	providing an exemption for federally qualified health
18	centers and entities owned by federally qualified health
19	centers from pts. I and III of ch. 641, F.S., under
20	certain circumstances; deleting the competitive
21	procurement requirement for provider service networks;
22	requiring provider service networks to comply with the
23	solvency requirements in s. 641.2261, F.S.; updating a
24	reference; including certain minority physician networks
25	and emergency room diversion programs in the description
26	of provider service networks; amending s. 409.91211, F.S.;
27	providing for distribution of upper payment limit,
28	hospital disproportionate share program, and low income
29	pool funds; providing legislative intent with respect to
30	distribution of said funds; providing for implementation
31	of the powers, duties, and responsibilities of the Agency
32	for Health Care Administration with respect to the pilot
33	program; including the Division of Children's Medical
34	Services Network within the Department of Health in a list
35	of state-authorized pilot programs; requiring the agency
36	to develop a data reporting system; requiring the agency
37	to implement procedures to minimize fraud and abuse;
38	providing that certain Medicaid and Supplemental Security
39	Income recipients are exempt from s. 409.9122, F.S.;
40	providing for Medicaid reimbursement of federally
41	qualified health centers that deliver certain school-based
42	services; authorizing the agency to assign certain
43	Medicaid recipients to reform plans; authorizing the
44	agency to implement the provisions of the waiver approved
45	by the Centers for Medicare and Medicaid Services and
46	requiring the agency to notify the Legislature prior to
47	seeking federal approval of modifications to said terms
48	and conditions; requiring the Secretary of Health Care
49	Administration to convene a technical advisory panel;
50	providing for membership and duties; limiting aggregate
51	risk score of certain managed care plans for payment
52	purposes for a specified period of time; providing for
53	phase in of capitation rates; providing applicability;
54	requiring rates to be certified and approved; defining the
55	term "capitated managed care plan"; providing for conflict
56	between specified provisions of ch. 409, F.S., and
57	requiring a report by the agency pertaining thereto;
58	creating s. 409.91212, F.S.; authorizing the agency to
59	expand the Medicaid reform demonstration program;
60	providing readiness criteria; providing for public
61	meetings; requiring notice of intent to expand the
62	demonstration program; requiring the agency to request a
63	hearing by the Joint Legislative Committee on Medicaid
64	Reform Implementation; authorizing the agency to request
65	certain budget transfers; amending s. 409.9122, F.S.;
66	revising provisions relating to assignment of certain
67	Medicaid recipients to managed care plans; requiring the
68	agency to submit reports to the Legislature; specifying
69	content of reports; creating s. 11.72, F.S.; creating the
70	Joint Legislative Committee on Medicaid Reform
71	Implementation; providing for membership, powers, and
72	duties; amending s. 216.346, F.S.; revising provisions
73	relating to contracts between state agencies; providing an
74	effective date.
75
76	Be It Enacted by the Legislature of the State of Florida:
77
78	Section 1.  Section 641.2261, Florida Statutes, is amended
79	to read:
80	641.2261  Application of federal solvency requirements to
81	provider-sponsored organizations and Medicaid provider service
82	networks.--
83	(1)  The solvency requirements of ss. 1855 and 1856 of the
84	Balanced Budget Act of 1997 and 42 C.F.R. s. 422.350 subpart H
85	rules adopted by the Secretary of the United States Department
86	of Health and Human Services apply to a health maintenance
87	organization that is a provider-sponsored organization rather
88	than the solvency requirements of this part. However, if the
89	provider-sponsored organization does not meet the solvency
90	requirements of this part, the organization is limited to the
91	issuance of Medicare+Choice plans to eligible individuals. For
92	the purposes of this section, the terms "Medicare+Choice plans,"
93	"provider-sponsored organizations," and "solvency requirements"
94	have the same meaning as defined in the federal act and federal
95	rules and regulations.
96	(2)  The solvency requirements of 42 C.F.R. s. 422.350
97	subpart H and the solvency requirements established in the
98	approved federal waiver pursuant to chapter 409 apply to a
99	Medicaid provider service network rather than the solvency
100	requirements of this part.
101	Section 2.  Subsection (9) of section 409.911, Florida
102	Statutes, is amended to read:
103	409.911  Disproportionate share program.--Subject to
104	specific allocations established within the General
105	Appropriations Act and any limitations established pursuant to
106	chapter 216, the agency shall distribute, pursuant to this
107	section, moneys to hospitals providing a disproportionate share
108	of Medicaid or charity care services by making quarterly
109	Medicaid payments as required. Notwithstanding the provisions of
110	s. 409.915, counties are exempt from contributing toward the
111	cost of this special reimbursement for hospitals serving a
112	disproportionate share of low-income patients.
113	(9)  The Agency for Health Care Administration shall create
114	a Medicaid Low Income Pool Disproportionate Share Council. The
115	Low Income Pool Council shall consist of 17 members, including
116	three representatives of statutory teaching hospitals, three
117	representatives of public hospitals, three representatives of
118	nonprofit hospitals, three representatives of for-profit
119	hospitals, two representatives of rural hospitals, two
120	representatives of units of local government which contribute
121	funding, and one representative of family practice teaching
122	hospitals. The council shall have the following
123	responsibilities:
124	(a)  Make recommendations on the financing of the upper
125	payment limit program, the hospital disproportionate share
126	program, or the low income pool as implemented by the agency
127	pursuant to federal waiver and on the distribution of funds.
128	(b)  Advise the agency on the development of the low income
129	pool plan required by the Centers for Medicare and Medicaid
130	Services pursuant to the Medicaid reform waiver.
131	(c)  Advise the agency on the distribution of hospital
132	funds used to adjust inpatient hospital rates and rebase rates
133	or otherwise exempt hospitals from reimbursement limits as
134	financed by intergovernmental transfers.
135	(a)  The purpose of the council is to study and make
136	recommendations regarding:
137	1.  The formula for the regular disproportionate share
138	program and alternative financing options.
139	2.  Enhanced Medicaid funding through the Special Medicaid
140	Payment program.
141	3.  The federal status of the upper-payment-limit funding
142	option and how this option may be used to promote health care
143	initiatives determined by the council to be state health care
144	priorities.
145	(b)  The council shall include representatives of the
146	Executive Office of the Governor and of the agency;
147	representatives from teaching, public, private nonprofit,
148	private for-profit, and family practice teaching hospitals; and
149	representatives from other groups as needed.
150	(d)(c)  The council shall submit its findings and
151	recommendations to the Governor and the Legislature no later
152	than February 1 of each year.
153	(e)  This subsection shall stand repealed on June 30, 2006,
154	unless reviewed and saved from repeal through reenactment by the
155	Legislature.
156	Section 3.  Paragraphs (b), (c), and (d) of subsection (4)
157	of section 409.912, Florida Statutes, are amended to read:
158	409.912  Cost-effective purchasing of health care.--The
159	agency shall purchase goods and services for Medicaid recipients
160	in the most cost-effective manner consistent with the delivery
161	of quality medical care. To ensure that medical services are
162	effectively utilized, the agency may, in any case, require a
163	confirmation or second physician's opinion of the correct
164	diagnosis for purposes of authorizing future services under the
165	Medicaid program. This section does not restrict access to
166	emergency services or poststabilization care services as defined
167	in 42 C.F.R. part 438.114. Such confirmation or second opinion
168	shall be rendered in a manner approved by the agency. The agency
169	shall maximize the use of prepaid per capita and prepaid
170	aggregate fixed-sum basis services when appropriate and other
171	alternative service delivery and reimbursement methodologies,
172	including competitive bidding pursuant to s. 287.057, designed
173	to facilitate the cost-effective purchase of a case-managed
174	continuum of care. The agency shall also require providers to
175	minimize the exposure of recipients to the need for acute
176	inpatient, custodial, and other institutional care and the
177	inappropriate or unnecessary use of high-cost services. The
178	agency shall contract with a vendor to monitor and evaluate the
179	clinical practice patterns of providers in order to identify
180	trends that are outside the normal practice patterns of a
181	provider's professional peers or the national guidelines of a
182	provider's professional association. The vendor must be able to
183	provide information and counseling to a provider whose practice
184	patterns are outside the norms, in consultation with the agency,
185	to improve patient care and reduce inappropriate utilization.
186	The agency may mandate prior authorization, drug therapy
187	management, or disease management participation for certain
188	populations of Medicaid beneficiaries, certain drug classes, or
189	particular drugs to prevent fraud, abuse, overuse, and possible
190	dangerous drug interactions. The Pharmaceutical and Therapeutics
191	Committee shall make recommendations to the agency on drugs for
192	which prior authorization is required. The agency shall inform
193	the Pharmaceutical and Therapeutics Committee of its decisions
194	regarding drugs subject to prior authorization. The agency is
195	authorized to limit the entities it contracts with or enrolls as
196	Medicaid providers by developing a provider network through
197	provider credentialing. The agency may competitively bid single-
198	source-provider contracts if procurement of goods or services
199	results in demonstrated cost savings to the state without
200	limiting access to care. The agency may limit its network based
201	on the assessment of beneficiary access to care, provider
202	availability, provider quality standards, time and distance
203	standards for access to care, the cultural competence of the
204	provider network, demographic characteristics of Medicaid
205	beneficiaries, practice and provider-to-beneficiary standards,
206	appointment wait times, beneficiary use of services, provider
207	turnover, provider profiling, provider licensure history,
208	previous program integrity investigations and findings, peer
209	review, provider Medicaid policy and billing compliance records,
210	clinical and medical record audits, and other factors. Providers
211	shall not be entitled to enrollment in the Medicaid provider
212	network. The agency shall determine instances in which allowing
213	Medicaid beneficiaries to purchase durable medical equipment and
214	other goods is less expensive to the Medicaid program than long-
215	term rental of the equipment or goods. The agency may establish
216	rules to facilitate purchases in lieu of long-term rentals in
217	order to protect against fraud and abuse in the Medicaid program
218	as defined in s. 409.913. The agency may seek federal waivers
219	necessary to administer these policies.
