HB 5007

1	A bill to be entitled
2	An act relating to health care; amending s. 391.026, F.S.;
3	requiring the Department of Health to contract with a
4	third-party administrator for certain services necessary
5	to the operation of the Children's Medical Services
6	network; authorizing the department to maintain a
7	specified minimum reserve for the network; amending s.
8	400.141, F.S.; providing a reference for purposes of
9	assessing compliance with standards for staffing levels in
10	nursing homes; amending s. 400.179, F.S.; revising the
11	amount of a certain fee to be paid by a leasehold licensee
12	upon transfer of ownership of a nursing facility under
13	certain circumstances; amending s. 400.23, F.S.; revising
14	minimum staffing requirements for nursing homes; amending
15	s. 409.811, F.S.; deleting the definition of the term
16	"enrollment ceiling"; amending s. 409.8134, F.S.; deleting
17	references to enrollment ceilings for the Florida KidCare
18	program; providing for enrollment to cease when the
19	expenditure ceiling is reached; amending ss. 409.814 and
20	409.818, F.S.; deleting references to enrollment ceilings
21	for the Florida KidCare program; amending s. 409.904,
22	F.S.; revising requirements relating to eligibility of
23	certain women for family planning services; amending s.
24	409.905, F.S.; revising provisions relating to the
25	implementation of a hospitalist program; authorizing the
26	Agency for Health Care Administration to procure
27	hospitalist services by individual county or combined
28	counties; requiring a qualified organization to contract
29	with or employ board-eligible physicians in specified
30	counties; amending s. 409.906, F.S.; revising provisions
31	relating to optional dental, hearing, and visual services
32	covered by Medicaid; amending s. 409.907, F.S.; revising
33	the enrollment effective date for Medicaid providers;
34	providing procedures for payment for certain claims for
35	services; amending s. 409.908, F.S.; revising provisions
36	relating to the effect of changes of ownership or of
37	licensed operator of a Medicaid provider on reimbursement
38	rates under certain circumstances; revising provisions to
39	permit rather than require a certain limit on the indirect
40	care component of the long-term care reimbursement plan;
41	amending s. 409.9081, F.S.; revising the limitation on
42	Medicaid recipient copayments for emergency room services;
43	amending s. 409.911, F.S., relating to the hospital
44	disproportionate share program; revising the method for
45	calculating disproportionate share payments to hospitals;
46	deleting obsolete provisions; amending s. 409.9113, F.S.;
47	providing guidelines for distribution of disproportionate
48	share funds to certain teaching hospitals; amending s.
49	409.9117, F.S., relating to the primary care
50	disproportionate share program; revising the time period
51	during which the agency shall not distribute certain
52	moneys; amending s. 409.912, F.S., relating to cost-
53	effective purchasing of health care; authorizing the
54	agency to post a preferred drug list and updates thereto
55	on an Internet website without following the rulemaking
56	procedures of ch. 120, F.S.; providing that adjustments
57	for health status be considered in agency evaluations of
58	the cost-effectiveness of Medicaid managed care plans;
59	amending s. 409.9122, F.S.; revising enrollment limits for
60	Medicaid recipients who are subject to mandatory
61	assignment to managed care plans and MediPass; creating s.
62	409.9301, F.S.; establishing a pharmaceutical expense
63	assistance program; providing eligibility requirements;
64	providing for the Agency for Health Care Administration to
65	pay certain coinsurance and deductibles for specified
66	medications; requiring the agency, in collaboration with
67	the Department of Elderly Affairs and the Department of
68	Children and Family Services, to administer the program;
69	authorizing the agency to adopt rules; requiring a report
70	to the Legislature; declaring that the program is not an
71	entitlement; providing for a waiting list; amending s.
72	430.04, F.S.; designating the Department of Elderly
73	Affairs as the state agency to receive federal funds for
74	adults eligible for assistance through the Adult Care Food
75	Program; requiring the department to develop standards and
76	procedures to govern sponsoring organizations and adult
77	day care centers for certain purposes; providing
78	rulemaking authority to the department; amending s.
79	430.705, F.S., relating to implementation of the long-term
80	care community diversion pilot projects; providing for
81	certain prospective participants in the pilot projects to
82	be designated "Medicaid Pending" while eligibility is
83	determined; providing conditions for reimbursement of
84	contractors; amending s. 624.91, F.S.; deleting provisions
85	requiring the Florida Healthy Kids Corporation to
86	establish a local match policy for the enrollment of
87	certain children in the Healthy Kids program; requiring
88	the Office of Program Policy Analysis and Government
89	Accountability to review functions performed by the
90	Comprehensive Assessment Review and Evaluation for Long-
91	Term Care Services Program; requiring a report to the
92	Legislature; repealing s. 409.8201, F.S., relating to the
93	enrollment ceiling for the non-Medicaid portion of the
94	Florida KidCare program; providing an effective date.
95
96	Be It Enacted by the Legislature of the State of Florida:
97
98	Section 1.  Subsection (16) of section 391.026, Florida
99	Statutes, is amended to read:
100	391.026  Powers and duties of the department.--The
101	department shall have the following powers, duties, and
102	responsibilities:
103	(16)  To receive and manage health care premiums,
104	capitation payments, and funds from federal, state, local, and
105	private entities for the program. The department may contract
106	with a third-party administrator for processing claims,
107	monitoring medical expenses, and other related services
108	necessary to the efficient and cost-effective operation of the
109	Children's Medical Services network. The department is
110	authorized to maintain a minimum reserve for the Children's
111	Medical Services network in an amount that is the greater of:
112	(a)  Ten percent of total projected expenditures for Title
113	XIX-funded and Title XXI-funded children; or
114	(b)  Two percent of total annualized payments from the
115	Agency for Health Care Administration for Title XIX and Title
116	XXI of the Social Security Act.
117	Section 2.  Paragraph (e) of subsection (15) of section
118	400.141, Florida Statutes, is amended to read:
119	400.141  Administration and management of nursing home
120	facilities.--Every licensed facility shall comply with all
121	applicable standards and rules of the agency and shall:
122	(15)  Submit semiannually to the agency, or more frequently
123	if requested by the agency, information regarding facility
124	staff-to-resident ratios, staff turnover, and staff stability,
125	including information regarding certified nursing assistants,
126	licensed nurses, the director of nursing, and the facility
127	administrator. For purposes of this reporting:
128	(e)  A nursing facility which does not have a conditional
129	license may be cited for failure to comply with the standards in
130	s. 400.23(3)(a)1.a. only if it has failed to meet those
131	standards on 2 consecutive days or if it has failed to meet at
132	least 97 percent of those standards on any one day.
133
134	Nothing in this section shall limit the agency's ability to
135	impose a deficiency or take other actions if a facility does not
136	have enough staff to meet the residents' needs.
137
138	Facilities that have been awarded a Gold Seal under the program
139	established in s. 400.235 may develop a plan to provide
140	certified nursing assistant training as prescribed by federal
141	regulations and state rules and may apply to the agency for
142	approval of their program.
143	Section 3.  Paragraph (d) of subsection (5) of section
144	400.179, Florida Statutes, is amended to read:
145	400.179  Sale or transfer of ownership of a nursing
146	facility; liability for Medicaid underpayments and
147	overpayments.--
148	(5)  Because any transfer of a nursing facility may expose
149	the fact that Medicaid may have underpaid or overpaid the
150	transferor, and because in most instances, any such underpayment
151	or overpayment can only be determined following a formal field
152	audit, the liabilities for any such underpayments or
153	overpayments shall be as follows:
154	(d)  Where the transfer involves a facility that has been
155	leased by the transferor:
156	1.  The transferee shall, as a condition to being issued a
157	license by the agency, acquire, maintain, and provide proof to
158	the agency of a bond with a term of 30 months, renewable
159	annually, in an amount not less than the total of 3 months'
160	months Medicaid payments to the facility computed on the basis
161	of the preceding 12-month average Medicaid payments to the
162	facility.
163	2.  A leasehold licensee may meet the requirements of
164	subparagraph 1. by payment of a nonrefundable fee, paid at
165	initial licensure, paid at the time of any subsequent change of
166	ownership, and paid at the time of any subsequent annual license
167	renewal, in the amount of 1 2 percent of the total of 3 months'
168	Medicaid payments to the facility computed on the basis of the
169	preceding 12-month average Medicaid payments to the facility. If
170	a preceding 12-month average is not available, projected
171	Medicaid payments may be used. The fee shall be deposited into
172	the Health Care Trust Fund and shall be accounted for separately
173	as a Medicaid nursing home overpayment account. These fees shall
174	be used at the sole discretion of the agency to repay nursing
175	home Medicaid overpayments. Payment of this fee shall not
176	release the licensee from any liability for any Medicaid
177	overpayments, nor shall payment bar the agency from seeking to
178	recoup overpayments from the licensee and any other liable
179	party. As a condition of exercising this lease bond alternative,
180	licensees paying this fee must maintain an existing lease bond
181	through the end of the 30-month term period of that bond. The
182	agency is herein granted specific authority to promulgate all
183	rules pertaining to the administration and management of this
184	account, including withdrawals from the account, subject to
185	federal review and approval. This provision shall take effect
186	upon becoming law and shall apply to any leasehold license
187	application. The financial viability of the Medicaid nursing
188	home overpayment account shall be determined by the agency
189	through annual review of the account balance and the amount of
190	total outstanding, unpaid Medicaid overpayments owing from
191	leasehold licensees to the agency as determined by final agency
192	audits.
193	3.  The leasehold licensee may meet the bond requirement
194	through other arrangements acceptable to the agency. The agency
195	is herein granted specific authority to promulgate rules
196	pertaining to lease bond arrangements.
197	4.  All existing nursing facility licensees, operating the
198	facility as a leasehold, shall acquire, maintain, and provide
199	proof to the agency of the 30-month bond required in
200	subparagraph 1., above, on and after July 1, 1993, for each
201	license renewal.
202	5.  It shall be the responsibility of all nursing facility
203	operators, operating the facility as a leasehold, to renew the
204	30-month bond and to provide proof of such renewal to the agency
205	annually at the time of application for license renewal.
