Amendment
Bill No. 5007

Amendment No. 961477

CHAMBER ACTION
Senate		House
.
.
.

---

---

1	Representative(s) Benson offered the following:
2
3	Amendment
4	Remove line(s) 638-865 and insert:
5	home and community-based services shall be actuarially
6	equivalent to plan experience.
7	Section 11.  Paragraphs (f) and (k) of subsection (2) of
8	section 409.9122, Florida Statutes, are amended to read:
9	409.9122  Mandatory Medicaid managed care enrollment;
10	programs and procedures.--
11	(2)
12	(f)  When a Medicaid recipient does not choose a managed
13	care plan or MediPass provider, the agency shall assign the
14	Medicaid recipient to a managed care plan or MediPass provider.
15	Medicaid recipients who are subject to mandatory assignment but
16	who fail to make a choice shall be assigned to managed care
17	plans until an enrollment of 35 40 percent in MediPass and 65 60
18	percent in managed care plans, of all those eligible to choose
19	managed care, is achieved. Once this enrollment is achieved, the
20	assignments shall be divided in order to maintain an enrollment
21	in MediPass and managed care plans which is in a 35 40 percent
22	and 65 60 percent proportion, respectively. Thereafter,
23	assignment of Medicaid recipients who fail to make a choice
24	shall be based proportionally on the preferences of recipients
25	who have made a choice in the previous period. Such proportions
26	shall be revised at least quarterly to reflect an update of the
27	preferences of Medicaid recipients. The agency shall
28	disproportionately assign Medicaid-eligible recipients who are
29	required to but have failed to make a choice of managed care
30	plan or MediPass, including children, and who are to be assigned
31	to the MediPass program to children's networks as described in
32	s. 409.912(4)(g), Children's Medical Services Network as defined
33	in s. 391.021, exclusive provider organizations, provider
34	service networks, minority physician networks, and pediatric
35	emergency department diversion programs authorized by this
36	chapter or the General Appropriations Act, in such manner as the
37	agency deems appropriate, until the agency has determined that
38	the networks and programs have sufficient numbers to be
39	economically operated. For purposes of this paragraph, when
40	referring to assignment, the term "managed care plans" includes
41	health maintenance organizations, exclusive provider
42	organizations, provider service networks, minority physician
43	networks, Children's Medical Services Network, and pediatric
44	emergency department diversion programs authorized by this
45	chapter or the General Appropriations Act. When making
46	assignments, the agency shall take into account the following
47	criteria:
48	1.  A managed care plan has sufficient network capacity to
49	meet the need of members.
50	2.  The managed care plan or MediPass has previously
51	enrolled the recipient as a member, or one of the managed care
52	plan's primary care providers or MediPass providers has
53	previously provided health care to the recipient.
54	3.  The agency has knowledge that the member has previously
55	expressed a preference for a particular managed care plan or
56	MediPass provider as indicated by Medicaid fee-for-service
57	claims data, but has failed to make a choice.
58	4.  The managed care plan's or MediPass primary care
59	providers are geographically accessible to the recipient's
60	residence.
61	(k)  When a Medicaid recipient does not choose a managed
62	care plan or MediPass provider, the agency shall assign the
63	Medicaid recipient to a managed care plan, except in those
64	counties in which there are fewer than two managed care plans
65	accepting Medicaid enrollees, in which case assignment shall be
66	to a managed care plan or a MediPass provider. Medicaid
67	recipients in counties with fewer than two managed care plans
68	accepting Medicaid enrollees who are subject to mandatory
69	assignment but who fail to make a choice shall be assigned to
70	managed care plans until an enrollment of 35 40 percent in
71	MediPass and 65 60 percent in managed care plans, of all those
72	eligible to choose managed care, is achieved. Once that
73	enrollment is achieved, the assignments shall be divided in
74	order to maintain an enrollment in MediPass and managed care
75	plans which is in a 35 40 percent and 65 60 percent proportion,
76	respectively. In service areas 1 and 6 of the Agency for Health
77	Care Administration where the agency is contracting for the
78	provision of comprehensive behavioral health services through a
79	capitated prepaid arrangement, recipients who fail to make a
80	choice shall be assigned equally to MediPass or a managed care
81	plan. For purposes of this paragraph, when referring to
82	assignment, the term "managed care plans" includes exclusive
83	provider organizations, provider service networks, Children's
84	Medical Services Network, minority physician networks, and
85	pediatric emergency department diversion programs authorized by
86	this chapter or the General Appropriations Act. When making
87	assignments, the agency shall take into account the following
88	criteria:
89	1.  A managed care plan has sufficient network capacity to
90	meet the need of members.
91	2.  The managed care plan or MediPass has previously
92	enrolled the recipient as a member, or one of the managed care
93	plan's primary care providers or MediPass providers has
94	previously provided health care to the recipient.
95	3.  The agency has knowledge that the member has previously
96	expressed a preference for a particular managed care plan or
97	MediPass provider as indicated by Medicaid fee-for-service
98	claims data, but has failed to make a choice.
99	4.  The managed care plan's or MediPass primary care
100	providers are geographically accessible to the recipient's
101	residence.
102	5.  The agency has authority to make mandatory assignments
103	based on quality of service and performance of managed care
104	plans.
105	Section 12.  Paragraph (b) of subsection (5) of section
106	624.91, Florida Statutes, is amended to read:
107	624.91  The Florida Healthy Kids Corporation Act.--
108	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
109	(b)  The Florida Healthy Kids Corporation shall:
110	1.  Arrange for the collection of any family, local
111	contributions, or employer payment or premium, in an amount to
112	be determined by the board of directors, to provide for payment
113	of premiums for comprehensive insurance coverage and for the
114	actual or estimated administrative expenses.
115	2.  Arrange for the collection of any voluntary
116	contributions to provide for payment of premiums for children
