| 1 | The Conference Committee on HB 5011 offered the following: |
| 2 |
|
| 3 | Conference Committee Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. Subsection (7) of section 409.1671, Florida |
| 6 | Statutes, is amended to read: |
| 7 | 409.1671 Foster care and related services; outsourcing.-- |
| 8 | (7) The Florida Coalition for Children, Inc., in |
| 9 | consultation with the department, shall develop a plan based on |
| 10 | an independent actuarial study regarding the long-term use and |
| 11 | structure of a statewide community-based care risk pool for the |
| 12 | protection of eligible lead community-based providers, their |
| 13 | subcontractors, and providers of other social services who |
| 14 | contract directly with the department. The plan must also |
| 15 | outline strategies to maximize federal earnings as they relate |
| 16 | to the community-based care risk pool. At a minimum, the plan |
| 17 | must allow for the use of federal earnings received from child |
| 18 | welfare programs to be allocated to the community-based care |
| 19 | risk pool by the department, which earnings are determined by |
| 20 | the department to be in excess of the amount appropriated in the |
| 21 | General Appropriations Act. The plan must specify the necessary |
| 22 | steps to ensure the financial integrity and industry-standard |
| 23 | risk management practices of the community-based care risk pool |
| 24 | and the continued availability of funding from federal, state, |
| 25 | and local sources. The plan must also include recommendations |
| 26 | that permit the program to be available to entities of the |
| 27 | department providing child welfare services until full |
| 28 | conversion to community-based care takes place. The final plan |
| 29 | shall be submitted to the department and then to the Executive |
| 30 | Office of the Governor and the Legislative Budget Commission for |
| 31 | formal adoption before January 1, 2005. Upon approval of the |
| 32 | plan by all parties, the department shall issue an interest-free |
| 33 | loan that is secured by the cumulative contractual revenue of |
| 34 | the community-based care risk pool membership, and the amount of |
| 35 | the loan shall equal the amount appropriated by the Legislature |
| 36 | for this purpose. The plan shall provide for a governance |
| 37 | structure that assures the department the ability to oversee the |
| 38 | operation of the community-based care risk pool at least until |
| 39 | this loan is repaid in full. |
| 40 | (a) The department, in consultation with the Florida |
| 41 | Coalition for Children, Inc., shall develop and implement a |
| 42 | community-based care risk pool initiative to mitigate the |
| 43 | financial risk to eligible lead community-based providers. This |
| 44 | initiative shall include: |
| 45 | 1. A risk pool application and protocol developed by the |
| 46 | department that outline submission criteria, including, but not |
| 47 | limited to, financial and program management, descriptive data |
| 48 | requirements, and timeframes for submission of applications. |
| 49 | Requests for funding from risk pool applicants shall be based on |
| 50 | relevant and verifiable service trends and changes that have |
| 51 | occurred during the current fiscal year. The application shall |
| 52 | confirm that expenditure of approved risk pool funds by the lead |
| 53 | community-based provider shall be completed within the current |
| 54 | fiscal year. |
| 55 | 2. A risk pool peer review committee, appointed by the |
| 56 | secretary and consisting of department staff and representatives |
| 57 | from at least three nonapplicant community-based care providers, |
| 58 | that reviews and assesses all risk pool applications. Upon |
| 59 | completion of each application review, the peer review committee |
| 60 | shall report its findings and recommendations to the secretary |
| 61 | providing, at a minimum, the following information: |
| 62 | a. Justification for the specific funding amount required |
| 63 | by the risk pool applicant based on current year service trend |
| 64 | data, including validation that the applicant's financial need |
| 65 | was caused by circumstances beyond the control of the lead |
| 66 | agency management; |
| 67 | b. Verification that the proposed use of risk pool funds |
| 68 | meets at least one of the criteria in paragraph (c); and |
| 69 | c. Evidence of technical assistance provided in an effort |
| 70 | to avoid the need to access the risk pool and recommendations |
| 71 | for technical assistance to the lead agency to ensure that risk |
| 72 | pool funds are expended effectively and that the agency's need |