206	6.  Any failure of the nursing facility operator to
207	acquire, maintain, renew annually, or provide proof to the
208	agency shall be grounds for the agency to deny, cancel, revoke,
209	or suspend the facility license to operate such facility and to
210	take any further action, including, but not limited to,
211	enjoining the facility, asserting a moratorium, or applying for
212	a receiver, deemed necessary to ensure compliance with this
213	section and to safeguard and protect the health, safety, and
214	welfare of the facility's residents. A lease agreement required
215	as a condition of bond financing or refinancing under s. 154.213
216	by a health facilities authority or required under s. 159.30 by
217	a county or municipality is not a leasehold for purposes of this
218	paragraph and is not subject to the bond requirement of this
219	paragraph.
220	Section 4.  Paragraph (a) of subsection (3) of section
221	400.23, Florida Statutes, is amended to read:
222	400.23  Rules; evaluation and deficiencies; licensure
223	status.--
224	(3)(a)1.  The agency shall adopt rules providing minimum
225	staffing requirements for nursing homes. These requirements
226	shall include, for each nursing home facility:,
227	a.  A minimum certified nursing assistant staffing of 2.3
228	hours of direct care per resident per day beginning January 1,
229	2002, increasing to 2.6 hours of direct care per resident per
230	day beginning January 1, 2003, and increasing to 2.7 2.9 hours
231	of direct care per resident per day beginning January 1, 2007
232	July 1, 2006. Beginning January 1, 2002, no facility shall staff
233	below one certified nursing assistant per 20 residents, and a
234	minimum licensed nursing staffing of 1.0 hour of direct resident
235	care per resident per day but never below one licensed nurse per
236	40 residents.
237	b.  Beginning January 1, 2007, a minimum weekly average
238	certified nursing assistant staffing of 2.9 hours of direct care
239	per resident per day. For the purpose of this sub-subparagraph,
240	a week is defined as Sunday through Saturday.
241	2.  Nursing assistants employed under s. 400.211(2) may be
242	included in computing the staffing ratio for certified nursing
243	assistants only if their job responsibilities include only
244	nursing-assistant-related duties they provide nursing assistance
245	services to residents on a full-time basis.
246	3.  Each nursing home must document compliance with
247	staffing standards as required under this paragraph and post
248	daily the names of staff on duty for the benefit of facility
249	residents and the public.
250	4.  The agency shall recognize the use of licensed nurses
251	for compliance with minimum staffing requirements for certified
252	nursing assistants, provided that the facility otherwise meets
253	the minimum staffing requirements for licensed nurses and that
254	the licensed nurses are performing the duties of a certified
255	nursing assistant. Unless otherwise approved by the agency,
256	licensed nurses counted toward the minimum staffing requirements
257	for certified nursing assistants must exclusively perform the
258	duties of a certified nursing assistant for the entire shift and
259	not also be counted toward the minimum staffing requirements for
260	licensed nurses. If the agency approved a facility's request to
261	use a licensed nurse to perform both licensed nursing and
262	certified nursing assistant duties, the facility must allocate
263	the amount of staff time specifically spent on certified nursing
264	assistant duties for the purpose of documenting compliance with
265	minimum staffing requirements for certified and licensed nursing
266	staff. In no event may the hours of a licensed nurse with dual
267	job responsibilities be counted twice.
268	Section 5.  Subsections (12) through (27) of section
269	409.811, Florida Statutes, are renumbered as subsections (11)
270	through (26), respectively, and present subsection (11) of that
271	section is amended to read:
272	409.811  Definitions relating to Florida KidCare Act.--As
273	used in ss. 409.810-409.820, the term:
274	(11)  "Enrollment ceiling" means the maximum number of
275	children receiving premium assistance payments, excluding
276	children enrolled in Medicaid, that may be enrolled at any time
277	in the Florida KidCare program. The maximum number shall be
278	established annually in the General Appropriations Act or by
279	general law.
280	Section 6.  Subsections (1) and (2) of section 409.8134,
281	Florida Statutes, are amended to read:
282	409.8134  Program enrollment and expenditure ceiling
283	ceilings.--
284	(1)  Except for the Medicaid program, a ceiling shall be
285	placed on annual federal and state expenditures for and on
286	enrollment in the Florida KidCare program as provided each year
287	in the General Appropriations Act.
288	(2)  The Florida KidCare program may conduct enrollment at
289	any time throughout the year for the purpose of enrolling
290	children eligible for all program components listed in s.
291	409.813 except Medicaid. The four Florida KidCare administrators
292	shall work together to ensure that the year-round enrollment
293	period is announced statewide. Eligible children shall be
294	enrolled on a first-come, first-served basis using the date the
295	enrollment application is received. Enrollment shall immediately
296	cease when the expenditure enrollment ceiling is reached. Year-
297	round enrollment shall only be held if the Social Services
298	Estimating Conference determines that sufficient federal and
299	state funds will be available to finance the increased
300	enrollment through federal fiscal year 2007. Any individual who
301	is not enrolled must reapply by submitting a new application.
302	The application for the Florida KidCare program shall be valid
303	for a period of 120 days after the date it was received. At the
304	end of the 120-day period, if the applicant has not been
305	enrolled in the program, the application shall be invalid and
306	the applicant shall be notified of the action. The applicant may
307	resubmit the application after notification of the action taken
308	by the program. Except for the Medicaid program, whenever the
309	Social Services Estimating Conference determines that there are
310	presently, or will be by the end of the current fiscal year,
311	insufficient funds to finance the current or projected
312	enrollment in the Florida KidCare program, all additional
313	enrollment must cease and additional enrollment may not resume
314	until sufficient funds are available to finance such enrollment.
315	Section 7.  Paragraph (d) of subsection (5) of section
316	409.814, Florida Statutes, is amended to read:
317	409.814  Eligibility.--A child who has not reached 19 years
318	of age whose family income is equal to or below 200 percent of
319	the federal poverty level is eligible for the Florida KidCare
320	program as provided in this section. For enrollment in the
321	Children's Medical Services Network, a complete application
322	includes the medical or behavioral health screening. If,
323	subsequently, an individual is determined to be ineligible for
324	coverage, he or she must immediately be disenrolled from the
325	respective Florida KidCare program component.
326	(5)  A child whose family income is above 200 percent of
327	the federal poverty level or a child who is excluded under the
328	provisions of subsection (4) may participate in the Florida
329	KidCare program, excluding the Medicaid program, but is subject
330	to the following provisions:
331	(d)  Children described in this subsection are not counted
332	in the annual enrollment ceiling for the Florida KidCare
333	program.
334	Section 8.  Paragraphs (c) through (g) of subsection (3) of
335	section 409.818, Florida Statutes, are redesignated as
336	paragraphs (b) through (f), respectively, and present paragraphs
337	(b) and (g) of subsection (3) of that section are amended to
338	read:
339	409.818  Administration.--In order to implement ss.
340	409.810-409.820, the following agencies shall have the following
341	duties:
342	(3)  The Agency for Health Care Administration, under the
343	authority granted in s. 409.914(1), shall:
344	(b)  Annually calculate the program enrollment ceiling
345	based on estimated per child premium assistance payments and the
346	estimated appropriation available for the program.
347	(f)(g)  Adopt rules necessary for calculating premium
348	assistance payment levels, calculating the program enrollment
349	ceiling, making premium assistance payments, monitoring access
350	and quality assurance standards, investigating and resolving
351	complaints and grievances, administering the Medikids program,
352	and approving health benefits coverage.
353
354	The agency is designated the lead state agency for Title XXI of
355	the Social Security Act for purposes of receipt of federal
356	funds, for reporting purposes, and for ensuring compliance with
357	federal and state regulations and rules.
358	Section 9.  Subsection (5) of section 409.904, Florida
359	Statutes, is amended to read:
360	409.904  Optional payments for eligible persons.--The
361	agency may make payments for medical assistance and related
362	services on behalf of the following persons who are determined
363	to be eligible subject to the income, assets, and categorical
364	eligibility tests set forth in federal and state law. Payment on
365	behalf of these Medicaid eligible persons is subject to the
366	availability of moneys and any limitations established by the
367	General Appropriations Act or chapter 216.
368	(5)  Subject to specific federal authorization, a
369	postpartum woman living in a family that has an income that is
370	at or below 185 percent of the most current federal poverty
371	level is eligible for family planning services as specified in
372	s. 409.905(3) for a period of up to 24 months following a loss
373	of Medicaid benefits pregnancy for which Medicaid paid for
374	pregnancy-related services.
375	Section 10.  Paragraph (d) of subsection (5) of section
376	409.905, Florida Statutes, is amended to read:
377	409.905  Mandatory Medicaid services.--The agency may make
378	payments for the following services, which are required of the
379	state by Title XIX of the Social Security Act, furnished by
380	Medicaid providers to recipients who are determined to be
381	eligible on the dates on which the services were provided. Any
382	service under this section shall be provided only when medically
383	necessary and in accordance with state and federal law.
384	Mandatory services rendered by providers in mobile units to
385	Medicaid recipients may be restricted by the agency. Nothing in
386	this section shall be construed to prevent or limit the agency
387	from adjusting fees, reimbursement rates, lengths of stay,
388	number of visits, number of services, or any other adjustments
389	necessary to comply with the availability of moneys and any
390	limitations or directions provided for in the General
391	Appropriations Act or chapter 216.
392	(5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay for
393	all covered services provided for the medical care and treatment
394	of a recipient who is admitted as an inpatient by a licensed
395	physician or dentist to a hospital licensed under part I of
396	chapter 395. However, the agency shall limit the payment for
397	inpatient hospital services for a Medicaid recipient 21 years of
398	age or older to 45 days or the number of days necessary to
399	comply with the General Appropriations Act.