117	who are not eligible for medical assistance under Title XXI of
118	the Social Security Act. Each fiscal year, the corporation shall
119	establish a local match policy for the enrollment of non-Title-
120	XXI-eligible children in the Healthy Kids program. By May 1 of
121	each year, the corporation shall provide written notification of
122	the amount to be remitted to the corporation for the following
123	fiscal year under that policy. Local match sources may include,
124	but are not limited to, funds provided by municipalities,
125	counties, school boards, hospitals, health care providers,
126	charitable organizations, special taxing districts, and private
127	organizations. The minimum local match cash contributions
128	required each fiscal year and local match credits shall be
129	determined by the General Appropriations Act. The corporation
130	shall calculate a county's local match rate based upon that
131	county's percentage of the state's total non-Title-XXI
132	expenditures as reported in the corporation's most recently
133	audited financial statement. In awarding the local match
134	credits, the corporation may consider factors including, but not
135	limited to, population density, per capita income, and existing
136	child-health-related expenditures and services. If local match
137	amounts collected exceed expenditures during any fiscal year,
138	including the 2005-2006 fiscal year, the corporation shall
139	return unspent local funds collected based on a formula
140	developed by the corporation.
141	3.  Subject to the provisions of s. 409.8134, accept
142	voluntary supplemental local match contributions that comply
143	with the requirements of Title XXI of the Social Security Act
144	for the purpose of providing additional coverage in contributing
145	counties under Title XXI.
146	4.  Establish the administrative and accounting procedures
147	for the operation of the corporation.
148	5.  Establish, with consultation from appropriate
149	professional organizations, standards for preventive health
150	services and providers and comprehensive insurance benefits
151	appropriate to children, provided that such standards for rural
152	areas shall not limit primary care providers to board-certified
153	pediatricians.
154	6.  Determine eligibility for children seeking to
155	participate in the Title XXI-funded components of the Florida
156	KidCare program consistent with the requirements specified in s.
157	409.814, as well as the non-Title-XXI-eligible children as
158	provided in subsection (3).
159	7.  Establish procedures under which providers of local
160	match to, applicants to and participants in the program may have
161	grievances reviewed by an impartial body and reported to the
162	board of directors of the corporation.
163	8.  Establish participation criteria and, if appropriate,
164	contract with an authorized insurer, health maintenance
165	organization, or third-party administrator to provide
166	administrative services to the corporation.
167	9.  Establish enrollment criteria which shall include
168	penalties or waiting periods of not fewer than 60 days for
169	reinstatement of coverage upon voluntary cancellation for
170	nonpayment of family premiums.
171	10.  Contract with authorized insurers or any provider of
172	health care services, meeting standards established by the
173	corporation, for the provision of comprehensive insurance
174	coverage to participants. Such standards shall include criteria
175	under which the corporation may contract with more than one
176	provider of health care services in program sites. Health plans
177	shall be selected through a competitive bid process. The Florida
178	Healthy Kids Corporation shall purchase goods and services in
179	the most cost-effective manner consistent with the delivery of
180	quality medical care. The maximum administrative cost for a
181	Florida Healthy Kids Corporation contract shall be 15 percent.
182	For health care contracts, the minimum medical loss ratio for a
183	Florida Healthy Kids Corporation contract shall be 85 percent.
184	For dental contracts, the remaining compensation to be paid to
185	the authorized insurer or provider under a Florida Healthy Kids
186	Corporation contract shall be no less than an amount which is 85
187	percent of premium; to the extent any contract provision does
188	not provide for this minimum compensation, this section shall
189	prevail. The health plan selection criteria and scoring system,
190	and the scoring results, shall be available upon request for
191	inspection after the bids have been awarded.
192	11.  Establish disenrollment criteria in the event local
193	matching funds are insufficient to cover enrollments.
194	12.  Develop and implement a plan to publicize the Florida
195	Healthy Kids Corporation, the eligibility requirements of the
196	program, and the procedures for enrollment in the program and to
197	maintain public awareness of the corporation and the program.
198	13.  Secure staff necessary to properly administer the
199	corporation. Staff costs shall be funded from state and local
200	matching funds and such other private or public funds as become
201	available. The board of directors shall determine the number of
202	staff members necessary to administer the corporation.
203	14.  Provide a report annually to the Governor, Chief
204	Financial Officer, Commissioner of Education, Senate President,
205	Speaker of the House of Representatives, and Minority Leaders of
206	the Senate and the House of Representatives.
207	15.  Establish benefit packages which conform to the
208	provisions of the Florida KidCare program, as created in ss.
209	409.810-409.820.
210	Section 13.  Subsection (4) of section 430.705, Florida
211	Statutes, is amended to read:
212	430.705  Implementation of the long-term care community
213	diversion pilot projects.--
214	(4)  Pursuant to 42 C.F.R. s. 438.6(c), the agency, in
215	consultation with the department, shall annually reevaluate and
216	recertify the capitation rates for the diversion pilot projects.
217	The agency, in consultation with the department, shall secure
218	the utilization and cost data for Medicaid and Medicare
219	beneficiaries served by the program which shall be used in
220	developing rates for the diversion pilot projects. The
221	capitation rates shall be risk adjusted by plan and reflect
222	members' level of chronic illness, functional limitations, and
223	risk of institutional placement, as determined by expenditures
224	for a comparable fee-for-service population. Payments for
225	Medicaid home and community-based services shall be actuarially
226	equivalent to plan experience.

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