| 73 | for future risk pool funding is diminished. |
| 74 | (b) Upon approval by the secretary of a risk pool |
| 75 | application, the department may request funds from the risk pool |
| 76 | in accordance with s. 216.181(6)(a). |
| 77 | (c)(a) The purposes for which the community-based care |
| 78 | risk pool shall be used include, but are not limited to: |
| 79 | 1. Significant changes in the number or composition of |
| 80 | clients eligible to receive services. |
| 81 | 2. Significant changes in the services that are eligible |
| 82 | for reimbursement. |
| 83 | 3. Scheduled or unanticipated, but necessary, advances to |
| 84 | providers or other cash-flow issues. |
| 85 | 4. Proposals to participate in optional Medicaid services |
| 86 | or other federal grant opportunities. |
| 87 | 5. Appropriate incentive structures. |
| 88 | 3.6. Continuity of care in the event of failure, |
| 89 | discontinuance of service, or financial misconduct by a lead |
| 90 | agency. |
| 91 | 7. Payment for time-limited technical assistance and |
| 92 | consultation to lead agencies in the event of serious |
| 93 | performance or management problems. |
| 94 | 8. Payment for meeting all traditional and nontraditional |
| 95 | insurance needs of eligible members. |
| 96 | 4.9. Significant changes in the mix of available funds. |
| 97 | (d)(b) After approval of the plan in the 2004-2005 fiscal |
| 98 | year and annually thereafter, The department may also request in |
| 99 | its annual legislative budget request, and the Governor may |
| 100 | recommend, that the funding necessary to carry out paragraph (c) |
| 101 | (a) be appropriated to the department. Subsequent funding of the |
| 102 | community-based care risk pool shall be supported by premiums |
| 103 | assessed to members of the community-based care risk pool on a |
| 104 | recurring basis. The community-based care risk pool may invest |
| 105 | and retain interest earned on these funds. In addition, the |
| 106 | department may request the allocation of transfer funds from to |
| 107 | the community-based care risk pool in accordance with s. |
| 108 | 216.181(6)(a) as available in order to ensure an adequate |
| 109 | funding level if the fund is declared to be insolvent and |
| 110 | approval is granted by the Legislative Budget Commission. Such |
| 111 | payments for insolvency shall be made only after a determination |
| 112 | is made by the department or its actuary that all participants |
| 113 | in the community-based care risk pool are current in their |
| 114 | payments of premiums and that assessments have been made at an |
| 115 | actuarially sound level. Such payments by participants in the |
| 116 | community-based care risk pool may not exceed reasonable |
| 117 | industry standards, as determined by the actuary. Funds Money |
| 118 | from this pool fund may be used to match available federal |
| 119 | dollars. Dividends or other payments, with the exception of |
| 120 | legitimate claims, may not be paid to members of the community- |
| 121 | based care risk pool until the loan issued by the department is |
| 122 | repaid in full. Dividends or other payments, with the exception |
| 123 | of legitimate claims and other purposes contained in the |
| 124 | approved plan, may not be paid to members of the community-based |
| 125 | care risk pool unless, at the time of distribution, the |
| 126 | community-based care risk pool is deemed actuarially sound and |
| 127 | solvent. Solvency shall be determined by an independent actuary |
| 128 | contracted by the department. The plan shall be developed in |
| 129 | consultation with the Office of Insurance Regulation. |
| 130 | 1. Such funds shall constitute partial security for |
| 131 | contract performance by lead agencies and shall be used to |
| 132 | offset the need for a performance bond. Subject to the approval |
| 133 | of the plan, the community-based care risk pool shall be managed |
| 134 | by the Florida Coalition for Children, Inc., or the designated |
| 135 | contractors of the Florida Coalition for Children, Inc. |
| 136 | Nonmembers of the community-based care risk pool may continue to |
| 137 | contract with the department but must provide a letter of credit |
| 138 | equal to one-twelfth of the annual contract amount in lieu of |
| 139 | membership in the community-based care risk pool. |
| 140 | 2. The department may separately require a bond to |
| 141 | mitigate the financial consequences of potential acts of |
| 142 | malfeasance, misfeasance, or criminal violations by the |
| 143 | provider. |
| 144 | (e) The department may issue an interest-free loan to the |