400	(d)  The agency shall implement a hospitalist program in
401	nonteaching certain high-volume participating hospitals, select
402	counties, or statewide. The program shall require hospitalists
403	to authorize and manage Medicaid recipients' hospital admissions
404	and lengths of stay. Individuals who are dually eligible for
405	Medicare and Medicaid are exempted from this requirement.
406	Medicaid participating physicians and other practitioners with
407	hospital admitting privileges shall coordinate and review
408	admissions of Medicaid recipients with the hospitalist. The
409	agency may competitively bid a contract for selection of a
410	single qualified organization to provide hospitalist services.
411	The agency may procure hospitalist services by individual county
412	or may combine counties in a single procurement. The qualified
413	organization shall contract with or employ board-eligible board
414	certified physicians in Miami-Dade, Palm Beach, Hillsborough,
415	Pasco, and Pinellas Counties who are full-time dedicated
416	employees of the contractor and have no outside practice. Where
417	used, the hospitalist program shall replace the existing
418	hospital utilization review program. The agency is authorized to
419	seek federal waivers to implement this program.
420	Section 11.  Paragraph (b) of subsection (1) and
421	subsections (12) and (23) of section 409.906, Florida Statutes,
422	are amended to read:
423	409.906  Optional Medicaid services.--Subject to specific
424	appropriations, the agency may make payments for services which
425	are optional to the state under Title XIX of the Social Security
426	Act and are furnished by Medicaid providers to recipients who
427	are determined to be eligible on the dates on which the services
428	were provided. Any optional service that is provided shall be
429	provided only when medically necessary and in accordance with
430	state and federal law. Optional services rendered by providers
431	in mobile units to Medicaid recipients may be restricted or
432	prohibited by the agency. Nothing in this section shall be
433	construed to prevent or limit the agency from adjusting fees,
434	reimbursement rates, lengths of stay, number of visits, or
435	number of services, or making any other adjustments necessary to
436	comply with the availability of moneys and any limitations or
437	directions provided for in the General Appropriations Act or
438	chapter 216. If necessary to safeguard the state's systems of
439	providing services to elderly and disabled persons and subject
440	to the notice and review provisions of s. 216.177, the Governor
441	may direct the Agency for Health Care Administration to amend
442	the Medicaid state plan to delete the optional Medicaid service
443	known as "Intermediate Care Facilities for the Developmentally
444	Disabled." Optional services may include:
445	(1)  ADULT DENTAL SERVICES.--
446	(b)  Beginning July 1, 2006 January 1, 2005, the agency may
447	pay for full or partial dentures, the procedures required to
448	seat full or partial dentures, and the repair and reline of full
449	or partial dentures, provided by or under the direction of a
450	licensed dentist, for a recipient who is 21 years of age or
451	older.
452	(12)  CHILDREN'S HEARING SERVICES.--The agency may pay for
453	hearing and related services, including hearing evaluations,
454	hearing aid devices, dispensing of the hearing aid, and related
455	repairs, if provided to a recipient younger than 21 years of age
456	by a licensed hearing aid specialist, otolaryngologist,
457	otologist, audiologist, or physician.
458	(23)  CHILDREN'S VISUAL SERVICES.--The agency may pay for
459	visual examinations, eyeglasses, and eyeglass repairs for a
460	recipient younger than 21 years of age, if they are prescribed
461	by a licensed physician specializing in diseases of the eye or
462	by a licensed optometrist. Eyeglasses for adult recipients shall
463	be limited to two pairs per year per recipient, except a third
464	pair may be provided after prior authorization.
465	Section 12.  Paragraph (a) of subsection (9) of section
466	409.907, Florida Statutes, is amended to read:
467	409.907  Medicaid provider agreements.--The agency may make
468	payments for medical assistance and related services rendered to
469	Medicaid recipients only to an individual or entity who has a
470	provider agreement in effect with the agency, who is performing
471	services or supplying goods in accordance with federal, state,
472	and local law, and who agrees that no person shall, on the
473	grounds of handicap, race, color, or national origin, or for any
474	other reason, be subjected to discrimination under any program
475	or activity for which the provider receives payment from the
476	agency.
477	(9)  Upon receipt of a completed, signed, and dated
478	application, and completion of any necessary background
479	investigation and criminal history record check, the agency must
480	either:
481	(a)  Enroll the applicant as a Medicaid provider no earlier
482	than the effective date of the approval of the provider
483	application. With respect to providers who were recently granted
484	a change of ownership and those who primarily provide emergency
485	medical services transportation or emergency services and care
486	pursuant to s. 395.1041 or s. 401.45, or services provided by
487	entities under s. 409.91255, and out-of-state providers, upon
488	approval of the provider application., The enrollment effective
489	date shall be of approval is considered to be the date the
490	agency receives the provider application. Payment for any claims
491	for services provided to Medicaid recipients between the date of
492	receipt of the application and the date of approval is
493	contingent on applying any and all applicable audits and edits
494	contained in the agency's claims adjudication and payment
495	processing systems; or
496	Section 13.  Paragraph (b) of subsection (2) of section
497	409.908, Florida Statutes, is amended to read:
498	409.908  Reimbursement of Medicaid providers.--Subject to
499	specific appropriations, the agency shall reimburse Medicaid
500	providers, in accordance with state and federal law, according
501	to methodologies set forth in the rules of the agency and in
502	policy manuals and handbooks incorporated by reference therein.
503	These methodologies may include fee schedules, reimbursement
504	methods based on cost reporting, negotiated fees, competitive
505	bidding pursuant to s. 287.057, and other mechanisms the agency
506	considers efficient and effective for purchasing services or
507	goods on behalf of recipients. If a provider is reimbursed based
508	on cost reporting and submits a cost report late and that cost
509	report would have been used to set a lower reimbursement rate
510	for a rate semester, then the provider's rate for that semester
511	shall be retroactively calculated using the new cost report, and
512	full payment at the recalculated rate shall be effected
513	retroactively. Medicare-granted extensions for filing cost
514	reports, if applicable, shall also apply to Medicaid cost
515	reports. Payment for Medicaid compensable services made on
516	behalf of Medicaid eligible persons is subject to the
517	availability of moneys and any limitations or directions
518	provided for in the General Appropriations Act or chapter 216.
519	Further, nothing in this section shall be construed to prevent
520	or limit the agency from adjusting fees, reimbursement rates,
521	lengths of stay, number of visits, or number of services, or
522	making any other adjustments necessary to comply with the
523	availability of moneys and any limitations or directions
524	provided for in the General Appropriations Act, provided the
525	adjustment is consistent with legislative intent.
526	(2)
527	(b)  Subject to any limitations or directions provided for
528	in the General Appropriations Act, the agency shall establish
529	and implement a Florida Title XIX Long-Term Care Reimbursement
530	Plan (Medicaid) for nursing home care in order to provide care
531	and services in conformance with the applicable state and
532	federal laws, rules, regulations, and quality and safety
533	standards and to ensure that individuals eligible for medical
534	assistance have reasonable geographic access to such care.
535	1.  Changes of ownership or of licensed operator may or may
536	do not qualify for increases in reimbursement rates associated
537	with the change of ownership or of licensed operator. The agency
538	may shall amend the Title XIX Long Term Care Reimbursement Plan
539	to provide that the initial nursing home reimbursement rates,
540	for the operating, patient care, and MAR components, associated
541	with related and unrelated party changes of ownership or
542	licensed operator filed on or after September 1, 2001, are
543	equivalent to the previous owner's reimbursement rate.
544	2.  The agency shall amend the long-term care reimbursement
545	plan and cost reporting system to create direct care and
546	indirect care subcomponents of the patient care component of the
547	per diem rate. These two subcomponents together shall equal the
548	patient care component of the per diem rate. Separate cost-based
549	ceilings shall be calculated for each patient care subcomponent.
550	The direct care subcomponent of the per diem rate shall be
551	limited by the cost-based class ceiling, and the indirect care
552	subcomponent may shall be limited by the lower of the cost-based
553	class ceiling, the target rate class ceiling, or the individual
554	provider target.
555	3.  The direct care subcomponent shall include salaries and
556	benefits of direct care staff providing nursing services
557	including registered nurses, licensed practical nurses, and
558	certified nursing assistants who deliver care directly to
559	residents in the nursing home facility. This excludes nursing
560	administration, minimum data set, and care plan coordinators,
561	staff development, and staffing coordinator.
562	4.  All other patient care costs shall be included in the
563	indirect care cost subcomponent of the patient care per diem
564	rate. There shall be no costs directly or indirectly allocated
565	to the direct care subcomponent from a home office or management
566	company.
567	5.  On July 1 of each year, the agency shall report to the
568	Legislature direct and indirect care costs, including average
569	direct and indirect care costs per resident per facility and
570	direct care and indirect care salaries and benefits per category
571	of staff member per facility.
572	6.  In order to offset the cost of general and professional
573	liability insurance, the agency shall amend the plan to allow
574	for interim rate adjustments to reflect increases in the cost of
575	general or professional liability insurance for nursing homes.
576	This provision shall be implemented to the extent existing
577	appropriations are available.
578
579	It is the intent of the Legislature that the reimbursement plan
580	achieve the goal of providing access to health care for nursing
581	home residents who require large amounts of care while
582	encouraging diversion services as an alternative to nursing home
583	care for residents who can be served within the community. The
584	agency shall base the establishment of any maximum rate of
585	payment, whether overall or component, on the available moneys
586	as provided for in the General Appropriations Act. The agency
587	may base the maximum rate of payment on the results of
588	scientifically valid analysis and conclusions derived from
589	objective statistical data pertinent to the particular maximum
590	rate of payment.
591	Section 14.  Paragraph (c) of subsection (1) of section
592	409.9081, Florida Statutes, is amended to read:
593	409.9081  Copayments.--
594	(1)  The agency shall require, subject to federal
595	regulations and limitations, each Medicaid recipient to pay at
596	the time of service a nominal copayment for the following
597	Medicaid services:
598	(c)  Hospital emergency department visits for nonemergency
599	care: 5 percent of up to the first $300 of the Medicaid payment
600	for emergency room services, not to exceed $15 for each
601	emergency department visit.
