Amendment
Bill No. 5007

Amendment No. 317461

CHAMBER ACTION
Senate		House
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1	Representative(s) Brown offered the following:
2
3	Amendment (with directory and title amendments)
4	Between line(s) 612 and 613, insert:
5	(4)  The agency may contract with:
6	(b)  An entity that is providing comprehensive behavioral
7	health care services to certain Medicaid recipients through a
8	capitated, prepaid arrangement pursuant to the federal waiver
9	provided for by s. 409.905(5). Such an entity must be licensed
10	under chapter 624, chapter 636, or chapter 641 and must possess
11	the clinical systems and operational competence to manage risk
12	and provide comprehensive behavioral health care to Medicaid
13	recipients. As used in this paragraph, the term "comprehensive
14	behavioral health care services" means covered mental health and
15	substance abuse treatment services that are available to
16	Medicaid recipients. The secretary of the Department of Children
17	and Family Services shall approve provisions of procurements
18	related to children in the department's care or custody prior to
19	enrolling such children in a prepaid behavioral health plan. Any
20	contract awarded under this paragraph must be competitively
21	procured. In developing the behavioral health care prepaid plan
22	procurement document, the agency shall ensure that the
23	procurement document requires the contractor to develop and
24	implement a plan to ensure compliance with s. 394.4574 related
25	to services provided to residents of licensed assisted living
26	facilities that hold a limited mental health license. Except as
27	provided in subparagraph 8., and except in counties where the
28	Medicaid managed care pilot program is authorized pursuant to s.
29	409.91211, the agency shall seek federal approval to contract
30	with a single entity meeting these requirements to provide
31	comprehensive behavioral health care services to all Medicaid
32	recipients not enrolled in a Medicaid managed care plan
33	authorized under s. 409.91211 or a Medicaid health maintenance
34	organization in an AHCA area. In an AHCA area where the Medicaid
35	managed care pilot program is authorized pursuant to s.
36	409.91211 in one or more counties, the agency may procure a
37	contract with a single entity to serve the remaining counties as
38	an AHCA area or the remaining counties may be included with an
39	adjacent AHCA area and shall be subject to this paragraph. Each
40	entity must offer sufficient choice of providers in its network
41	to ensure recipient access to care and the opportunity to select
42	a provider with whom they are satisfied. The network shall
43	include all public mental health hospitals. To ensure unimpaired
44	access to behavioral health care services by Medicaid
45	recipients, all contracts issued pursuant to this paragraph
46	shall require 80 percent of the capitation paid to the managed
47	care plan, including health maintenance organizations, to be
48	expended for the provision of behavioral health care services.
49	In the event the managed care plan expends less than 80 percent
50	of the capitation paid pursuant to this paragraph for the
51	provision of behavioral health care services, the difference
52	shall be returned to the agency. The agency shall provide the
53	managed care plan with a certification letter indicating the
54	amount of capitation paid during each calendar year for the
55	provision of behavioral health care services pursuant to this
56	section. the agency may reimburse for substance abuse treatment
57	services on a fee-for-service basis until the agency finds that
58	adequate funds are available for capitated, prepaid
59	arrangements.
60	1.  By January 1, 2001, the agency shall modify the
61	contracts with the entities providing comprehensive inpatient
62	and outpatient mental health care services to Medicaid
63	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
64	Counties, to include substance abuse treatment services.
65	2.  By July 1, 2003, the agency and the Department of
66	Children and Family Services shall execute a written agreement
67	that requires collaboration and joint development of all policy,
68	budgets, procurement documents, contracts, and monitoring plans
69	that have an impact on the state and Medicaid community mental
70	health and targeted case management programs.
71	3.  Except as provided in subparagraph 8., by July 1, 2006,
72	the agency and the Department of Children and Family Services
73	shall contract with managed care entities in each AHCA area
74	except area 6 or arrange to provide comprehensive inpatient and
75	outpatient mental health and substance abuse services through
76	capitated prepaid arrangements to all Medicaid recipients who
77	are eligible to participate in such plans under federal law and
78	regulation. In AHCA areas where eligible individuals number less
79	than 150,000, the agency shall contract with a single managed
80	care plan to provide comprehensive behavioral health services to
81	all recipients who are not enrolled in a Medicaid health
82	maintenance organization or a Medicaid capitated managed care
83	plan authorized under s. 409.91211. The agency may contract with
84	more than one comprehensive behavioral health provider to
85	provide care to recipients who are not enrolled in a Medicaid
86	capitated managed care plan authorized under s. 409.91211 or a
87	Medicaid health maintenance organization in AHCA areas where the
88	eligible population exceeds 150,000. In an AHCA area where the
89	Medicaid managed care pilot program is authorized pursuant to s.
90	409.91211 in one or more counties, the agency may procure a
91	contract with a single entity to serve the remaining counties as
92	an AHCA area or the remaining counties may be included with an
93	adjacent AHCA area and shall be subject to this paragraph.