220	(4)  The agency may contract with:
221	(b)  An entity that is providing comprehensive behavioral
222	health care services to certain Medicaid recipients through a
223	capitated, prepaid arrangement pursuant to the federal waiver
224	provided for by s. 409.905(5). Such an entity must be licensed
225	under chapter 624, chapter 636, or chapter 641 and must possess
226	the clinical systems and operational competence to manage risk
227	and provide comprehensive behavioral health care to Medicaid
228	recipients. As used in this paragraph, the term "comprehensive
229	behavioral health care services" means covered mental health and
230	substance abuse treatment services that are available to
231	Medicaid recipients. The secretary of the Department of Children
232	and Family Services shall approve provisions of procurements
233	related to children in the department's care or custody prior to
234	enrolling such children in a prepaid behavioral health plan. Any
235	contract awarded under this paragraph must be competitively
236	procured. In developing the behavioral health care prepaid plan
237	procurement document, the agency shall ensure that the
238	procurement document requires the contractor to develop and
239	implement a plan to ensure compliance with s. 394.4574 related
240	to services provided to residents of licensed assisted living
241	facilities that hold a limited mental health license. Except as
242	provided in subparagraph 8. and except in counties where the
243	Medicaid managed care pilot program is authorized under s.
244	409.91211, the agency shall seek federal approval to contract
245	with a single entity meeting these requirements to provide
246	comprehensive behavioral health care services to all Medicaid
247	recipients not enrolled in a Medicaid capitated managed care
248	plan authorized under s. 409.91211 or a Medicaid health
249	maintenance organization in an AHCA area. In an AHCA area where
250	the Medicaid managed care pilot program is authorized under s.
251	409.91211 in one or more counties, the agency may procure a
252	contract with a single entity to serve the remaining counties as
253	an AHCA area or the remaining counties may be included with an
254	adjacent AHCA area and shall be subject to this paragraph. Each
255	entity must offer sufficient choice of providers in its network
256	to ensure recipient access to care and the opportunity to select
257	a provider with whom they are satisfied. The network shall
258	include all public mental health hospitals. To ensure unimpaired
259	access to behavioral health care services by Medicaid
260	recipients, all contracts issued pursuant to this paragraph
261	shall require 80 percent of the capitation paid to the managed
262	care plan, including health maintenance organizations, to be
263	expended for the provision of behavioral health care services.
264	In the event the managed care plan expends less than 80 percent
265	of the capitation paid pursuant to this paragraph for the
266	provision of behavioral health care services, the difference
267	shall be returned to the agency. The agency shall provide the
268	managed care plan with a certification letter indicating the
269	amount of capitation paid during each calendar year for the
270	provision of behavioral health care services pursuant to this
271	section. The agency may reimburse for substance abuse treatment
272	services on a fee-for-service basis until the agency finds that
273	adequate funds are available for capitated, prepaid
274	arrangements.
275	1.  By January 1, 2001, the agency shall modify the
276	contracts with the entities providing comprehensive inpatient
277	and outpatient mental health care services to Medicaid
278	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
279	Counties, to include substance abuse treatment services.
280	2.  By July 1, 2003, the agency and the Department of
281	Children and Family Services shall execute a written agreement
282	that requires collaboration and joint development of all policy,
283	budgets, procurement documents, contracts, and monitoring plans
284	that have an impact on the state and Medicaid community mental
285	health and targeted case management programs.
286	3.  Except as provided in subparagraph 8., by July 1, 2006,
287	the agency and the Department of Children and Family Services
288	shall contract with managed care entities in each AHCA area
289	except area 6 or arrange to provide comprehensive inpatient and
290	outpatient mental health and substance abuse services through
291	capitated prepaid arrangements to all Medicaid recipients who
292	are eligible to participate in such plans under federal law and
293	regulation. In AHCA areas where eligible individuals number less
294	than 150,000, the agency shall contract with a single managed
295	care plan to provide comprehensive behavioral health services to
296	all recipients who are not enrolled in a Medicaid health
297	maintenance organization or a Medicaid capitated managed care
298	plan authorized under s. 409.91211. The agency may contract with
299	more than one comprehensive behavioral health provider to
300	provide care to recipients who are not enrolled in a Medicaid
301	health maintenance organization or a Medicaid capitated managed
302	care plan authorized under s. 409.91211 in AHCA areas where the
303	eligible population exceeds 150,000. In an AHCA area where the
304	Medicaid managed care pilot program is authorized under s.
305	409.91211 in one or more counties, the agency may procure a
306	contract with a single entity to serve the remaining counties as
307	an AHCA area or the remaining counties may be included with an
308	adjacent AHCA area and shall be subject to this paragraph.
309	Contracts for comprehensive behavioral health providers awarded
310	pursuant to this section shall be competitively procured. Both
311	for-profit and not-for-profit corporations shall be eligible to
312	compete. Managed care plans contracting with the agency under
313	subsection (3) shall provide and receive payment for the same
314	comprehensive behavioral health benefits as provided in AHCA
315	rules, including handbooks incorporated by reference. In AHCA
316	area 11, the agency shall contract with at least two
317	comprehensive behavioral health care providers to provide
318	behavioral health care to recipients in that area who are
319	enrolled in, or assigned to, the MediPass program. One of the
320	behavioral health care contracts shall be with the existing
321	provider service network pilot project, as described in
322	paragraph (d), for the purpose of demonstrating the cost-
323	effectiveness of the provision of quality mental health services
324	through a public hospital-operated managed care model. Payment
325	shall be at an agreed-upon capitated rate to ensure cost
326	savings. Of the recipients in area 11 who are assigned to
327	MediPass under the provisions of s. 409.9122(2)(k), A minimum of
328	50,000 of those MediPass-enrolled recipients shall be assigned
329	to the existing provider service network in area 11 for their
330	behavioral care.
331	4.  By October 1, 2003, the agency and the department shall
332	submit a plan to the Governor, the President of the Senate, and
333	the Speaker of the House of Representatives which provides for
334	the full implementation of capitated prepaid behavioral health
335	care in all areas of the state.
336	a.  Implementation shall begin in 2003 in those AHCA areas
337	of the state where the agency is able to establish sufficient
338	capitation rates.
339	b.  If the agency determines that the proposed capitation
340	rate in any area is insufficient to provide appropriate
341	services, the agency may adjust the capitation rate to ensure
342	that care will be available. The agency and the department may
343	use existing general revenue to address any additional required
344	match but may not over-obligate existing funds on an annualized
345	basis.
346	c.  Subject to any limitations provided for in the General
347	Appropriations Act, the agency, in compliance with appropriate
348	federal authorization, shall develop policies and procedures
349	that allow for certification of local and state funds.
350	5.  Children residing in a statewide inpatient psychiatric
351	program, or in a Department of Juvenile Justice or a Department
352	of Children and Family Services residential program approved as
353	a Medicaid behavioral health overlay services provider shall not
354	be included in a behavioral health care prepaid health plan or
355	any other Medicaid managed care plan pursuant to this paragraph.
356	6.  In converting to a prepaid system of delivery, the
357	agency shall in its procurement document require an entity
358	providing only comprehensive behavioral health care services to
359	prevent the displacement of indigent care patients by enrollees
360	in the Medicaid prepaid health plan providing behavioral health
361	care services from facilities receiving state funding to provide
362	indigent behavioral health care, to facilities licensed under
363	chapter 395 which do not receive state funding for indigent
364	behavioral health care, or reimburse the unsubsidized facility
365	for the cost of behavioral health care provided to the displaced
366	indigent care patient.
367	7.  Traditional community mental health providers under
368	contract with the Department of Children and Family Services
369	pursuant to part IV of chapter 394, child welfare providers
370	under contract with the Department of Children and Family
371	Services in areas 1 and 6, and inpatient mental health providers
372	licensed pursuant to chapter 395 must be offered an opportunity
373	to accept or decline a contract to participate in any provider
374	network for prepaid behavioral health services.
375	8.  For fiscal year 2004-2005, all Medicaid eligible
376	children, except children in areas 1 and 6, whose cases are open
377	for child welfare services in the HomeSafeNet system, shall be
378	enrolled in MediPass or in Medicaid fee-for-service and all
379	their behavioral health care services including inpatient,
380	outpatient psychiatric, community mental health, and case
381	management shall be reimbursed on a fee-for-service basis.
382	Beginning July 1, 2005, such children, who are open for child
383	welfare services in the HomeSafeNet system, shall receive their
384	behavioral health care services through a specialty prepaid plan
385	operated by community-based lead agencies either through a
386	single agency or formal agreements among several agencies. The
387	specialty prepaid plan must result in savings to the state
388	comparable to savings achieved in other Medicaid managed care
389	and prepaid programs. Such plan must provide mechanisms to
390	maximize state and local revenues. The specialty prepaid plan
391	shall be developed by the agency and the Department of Children
392	and Family Services. The agency is authorized to seek any
393	federal waivers to implement this initiative.