| 145 | Florida Coalition for Children, Inc., for the purpose of |
| 146 | creating a self-insurance program pursuant to law. The loan |
| 147 | shall be secured by the cumulative contractual revenue of the |
| 148 | community-based care lead agencies participating in the self- |
| 149 | insurance program. The amount of the loan shall be in an amount |
| 150 | equal to the amount appropriated by the Legislature for this |
| 151 | purpose. The terms of the repayment of the loan shall be based |
| 152 | on the economic viability of the self-insurance program. |
| 153 | Section 2. Pilot project and financial issues.-- |
| 154 | (1) A 3-year pilot program is established for the |
| 155 | community-based care lead agencies serving Miami-Dade, Monroe, |
| 156 | and Broward Counties. This pilot program shall allow for the |
| 157 | transfer of the current lead agency oversight responsibilities |
| 158 | of the Department of Children and Family Services to independent |
| 159 | entities and for funding the program through a grant that |
| 160 | enhances funding flexibility. The pilot program shall expand the |
| 161 | responsibilities and services provided by these lead agencies. |
| 162 | (2) The Department of Children and Family Services shall |
| 163 | enter into a 3-year contract with the designated community-based |
| 164 | care lead agency serving Miami-Dade and Monroe Counties and with |
| 165 | the designated community-based care lead agency serving Broward |
| 166 | County, which have been established in accordance with s. |
| 167 | 409.1671, Florida Statutes. The department and the lead agencies |
| 168 | in this pilot program shall submit to the Chief Financial |
| 169 | Officer proposed contract language no later than June 1, 2006. |
| 170 | The Chief Financial Officer shall review the contracts for |
| 171 | sufficiency and respond to the parties no later than June 15, |
| 172 | 2006. This subsection shall take effect upon this act becoming a |
| 173 | law. |
| 174 | (3) The amount of federal Title IV-E funding allocated in |
| 175 | each year of the 3-year pilot program shall be equal to the |
| 176 | amount earned by each of the lead agencies and by the |
| 177 | department's district or zone community-based care activities |
| 178 | during the 2005-2006 fiscal year that is transitioned to the |
| 179 | lead agencies as part of this pilot program. The lead agencies |
| 180 | shall annually provide certified audited financial statements to |
| 181 | the Governor, the Department of Children and Family Services, |
| 182 | the appropriations committees of the Legislature, and the local |
| 183 | community-based care alliances of Broward, Miami-Dade, and |
| 184 | Monroe Counties. In implementing the pilot program, the |
| 185 | department shall not use funds appropriated or allocated to |
| 186 | community-based care lead agencies located outside of the pilot |
| 187 | program area. |
| 188 | (4) Fiscal monitoring, administrative monitoring, and |
| 189 | programmatic monitoring shall be conducted by independent, |
| 190 | nongovernmental third-party entities under contract with the |
| 191 | department and shall be conducted in a manner jointly agreed to |
| 192 | by the lead agencies and the department. The department shall |
| 193 | fund the cost of contracting with these entities. |
| 194 | Notwithstanding any other provision to the contrary, the pilot |
| 195 | program may not be implemented until the parties have agreed to |
| 196 | the selection of these entities and the manner in which they are |
| 197 | to carry out their responsibilities. Such agreement must be |
| 198 | reached by the parties no later than July 1, 2006. The selection |
| 199 | of the third-party entities under this subsection shall be |
| 200 | exempt from s. 287.057, Florida Statutes, from the effective |
| 201 | date of this subsection through June 30, 2007. Fiscal oversight |
| 202 | shall be conducted in a manner similar to the model used by the |
| 203 | department during the 2005-2006 fiscal year in Miami-Dade and |
| 204 | Monroe Counties. This subsection shall take effect upon this act |
| 205 | becoming a law. |
| 206 | (5) To compare the performance of the pilot program's lead |
| 207 | agencies with that of other lead agencies, the programmatic |
| 208 | performance of the pilot program's lead agencies shall be |
| 209 | measured and monitored by outcome measures contained in their |
| 210 | contracts with the department that are in effect on the |
| 211 | effective date of this section and other outcomes designed to |
| 212 | best determine the quality of performance of the lead agencies |