602	Section 15.  Subsections (2), (3), and (4) of section
603	409.911, Florida Statutes, are amended to read:
604	409.911  Disproportionate share program.--Subject to
605	specific allocations established within the General
606	Appropriations Act and any limitations established pursuant to
607	chapter 216, the agency shall distribute, pursuant to this
608	section, moneys to hospitals providing a disproportionate share
609	of Medicaid or charity care services by making quarterly
610	Medicaid payments as required. Notwithstanding the provisions of
611	s. 409.915, counties are exempt from contributing toward the
612	cost of this special reimbursement for hospitals serving a
613	disproportionate share of low-income patients.
614	(2)  The Agency for Health Care Administration shall use
615	the following actual audited data to determine the Medicaid days
616	and charity care to be used in calculating the disproportionate
617	share payment:
618	(a)  The average of the 1998, 1999, and 2000, 2001, and
619	2002 audited disproportionate share data to determine each
620	hospital's Medicaid days and charity care for the 2006-2007
621	2004-2005 state fiscal year and the average of the 1999, 2000,
622	and 2001 audited disproportionate share data to determine the
623	Medicaid days and charity care for the 2005-2006 state fiscal
624	year.
625	(b)  If the Agency for Health Care Administration does not
626	have the prescribed 3 years of audited disproportionate share
627	data as noted in paragraph (a) for a hospital, the agency shall
628	use the average of the years of the audited disproportionate
629	share data as noted in paragraph (a) which is available.
630	(c)  In accordance with s. 1923(b) of the Social Security
631	Act, a hospital with a Medicaid inpatient utilization rate
632	greater than one standard deviation above the statewide mean or
633	a hospital with a low-income utilization rate of 25 percent or
634	greater shall qualify for reimbursement.
635	(3)  Hospitals that qualify for a disproportionate share
636	payment solely under paragraph (2)(c) shall have their payment
637	calculated in accordance with the following formulas:
638
639	DSHP = (HMD/TMSD) x $1 million
640
641	Where:
642	DSHP = disproportionate share hospital payment.
643	HMD = hospital Medicaid days.
644	TSD = total state Medicaid days.
645
646	Any funds not allocated to hospitals qualifying under this
647	section shall be redistributed to the non-state government owned
648	or operated hospitals with greater than 3,100 3,300 Medicaid
649	days.
650	(4)  The following formulas shall be used to pay
651	disproportionate share dollars to public hospitals:
652	(a)  For state mental health hospitals:
653
654	DSHP = (HMD/TMDMH) x TAAMH
655
656	shall be the difference between the federal cap for Institutions
657	for Mental Diseases and the amounts paid under the mental health
658	disproportionate share program.
659
660	Where:
661	DSHP = disproportionate share hospital payment.
662	HMD = hospital Medicaid days.
663	TMDHH = total Medicaid days for state mental health
664	hospitals.
665	TAAMH = total amount available for mental health hospitals.
666	(b)  For non-state government owned or operated hospitals
667	with 3,100 3,300 or more Medicaid days:
668
669	DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)]
670	x TAAPH
671	TAAPH = TAA - TAAMH
672
673	Where:
674	TAA = total available appropriation.
675	TAAPH = total amount available for public hospitals.
676	DSHP = disproportionate share hospital payments.
677	HMD = hospital Medicaid days.
678	TMD = total state Medicaid days for public hospitals.
679	HCCD = hospital charity care dollars.
680	TCCD = total state charity care dollars for public non-
681	state hospitals.
682
683	1.  For the 2005-2006 state fiscal year only, the DSHP for
684	the public nonstate hospitals shall be computed using a weighted
685	average of the disproportionate share payments for the 2004-2005
686	state fiscal year which uses an average of the 1998, 1999, and
687	2000 audited disproportionate share data and the
688	disproportionate share payments for the 2005-2006 state fiscal
689	year as computed using the formula above and using the average
690	of the 1999, 2000, and 2001 audited disproportionate share data.
691	The final DSHP for the public nonstate hospitals shall be
692	computed as an average using the calculated payments for the
693	2005-2006 state fiscal year weighted at 65 percent and the
694	disproportionate share payments for the 2004-2005 state fiscal
695	year weighted at 35 percent.
696	2.  The TAAPH shall be reduced by $6,365,257 before
697	computing the DSHP for each public hospital. The $6,365,257
698	shall be distributed equally between the public hospitals that
699	are also designated statutory teaching hospitals.
700	(c)  For non-state government owned or operated hospitals
701	with less than 3,100 3,300 Medicaid days, a total of $750,000
702	shall be distributed equally among these hospitals.
703	Section 16.  Section 409.9113, Florida Statutes, is amended
704	to read:
705	409.9113  Disproportionate share program for teaching
706	hospitals.--In addition to the payments made under ss. 409.911
707	and 409.9112, the Agency for Health Care Administration shall
708	make disproportionate share payments to statutorily defined
709	teaching hospitals for their increased costs associated with
710	medical education programs and for tertiary health care services
711	provided to the indigent. This system of payments shall conform
712	with federal requirements and shall distribute funds in each
713	fiscal year for which an appropriation is made by making
714	quarterly Medicaid payments. Notwithstanding s. 409.915,
715	counties are exempt from contributing toward the cost of this
716	special reimbursement for hospitals serving a disproportionate
717	share of low-income patients. For the state fiscal year 2006-
718	2007 2005-2006, the agency shall not distribute the moneys
719	provided in the General Appropriations Act to statutorily
720	defined teaching hospitals and family practice teaching
721	hospitals under the teaching hospital disproportionate share
722	program. The funds provided for statutorily defined teaching
723	hospitals shall be distributed in the same proportion as the
724	state fiscal year 2003-2004 teaching hospital disproportionate
725	share funds were distributed. The funds provided for family
726	practice teaching hospitals shall be distributed equally among
727	family practice teaching hospitals.
728	(1)  On or before September 15 of each year, the Agency for
729	Health Care Administration shall calculate an allocation
730	fraction to be used for distributing funds to state statutory
731	teaching hospitals. Subsequent to the end of each quarter of the
732	state fiscal year, the agency shall distribute to each statutory
733	teaching hospital, as defined in s. 408.07, an amount determined
734	by multiplying one-fourth of the funds appropriated for this
735	purpose by the Legislature times such hospital's allocation
736	fraction. The allocation fraction for each such hospital shall
737	be determined by the sum of three primary factors, divided by
738	three. The primary factors are:
739	(a)  The number of nationally accredited graduate medical
740	education programs offered by the hospital, including programs
741	accredited by the Accreditation Council for Graduate Medical
742	Education and the combined Internal Medicine and Pediatrics
743	programs acceptable to both the American Board of Internal
744	Medicine and the American Board of Pediatrics at the beginning
745	of the state fiscal year preceding the date on which the
746	allocation fraction is calculated. The numerical value of this
747	factor is the fraction that the hospital represents of the total
748	number of programs, where the total is computed for all state
749	statutory teaching hospitals.
750	(b)  The number of full-time equivalent trainees in the
751	hospital, which comprises two components:
752	1.  The number of trainees enrolled in nationally
753	accredited graduate medical education programs, as defined in
754	paragraph (a). Full-time equivalents are computed using the
755	fraction of the year during which each trainee is primarily
756	assigned to the given institution, over the state fiscal year
757	preceding the date on which the allocation fraction is
758	calculated. The numerical value of this factor is the fraction
759	that the hospital represents of the total number of full-time
760	equivalent trainees enrolled in accredited graduate programs,
761	where the total is computed for all state statutory teaching
762	hospitals.
763	2.  The number of medical students enrolled in accredited
764	colleges of medicine and engaged in clinical activities,
765	including required clinical clerkships and clinical electives.
766	Full-time equivalents are computed using the fraction of the
767	year during which each trainee is primarily assigned to the
768	given institution, over the course of the state fiscal year
769	preceding the date on which the allocation fraction is
770	calculated. The numerical value of this factor is the fraction
771	that the given hospital represents of the total number of full-
772	time equivalent students enrolled in accredited colleges of
773	medicine, where the total is computed for all state statutory
774	teaching hospitals.
775
776	The primary factor for full-time equivalent trainees is computed
777	as the sum of these two components, divided by two.
778	(c)  A service index that comprises three components:
779	1.  The Agency for Health Care Administration Service
780	Index, computed by applying the standard Service Inventory
781	Scores established by the Agency for Health Care Administration
782	to services offered by the given hospital, as reported on
783	Worksheet A-2 for the last fiscal year reported to the agency
784	before the date on which the allocation fraction is calculated.
785	The numerical value of this factor is the fraction that the
786	given hospital represents of the total Agency for Health Care
787	Administration Service Index values, where the total is computed
788	for all state statutory teaching hospitals.
789	2.  A volume-weighted service index, computed by applying
790	the standard Service Inventory Scores established by the Agency
791	for Health Care Administration to the volume of each service,
792	expressed in terms of the standard units of measure reported on
793	Worksheet A-2 for the last fiscal year reported to the agency
794	before the date on which the allocation factor is calculated.
795	The numerical value of this factor is the fraction that the
796	given hospital represents of the total volume-weighted service
797	index values, where the total is computed for all state
798	statutory teaching hospitals.
799	3.  Total Medicaid payments to each hospital for direct
800	inpatient and outpatient services during the fiscal year
801	preceding the date on which the allocation factor is calculated.
802	This includes payments made to each hospital for such services
803	by Medicaid prepaid health plans, whether the plan was
804	administered by the hospital or not. The numerical value of this
805	factor is the fraction that each hospital represents of the
806	total of such Medicaid payments, where the total is computed for
807	all state statutory teaching hospitals.
808
809	The primary factor for the service index is computed as the sum
810	of these three components, divided by three.
811	(2)  By October 1 of each year, the agency shall use the
812	following formula to calculate the maximum additional
813	disproportionate share payment for statutorily defined teaching
814	hospitals:
815
816	TAP = THAF x A
817
818	Where:
819	TAP = total additional payment.
820	THAF = teaching hospital allocation factor.
821	A = amount appropriated for a teaching hospital
822	disproportionate share program.
823	Section 17.  Section 409.9117, Florida Statutes, is amended
824	to read:
825	409.9117  Primary care disproportionate share program.--For
826	the state fiscal year 2006-2007 2005-2006, the agency shall not
827	distribute moneys under the primary care disproportionate share
828	program.