394	(c)  A federally qualified health center or an entity owned
395	by one or more federally qualified health centers or an entity
396	owned by other migrant and community health centers receiving
397	non-Medicaid financial support from the Federal Government to
398	provide health care services on a prepaid or fixed-sum basis to
399	recipients. A federally qualified health center or an entity
400	owned by one or more federally qualified health centers that is
401	reimbursed by the agency on a prepaid basis is exempt from parts
402	I and III of chapter 641 but must comply with the solvency
403	requirements in s. 641.2261(2) and meet the appropriate
404	requirements governing financial reserve, quality assurance, and
405	patients' rights established by the agency. Such prepaid health
406	care services entity must be licensed under parts I and III of
407	chapter 641, but shall be prohibited from serving Medicaid
408	recipients on a prepaid basis, until such licensure has been
409	obtained. However, such an entity is exempt from s. 641.225 if
410	the entity meets the requirements specified in subsections (17)
411	and (18).
412	(d)  A provider service network which may be reimbursed on
413	a fee-for-service or prepaid basis. A provider service network
414	which is reimbursed by the agency on a prepaid basis shall be
415	exempt from parts I and III of chapter 641, but must comply with
416	the solvency requirements in s. 641.2261(2) and meet appropriate
417	financial reserve, quality assurance, and patient rights
418	requirements as established by the agency. The agency shall
419	award contracts on a competitive bid basis and shall select
420	bidders based upon price and quality of care. Medicaid
421	recipients assigned to a provider service network demonstration
422	project shall be chosen equally from those who would otherwise
423	have been assigned to prepaid plans and MediPass. The agency is
424	authorized to seek federal Medicaid waivers as necessary to
425	implement the provisions of this section. Any contract
426	previously awarded to a provider service network operated by a
427	hospital pursuant to this subsection shall remain in effect for
428	a period of 3 years following the current contract expiration
429	date, regardless of any contractual provisions to the contrary.
430	A provider service network is a network established or organized
431	and operated by a health care provider, or group of affiliated
432	health care providers, including minority physician networks and
433	emergency room diversion programs that meet the requirements of
434	s. 409.91211, which provides a substantial proportion of the
435	health care items and services under a contract directly through
436	the provider or affiliated group of providers and may make
437	arrangements with physicians or other health care professionals,
438	health care institutions, or any combination of such individuals
439	or institutions to assume all or part of the financial risk on a
440	prospective basis for the provision of basic health services by
441	the physicians, by other health professionals, or through the
442	institutions. The health care providers must have a controlling
443	interest in the governing body of the provider service network
444	organization.
445	Section 4.  Section 409.91211, Florida Statutes, is amended
446	to read:
447	409.91211  Medicaid managed care pilot program.--
448	(1)(a)  The agency is authorized to seek experimental,
449	pilot, or demonstration project waivers, pursuant to s. 1115 of
450	the Social Security Act, to create a statewide initiative to
451	provide for a more efficient and effective service delivery
452	system that enhances quality of care and client outcomes in the
453	Florida Medicaid program pursuant to this section. Phase one of
454	the demonstration shall be implemented in two geographic areas.
455	One demonstration site shall include only Broward County. A
456	second demonstration site shall initially include Duval County
457	and shall be expanded to include Baker, Clay, and Nassau
458	Counties within 1 year after the Duval County program becomes
459	operational. This waiver authority is contingent upon federal
460	approval to preserve the upper-payment-limit funding mechanism
461	for hospitals, including a guarantee of a reasonable growth
462	factor, a methodology to allow the use of a portion of these
463	funds to serve as a risk pool for demonstration sites,
464	provisions to preserve the state's ability to use
465	intergovernmental transfers, and provisions to protect the
466	disproportionate share program authorized pursuant to this
467	chapter. Under the upper payment limit program, the hospital
468	disproportionate share program, or the low income pool as
469	implemented by the agency pursuant to federal waiver, the state
470	matching funds required for the program shall be provided by the
471	state and by local governmental entities through
472	intergovernmental transfers in accordance with published federal
473	statutes and regulations. The agency shall distribute funds from
474	the upper payment limit program, the hospital disproportionate
475	share program, and the low income pool in accordance with
476	published federal statutes, regulations, and waivers and the low
477	income pool methodology approved by the Centers for Medicare and
478	Medicaid Services. Upon completion of the evaluation conducted
479	under s. 3, ch. 2005-133, Laws of Florida, the agency may
480	request statewide expansion of the demonstration projects.
481	Statewide phase-in to additional counties shall be contingent
482	upon review and approval by the Legislature.
483	(b)  It is the intent of the Legislature that the low
484	income pool plan required by the terms and conditions of the
485	Medicaid reform waiver and submitted to the Centers for Medicare
486	and Medicaid Services propose the distribution of the program
487	funds in paragraph (a) based on the following objectives:
488	1.  Ensure a broad and fair distribution of available funds
489	based on the access provided by Medicaid participating
490	hospitals, regardless of their ownership status, through their
491	delivery of inpatient or outpatient care for Medicaid
492	beneficiaries and uninsured and underinsured individuals.
493	2.  Ensure accessible emergency inpatient and outpatient
494	care for Medicaid beneficiaries and uninsured and underinsured
495	individuals.
496	3.  Enhance primary, preventive, and other ambulatory care
497	coverages for uninsured individuals.
498	4.  Promote teaching and specialty hospital programs.
499	5.  Promote the stability and viability of statutorily
500	defined rural hospitals and hospitals that serve as sole
501	community hospitals.
502	6.  Recognize the extent of hospital uncompensated care
503	costs.
504	7.  Maintain and enhance essential community hospital care.
505	8.  Maintain incentives for local governmental entities to
506	contribute to the cost of uncompensated care.
507	9.  Promote measures to avoid preventable hospitalizations.
508	10.  Account for hospital efficiency.
509	11.  Contribute to a community's overall health system.
510	(2)  The Legislature intends for the capitated managed care
511	pilot program to:
512	(a)  Provide recipients in Medicaid fee-for-service or the
513	MediPass program a comprehensive and coordinated capitated
514	managed care system for all health care services specified in
515	ss. 409.905 and 409.906.
516	(b)  Stabilize Medicaid expenditures under the pilot
517	program compared to Medicaid expenditures in the pilot area for
518	the 3 years before implementation of the pilot program, while
519	ensuring:
520	1.  Consumer education and choice.
521	2.  Access to medically necessary services.
522	3.  Coordination of preventative, acute, and long-term
523	care.
524	4.  Reductions in unnecessary service utilization.
525	(c)  Provide an opportunity to evaluate the feasibility of
526	statewide implementation of capitated managed care networks as a
527	replacement for the current Medicaid fee-for-service and
528	MediPass systems.
529	(3)  The agency shall have the following powers, duties,
530	and responsibilities with respect to the development of a pilot
531	program:
532	(a)  To implement develop and recommend a system to deliver
533	all mandatory services specified in s. 409.905 and optional
534	services specified in s. 409.906, as approved by the Centers for
535	Medicare and Medicaid Services and the Legislature in the waiver
536	pursuant to this section. Services to recipients under plan
537	benefits shall include emergency services provided under s.
538	409.9128.
539	(b)  To implement a pilot program that includes recommend
540	Medicaid eligibility categories, from those specified in ss.
541	409.903 and 409.904 as authorized in an approved federal waiver,
542	which shall be included in the pilot program.
543	(c)  To implement determine and recommend how to design the
544	managed care pilot program that maximizes in order to take
545	maximum advantage of all available state and federal funds,
546	including those obtained through intergovernmental transfers,
547	the low income pool, supplemental Medicaid payments upper-
548	payment-level funding systems, and the disproportionate share
549	program. Within the parameters allowed by federal statute and
550	rule, the agency is authorized to seek options for making direct
551	payments to hospitals and physicians employed by or under
552	contract with the state's medical schools for the costs
553	associated with graduate medical education under Medicaid
554	reform.
555	(d)  To implement determine and recommend actuarially
556	sound, risk-adjusted capitation rates for Medicaid recipients in
557	the pilot program which can be separated to cover comprehensive
558	care, enhanced services, and catastrophic care.
559	(e)  To implement determine and recommend policies and
560	guidelines for phasing in financial risk for approved provider
561	service networks over a 3-year period. These policies and
562	guidelines shall include an option for a provider service
563	network to be paid to pay fee-for-service rates. For any
564	provider service network established in a managed care pilot
565	area, the option to be paid fee-for-service rates shall include
566	a savings-settlement mechanism that is consistent with s.
567	409.912(44) that may include a savings-settlement option for at
568	least 2 years. This model shall may be converted to a risk-
569	adjusted capitated rate no later than the beginning of the
570	fourth in the third year of operation and may be converted
571	earlier at the option of the provider service network. Federally
572	qualified health centers may be offered an opportunity to accept
573	or decline a contract to participate in any provider network for
574	prepaid primary care services.
575	(f)  To implement determine and recommend provisions
576	related to stop-loss requirements and the transfer of excess
577	cost to catastrophic coverage that accommodates the risks
578	associated with the development of the pilot program.
579	(g)  To determine and recommend a process to be used by the
580	Social Services Estimating Conference to determine and validate
581	the rate of growth of the per-member costs of providing Medicaid
582	services under the managed care pilot program.