| 213 | and developed by the parties in conjunction with the |
| 214 | independent, nongovernmental third-party entities as part of the |
| 215 | agreement on programmatic monitoring. The independent entities |
| 216 | shall submit their reports directly to the Governor, the |
| 217 | President of the Senate, the Speaker of the House of |
| 218 | Representatives, and the community-based care alliances of |
| 219 | Broward, Miami-Dade, and Monroe Counties. |
| 220 | (6) For purposes of this section, the term "parties" means |
| 221 | the two lead agencies implementing this pilot program and the |
| 222 | Department of Children and Family Services. |
| 223 | (7) The department and the lead agencies implementing the |
| 224 | pilot program shall develop an implementation plan with the |
| 225 | Agency for Health Care Administration regarding the pending |
| 226 | Medicaid mental health reform for the purpose of implementing a |
| 227 | local model that allows for the integration of behavioral health |
| 228 | and physical health with the local child welfare systems of |
| 229 | care. |
| 230 | (8) The annual evaluation required by s. 409.1671(4)(a), |
| 231 | Florida Statutes, shall include an evaluation of the pilot |
| 232 | program described in this section that compares performance and |
| 233 | fiscal management of the community-based care lead agencies in |
| 234 | the pilot program to those that are not in the pilot program. In |
| 235 | addition, the Office of Program Policy Analysis and Government |
| 236 | Accountability and the Office of the Auditor General shall |
| 237 | jointly complete an evaluation of the pilot program and provide |
| 238 | an interim report to the President of the Senate and the Speaker |
| 239 | of the House of Representatives no later than February 1, 2008, |
| 240 | and a final report no later than February 1, 2009. |
| 241 | (9) The provisions of this subsection shall be included in |
| 242 | the contracts with the lead agencies in the pilot program and |
| 243 | may be implemented with other community-based care lead agencies |
| 244 | established under s. 409.1671, Florida Statutes. The contracts |
| 245 | must be fixed-price funded in 36 equal monthly installments. The |
| 246 | first 2 months shall be paid in advance on July 10, 2006. The |
| 247 | contracts shall be funded by a grant of general revenue and by |
| 248 | applicable federal funding sources. The lead agencies are |
| 249 | responsible for documenting federal earnings, and federal |
| 250 | earnings not documented shall be returned to the department. |
| 251 | Notwithstanding s. 409.1671(8), Florida Statutes, the lead |
| 252 | agencies' annual contract amounts may be increased by excess |
| 253 | federal earnings in accordance with s. 216.181(11), Florida |
| 254 | Statutes. Monthly reporting requirements shall be limited to |
| 255 | only the reports required to support monthly federal expenditure |
| 256 | reporting and statutorily restricted state expenditures as |
| 257 | defined in the lead agencies' approved cost allocation plan. |
| 258 | Quarterly reconciliation shall be required from the |
| 259 | participating lead agencies. All other required fiscal reporting |
| 260 | shall be determined by the independent fiscal monitors. |
| 261 | Notwithstanding any other provision of law, the following lead |
| 262 | agency expenditures are permissible: staff cellular telephone |
| 263 | allowances; contracts requiring deferred payments and |
| 264 | maintenance agreements; security deposits for office leases; |
| 265 | related professional membership dues and professional state |
| 266 | license fees; food and refreshment; promotional materials; and |
| 267 | costs associated with fundraising personnel either employed or |
| 268 | contracted with by the lead agency. |
| 269 | (10) The department, in consultation with the Department |
| 270 | of Financial Services, shall develop a compliance supplement for |
| 271 | the state financial assistance regarding flexibility of |
| 272 | allowable expenditures in accordance with s. 215.97, Florida |
| 273 | Statutes, which shall be applicable to all community-based lead |
| 274 | agencies. |
| 275 | (11) The department shall submit a plan to the Executive |
| 276 | Office of the Governor, the chair of the Senate Ways and Means |
| 277 | Committee, and the chair of the House of Representatives Fiscal |
| 278 | Council describing the most efficient use of resources relating |
| 279 | to community-based care in the district administration and the |
| 280 | program management and compliance budget entities. Any cost |
| 281 | savings achieved as a result of this plan shall be distributed |
