Amendment
Bill No. 1116

Amendment No. 667869

CHAMBER ACTION
Senate		House
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1	Representative(s) Bean offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Subsection (2) of section 409.911, Florida
6	Statutes, is amended to read:
7	409.911  Disproportionate share program.--Subject to
8	specific allocations established within the General
9	Appropriations Act and any limitations established pursuant to
10	chapter 216, the agency shall distribute, pursuant to this
11	section, moneys to hospitals providing a disproportionate share
12	of Medicaid or charity care services by making quarterly
13	Medicaid payments as required. Notwithstanding the provisions of
14	s. 409.915, counties are exempt from contributing toward the
15	cost of this special reimbursement for hospitals serving a
16	disproportionate share of low-income patients.
17	(2)  The Agency for Health Care Administration shall use
18	the following actual audited data to determine the Medicaid days
19	and charity care to be used in calculating the disproportionate
20	share payment:
21	(a)  The average of the 2001, 2002, and 2003 2000, 2001,
22	and 2002 audited disproportionate share data to determine each
23	hospital's Medicaid days and charity care for the 2007-2008
24	2006-2007 state fiscal year.
25	(b)  If the Agency for Health Care Administration does not
26	have the prescribed 3 years of audited disproportionate share
27	data as noted in paragraph (a) for a hospital, the agency shall
28	use the average of the years of the audited disproportionate
29	share data as noted in paragraph (a) which is available.
30	(c)  In accordance with s. 1923(b) of the Social Security
31	Act, a hospital with a Medicaid inpatient utilization rate
32	greater than one standard deviation above the statewide mean or
33	a hospital with a low-income utilization rate of 25 percent or
34	greater shall qualify for reimbursement.
35	Section 2.  Section 409.9112, Florida Statutes, is amended
36	to read:
37	409.9112  Disproportionate share program for regional
38	perinatal intensive care centers.--In addition to the payments
39	made under s. 409.911, the Agency for Health Care Administration
40	shall design and implement a system of making disproportionate
41	share payments to those hospitals that participate in the
42	regional perinatal intensive care center program established
43	pursuant to chapter 383. This system of payments shall conform
44	with federal requirements and shall distribute funds in each
45	fiscal year for which an appropriation is made by making
46	quarterly Medicaid payments. Notwithstanding the provisions of
47	s. 409.915, counties are exempt from contributing toward the
48	cost of this special reimbursement for hospitals serving a
49	disproportionate share of low-income patients. For the state
50	fiscal year 2007-2008 2005-2006, the agency shall not distribute
51	moneys under the regional perinatal intensive care centers
52	disproportionate share program.
53	(1)  The following formula shall be used by the agency to
54	calculate the total amount earned for hospitals that participate
55	in the regional perinatal intensive care center program:
56
57	TAE = HDSP/THDSP
58
59	Where:
60	TAE = total amount earned by a regional perinatal intensive
61	care center.
62	HDSP = the prior state fiscal year regional perinatal
63	intensive care center disproportionate share payment to the
64	individual hospital.
65	THDSP = the prior state fiscal year total regional
66	perinatal intensive care center disproportionate share payments
67	to all hospitals.
68	(2)  The total additional payment for hospitals that
69	participate in the regional perinatal intensive care center
70	program shall be calculated by the agency as follows:
71
72	TAP = TAE x TA
73
74	Where:
75	TAP = total additional payment for a regional perinatal
76	intensive care center.
77	TAE = total amount earned by a regional perinatal intensive
78	care center.
79	TA = total appropriation for the regional perinatal
80	intensive care center disproportionate share program.
81	(3)  In order to receive payments under this section, a
82	hospital must be participating in the regional perinatal
83	intensive care center program pursuant to chapter 383 and must
84	meet the following additional requirements:
85	(a)  Agree to conform to all departmental and agency
86	requirements to ensure high quality in the provision of
87	services, including criteria adopted by departmental and agency
88	rule concerning staffing ratios, medical records, standards of
89	care, equipment, space, and such other standards and criteria as
90	the department and agency deem appropriate as specified by rule.
91	(b)  Agree to provide information to the department and
92	agency, in a form and manner to be prescribed by rule of the
93	department and agency, concerning the care provided to all
94	patients in neonatal intensive care centers and high-risk
95	maternity care.
96	(c)  Agree to accept all patients for neonatal intensive
97	care and high-risk maternity care, regardless of ability to pay,
98	on a functional space-available basis.
99	(d)  Agree to develop arrangements with other maternity and
100	neonatal care providers in the hospital's region for the
101	appropriate receipt and transfer of patients in need of
102	specialized maternity and neonatal intensive care services.
103	(e)  Agree to establish and provide a developmental
104	evaluation and services program for certain high-risk neonates,
105	as prescribed and defined by rule of the department.
106	(f)  Agree to sponsor a program of continuing education in
107	perinatal care for health care professionals within the region
108	of the hospital, as specified by rule.
109	(g)  Agree to provide backup and referral services to the
110	department's county health departments and other low-income
111	perinatal providers within the hospital's region, including the
112	development of written agreements between these organizations
113	and the hospital.