583	(h)  To implement determine and recommend program standards
584	and credentialing requirements for capitated managed care
585	networks to participate in the pilot program, including those
586	related to fiscal solvency, quality of care, and adequacy of
587	access to health care providers. It is the intent of the
588	Legislature that, to the extent possible, any pilot program
589	authorized by the state under this section include any federally
590	qualified health center, any federally qualified rural health
591	clinic, county health department, the Division of Children's
592	Medical Services Network within the Department of Health, or any
593	other federally, state, or locally funded entity that serves the
594	geographic areas within the boundaries of the pilot program that
595	requests to participate. This paragraph does not relieve an
596	entity that qualifies as a capitated managed care network under
597	this section from any other licensure or regulatory requirements
598	contained in state or federal law which would otherwise apply to
599	the entity. The standards and credentialing requirements shall
600	be based upon, but are not limited to:
601	1.  Compliance with the accreditation requirements as
602	provided in s. 641.512.
603	2.  Compliance with early and periodic screening,
604	diagnosis, and treatment screening requirements under federal
605	law.
606	3.  The percentage of voluntary disenrollments.
607	4.  Immunization rates.
608	5.  Standards of the National Committee for Quality
609	Assurance and other approved accrediting bodies.
610	6.  Recommendations of other authoritative bodies.
611	7.  Specific requirements of the Medicaid program, or
612	standards designed to specifically meet the unique needs of
613	Medicaid recipients.
614	8.  Compliance with the health quality improvement system
615	as established by the agency, which incorporates standards and
616	guidelines developed by the Centers for Medicare and Medicaid
617	Services as part of the quality assurance reform initiative.
618	9.  The network's infrastructure capacity to manage
619	financial transactions, recordkeeping, data collection, and
620	other administrative functions.
621	10.  The network's ability to submit any financial,
622	programmatic, or patient-encounter data or other information
623	required by the agency to determine the actual services provided
624	and the cost of administering the plan.
625	(i)  To implement develop and recommend a mechanism for
626	providing information to Medicaid recipients for the purpose of
627	selecting a capitated managed care plan. For each plan available
628	to a recipient, the agency, at a minimum, shall ensure that the
629	recipient is provided with:
630	1.  A list and description of the benefits provided.
631	2.  Information about cost sharing.
632	3.  Plan performance data, if available.
633	4.  An explanation of benefit limitations.
634	5.  Contact information, including identification of
635	providers participating in the network, geographic locations,
636	and transportation limitations.
637	6.  Any other information the agency determines would
638	facilitate a recipient's understanding of the plan or insurance
639	that would best meet his or her needs.
640	(j)  To implement develop and recommend a system to ensure
641	that there is a record of recipient acknowledgment that choice
642	counseling has been provided.
643	(k)  To implement develop and recommend a choice counseling
644	system to ensure that the choice counseling process and related
645	material are designed to provide counseling through face-to-face
646	interaction, by telephone, and in writing and through other
647	forms of relevant media. Materials shall be written at the
648	fourth-grade reading level and available in a language other
649	than English when 5 percent of the county speaks a language
650	other than English. Choice counseling shall also use language
651	lines and other services for impaired recipients, such as
652	TTD/TTY.
653	(l)  To implement develop and recommend a system that
654	prohibits capitated managed care plans, their representatives,
655	and providers employed by or contracted with the capitated
656	managed care plans from recruiting persons eligible for or
657	enrolled in Medicaid, from providing inducements to Medicaid
658	recipients to select a particular capitated managed care plan,
659	and from prejudicing Medicaid recipients against other capitated
660	managed care plans. The system shall require the entity
661	performing choice counseling to determine if the recipient has
662	made a choice of a plan or has opted out because of duress,
663	threats, payment to the recipient, or incentives promised to the
664	recipient by a third party. If the choice counseling entity
665	determines that the decision to choose a plan was unlawfully
666	influenced or a plan violated any of the provisions of s.
667	409.912(21), the choice counseling entity shall immediately
668	report the violation to the agency's program integrity section
669	for investigation. Verification of choice counseling by the
670	recipient shall include a stipulation that the recipient
671	acknowledges the provisions of this subsection.
672	(m)  To implement develop and recommend a choice counseling
673	system that promotes health literacy and provides information
674	aimed to reduce minority health disparities through outreach
675	activities for Medicaid recipients.
676	(n)  To develop and recommend a system for the agency to
677	contract with entities to perform choice counseling. The agency
678	may establish standards and performance contracts, including
679	standards requiring the contractor to hire choice counselors who
680	are representative of the state's diverse population and to
681	train choice counselors in working with culturally diverse
682	populations.
683	(o)  To implement determine and recommend descriptions of
684	the eligibility assignment processes which will be used to
685	facilitate client choice while ensuring pilot programs of
686	adequate enrollment levels. These processes shall ensure that
687	pilot sites have sufficient levels of enrollment to conduct a
688	valid test of the managed care pilot program within a 2-year
689	timeframe.
690	(p)  To implement standards for plan compliance, including,
691	but not limited to, quality assurance and performance
692	improvement standards, peer or professional review standards,
693	grievance policies, and program integrity policies.
694	(q)  To develop a data reporting system, seek input from
695	managed care plans to establish patient-encounter reporting
696	requirements, and ensure that the data reported is accurate and
697	complete.
698	(r)  To work with managed care plans to establish a uniform
699	system to measure and monitor outcomes of a recipient of
700	Medicaid services which shall use financial, clinical, and other
701	criteria based on pharmacy services, medical services, and other
702	data related to the provision of Medicaid services, including,
703	but not limited to:
704	1.  Health Plan Employer Data and Information Set (HEDIS)
705	or HEDIS measures specific to Medicaid.
706	2.  Member satisfaction.
707	3.  Provider satisfaction.
708	4.  Report cards on plan performance and best practices.
709	5.  Compliance with the prompt payment of claims
710	requirements provided in ss. 627.613, 641.3155, and 641.513.
711	6.  Utilization and quality data for the purpose of
712	ensuring access to medically necessary services, including
713	underutilization or inappropriate denial of services.
714	(s)  To require managed care plans that have contracted
715	with the agency to establish a quality assurance system that
716	incorporates the provisions of s. 409.912(27) and any standards,
717	rules, and guidelines developed by the agency.
718	(t)  To establish a patient-encounter database to compile
719	data on health care services rendered by health care
720	practitioners that provide services to patients enrolled in
721	managed care plans in the demonstration sites. Health care
722	practitioners and facilities in the demonstration sites shall
723	submit, and managed care plans participating in the
724	demonstration sites shall receive, claims payment and any other
725	information reasonably related to the patient-encounter database
726	electronically in a standard format as required by the agency.
727	The agency shall establish reasonable deadlines for phasing in
728	the electronic transmittal of full-encounter data. The patient-
729	encounter database shall:
730	1.  Collect the following information, if applicable, for
731	each type of patient encounter with a health care practitioner
732	or facility, including:
733	a.  The demographic characteristics of the patient.
734	b.  The principal, secondary, and tertiary diagnosis.
735	c.  The procedure performed.
736	d.  The date when and the location where the procedure was
737	performed.
738	e.  The amount of the payment for the procedure.
739	f.  The health care practitioner's universal identification
740	number.
741	g.  If the health care practitioner rendering the service
742	is a dependent practitioner, the modifiers appropriate to
743	indicate that the service was delivered by the dependent
744	practitioner.
745	2.  Collect appropriate information relating to
746	prescription drugs for each type of patient encounter.
747	3.  Collect appropriate information related to health care
748	costs and utilization from managed care plans participating in
749	the demonstration sites. To the extent practicable, the agency
750	shall utilize a standardized claim form or electronic transfer
751	system that is used by health care practitioners, facilities,
752	and payors. To develop and recommend a system to monitor the
753	provision of health care services in the pilot program,
754	including utilization and quality of health care services for
755	the purpose of ensuring access to medically necessary services.
756	This system shall include an encounter data-information system
757	that collects and reports utilization information. The system
758	shall include a method for verifying data integrity within the
759	database and within the provider's medical records.
760	(u)(q)  To implement recommend a grievance resolution
761	process for Medicaid recipients enrolled in a capitated managed
762	care network under the pilot program modeled after the
763	subscriber assistance panel, as created in s. 408.7056. This
764	process shall include a mechanism for an expedited review of no
765	greater than 24 hours after notification of a grievance if the
766	life of a Medicaid recipient is in imminent and emergent
767	jeopardy.
768	(v)(r)  To implement recommend a grievance resolution
769	process for health care providers employed by or contracted with
770	a capitated managed care network under the pilot program in
771	order to settle disputes among the provider and the managed care
772	network or the provider and the agency.
773	(w)(s)  To implement develop and recommend criteria in an
774	approved federal waiver to designate health care providers as
775	eligible to participate in the pilot program. The agency and
776	capitated managed care networks must follow national guidelines
777	for selecting health care providers, whenever available. These
778	criteria must include at a minimum those criteria specified in
779	s. 409.907.
780	(x)(t)  To use develop and recommend health care provider
781	agreements for participation in the pilot program.
782	(y)(u)  To require that all health care providers under
783	contract with the pilot program be duly licensed in the state,
784	if such licensure is available, and meet other criteria as may
785	be established by the agency. These criteria shall include at a
786	minimum those criteria specified in s. 409.907.
787	(z)(v)  To ensure that managed care organizations work
788	collaboratively develop and recommend agreements with other
789	state or local governmental programs or institutions for the
790	coordination of health care to eligible individuals receiving
791	services from such programs or institutions.
792	(aa)(w)  To implement procedures to minimize the risk of
793	Medicaid fraud and abuse in all plans operating in the Medicaid
794	managed care pilot program authorized in this section:
795	1.  The agency shall ensure that applicable provisions of
796	chapters 409, 414, 626, 641, and 932, relating to Medicaid fraud
797	and abuse, are applied and enforced at the demonstration sites.