829	(1)  If federal funds are available for disproportionate
830	share programs in addition to those otherwise provided by law,
831	there shall be created a primary care disproportionate share
832	program.
833	(2)  The following formula shall be used by the agency to
834	calculate the total amount earned for hospitals that participate
835	in the primary care disproportionate share program:
836
837	TAE = HDSP/THDSP
838
839	Where:
840	TAE = total amount earned by a hospital participating in
841	the primary care disproportionate share program.
842	HDSP = the prior state fiscal year primary care
843	disproportionate share payment to the individual hospital.
844	THDSP = the prior state fiscal year total primary care
845	disproportionate share payments to all hospitals.
846	(3)  The total additional payment for hospitals that
847	participate in the primary care disproportionate share program
848	shall be calculated by the agency as follows:
849
850	TAP = TAE x TA
851
852	Where:
853	TAP = total additional payment for a primary care hospital.
854	TAE = total amount earned by a primary care hospital.
855	TA = total appropriation for the primary care
856	disproportionate share program.
857	(4)  In the establishment and funding of this program, the
858	agency shall use the following criteria in addition to those
859	specified in s. 409.911, payments may not be made to a hospital
860	unless the hospital agrees to:
861	(a)  Cooperate with a Medicaid prepaid health plan, if one
862	exists in the community.
863	(b)  Ensure the availability of primary and specialty care
864	physicians to Medicaid recipients who are not enrolled in a
865	prepaid capitated arrangement and who are in need of access to
866	such physicians.
867	(c)  Coordinate and provide primary care services free of
868	charge, except copayments, to all persons with incomes up to 100
869	percent of the federal poverty level who are not otherwise
870	covered by Medicaid or another program administered by a
871	governmental entity, and to provide such services based on a
872	sliding fee scale to all persons with incomes up to 200 percent
873	of the federal poverty level who are not otherwise covered by
874	Medicaid or another program administered by a governmental
875	entity, except that eligibility may be limited to persons who
876	reside within a more limited area, as agreed to by the agency
877	and the hospital.
878	(d)  Contract with any federally qualified health center,
879	if one exists within the agreed geopolitical boundaries,
880	concerning the provision of primary care services, in order to
881	guarantee delivery of services in a nonduplicative fashion, and
882	to provide for referral arrangements, privileges, and
883	admissions, as appropriate. The hospital shall agree to provide
884	at an onsite or offsite facility primary care services within 24
885	hours to which all Medicaid recipients and persons eligible
886	under this paragraph who do not require emergency room services
887	are referred during normal daylight hours.
888	(e)  Cooperate with the agency, the county, and other
889	entities to ensure the provision of certain public health
890	services, case management, referral and acceptance of patients,
891	and sharing of epidemiological data, as the agency and the
892	hospital find mutually necessary and desirable to promote and
893	protect the public health within the agreed geopolitical
894	boundaries.
895	(f)  In cooperation with the county in which the hospital
896	resides, develop a low-cost, outpatient, prepaid health care
897	program to persons who are not eligible for the Medicaid
898	program, and who reside within the area.
899	(g)  Provide inpatient services to residents within the
900	area who are not eligible for Medicaid or Medicare, and who do
901	not have private health insurance, regardless of ability to pay,
902	on the basis of available space, except that nothing shall
903	prevent the hospital from establishing bill collection programs
904	based on ability to pay.
905	(h)  Work with the Florida Healthy Kids Corporation, the
906	Florida Health Care Purchasing Cooperative, and business health
907	coalitions, as appropriate, to develop a feasibility study and
908	plan to provide a low-cost comprehensive health insurance plan
909	to persons who reside within the area and who do not have access
910	to such a plan.
911	(i)  Work with public health officials and other experts to
912	provide community health education and prevention activities
913	designed to promote healthy lifestyles and appropriate use of
914	health services.
915	(j)  Work with the local health council to develop a plan
916	for promoting access to affordable health care services for all
917	persons who reside within the area, including, but not limited
918	to, public health services, primary care services, inpatient
919	services, and affordable health insurance generally.
920
921	Any hospital that fails to comply with any of the provisions of
922	this subsection, or any other contractual condition, may not
923	receive payments under this section until full compliance is
924	achieved.
925	Section 18.  Paragraph (a) of subsection (39) and
926	subsection (44) of section 409.912, Florida Statutes, are
927	amended to read:
928	409.912  Cost-effective purchasing of health care.--The
929	agency shall purchase goods and services for Medicaid recipients
930	in the most cost-effective manner consistent with the delivery
931	of quality medical care. To ensure that medical services are
932	effectively utilized, the agency may, in any case, require a
933	confirmation or second physician's opinion of the correct
934	diagnosis for purposes of authorizing future services under the
935	Medicaid program. This section does not restrict access to
936	emergency services or poststabilization care services as defined
937	in 42 C.F.R. part 438.114. Such confirmation or second opinion
938	shall be rendered in a manner approved by the agency. The agency
939	shall maximize the use of prepaid per capita and prepaid
940	aggregate fixed-sum basis services when appropriate and other
941	alternative service delivery and reimbursement methodologies,
942	including competitive bidding pursuant to s. 287.057, designed
943	to facilitate the cost-effective purchase of a case-managed
944	continuum of care. The agency shall also require providers to
945	minimize the exposure of recipients to the need for acute
946	inpatient, custodial, and other institutional care and the
947	inappropriate or unnecessary use of high-cost services. The
948	agency shall contract with a vendor to monitor and evaluate the
949	clinical practice patterns of providers in order to identify
950	trends that are outside the normal practice patterns of a
951	provider's professional peers or the national guidelines of a
952	provider's professional association. The vendor must be able to
953	provide information and counseling to a provider whose practice
954	patterns are outside the norms, in consultation with the agency,
955	to improve patient care and reduce inappropriate utilization.
956	The agency may mandate prior authorization, drug therapy
957	management, or disease management participation for certain
958	populations of Medicaid beneficiaries, certain drug classes, or
959	particular drugs to prevent fraud, abuse, overuse, and possible
960	dangerous drug interactions. The Pharmaceutical and Therapeutics
961	Committee shall make recommendations to the agency on drugs for
962	which prior authorization is required. The agency shall inform
963	the Pharmaceutical and Therapeutics Committee of its decisions
964	regarding drugs subject to prior authorization. The agency is
965	authorized to limit the entities it contracts with or enrolls as
966	Medicaid providers by developing a provider network through
967	provider credentialing. The agency may competitively bid single-
968	source-provider contracts if procurement of goods or services
969	results in demonstrated cost savings to the state without
970	limiting access to care. The agency may limit its network based
971	on the assessment of beneficiary access to care, provider
972	availability, provider quality standards, time and distance
973	standards for access to care, the cultural competence of the
974	provider network, demographic characteristics of Medicaid
975	beneficiaries, practice and provider-to-beneficiary standards,
976	appointment wait times, beneficiary use of services, provider
977	turnover, provider profiling, provider licensure history,
978	previous program integrity investigations and findings, peer
979	review, provider Medicaid policy and billing compliance records,
980	clinical and medical record audits, and other factors. Providers
981	shall not be entitled to enrollment in the Medicaid provider
982	network. The agency shall determine instances in which allowing
983	Medicaid beneficiaries to purchase durable medical equipment and
984	other goods is less expensive to the Medicaid program than long-
985	term rental of the equipment or goods. The agency may establish
986	rules to facilitate purchases in lieu of long-term rentals in
987	order to protect against fraud and abuse in the Medicaid program
988	as defined in s. 409.913. The agency may seek federal waivers
989	necessary to administer these policies.
990	(39)(a)  The agency shall implement a Medicaid prescribed-
991	drug spending-control program that includes the following
992	components:
993	1.  A Medicaid preferred drug list, which shall be a
994	listing of cost-effective therapeutic options recommended by the
995	Medicaid Pharmacy and Therapeutics Committee established
996	pursuant to s. 409.91195 and adopted by the agency for each
997	therapeutic class on the preferred drug list. At the discretion
998	of the committee, and when feasible, the preferred drug list
999	should include at least two products in a therapeutic class. The
1000	agency may post the preferred drug list and updates to the
1001	preferred drug list on an Internet website without following the
1002	rulemaking procedures of chapter 120. Antiretroviral agents are
1003	excluded from the preferred drug list. The agency shall also
1004	limit the amount of a prescribed drug dispensed to no more than
1005	a 34-day supply unless the drug products' smallest marketed
1006	package is greater than a 34-day supply, or the drug is
1007	determined by the agency to be a maintenance drug in which case
1008	a 100-day maximum supply may be authorized. The agency is
1009	authorized to seek any federal waivers necessary to implement
1010	these cost-control programs and to continue participation in the
1011	federal Medicaid rebate program, or alternatively to negotiate
1012	state-only manufacturer rebates. The agency may adopt rules to
1013	implement this subparagraph. The agency shall continue to
1014	provide unlimited contraceptive drugs and items. The agency must
1015	establish procedures to ensure that:
1016	a.  There will be a response to a request for prior
1017	consultation by telephone or other telecommunication device
1018	within 24 hours after receipt of a request for prior
1019	consultation; and
1020	b.  A 72-hour supply of the drug prescribed will be
1021	provided in an emergency or when the agency does not provide a
1022	response within 24 hours as required by sub-subparagraph a.
1023	2.  Reimbursement to pharmacies for Medicaid prescribed
1024	drugs shall be set at the lesser of: the average wholesale price
1025	(AWP) minus 15.4 percent, the wholesaler acquisition cost (WAC)
1026	plus 5.75 percent, the federal upper limit (FUL), the state
1027	maximum allowable cost (SMAC), or the usual and customary (UAC)
1028	charge billed by the provider.