| 282 | to the lead agencies by a methodology described in the plan. The |
| 283 | department's plan shall be submitted no later than July 1, 2006. |
| 284 | This subsection shall take effect upon this act becoming a law. |
| 285 | (12) This section is repealed July 1, 2009. |
| 286 | Section 3. Except as otherwise expressly provided in this |
| 287 | act and except for this section, which shall take effect upon |
| 288 | this act becoming a law, this act shall take effect July 1, |
| 289 | 2006. |
| 290 |
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| 291 |
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| 292 | ======= T I T L E A M E N D M E N T ======== |
| 293 | Remove the entire title and insert: |
| 294 | A bill to be entitled |
| 295 | An act relating to foster care and related services; |
| 296 | amending s. 409.1671, F.S.; removing provisions requiring |
| 297 | the Department of Children and Family Services to develop |
| 298 | a statewide plan for outsourcing foster care and related |
| 299 | services; removing certain plan requirements; removing an |
| 300 | obsolete date; removing a requirement to issue certain |
| 301 | loans; requiring a community-based risk pool initiative |
| 302 | for certain purposes; providing for the components of the |
| 303 | initiative; establishing a risk pool peer review |
| 304 | committee; requiring a report to the secretary of the |
| 305 | department; authorizing expenditures from the risk pool |
| 306 | under certain circumstances; providing for uses of the |
| 307 | risk pool; removing certain provisions relating to the |
| 308 | sources of future funding; making conforming changes; |
| 309 | removing authority of the Florida Coalition for Children, |
| 310 | Inc., or its subcontractors to manage certain risk pool |
| 311 | funds; authorizing the department to issue an interest- |
| 312 | free loan to the Florida Coalition for Children, Inc., to |
| 313 | establish a self-insurance program based on certain |
| 314 | appropriations; providing terms for repayment of the loan; |
| 315 | establishing a 3-year pilot program in Miami-Dade, Monroe, |
| 316 | and Broward Counties; providing for the transfer of |
| 317 | certain responsibilities from the Department of Children |
| 318 | and Family Services to specified community-based care lead |
| 319 | agencies; requiring review of the proposed contract by the |
| 320 | Chief Financial Officer by a certain date; providing for |
| 321 | funding the pilot program from grants and federal funds; |
| 322 | requiring that annual financial statements regarding the |
| 323 | pilot program be provided to the Governor, the |
| 324 | Legislature, the department, and certain local community- |
| 325 | based care alliances; prohibiting the department from |
| 326 | using certain funds; requiring that fiscal, |
| 327 | administrative, and programmatic monitoring be conducted |
| 328 | by third-party entities; requiring the department to fund |
| 329 | the cost of the third-party monitoring; exempting the |
| 330 | selection of the third-party entities from the provisions |
| 331 | of s. 287.057, F.S., for a specified period of time; |
| 332 | requiring such entities to submit reports to the Governor, |
| 333 | the Legislature, and certain local community-based care |
| 334 | alliances; defining "parties"; requiring that the |
| 335 | department, the lead agencies implementing the pilot |
| 336 | program, and the Agency for Health Care Administration |
| 337 | develop a plan for integrating certain Medicaid health |
| 338 | services; specifying that the annual evaluation required |
| 339 | in s. 409.1671, F.S., include an evaluation of the pilot |
| 340 | program; directing the Office of Program Policy Analysis |
| 341 | and Government Accountability and the Office of the |
| 342 | Auditor General to complete an evaluation of the pilot |
| 343 | program and to report to the Legislature; providing for |
| 344 | certain provisions to be included in the contract; |
| 345 | requiring the department to enter into fixed-price |
| 346 | contracts; authorizing increased contract payments under |
| 347 | certain circumstances; requiring fiscal reporting and |
| 348 | reconciliation; providing for certain expenditures by lead |
| 349 | agencies; providing for a compliance supplement applicable |
| 350 | to all community-based lead agencies; requiring the |
| 351 | department to submit a plan by July 1, 2006, to the |
| 352 | Governor and Legislature for the efficient use of |
| 353 | resources; providing for distribution of savings resulting |
| 354 | from the plan; providing for future repeal; providing |
| 355 | effective dates. |