798	2.  Providers shall have the necessary certification,
799	license, and credentials required by law and federal waiver.
800	3.  The agency shall ensure that the plan is in compliance
801	with the provisions of s. 409.912(21) and (22).
802	4.  The agency shall require each plan to establish program
803	integrity functions and activities to reduce the incidence of
804	fraud and abuse. Plans must report instances of fraud and abuse
805	pursuant to chapter 641.
806	5.  The plan shall have written administrative and
807	management procedures, including a mandatory compliance plan,
808	that are designed to guard against fraud and abuse. The plan
809	shall designate a compliance officer with sufficient experience
810	in health care.
811	6.a.  The agency shall require all managed care plan
812	contractors in the pilot program to report all instances of
813	suspected fraud and abuse. A failure to report instances of
814	suspected fraud and abuse is a violation of law and subject to
815	the penalties provided by law.
816	b.  An instance of fraud and abuse in the managed care
817	plan, including, but not limited to, defrauding the state health
818	care benefit program by misrepresentation of fact in reports,
819	claims, certifications, enrollment claims, demographic
820	statistics, and patient-encounter data; misrepresentation of the
821	qualifications of persons rendering health care and ancillary
822	services; bribery and false statements relating to the delivery
823	of health care; unfair and deceptive marketing practices; and
824	managed care false claims actions, is a violation of law and
825	subject to the penalties provided by law.
826	c.  The agency shall require all contractors to make all
827	files and relevant billing and claims data accessible to state
828	regulators and investigators and all such data shall be linked
829	into a unified system for seamless reviews and investigations.
830	To develop and recommend a system to oversee the activities of
831	pilot program participants, health care providers, capitated
832	managed care networks, and their representatives in order to
833	prevent fraud or abuse, overutilization or duplicative
834	utilization, underutilization or inappropriate denial of
835	services, and neglect of participants and to recover
836	overpayments as appropriate. For the purposes of this paragraph,
837	the terms "abuse" and "fraud" have the meanings as provided in
838	s. 409.913. The agency must refer incidents of suspected fraud,
839	abuse, overutilization and duplicative utilization, and
840	underutilization or inappropriate denial of services to the
841	appropriate regulatory agency.
842	(bb)(x)  To develop and provide actuarial and benefit
843	design analyses that indicate the effect on capitation rates and
844	benefits offered in the pilot program over a prospective 5-year
845	period based on the following assumptions:
846	1.  Growth in capitation rates which is limited to the
847	estimated growth rate in general revenue.
848	2.  Growth in capitation rates which is limited to the
849	average growth rate over the last 3 years in per-recipient
850	Medicaid expenditures.
851	3.  Growth in capitation rates which is limited to the
852	growth rate of aggregate Medicaid expenditures between the 2003-
853	2004 fiscal year and the 2004-2005 fiscal year.
854	(cc)(y)  To develop a mechanism to require capitated
855	managed care plans to reimburse qualified emergency service
856	providers, including, but not limited to, ambulance services, in
857	accordance with ss. 409.908 and 409.9128. The pilot program must
858	include a provision for continuing fee-for-service payments for
859	emergency services, including, but not limited to, individuals
860	who access ambulance services or emergency departments and who
861	are subsequently determined to be eligible for Medicaid
862	services.
863	(dd)(z)  To ensure develop a system whereby school
864	districts participating in the certified school match program
865	pursuant to ss. 409.908(21) and 1011.70 shall be reimbursed by
866	Medicaid, subject to the limitations of s. 1011.70(1), for a
867	Medicaid-eligible child participating in the services as
868	authorized in s. 1011.70, as provided for in s. 409.9071,
869	regardless of whether the child is enrolled in a capitated
870	managed care network. Capitated managed care networks must make
871	a good faith effort to execute agreements with school districts
872	regarding the coordinated provision of services authorized under
873	s. 1011.70. County health departments and federally qualified
874	health centers delivering school-based services pursuant to ss.
875	381.0056 and 381.0057 must be reimbursed by Medicaid for the
876	federal share for a Medicaid-eligible child who receives
877	Medicaid-covered services in a school setting, regardless of
878	whether the child is enrolled in a capitated managed care
879	network. Capitated managed care networks must make a good faith
880	effort to execute agreements with county health departments
881	regarding the coordinated provision of services to a Medicaid-
882	eligible child. To ensure continuity of care for Medicaid
883	patients, the agency, the Department of Health, and the
884	Department of Education shall develop procedures for ensuring
885	that a student's capitated managed care network provider
886	receives information relating to services provided in accordance
887	with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
888	(ee)(aa)  To implement develop and recommend a mechanism
889	whereby Medicaid recipients who are already enrolled in a
890	managed care plan or the MediPass program in the pilot areas
891	shall be offered the opportunity to change to capitated managed
892	care plans on a staggered basis, as defined by the agency. All
893	Medicaid recipients shall have 30 days in which to make a choice
894	of capitated managed care plans. Those Medicaid recipients who
895	do not make a choice shall be assigned to a capitated managed
896	care plan in accordance with paragraph (4)(a) and shall be
897	exempt from s. 409.9122. To facilitate continuity of care for a
898	Medicaid recipient who is also a recipient of Supplemental
899	Security Income (SSI), prior to assigning the SSI recipient to a
900	capitated managed care plan, the agency shall determine whether
901	the SSI recipient has an ongoing relationship with a provider or
902	capitated managed care plan, and, if so, the agency shall assign
903	the SSI recipient to that provider or capitated managed care
904	plan where feasible. Those SSI recipients who do not have such a
905	provider relationship shall be assigned to a capitated managed
906	care plan provider in accordance with paragraph (4)(a) and shall
907	be exempt from s. 409.9122.
908	(ff)(bb)  To develop and recommend a service delivery
909	alternative for children having chronic medical conditions which
910	establishes a medical home project to provide primary care
911	services to this population. The project shall provide
912	community-based primary care services that are integrated with
913	other subspecialties to meet the medical, developmental, and
914	emotional needs for children and their families. This project
915	shall include an evaluation component to determine impacts on
916	hospitalizations, length of stays, emergency room visits, costs,
917	and access to care, including specialty care and patient and
918	family satisfaction.
919	(gg)(cc)  To develop and recommend service delivery
920	mechanisms within capitated managed care plans to provide
921	Medicaid services as specified in ss. 409.905 and 409.906 to
922	persons with developmental disabilities sufficient to meet the
923	medical, developmental, and emotional needs of these persons.
924	(hh)(dd)  To develop and recommend service delivery
925	mechanisms within capitated managed care plans to provide
926	Medicaid services as specified in ss. 409.905 and 409.906 to
927	Medicaid-eligible children in foster care. These services must
928	be coordinated with community-based care providers as specified
929	in s. 409.1675, where available, and be sufficient to meet the
930	medical, developmental, and emotional needs of these children.
931	(4)(a)  A Medicaid recipient in the pilot area who is not
932	currently enrolled in a capitated managed care plan upon
933	implementation is not eligible for services as specified in ss.
934	409.905 and 409.906, for the amount of time that the recipient
935	does not enroll in a capitated managed care network. If a
936	Medicaid recipient has not enrolled in a capitated managed care
937	plan within 30 days after eligibility, the agency shall assign
938	the Medicaid recipient to a capitated managed care plan based on
939	the assessed needs of the recipient as determined by the agency
940	and shall be exempt from s. 409.9122. When making assignments,
941	the agency shall take into account the following criteria:
942	1.  A capitated managed care network has sufficient network
943	capacity to meet the needs of members.
944	2.  The capitated managed care network has previously
945	enrolled the recipient as a member, or one of the capitated
946	managed care network's primary care providers has previously
947	provided health care to the recipient.
948	3.  The agency has knowledge that the member has previously
949	expressed a preference for a particular capitated managed care
950	network as indicated by Medicaid fee-for-service claims data,
951	but has failed to make a choice.
952	4.  The capitated managed care network's primary care
953	providers are geographically accessible to the recipient's
954	residence.
955	(b)  When more than one capitated managed care network
956	provider meets the criteria specified in paragraph (3)(h), the
957	agency shall make recipient assignments consecutively by family
958	unit.
959	(c)  If a recipient is currently enrolled with a Medicaid
960	managed care organization that also operates an approved reform
961	plan within a pilot area and the recipient fails to choose a
962	plan during the reform enrollment process or during
963	redetermination of eligibility, the recipient shall be
964	automatically assigned by the agency into the most appropriate
965	reform plan operated by the recipient's current Medicaid managed
966	care organization. If the recipient's current managed care
967	organization does not operate a reform plan in the pilot area
968	that adequately meets the needs of the Medicaid recipient, the
969	agency shall use the auto assignment process as prescribed in
970	the Centers for Medicare and Medicaid Services Special Terms and
971	Conditions number 11-W-00206/4. All agency enrollment and choice
972	counseling materials shall communicate the provisions of this
973	paragraph to current managed care recipients.
974	(d)(c)  The agency may not engage in practices that are
975	designed to favor one capitated managed care plan over another
976	or that are designed to influence Medicaid recipients to enroll
977	in a particular capitated managed care network in order to
978	strengthen its particular fiscal viability.