1029	3.  The agency shall develop and implement a process for
1030	managing the drug therapies of Medicaid recipients who are using
1031	significant numbers of prescribed drugs each month. The
1032	management process may include, but is not limited to,
1033	comprehensive, physician-directed medical-record reviews, claims
1034	analyses, and case evaluations to determine the medical
1035	necessity and appropriateness of a patient's treatment plan and
1036	drug therapies. The agency may contract with a private
1037	organization to provide drug-program-management services. The
1038	Medicaid drug benefit management program shall include
1039	initiatives to manage drug therapies for HIV/AIDS patients,
1040	patients using 20 or more unique prescriptions in a 180-day
1041	period, and the top 1,000 patients in annual spending. The
1042	agency shall enroll any Medicaid recipient in the drug benefit
1043	management program if he or she meets the specifications of this
1044	provision and is not enrolled in a Medicaid health maintenance
1045	organization.
1046	4.  The agency may limit the size of its pharmacy network
1047	based on need, competitive bidding, price negotiations,
1048	credentialing, or similar criteria. The agency shall give
1049	special consideration to rural areas in determining the size and
1050	location of pharmacies included in the Medicaid pharmacy
1051	network. A pharmacy credentialing process may include criteria
1052	such as a pharmacy's full-service status, location, size,
1053	patient educational programs, patient consultation, disease
1054	management services, and other characteristics. The agency may
1055	impose a moratorium on Medicaid pharmacy enrollment when it is
1056	determined that it has a sufficient number of Medicaid-
1057	participating providers. The agency must allow dispensing
1058	practitioners to participate as a part of the Medicaid pharmacy
1059	network regardless of the practitioner's proximity to any other
1060	entity that is dispensing prescription drugs under the Medicaid
1061	program. A dispensing practitioner must meet all credentialing
1062	requirements applicable to his or her practice, as determined by
1063	the agency.
1064	5.  The agency shall develop and implement a program that
1065	requires Medicaid practitioners who prescribe drugs to use a
1066	counterfeit-proof prescription pad for Medicaid prescriptions.
1067	The agency shall require the use of standardized counterfeit-
1068	proof prescription pads by Medicaid-participating prescribers or
1069	prescribers who write prescriptions for Medicaid recipients. The
1070	agency may implement the program in targeted geographic areas or
1071	statewide.
1072	6.  The agency may enter into arrangements that require
1073	manufacturers of generic drugs prescribed to Medicaid recipients
1074	to provide rebates of at least 15.1 percent of the average
1075	manufacturer price for the manufacturer's generic products.
1076	These arrangements shall require that if a generic-drug
1077	manufacturer pays federal rebates for Medicaid-reimbursed drugs
1078	at a level below 15.1 percent, the manufacturer must provide a
1079	supplemental rebate to the state in an amount necessary to
1080	achieve a 15.1-percent rebate level.
1081	7.  The agency may establish a preferred drug list as
1082	described in this subsection, and, pursuant to the establishment
1083	of such preferred drug list, it is authorized to negotiate
1084	supplemental rebates from manufacturers that are in addition to
1085	those required by Title XIX of the Social Security Act and at no
1086	less than 14 percent of the average manufacturer price as
1087	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
1088	the federal or supplemental rebate, or both, equals or exceeds
1089	29 percent. There is no upper limit on the supplemental rebates
1090	the agency may negotiate. The agency may determine that specific
1091	products, brand-name or generic, are competitive at lower rebate
1092	percentages. Agreement to pay the minimum supplemental rebate
1093	percentage will guarantee a manufacturer that the Medicaid
1094	Pharmaceutical and Therapeutics Committee will consider a
1095	product for inclusion on the preferred drug list. However, a
1096	pharmaceutical manufacturer is not guaranteed placement on the
1097	preferred drug list by simply paying the minimum supplemental
1098	rebate. Agency decisions will be made on the clinical efficacy
1099	of a drug and recommendations of the Medicaid Pharmaceutical and
1100	Therapeutics Committee, as well as the price of competing
1101	products minus federal and state rebates. The agency is
1102	authorized to contract with an outside agency or contractor to
1103	conduct negotiations for supplemental rebates. For the purposes
1104	of this section, the term "supplemental rebates" means cash
1105	rebates. Effective July 1, 2004, value-added programs as a
1106	substitution for supplemental rebates are prohibited. The agency
1107	is authorized to seek any federal waivers to implement this
1108	initiative.
1109	8.  The Agency for Health Care Administration shall expand
1110	home delivery of pharmacy products. To assist Medicaid patients
1111	in securing their prescriptions and reduce program costs, the
1112	agency shall expand its current mail-order-pharmacy diabetes-
1113	supply program to include all generic and brand-name drugs used
1114	by Medicaid patients with diabetes. Medicaid recipients in the
1115	current program may obtain nondiabetes drugs on a voluntary
1116	basis. This initiative is limited to the geographic area covered
1117	by the current contract. The agency may seek and implement any
1118	federal waivers necessary to implement this subparagraph.
1119	9.  The agency shall limit to one dose per month any drug
1120	prescribed to treat erectile dysfunction.
1121	10.a.  The agency may implement a Medicaid behavioral drug
1122	management system. The agency may contract with a vendor that
1123	has experience in operating behavioral drug management systems
1124	to implement this program. The agency is authorized to seek
1125	federal waivers to implement this program.
1126	b.  The agency, in conjunction with the Department of
1127	Children and Family Services, may implement the Medicaid
1128	behavioral drug management system that is designed to improve
1129	the quality of care and behavioral health prescribing practices
1130	based on best practice guidelines, improve patient adherence to
1131	medication plans, reduce clinical risk, and lower prescribed
1132	drug costs and the rate of inappropriate spending on Medicaid
1133	behavioral drugs. The program may include the following
1134	elements:
1135	(I)  Provide for the development and adoption of best
1136	practice guidelines for behavioral health-related drugs such as
1137	antipsychotics, antidepressants, and medications for treating
1138	bipolar disorders and other behavioral conditions; translate
1139	them into practice; review behavioral health prescribers and
1140	compare their prescribing patterns to a number of indicators
1141	that are based on national standards; and determine deviations
1142	from best practice guidelines.
1143	(II)  Implement processes for providing feedback to and
1144	educating prescribers using best practice educational materials
1145	and peer-to-peer consultation.
1146	(III)  Assess Medicaid beneficiaries who are outliers in
1147	their use of behavioral health drugs with regard to the numbers
1148	and types of drugs taken, drug dosages, combination drug
1149	therapies, and other indicators of improper use of behavioral
1150	health drugs.
1151	(IV)  Alert prescribers to patients who fail to refill
1152	prescriptions in a timely fashion, are prescribed multiple same-
1153	class behavioral health drugs, and may have other potential
1154	medication problems.
1155	(V)  Track spending trends for behavioral health drugs and
1156	deviation from best practice guidelines.
1157	(VI)  Use educational and technological approaches to
1158	promote best practices, educate consumers, and train prescribers
1159	in the use of practice guidelines.
1160	(VII)  Disseminate electronic and published materials.
1161	(VIII)  Hold statewide and regional conferences.
1162	(IX)  Implement a disease management program with a model
1163	quality-based medication component for severely mentally ill
1164	individuals and emotionally disturbed children who are high
1165	users of care.
1166	11.a.  The agency shall implement a Medicaid prescription
1167	drug management system. The agency may contract with a vendor
1168	that has experience in operating prescription drug management
1169	systems in order to implement this system. Any management system
1170	that is implemented in accordance with this subparagraph must
1171	rely on cooperation between physicians and pharmacists to
1172	determine appropriate practice patterns and clinical guidelines
1173	to improve the prescribing, dispensing, and use of drugs in the
1174	Medicaid program. The agency may seek federal waivers to
1175	implement this program.
1176	b.  The drug management system must be designed to improve
1177	the quality of care and prescribing practices based on best
1178	practice guidelines, improve patient adherence to medication
1179	plans, reduce clinical risk, and lower prescribed drug costs and
1180	the rate of inappropriate spending on Medicaid prescription
1181	drugs. The program must:
1182	(I)  Provide for the development and adoption of best
1183	practice guidelines for the prescribing and use of drugs in the
1184	Medicaid program, including translating best practice guidelines
1185	into practice; reviewing prescriber patterns and comparing them
1186	to indicators that are based on national standards and practice
1187	patterns of clinical peers in their community, statewide, and
1188	nationally; and determine deviations from best practice
1189	guidelines.
1190	(II)  Implement processes for providing feedback to and
1191	educating prescribers using best practice educational materials
1192	and peer-to-peer consultation.
1193	(III)  Assess Medicaid recipients who are outliers in their
1194	use of a single or multiple prescription drugs with regard to
1195	the numbers and types of drugs taken, drug dosages, combination
1196	drug therapies, and other indicators of improper use of
1197	prescription drugs.
1198	(IV)  Alert prescribers to patients who fail to refill
1199	prescriptions in a timely fashion, are prescribed multiple drugs
1200	that may be redundant or contraindicated, or may have other
1201	potential medication problems.
1202	(V)  Track spending trends for prescription drugs and
1203	deviation from best practice guidelines.
1204	(VI)  Use educational and technological approaches to
1205	promote best practices, educate consumers, and train prescribers
1206	in the use of practice guidelines.
1207	(VII)  Disseminate electronic and published materials.
1208	(VIII)  Hold statewide and regional conferences.
1209	(IX)  Implement disease management programs in cooperation
1210	with physicians and pharmacists, along with a model quality-
1211	based medication component for individuals having chronic
1212	medical conditions.
1213	12.  The agency is authorized to contract for drug rebate
1214	administration, including, but not limited to, calculating
1215	rebate amounts, invoicing manufacturers, negotiating disputes
1216	with manufacturers, and maintaining a database of rebate
1217	collections.
1218	13.  The agency may specify the preferred daily dosing form
1219	or strength for the purpose of promoting best practices with
1220	regard to the prescribing of certain drugs as specified in the
1221	General Appropriations Act and ensuring cost-effective
1222	prescribing practices.
1223	14.  The agency may require prior authorization for
1224	Medicaid-covered prescribed drugs. The agency may, but is not
1225	required to, prior-authorize the use of a product:
1226	a.  For an indication not approved in labeling;
1227	b.  To comply with certain clinical guidelines; or
1228	c.  If the product has the potential for overuse, misuse,
1229	or abuse.