94	Contracts for comprehensive behavioral health providers awarded
95	pursuant to this section shall be competitively procured. Both
96	for-profit and not-for-profit corporations shall be eligible to
97	compete. Managed care plans contracting with the agency under
98	subsection (3) shall provide and receive payment for the same
99	comprehensive behavioral health benefits as provided in AHCA
100	rules, including handbooks incorporated by reference. In AHCA
101	area 11, the agency shall contract with at least two
102	comprehensive behavioral health care providers to provide
103	behavioral health care to recipients in that area who are
104	enrolled in, or assigned to, the MediPass program. One of the
105	behavioral health care contracts shall be with the existing
106	provider service network pilot project, as described in
107	paragraph (d), for the purpose of demonstrating the cost-
108	effectiveness of the provision of quality mental health services
109	through a public hospital-operated managed care model. Payment
110	shall be at an agreed-upon capitated rate to ensure cost
111	savings. Of the recipients in area 11 who are assigned to
112	MediPass under the provisions of s. 409.9122(2)(k), a minimum of
113	50,000 of those MediPass-enrolled recipients shall be assigned
114	to the existing provider service network in area 11 for their
115	behavioral care.
116	4.  By October 1, 2003, the agency and the department shall
117	submit a plan to the Governor, the President of the Senate, and
118	the Speaker of the House of Representatives which provides for
119	the full implementation of capitated prepaid behavioral health
120	care in all areas of the state.
121	a.  Implementation shall begin in 2003 in those AHCA areas
122	of the state where the agency is able to establish sufficient
123	capitation rates.
124	b.  If the agency determines that the proposed capitation
125	rate in any area is insufficient to provide appropriate
126	services, the agency may adjust the capitation rate to ensure
127	that care will be available. The agency and the department may
128	use existing general revenue to address any additional required
129	match but may not over-obligate existing funds on an annualized
130	basis.
131	c.  Subject to any limitations provided for in the General
132	Appropriations Act, the agency, in compliance with appropriate
133	federal authorization, shall develop policies and procedures
134	that allow for certification of local and state funds.
135	5.  Children residing in a statewide inpatient psychiatric
136	program, or in a Department of Juvenile Justice or a Department
137	of Children and Family Services residential program approved as
138	a Medicaid behavioral health overlay services provider shall not
139	be included in a behavioral health care prepaid health plan or
140	any other Medicaid managed care plan pursuant to this paragraph.
141	6.  In converting to a prepaid system of delivery, the
142	agency shall in its procurement document require an entity
143	providing only comprehensive behavioral health care services to
144	prevent the displacement of indigent care patients by enrollees
145	in the Medicaid prepaid health plan providing behavioral health
146	care services from facilities receiving state funding to provide
147	indigent behavioral health care, to facilities licensed under
148	chapter 395 which do not receive state funding for indigent
149	behavioral health care, or reimburse the unsubsidized facility
150	for the cost of behavioral health care provided to the displaced
151	indigent care patient.
152	7.  Traditional community mental health providers under
153	contract with the Department of Children and Family Services
154	pursuant to part IV of chapter 394, child welfare providers
155	under contract with the Department of Children and Family
156	Services in areas 1 and 6, and inpatient mental health providers
157	licensed pursuant to chapter 395 must be offered an opportunity
158	to accept or decline a contract to participate in any provider
159	network for prepaid behavioral health services.
160	8.  For fiscal year 2004-2005, all Medicaid eligible
161	children, except children in areas 1 and 6, whose cases are open
162	for child welfare services in the HomeSafeNet system, shall be
163	enrolled in MediPass or in Medicaid fee-for-service and all
164	their behavioral health care services including inpatient,
165	outpatient psychiatric, community mental health, and case
166	management shall be reimbursed on a fee-for-service basis.
167	Beginning July 1, 2005, such children, who are open for child
168	welfare services in the HomeSafeNet system, shall receive their
169	behavioral health care services through a specialty prepaid plan
170	operated by community-based lead agencies either through a
171	single agency or formal agreements among several agencies. The
172	specialty prepaid plan must result in savings to the state
173	comparable to savings achieved in other Medicaid managed care
174	and prepaid programs. Such plan must provide mechanisms to
175	maximize state and local revenues. The specialty prepaid plan
176	shall be developed by the agency and the Department of Children
177	and Family Services. The agency is authorized to seek any
178	federal waivers to implement this initiative.
179
180	====== D I R E C T O R Y  A M E N D M E N T =====
181	Remove line(s) 548 and 549 and insert:
182	Section 10.  Paragraph (b) of subsection (4) and subsection
183	(44) of section 409.912, Florida Statutes, are amended, and
184	subsection (53) is added to that
185
186	======= T I T L E  A M E N D M E N T =======
187	Remove line(s) 27 and insert:
188	effective purchasing of health care; deleting an obsolete
189	provision requiring a certain percentage of capitation paid to
190	managed care plans to be expended for behavioral health
191	services; providing that

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