979	(e)(d)  After a recipient has made a selection or has been
980	enrolled in a capitated managed care network, the recipient
981	shall have 90 days in which to voluntarily disenroll and select
982	another capitated managed care network. After 90 days, no
983	further changes may be made except for cause. Cause shall
984	include, but not be limited to, poor quality of care, lack of
985	access to necessary specialty services, an unreasonable delay or
986	denial of service, inordinate or inappropriate changes of
987	primary care providers, service access impairments due to
988	significant changes in the geographic location of services, or
989	fraudulent enrollment. The agency may require a recipient to use
990	the capitated managed care network's grievance process as
991	specified in paragraph (3)(g) prior to the agency's
992	determination of cause, except in cases in which immediate risk
993	of permanent damage to the recipient's health is alleged. The
994	grievance process, when used, must be completed in time to
995	permit the recipient to disenroll no later than the first day of
996	the second month after the month the disenrollment request was
997	made. If the capitated managed care network, as a result of the
998	grievance process, approves an enrollee's request to disenroll,
999	the agency is not required to make a determination in the case.
1000	The agency must make a determination and take final action on a
1001	recipient's request so that disenrollment occurs no later than
1002	the first day of the second month after the month the request
1003	was made. If the agency fails to act within the specified
1004	timeframe, the recipient's request to disenroll is deemed to be
1005	approved as of the date agency action was required. Recipients
1006	who disagree with the agency's finding that cause does not exist
1007	for disenrollment shall be advised of their right to pursue a
1008	Medicaid fair hearing to dispute the agency's finding.
1009	(f)(e)  The agency shall apply for federal waivers from the
1010	Centers for Medicare and Medicaid Services to lock eligible
1011	Medicaid recipients into a capitated managed care network for 12
1012	months after an open enrollment period. After 12 months of
1013	enrollment, a recipient may select another capitated managed
1014	care network. However, nothing shall prevent a Medicaid
1015	recipient from changing primary care providers within the
1016	capitated managed care network during the 12-month period.
1017	(g)(f)  The agency shall apply for federal waivers from the
1018	Centers for Medicare and Medicaid Services to allow recipients
1019	to purchase health care coverage through an employer-sponsored
1020	health insurance plan instead of through a Medicaid-certified
1021	plan. This provision shall be known as the opt-out option.
1022	1.  A recipient who chooses the Medicaid opt-out option
1023	shall have an opportunity for a specified period of time, as
1024	authorized under a waiver granted by the Centers for Medicare
1025	and Medicaid Services, to select and enroll in a Medicaid-
1026	certified plan. If the recipient remains in the employer-
1027	sponsored plan after the specified period, the recipient shall
1028	remain in the opt-out program for at least 1 year or until the
1029	recipient no longer has access to employer-sponsored coverage,
1030	until the employer's open enrollment period for a person who
1031	opts out in order to participate in employer-sponsored coverage,
1032	or until the person is no longer eligible for Medicaid,
1033	whichever time period is shorter.
1034	2.  Notwithstanding any other provision of this section,
1035	coverage, cost sharing, and any other component of employer-
1036	sponsored health insurance shall be governed by applicable state
1037	and federal laws.
1038	(5)  This section does not authorize the agency to
1039	implement any provision of s. 1115 of the Social Security Act
1040	experimental, pilot, or demonstration project waiver to reform
1041	the state Medicaid program in any part of the state other than
1042	the two geographic areas specified in this section unless
1043	approved by the Legislature.
1044	(5)(6)  The agency shall develop and submit for approval
1045	applications for waivers of applicable federal laws and
1046	regulations as necessary to implement the managed care pilot
1047	project as defined in this section. The agency shall post all
1048	waiver applications under this section on its Internet website
1049	30 days before submitting the applications to the United States
1050	Centers for Medicare and Medicaid Services. All waiver
1051	applications shall be provided for review and comment to the
1052	appropriate committees of the Senate and House of
1053	Representatives for at least 10 working days prior to
1054	submission. All waivers submitted to and approved by the United
1055	States Centers for Medicare and Medicaid Services under this
1056	section must be approved by the Legislature. Federally approved
1057	waivers must be submitted to the President of the Senate and the
1058	Speaker of the House of Representatives for referral to the
1059	appropriate legislative committees. The appropriate committees
1060	shall recommend whether to approve the implementation of any
1061	waivers to the Legislature as a whole. The agency shall submit a
1062	plan containing a recommended timeline for implementation of any
1063	waivers and budgetary projections of the effect of the pilot
1064	program under this section on the total Medicaid budget for the
1065	2006-2007 through 2009-2010 state fiscal years. This
1066	implementation plan shall be submitted to the President of the
1067	Senate and the Speaker of the House of Representatives at the
1068	same time any waivers are submitted for consideration by the
1069	Legislature. The agency is authorized to implement the waiver
1070	and Centers for Medicare and Medicaid Services Special Terms and
1071	Conditions number 11-W-00206/4. If the agency seeks approval by
1072	the Federal Government of any modifications to these special
1073	terms and conditions, the agency shall provide written
1074	notification of its intent to modify these terms and conditions
1075	to the President of the Senate and Speaker of the House of
1076	Representatives at least 15 days prior to submitting the
1077	modifications to the Federal Government for consideration. The
1078	notification shall identify all modifications being pursued and
1079	the reason they are needed. Upon receiving federal approval of
1080	any modifications to the special terms and conditions, the
1081	agency shall report to the Legislature describing the federally
1082	approved modifications to the special terms and conditions
1083	within 7 days after their approval by the Federal Government.
1084	(6)(7)  Upon review and approval of the applications for
1085	waivers of applicable federal laws and regulations to implement
1086	the managed care pilot program by the Legislature, the agency
1087	may initiate adoption of rules pursuant to ss. 120.536(1) and
1088	120.54 to implement and administer the managed care pilot
1089	program as provided in this section.
1090	(7)(a)  The Secretary of Health Care Administration shall
1091	convene a technical advisory panel to advise the agency in the
1092	following areas:  risk-adjusted rate setting, benefit design,
1093	and choice counseling. The panel shall include representatives
1094	from the Florida Association of Health Plans, representatives
1095	from provider-sponsored networks, and a representative from the
1096	Office of Insurance Regulation.
1097	(b)  The technical advisory panel shall advise the agency
1098	on the following:
1099	1.  The risk-adjusted rate methodology to be used by the
1100	agency including recommendations on mechanisms to recognize the
1101	risk of all Medicaid enrollees and transitioning to a risk-
1102	adjustment system, including recommendations for phasing in risk
1103	adjustment and the uses of risk corridors.
1104	2.  Implementation of an encounter data system to be used
1105	for risk-adjusted rates.
1106	3.  Administrative and implementation issues regarding the
1107	use of risk-adjusted rates, including, but not limited to, cost,
1108	simplicity, client privacy, data accuracy, and data exchange.
1109	4.  Benefit design issues, including the actuarial
1110	equivalence and sufficiency standards to be used.
1111	5.  The implementation plan for the proposed choice
1112	counseling system, including the information and materials to be
1113	provided to recipients, the methodologies by which recipients
1114	will be counseled regarding choices, criteria to be used to
1115	assess plan quality, the methodology to be used to assign
1116	recipients to plans if they fail to choose a managed care plan,
1117	and the standards to be used for responsiveness to recipient
1118	inquiries.
1119	(c)  The technical advisory panel shall continue in
1120	existence and advise the secretary on matters outlined in this
1121	subsection.
1122	(8)  The agency must ensure in the first 2 state fiscal
1123	years in which a risk-adjusted methodology is a component of
1124	rate setting that no managed care plan providing comprehensive
1125	benefits to TANF and SSI recipients has an aggregate risk score
1126	that varies by more than 10 percent from the aggregate weighted
1127	mean of all managed care plans providing comprehensive benefits
1128	to TANF and SSI recipients in a reform area. The agency's
1129	payment to a managed care plan shall be based on such revised
1130	aggregate risk score.
1131	(9)  After any calculations of aggregate risk scores or
1132	revised aggregate risk scores pursuant to subsection (8), the
1133	capitation rates for plans participating under 409.91211 shall
1134	be phased in as follows:
1135	(a)  In the first fiscal year, the capitation rates shall
1136	be weighted so that 75 percent of each capitation rate is based
1137	on the current methodology and 25 percent is based upon a new
1138	risk-adjusted capitation rate methodology.
1139	(b)  In the second fiscal year, the capitation rates shall
1140	be weighted so that 50 percent of each capitation rate is based
1141	on the current methodology and 50 percent is based on a new
1142	risk-adjusted rate methodology.
1143	(c)  In the following fiscal year, the risk-adjusted
1144	capitation methodology may be fully implemented.
1145	(10)  Subsections (8) and (9) shall not apply to managed
1146	care plans offering benefits exclusively to high-risk, specialty
1147	populations. The agency shall have the discretion to set risk-
1148	adjusted rates immediately for said plans.
1149	(11)  Prior to the implementation of risk-adjusted rates,
1150	rates shall be certified by an actuary and approved by the
1151	federal Centers for Medicare and Medicaid Services.
1152	(12)  For purposes of this section, the term "capitated
1153	managed care plan" includes health insurers authorized under
1154	chapter 624, exclusive provider organizations authorized under
1155	chapter 627, health maintenance organizations authorized under
1156	chapter 641, the Children's Medical Services Network authorized
1157	under chapter 391, and provider service networks that elect to
1158	be paid fee-for-service for up to 3 years as authorized under
1159	this section.
1160	(13)  It is the intent of the Legislature that if any
1161	conflict exists between the provisions contained in this section
1162	and other provisions of chapter 409, as they relate to
1163	implementation of the Medicaid managed care pilot program, the
1164	provisions contained in this section shall control. The agency
1165	shall provide a written report to the President of the Senate
1166	and the Speaker of the House of Representatives by April 1,
1167	2006, identifying any provisions of chapter 409 that conflict
1168	with the implementation of the Medicaid managed care pilot
1169	program as created in this section. After April 1, 2006, the
1170	agency shall provide a written report to the President of the
1171	Senate and the Speaker of the House of Representatives
1172	immediately upon identifying any provisions of chapter 409 that
1173	conflict with the implementation of the Medicaid managed care
1174	pilot program as created in this section.