1230
1231	The agency may require the prescribing professional to provide
1232	information about the rationale and supporting medical evidence
1233	for the use of a drug. The agency may post prior authorization
1234	criteria and protocol and updates to the list of drugs that are
1235	subject to prior authorization on an Internet website without
1236	amending its rule or engaging in additional rulemaking.
1237	15.  The agency, in conjunction with the Pharmaceutical and
1238	Therapeutics Committee, may require age-related prior
1239	authorizations for certain prescribed drugs. The agency may
1240	preauthorize the use of a drug for a recipient who may not meet
1241	the age requirement or may exceed the length of therapy for use
1242	of this product as recommended by the manufacturer and approved
1243	by the Food and Drug Administration. Prior authorization may
1244	require the prescribing professional to provide information
1245	about the rationale and supporting medical evidence for the use
1246	of a drug.
1247	16.  The agency shall implement a step-therapy prior
1248	authorization approval process for medications excluded from the
1249	preferred drug list. Medications listed on the preferred drug
1250	list must be used within the previous 12 months prior to the
1251	alternative medications that are not listed. The step-therapy
1252	prior authorization may require the prescriber to use the
1253	medications of a similar drug class or for a similar medical
1254	indication unless contraindicated in the Food and Drug
1255	Administration labeling. The trial period between the specified
1256	steps may vary according to the medical indication. The step-
1257	therapy approval process shall be developed in accordance with
1258	the committee as stated in s. 409.91195(7) and (8). A drug
1259	product may be approved without meeting the step-therapy prior
1260	authorization criteria if the prescribing physician provides the
1261	agency with additional written medical or clinical documentation
1262	that the product is medically necessary because:
1263	a.  There is not a drug on the preferred drug list to treat
1264	the disease or medical condition which is an acceptable clinical
1265	alternative;
1266	b.  The alternatives have been ineffective in the treatment
1267	of the beneficiary's disease; or
1268	c.  Based on historic evidence and known characteristics of
1269	the patient and the drug, the drug is likely to be ineffective,
1270	or the number of doses have been ineffective.
1271
1272	The agency shall work with the physician to determine the best
1273	alternative for the patient. The agency may adopt rules waiving
1274	the requirements for written clinical documentation for specific
1275	drugs in limited clinical situations.
1276	17.  The agency shall implement a return and reuse program
1277	for drugs dispensed by pharmacies to institutional recipients,
1278	which includes payment of a $5 restocking fee for the
1279	implementation and operation of the program. The return and
1280	reuse program shall be implemented electronically and in a
1281	manner that promotes efficiency. The program must permit a
1282	pharmacy to exclude drugs from the program if it is not
1283	practical or cost-effective for the drug to be included and must
1284	provide for the return to inventory of drugs that cannot be
1285	credited or returned in a cost-effective manner. The agency
1286	shall determine if the program has reduced the amount of
1287	Medicaid prescription drugs which are destroyed on an annual
1288	basis and if there are additional ways to ensure more
1289	prescription drugs are not destroyed which could safely be
1290	reused. The agency's conclusion and recommendations shall be
1291	reported to the Legislature by December 1, 2005.
1292	(44)  The Agency for Health Care Administration shall
1293	ensure that any Medicaid managed care plan as defined in s.
1294	409.9122(2)(f)(h), whether paid on a capitated basis or a shared
1295	savings basis, is cost-effective. For purposes of this
1296	subsection, the term "cost-effective" means that a network's
1297	per-member, per-month costs to the state, including, but not
1298	limited to, fee-for-service costs, administrative costs, and
1299	case-management fees, if any, must be no greater than the
1300	state's costs associated with contracts for Medicaid services
1301	established under subsection (3), which may shall be actuarially
1302	adjusted for health status case mix, model, and service area.
1303	The agency shall conduct actuarially sound adjustments for
1304	health status audits adjusted for case mix and model in order to
1305	ensure such cost-effectiveness and shall publish the audit
1306	results on its Internet website and submit the audit results
1307	annually to the Governor, the President of the Senate, and the
1308	Speaker of the House of Representatives no later than December
1309	31 of each year. Contracts established pursuant to this
1310	subsection which are not cost-effective may not be renewed.
1311	Section 19.  Paragraphs (f) and (k) of subsection (2) of
1312	section 409.9122, Florida Statutes, are amended to read:
1313	409.9122  Mandatory Medicaid managed care enrollment;
1314	programs and procedures.--
1315	(2)
1316	(f)  When a Medicaid recipient does not choose a managed
1317	care plan or MediPass provider, the agency shall assign the
1318	Medicaid recipient to a managed care plan or MediPass provider.
1319	Medicaid recipients who are subject to mandatory assignment but
1320	who fail to make a choice shall be assigned to managed care
1321	plans until an enrollment of 35 40 percent in MediPass and 65 60
1322	percent in managed care plans, of all those eligible to choose
1323	managed care, is achieved. Once this enrollment is achieved, the
1324	assignments shall be divided in order to maintain an enrollment
1325	in MediPass and managed care plans which is in a 35 40 percent
1326	and 65 60 percent proportion, respectively. Thereafter,
1327	assignment of Medicaid recipients who fail to make a choice
1328	shall be based proportionally on the preferences of recipients
1329	who have made a choice in the previous period. Such proportions
1330	shall be revised at least quarterly to reflect an update of the
1331	preferences of Medicaid recipients. The agency shall
1332	disproportionately assign Medicaid-eligible recipients who are
1333	required to but have failed to make a choice of managed care
1334	plan or MediPass, including children, and who are to be assigned
1335	to the MediPass program to children's networks as described in
1336	s. 409.912(4)(g), Children's Medical Services Network as defined
1337	in s. 391.021, exclusive provider organizations, provider
1338	service networks, minority physician networks, and pediatric
1339	emergency department diversion programs authorized by this
1340	chapter or the General Appropriations Act, in such manner as the
1341	agency deems appropriate, until the agency has determined that
1342	the networks and programs have sufficient numbers to be
1343	economically operated. For purposes of this paragraph, when
1344	referring to assignment, the term "managed care plans" includes
1345	health maintenance organizations, exclusive provider
1346	organizations, provider service networks, minority physician
1347	networks, Children's Medical Services Network, and pediatric
1348	emergency department diversion programs authorized by this
1349	chapter or the General Appropriations Act. When making
1350	assignments, the agency shall take into account the following
1351	criteria:
1352	1.  A managed care plan has sufficient network capacity to
1353	meet the need of members.
1354	2.  The managed care plan or MediPass has previously
1355	enrolled the recipient as a member, or one of the managed care
1356	plan's primary care providers or MediPass providers has
1357	previously provided health care to the recipient.
1358	3.  The agency has knowledge that the member has previously
1359	expressed a preference for a particular managed care plan or
1360	MediPass provider as indicated by Medicaid fee-for-service
1361	claims data, but has failed to make a choice.
1362	4.  The managed care plan's or MediPass primary care
1363	providers are geographically accessible to the recipient's
1364	residence.
1365	(k)  When a Medicaid recipient does not choose a managed
1366	care plan or MediPass provider, the agency shall assign the
1367	Medicaid recipient to a managed care plan, except in those
1368	counties in which there are fewer than two managed care plans
1369	accepting Medicaid enrollees, in which case assignment shall be
1370	to a managed care plan or a MediPass provider. Medicaid
1371	recipients in counties with fewer than two managed care plans
1372	accepting Medicaid enrollees who are subject to mandatory
1373	assignment but who fail to make a choice shall be assigned to
1374	managed care plans until an enrollment of 35 40 percent in
1375	MediPass and 65 60 percent in managed care plans, of all those
1376	eligible to choose managed care, is achieved. Once that
1377	enrollment is achieved, the assignments shall be divided in
1378	order to maintain an enrollment in MediPass and managed care
1379	plans which is in a 35 40 percent and 65 60 percent proportion,
1380	respectively. In service areas 1 and 6 of the Agency for Health
1381	Care Administration where the agency is contracting for the
1382	provision of comprehensive behavioral health services through a
1383	capitated prepaid arrangement, recipients who fail to make a
1384	choice shall be assigned equally to MediPass or a managed care
1385	plan. For purposes of this paragraph, when referring to
1386	assignment, the term "managed care plans" includes exclusive
1387	provider organizations, provider service networks, Children's
1388	Medical Services Network, minority physician networks, and
1389	pediatric emergency department diversion programs authorized by
1390	this chapter or the General Appropriations Act. When making
1391	assignments, the agency shall take into account the following
1392	criteria:
1393	1.  A managed care plan has sufficient network capacity to
1394	meet the need of members.
1395	2.  The managed care plan or MediPass has previously
1396	enrolled the recipient as a member, or one of the managed care
1397	plan's primary care providers or MediPass providers has
1398	previously provided health care to the recipient.
1399	3.  The agency has knowledge that the member has previously
1400	expressed a preference for a particular managed care plan or
1401	MediPass provider as indicated by Medicaid fee-for-service
1402	claims data, but has failed to make a choice.
1403	4.  The managed care plan's or MediPass primary care
1404	providers are geographically accessible to the recipient's
1405	residence.
1406	5.  The agency has authority to make mandatory assignments
1407	based on quality of service and performance of managed care
1408	plans.
1409	Section 20.  Section 409.9301, Florida Statutes, is created
1410	to read:
1411	409.9301  Pharmaceutical expense assistance.--
1412	(1)  PROGRAM ESTABLISHED.--A program is established in the
1413	Agency for Health Care Administration to provide pharmaceutical
1414	expense assistance to individuals diagnosed with cancer or
1415	individuals who have received organ transplants who were
1416	medically needy recipients prior to January 1, 2006.
1417	(2)  ELIGIBILITY.--Eligibility for the program is limited
1418	to an individual who:
1419	(a)  Is a resident of this state;
1420	(b)  Was a Medicaid recipient under the Florida Medicaid
1421	medically needy program prior to January 1, 2006;
1422	(c)  Is eligible for Medicare;
1423	(d)  Is a cancer patient or an organ transplant recipient;
1424	and
1425	(e)  Requests to be enrolled in the program.