1175	Section 5.  Section 409.91212, Florida Statutes, is created
1176	to read:
1177	409.91212  Medicaid reform demonstration program
1178	expansion.--
1179	(1)  The agency may expand the Medicaid reform
1180	demonstration program pursuant to s. 409.91211 into any county
1181	of the state beginning in year two of the demonstration program
1182	if readiness criteria are met, the Joint Legislative Committee
1183	on Medicaid Reform Implementation has submitted a recommendation
1184	pursuant to s. 11.72 regarding the extent to which the criteria
1185	have been met, and the agency has secured budget approval from
1186	the Legislative Budget Commission pursuant to s. 11.90. For the
1187	purpose of this section, the term "readiness" means there is
1188	evidence that at least two programs in a county meet the
1189	following criteria:
1190	(a)  Demonstrate knowledge and understanding of managed
1191	care under the framework of Medicaid reform.
1192	(b)  Demonstrate financial capability to meet solvency
1193	standards.
1194	(c)  Demonstrate adequate controls and process for
1195	financial management.
1196	(d)  Demonstrate the capability for clinical management of
1197	Medicaid recipients.
1198	(e)  Demonstrate the adequacy, capacity, and accessibility
1199	of the services network.
1200	(f)  Demonstrate the capability to operate a management
1201	information system and an encounter data system.
1202	(g)  Demonstrate capability to implement quality assurance
1203	and utilization management activities.
1204	(h)  Demonstrate capability to implement fraud control
1205	activities.
1206	(2)  The agency shall conduct meetings and public hearings
1207	in the targeted expansion county with the public and provider
1208	community. The agency shall provide notice regarding public
1209	hearings. The agency shall maintain records of the proceedings.
1210	(3)  The agency shall provide a 30-day notice of intent to
1211	expand the demonstration program with supporting documentation
1212	that the readiness criteria has been met to the President of the
1213	Senate, the Speaker of the House of Representatives, the
1214	Minority Leader of the Senate, the Minority Leader of the House
1215	of Representatives, and the Office of Program Policy Analysis
1216	and Government Accountability.
1217	(4)  The agency shall request a hearing and consideration
1218	by the Joint Legislative Committee on Medicaid Reform
1219	Implementation after the 30-day notice required in subsection
1220	(3) has expired in the form of a letter to the chair of the
1221	committee.
1222	(5)  Upon receiving a memorandum from the Joint Legislative
1223	Committee on Medicaid Reform Implementation regarding the extent
1224	to which the expansion criteria pursuant to subsection (1) have
1225	been met, the agency may submit a budget amendment, pursuant to
1226	chapter 216, to request the necessary budget transfers
1227	associated with the expansion of the demonstration program.
1228	Section 6.  Subsections (8) through (14) of section
1229	409.9122, Florida Statutes, are renumbered as subsections (7)
1230	through (13), respectively, and paragraphs (e), (f), (g), (h),
1231	(k), and (l) of subsection (2) and present subsection (7) of
1232	that section are amended to read:
1233	409.9122  Mandatory Medicaid managed care enrollment;
1234	programs and procedures.--
1235	(2)
1236	(e)  Medicaid recipients who are already enrolled in a
1237	managed care plan or MediPass shall be offered the opportunity
1238	to change managed care plans or MediPass providers on a
1239	staggered basis, as defined by the agency. All Medicaid
1240	recipients shall have 30 days in which to make a choice of
1241	managed care plans or MediPass providers. Those Medicaid
1242	recipients who do not make a choice shall be assigned to a
1243	managed care plan or MediPass in accordance with paragraph (f).
1244	To facilitate continuity of care, for a Medicaid recipient who
1245	is also a recipient of Supplemental Security Income (SSI), prior
1246	to assigning the SSI recipient to a managed care plan or
1247	MediPass, the agency shall determine whether the SSI recipient
1248	has an ongoing relationship with a MediPass provider or managed
1249	care plan, and if so, the agency shall assign the SSI recipient
1250	to that MediPass provider or managed care plan. Those SSI
1251	recipients who do not have such a provider relationship shall be
1252	assigned to a managed care plan or MediPass provider in
1253	accordance with paragraph (f).
1254	(f)  When a Medicaid recipient does not choose a managed
1255	care plan or MediPass provider, the agency shall assign the
1256	Medicaid recipient to a managed care plan or MediPass provider.
1257	Medicaid recipients who are subject to mandatory assignment but
1258	who fail to make a choice shall be assigned to managed care
1259	plans until an enrollment of 40 percent in MediPass and 60
1260	percent in managed care plans is achieved. Once this enrollment
1261	is achieved, the assignments shall be divided in order to
1262	maintain an enrollment in MediPass and managed care plans which
1263	is in a 40 percent and 60 percent proportion, respectively.
1264	Thereafter, assignment of Medicaid recipients who fail to make a
1265	choice shall be based proportionally on the preferences of
1266	recipients who have made a choice in the previous period. Such
1267	proportions shall be revised at least quarterly to reflect an
1268	update of the preferences of Medicaid recipients. The agency
1269	shall disproportionately assign Medicaid-eligible recipients who
1270	are required to but have failed to make a choice of managed care
1271	plan or MediPass, including children, and who are to be assigned
1272	to the MediPass program to children's networks as described in
1273	s. 409.912(4)(g), Children's Medical Services Network as defined
1274	in s. 391.021, exclusive provider organizations, provider
1275	service networks, minority physician networks, and pediatric
1276	emergency department diversion programs authorized by this
1277	chapter or the General Appropriations Act, in such manner as the
1278	agency deems appropriate, until the agency has determined that
1279	the networks and programs have sufficient numbers to be
1280	economically operated. For purposes of this paragraph, when
1281	referring to assignment, the term "managed care plans" includes
1282	health maintenance organizations, exclusive provider
1283	organizations, provider service networks, minority physician
1284	networks, Children's Medical Services Network, and pediatric
1285	emergency department diversion programs authorized by this
1286	chapter or the General Appropriations Act. When making
1287	assignments, the agency shall take into account the following
1288	criteria:
1289	1.  A managed care plan has sufficient network capacity to
1290	meet the need of members.
1291	2.  The managed care plan or MediPass has previously
1292	enrolled the recipient as a member, or one of the managed care
1293	plan's primary care providers or MediPass providers has
1294	previously provided health care to the recipient.
1295	3.  The agency has knowledge that the member has previously
1296	expressed a preference for a particular managed care plan or
1297	MediPass provider as indicated by Medicaid fee-for-service
1298	claims data, but has failed to make a choice.
1299	4.  The managed care plan is plan's or MediPass primary
1300	care providers are geographically accessible to the recipient's
1301	residence.
1302	5.  The agency has authority to make mandatory assignments
1303	based on quality of service and performance of managed care
1304	plans.
1305	(g)  When more than one managed care plan or MediPass
1306	provider meets the criteria specified in paragraph (f), the
1307	agency shall make recipient assignments consecutively by family
1308	unit.
1309	(h)  The agency may not engage in practices that are
1310	designed to favor one managed care plan over another or that are
1311	designed to influence Medicaid recipients to enroll in MediPass
1312	rather than in a managed care plan or to enroll in a managed
1313	care plan rather than in MediPass. This subsection does not
1314	prohibit the agency from reporting on the performance of
1315	MediPass or any managed care plan, as measured by performance
1316	criteria developed by the agency.
1317	(k)  When a Medicaid recipient does not choose a managed
1318	care plan or MediPass provider, the agency shall assign the
1319	Medicaid recipient to a managed care plan, except in those
1320	counties in which there are fewer than two managed care plans
1321	accepting Medicaid enrollees, in which case assignment shall be
1322	to a managed care plan or a MediPass provider. Medicaid
1323	recipients in counties with fewer than two managed care plans
1324	accepting Medicaid enrollees who are subject to mandatory
1325	assignment but who fail to make a choice shall be assigned to
1326	managed care plans until an enrollment of 40 percent in MediPass
1327	and 60 percent in managed care plans is achieved. Once that
1328	enrollment is achieved, the assignments shall be divided in
1329	order to maintain an enrollment in MediPass and managed care
1330	plans which is in a 40 percent and 60 percent proportion,
1331	respectively. In service areas 1 and 6 of the Agency for Health
1332	Care Administration where the agency is contracting for the
1333	provision of comprehensive behavioral health services through a
1334	capitated prepaid arrangement, recipients who fail to make a
1335	choice shall be assigned equally to MediPass or a managed care
1336	plan. For purposes of this paragraph, when referring to
1337	assignment, the term "managed care plans" includes exclusive
1338	provider organizations, provider service networks, Children's
1339	Medical Services Network, minority physician networks, and
1340	pediatric emergency department diversion programs authorized by
1341	this chapter or the General Appropriations Act. When making
1342	assignments, the agency shall take into account the following
1343	criteria:
1344	1.  A managed care plan has sufficient network capacity to
1345	meet the need of members.
1346	2.  The managed care plan or MediPass has previously
1347	enrolled the recipient as a member, or one of the managed care
1348	plan's primary care providers or MediPass providers has
1349	previously provided health care to the recipient.
1350	3.  The agency has knowledge that the member has previously
1351	expressed a preference for a particular managed care plan or
1352	MediPass provider as indicated by Medicaid fee-for-service
1353	claims data, but has failed to make a choice.
1354	4.  The managed care plan's or MediPass primary care
1355	providers are geographically accessible to the recipient's
1356	residence.
1357	5.  The agency has authority to make mandatory assignments
1358	based on quality of service and performance of managed care
1359	plans.
1360	(k)(l)  Notwithstanding the provisions of chapter 287, the
1361	agency may, at its discretion, renew cost-effective contracts
1362	for choice counseling services once or more for such periods as
1363	the agency may decide. However, all such renewals may not
1364	combine to exceed a total period longer than the term of the
1365	original contract.
1366	(7)  The agency shall investigate the feasibility of
1367	developing managed care plan and MediPass options for the
1368	following groups of Medicaid recipients:
1369	(a)  Pregnant women and infants.
1370	(b)  Elderly and disabled recipients, especially those who
1371	are at risk of nursing home placement.
1372	(c)  Persons with developmental disabilities.
1373	(d)  Qualified Medicare beneficiaries.
1374	(e)  Adults who have chronic, high-cost medical conditions.
1375	(f)  Adults and children who have mental health problems.
1376	(g)  Other recipients for whom managed care plans and
1377	MediPass offer the opportunity of more cost-effective care and
1378	greater access to qualified providers.
1379	Section 7.  The Agency for Health Care Administration shall
1380	report to the Legislature by April 1, 2006, the specific
1381	preimplementation milestones required by the Centers for
1382	Medicare and Medicaid Services Special Terms and Conditions
1383	related to the low income pool that have been approved by the
1384	Federal Government and the status of any remaining
1385	preimplementation milestones that have not been approved by the
1386	Federal Government.
1387	Section 8.  Quarterly progress and annual reports.--The
1388	Agency for Health Care Administration shall submit to the
1389	Governor, the President of the Senate, the Speaker of the House
1390	of Representatives, the Minority Leader of the Senate, the
1391	Minority Leader of the House of Representatives, and the Office
1392	of Program Policy Analysis and Government Accountability the
1393	following reports:
1394	(1)  Quarterly progress reports submitted to Centers for
1395	Medicare and Medicaid Services no later than 60 days following
1396	the end of each quarter. These reports shall present the
1397	agency's analysis and the status of various operational areas.
1398	The quarterly progress reports shall include, but are not
1399	limited to, the following:
1400	(a)  Documentation of events that occurred during the
1401	quarter or that are anticipated to occur in the near future that
1402	affect health care delivery, including, but not limited to, the
1403	approval of contracts with new managed care plans, the
1404	procedures for designating coverage areas, the process of
1405	phasing in managed care, a description of the populations served
1406	and the benefits provided, the number of recipients enrolled, a
1407	list of grievances submitted by enrollees, and other operational
1408	issues.
1409	(b)  Action plans for addressing policy and administrative
1410	issues.
1411	(c)  Documentation of agency efforts related to the
1412	collection and verification of encounter and utilization data.
1413	(d)  Enrollment data for each managed care plan according
1414	to the following specifications: total number of enrollees,
1415	eligibility category, number of enrollees receiving Temporary
1416	Assistance for Needy Families or Supplemental Security Income,
1417	market share, and percentage change in enrollment. In addition,
1418	the agency shall provide a summary of voluntary and mandatory
1419	selection rates and disenrollment data. Enrollment data, number
1420	of members by month, and expenditures shall be submitted in the
1421	format for monitoring budget neutrality provided by the Centers
1422	for Medicare and Medicaid Services.
1423	(e)  Documentation of low income pool activities and
1424	associated expenditures.
1425	(f)  Documentation of activities related to the
1426	implementation of choice counseling including efforts to improve
1427	health literacy and the methods used to obtain public input
1428	including recipient focus groups.
1429	(g)  Participation rates in the Enhanced Benefit Accounts
1430	Program, as established in the Centers for Medicare and Medicaid
1431	Services Special Terms and Conditions number 11-W-00206/4, which
1432	shall include: participation levels, summary of activities and
1433	associated expenditures, number of accounts established
1434	including active participants and individuals who continue to
1435	retain access to funds in an account but no longer actively
1436	participate, estimated quarterly deposits in accounts, and
1437	expenditures from the accounts.
1438	(h)  Enrollment data on employer-sponsored insurance that
1439	documents the number of individuals selecting to opt out when
1440	employer-sponsored insurance is available. The agency shall
1441	include data that identifies enrollee characteristics to include
1442	eligibility category, type of employer-sponsored insurance, and
1443	type of coverage based on whether the coverage is for the
1444	individual or the family. The agency shall develop and maintain
1445	disenrollment reports specifying the reason for disenrolling in
1446	an employer-sponsored insurance program. The agency shall also
1447	track and report on those enrollees who elect to reenroll in the
1448	Medicaid reform waiver demonstration program.
1449	(i)  Documentation of progress toward the demonstration
1450	program goals.
1451	(j)  Documentation of evaluation activities.
1452	(2)  The annual report shall document accomplishments,
1453	program status, quantitative and case study findings,
1454	utilization data, and policy and administrative difficulties in
1455	the operation of the Medicaid reform waiver demonstration
1456	program. The agency shall submit the draft annual report no
1457	later than October 1 after the end of each fiscal year.
1458	(a)  Beginning with the annual report for demonstration
1459	program year two, the agency shall include a section on the
1460	administration of enhanced benefit accounts, participation
1461	rates, an assessment of expenditures, and potential cost
1462	savings.
1463	(b)  Beginning with the annual report for demonstration
1464	program year four, the agency shall include a section that
1465	provides qualitative and quantitative data that describes the
1466	impact of the low income pool on the number of uninsured persons
1467	in the state from the start of the implementation of the
1468	demonstration program.
1469	Section 9.  Section 11.72, Florida Statutes, is created to
1470	read:
1471	11.72  Joint Legislative Committee on Medicaid Reform
1472	Implementation; creation; membership; powers; duties.--
1473	(1)  There is created a standing joint committee of the
1474	Legislature designated the Joint Legislative Committee on
1475	Medicaid Reform Implementation for the purpose of reviewing
1476	policy issues related to expansion of the Medicaid managed care
1477	pilot program pursuant to s. 409.91211.
1478	(2)  The Joint Legislative Committee on Medicaid Reform
1479	Implementation shall be composed of eight members appointed as
1480	follows: four members of the House of Representatives appointed
1481	by the Speaker of the House of Representatives, one of whom
1482	shall be a member of the minority party; and four members of the
1483	Senate appointed by the President of the Senate, one of whom
1484	shall be a member of the minority party. The President of the
1485	Senate shall appoint the chair in even-numbered years and the
1486	vice chair in odd-numbered years, and the Speaker of the House
1487	of Representatives shall appoint the chair in odd-numbered years
1488	and the vice chair in even-numbered years from among the
1489	committee membership. Vacancies shall be filled in the same
1490	manner as the original appointment. Members shall serve without
1491	compensation, except that members are entitled to reimbursement
1492	for per diem and travel expenses in accordance with s. 112.061.
1493	(3)  The committee shall be governed by joint rules of the
1494	Senate and the House of Representatives which shall remain in
1495	effect until repealed or amended by concurrent resolution.
1496	(4)  The committee shall meet at the call of the chair. The
1497	committee may hold hearings on matters within its purview which
1498	are in the public interest. A quorum shall consist of a majority
1499	of members from each house, plus one additional member from
1500	either house. Action by the committee requires a majority vote
1501	of the members present of each house.
1502	(5)  The committee shall be jointly staffed by the
1503	appropriations and substantive committees of the House of
1504	Representatives and the Senate. During even-numbered years the
1505	Senate shall serve as lead staff and during odd-numbered years
1506	the House of Representatives shall serve as lead staff.
1507	(6)  The committee shall:
1508	(a)  Review reports, public hearing proceedings, documents,
1509	and materials provided by the Agency for Health Care
1510	Administration relating to the expansion of the Medicaid managed
1511	care pilot program to other counties of the state pursuant to s.
1512	409.91212.
1513	(b)  Consult with the substantive and fiscal committees of
1514	the House of Representatives and the Senate which have
1515	jurisdiction over the Medicaid matters relating to agency action
1516	to expand the Medicaid managed care pilot program.
1517	(c)  Meet to consider and make a recommendation regarding
1518	the extent to which the expansion criteria pursuant to s.
1519	409.91212 have been met.
1520	(7)  Within 2 days after meeting, during which the
1521	committee reviewed documents, material, and testimony related to
1522	the expansion criteria, the committee shall submit a memorandum
1523	to the Speaker of the House of Representatives, the President of
1524	the Senate, the Legislative Budget Commission, and the agency
1525	delineating the extent to which the agency met the expansion
1526	criteria.
1527	Section 10.  Section 216.346, Florida Statutes, is amended
1528	to read:
1529	216.346  Contracts between state agencies; restriction on
1530	overhead or other indirect costs.--In any contract between state
1531	agencies, including any contract involving the State University
1532	System or the Florida Community College System, the agency
1533	receiving the contract or grant moneys shall charge no more than
1534	a reasonable percentage 5 percent of the total cost of the
1535	contract or grant for overhead or indirect costs or any other
1536	costs not required for the payment of direct costs. This
1537	provision is not intended to limit an agency's ability to
1538	certify matching funds or designate in-kind contributions which
1539	will allow the drawdown of federal Medicaid dollars that do not
1540	affect state budgeting.
1541	Section 11.  This act shall take effect upon becoming a
1542	law.

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