1426	(3)  BENEFITS.--Subject to an appropriation in the General
1427	Appropriations Act and the availability of funds, the Agency for
1428	Health Care Administration shall pay, using Medicaid payment
1429	policies, the Medicare Part-B prescription drug coinsurance and
1430	deductibles for Medicare Part-B medications that treat eligible
1431	cancer and organ transplant patients.
1432	(4)  ADMINISTRATION.--The pharmaceutical expense assistance
1433	program shall be administered by the agency, in collaboration
1434	with the Department of Elderly Affairs and the Department of
1435	Children and Family Services.
1436	(a)  The agency may adopt rules pursuant to ss. 120.536(1)
1437	and 120.54 to implement the provisions of this section.
1438	(b)  By January 1 of each year, the agency shall report to
1439	the Legislature on the operation of the program. The report
1440	shall include information on the number of individuals served,
1441	use rates, and expenditures under the program.
1442	(5)  NONENTITLEMENT.--The pharmaceutical expense assistance
1443	program established by this section is not an entitlement. The
1444	agency may develop a waiting list based on application dates to
1445	use in enrolling individuals when funds become available for
1446	unfilled enrollment slots.
1447	Section 21.  Subsection (17) is added to section 430.04,
1448	Florida Statutes, to read:
1449	430.04  Duties and responsibilities of the Department of
1450	Elderly Affairs.--The Department of Elderly Affairs shall:
1451	(17)  Be designated as a state agency that is eligible to
1452	receive federal funds for adults who are eligible for assistance
1453	through the portion of the federal Child and Adult Care Food
1454	Program for adults, which is referred to as the Adult Care Food
1455	Program, and that is responsible for establishing and
1456	administering the program. The purpose of the Adult Care Food
1457	Program is to provide nutritious and wholesome meals and snacks
1458	for adults in nonresidential day care centers or residential
1459	treatment facilities. To ensure the quality and integrity of the
1460	program, the department shall develop standards and procedures
1461	that govern sponsoring organizations and adult day care centers.
1462	The department shall follow federal requirements and may adopt
1463	any rules necessary pursuant to ss. 120.536(1) and 120.54 for
1464	the implementation of the Adult Care Food Program. With respect
1465	to the Adult Care Food Program, the department shall adopt rules
1466	pursuant to ss. 120.536(1) and 120.54 that implement relevant
1467	federal regulations, including 7 C.F.R. part 226. The rules may
1468	address, at a minimum, the program requirements and procedures
1469	identified in this subsection.
1470	Section 22.  Subsection (5) of section 430.705, Florida
1471	Statutes, is amended to read:
1472	430.705  Implementation of the long-term care community
1473	diversion pilot projects.--
1474	(5)  A prospective participant who applies for the
1475	long-term care community diversion pilot project and is
1476	determined by the Comprehensive Assessment Review and Evaluation
1477	for Long-Term Care Services (CARES) Program within the
1478	Department of Elderly Affairs to be medically eligible, but has
1479	not been determined financially eligible by the Department of
1480	Children and Family Services, shall be designated "Medicaid
1481	Pending." CARES shall determine each applicant's eligibility
1482	within 22 days after receiving the application. Contractors may
1483	elect to provide services to Medicaid Pending individuals until
1484	their financial eligibility is determined. If the individual is
1485	determined financially eligible, the agency shall pay the
1486	contractor that provided the services a capitated rate
1487	retroactive to the first of the month following the CARES
1488	eligibility determination. If the individual is not financially
1489	eligible for Medicaid, the contractor may terminate services and
1490	seek reimbursement from the individual. In order to achieve
1491	rapid enrollment into the program and efficient diversion of
1492	applicants from nursing home care, the department and the agency
1493	shall allow enrollment of Medicaid beneficiaries on the date
1494	that eligibility for the community diversion pilot project is
1495	approved. The provider shall receive a prorated capitated rate
1496	for those enrollees who are enrolled after the first of each
1497	month.
1498	Section 23.  Paragraph (b) of subsection (5) of section
1499	624.91, Florida Statutes, is amended to read:
1500	624.91  The Florida Healthy Kids Corporation Act.--
1501	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1502	(b)  The Florida Healthy Kids Corporation shall:
1503	1.  Arrange for the collection of any family, local
1504	contributions, or employer payment or premium, in an amount to
1505	be determined by the board of directors, to provide for payment
1506	of premiums for comprehensive insurance coverage and for the
1507	actual or estimated administrative expenses.
1508	2.  Arrange for the collection of any voluntary
1509	contributions to provide for payment of premiums for children
1510	who are not eligible for medical assistance under Title XXI of
1511	the Social Security Act. Each fiscal year, the corporation shall
1512	establish a local match policy for the enrollment of non-Title-
1513	XXI-eligible children in the Healthy Kids program. By May 1 of
1514	each year, the corporation shall provide written notification of
1515	the amount to be remitted to the corporation for the following
1516	fiscal year under that policy. Local match sources may include,
1517	but are not limited to, funds provided by municipalities,
1518	counties, school boards, hospitals, health care providers,
1519	charitable organizations, special taxing districts, and private
1520	organizations. The minimum local match cash contributions
1521	required each fiscal year and local match credits shall be
1522	determined by the General Appropriations Act. The corporation
1523	shall calculate a county's local match rate based upon that
1524	county's percentage of the state's total non-Title-XXI
1525	expenditures as reported in the corporation's most recently
1526	audited financial statement. In awarding the local match
1527	credits, the corporation may consider factors including, but not
1528	limited to, population density, per capita income, and existing
1529	child-health-related expenditures and services.
1530	3.  Subject to the provisions of s. 409.8134, accept
1531	voluntary supplemental local match contributions that comply
1532	with the requirements of Title XXI of the Social Security Act
1533	for the purpose of providing additional coverage in contributing
1534	counties under Title XXI.
1535	4.  Establish the administrative and accounting procedures
1536	for the operation of the corporation.
1537	5.  Establish, with consultation from appropriate
1538	professional organizations, standards for preventive health
1539	services and providers and comprehensive insurance benefits
1540	appropriate to children, provided that such standards for rural
1541	areas shall not limit primary care providers to board-certified
1542	pediatricians.
1543	6.  Determine eligibility for children seeking to
1544	participate in the Title XXI-funded components of the Florida
1545	KidCare program consistent with the requirements specified in s.
1546	409.814, as well as the non-Title-XXI-eligible children as
1547	provided in subsection (3).
1548	7.  Establish procedures under which providers of local
1549	match to, applicants to and participants in the program may have
1550	grievances reviewed by an impartial body and reported to the
1551	board of directors of the corporation.
1552	8.  Establish participation criteria and, if appropriate,
1553	contract with an authorized insurer, health maintenance
1554	organization, or third-party administrator to provide
1555	administrative services to the corporation.
1556	9.  Establish enrollment criteria which shall include
1557	penalties or waiting periods of not fewer than 60 days for
1558	reinstatement of coverage upon voluntary cancellation for
1559	nonpayment of family premiums.
1560	10.  Contract with authorized insurers or any provider of
1561	health care services, meeting standards established by the
1562	corporation, for the provision of comprehensive insurance
1563	coverage to participants. Such standards shall include criteria
1564	under which the corporation may contract with more than one
1565	provider of health care services in program sites. Health plans
1566	shall be selected through a competitive bid process. The Florida
1567	Healthy Kids Corporation shall purchase goods and services in
1568	the most cost-effective manner consistent with the delivery of
1569	quality medical care. The maximum administrative cost for a
1570	Florida Healthy Kids Corporation contract shall be 15 percent.
1571	For health care contracts, the minimum medical loss ratio for a
1572	Florida Healthy Kids Corporation contract shall be 85 percent.
1573	For dental contracts, the remaining compensation to be paid to
1574	the authorized insurer or provider under a Florida Healthy Kids
1575	Corporation contract shall be no less than an amount which is 85
1576	percent of premium; to the extent any contract provision does
1577	not provide for this minimum compensation, this section shall
1578	prevail. The health plan selection criteria and scoring system,
1579	and the scoring results, shall be available upon request for
1580	inspection after the bids have been awarded.
1581	11.  Establish disenrollment criteria in the event local
1582	matching funds are insufficient to cover enrollments.
1583	12.  Develop and implement a plan to publicize the Florida
1584	Healthy Kids Corporation, the eligibility requirements of the
1585	program, and the procedures for enrollment in the program and to
1586	maintain public awareness of the corporation and the program.
1587	13.  Secure staff necessary to properly administer the
1588	corporation. Staff costs shall be funded from state and local
1589	matching funds and such other private or public funds as become
1590	available. The board of directors shall determine the number of
1591	staff members necessary to administer the corporation.
1592	14.  Provide a report annually to the Governor, Chief
1593	Financial Officer, Commissioner of Education, Senate President,
1594	Speaker of the House of Representatives, and Minority Leaders of
1595	the Senate and the House of Representatives.
1596	15.  Establish benefit packages which conform to the
1597	provisions of the Florida KidCare program, as created in ss.
1598	409.810-409.820.
1599	Section 24.  The Office of Program Policy Analysis and
1600	Government Accountability shall review the functions currently
1601	performed by the Comprehensive Assessment Review and Evaluation
1602	for Long-Term Care Services (CARES) Program within the
1603	Department of Elderly Affairs. The Office of Program Policy
1604	Analysis and Government Accountability shall identify the
1605	factors affecting the time currently required for CARES staff to
1606	assess an individual's eligibility for long-term care services.
1607	As part of this study, the Office of Program Policy Analysis and
1608	Government Accountability shall also examine circumstances that
1609	could delay an individual's placement into the long-term care
1610	community diversion pilot project. The Office of Program Policy
1611	Analysis and Government Accountability shall report its findings
1612	to the President of the Senate and the Speaker of the House of
1613	Representatives by February 1, 2007.
1614	Section 25.  Section 409.8201, Florida Statutes, is
1615	repealed.
1616	Section 26.  This act shall take effect July 1, 2006.

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