114	(h)  Agree to arrange for transportation for high-risk
115	obstetrical patients and neonates in need of transfer from the
116	community to the hospital or from the hospital to another more
117	appropriate facility.
118	(4)  Hospitals which fail to comply with any of the
119	conditions in subsection (3) or the applicable rules of the
120	department and agency shall not receive any payments under this
121	section until full compliance is achieved. A hospital which is
122	not in compliance in two or more consecutive quarters shall not
123	receive its share of the funds. Any forfeited funds shall be
124	distributed by the remaining participating regional perinatal
125	intensive care center program hospitals.
126	Section 3.  Section 409.9113, Florida Statutes, is amended
127	to read:
128	409.9113  Disproportionate share program for teaching
129	hospitals.--In addition to the payments made under ss. 409.911
130	and 409.9112, the Agency for Health Care Administration shall
131	make disproportionate share payments to statutorily defined
132	teaching hospitals for their increased costs associated with
133	medical education programs and for tertiary health care services
134	provided to the indigent. This system of payments shall conform
135	with federal requirements and shall distribute funds in each
136	fiscal year for which an appropriation is made by making
137	quarterly Medicaid payments. Notwithstanding s. 409.915,
138	counties are exempt from contributing toward the cost of this
139	special reimbursement for hospitals serving a disproportionate
140	share of low-income patients. For the state fiscal year 2007-
141	2008 2006-2007, the agency shall distribute the moneys provided
142	in the General Appropriations Act to statutorily defined
143	teaching hospitals and family practice teaching hospitals under
144	the teaching hospital disproportionate share program. The funds
145	provided for statutorily defined teaching hospitals shall be
146	distributed in the same proportion as the state fiscal year
147	2003-2004 teaching hospital disproportionate share funds were
148	distributed. The funds provided for family practice teaching
149	hospitals shall be distributed equally among family practice
150	teaching hospitals.
151	(1)  On or before September 15 of each year, the Agency for
152	Health Care Administration shall calculate an allocation
153	fraction to be used for distributing funds to state statutory
154	teaching hospitals. Subsequent to the end of each quarter of the
155	state fiscal year, the agency shall distribute to each statutory
156	teaching hospital, as defined in s. 408.07, an amount determined
157	by multiplying one-fourth of the funds appropriated for this
158	purpose by the Legislature times such hospital's allocation
159	fraction. The allocation fraction for each such hospital shall
160	be determined by the sum of three primary factors, divided by
161	three. The primary factors are:
162	(a)  The number of nationally accredited graduate medical
163	education programs offered by the hospital, including programs
164	accredited by the Accreditation Council for Graduate Medical
165	Education and the combined Internal Medicine and Pediatrics
166	programs acceptable to both the American Board of Internal
167	Medicine and the American Board of Pediatrics at the beginning
168	of the state fiscal year preceding the date on which the
169	allocation fraction is calculated. The numerical value of this
170	factor is the fraction that the hospital represents of the total
171	number of programs, where the total is computed for all state
172	statutory teaching hospitals.
173	(b)  The number of full-time equivalent trainees in the
174	hospital, which comprises two components:
175	1.  The number of trainees enrolled in nationally
176	accredited graduate medical education programs, as defined in
177	paragraph (a). Full-time equivalents are computed using the
178	fraction of the year during which each trainee is primarily
179	assigned to the given institution, over the state fiscal year
180	preceding the date on which the allocation fraction is
181	calculated. The numerical value of this factor is the fraction
182	that the hospital represents of the total number of full-time
183	equivalent trainees enrolled in accredited graduate programs,
184	where the total is computed for all state statutory teaching
185	hospitals.
186	2.  The number of medical students enrolled in accredited
187	colleges of medicine and engaged in clinical activities,
188	including required clinical clerkships and clinical electives.
189	Full-time equivalents are computed using the fraction of the
190	year during which each trainee is primarily assigned to the
191	given institution, over the course of the state fiscal year
192	preceding the date on which the allocation fraction is
193	calculated. The numerical value of this factor is the fraction
194	that the given hospital represents of the total number of full-
195	time equivalent students enrolled in accredited colleges of
196	medicine, where the total is computed for all state statutory
197	teaching hospitals.
198
199	The primary factor for full-time equivalent trainees is computed
200	as the sum of these two components, divided by two.
201	(c)  A service index that comprises three components:
202	1.  The Agency for Health Care Administration Service
203	Index, computed by applying the standard Service Inventory
204	Scores established by the Agency for Health Care Administration
205	to services offered by the given hospital, as reported on
206	Worksheet A-2 for the last fiscal year reported to the agency
207	before the date on which the allocation fraction is calculated.
208	The numerical value of this factor is the fraction that the
209	given hospital represents of the total Agency for Health Care
210	Administration Service Index values, where the total is computed
211	for all state statutory teaching hospitals.
212	2.  A volume-weighted service index, computed by applying
213	the standard Service Inventory Scores established by the Agency
214	for Health Care Administration to the volume of each service,
215	expressed in terms of the standard units of measure reported on
216	Worksheet A-2 for the last fiscal year reported to the agency
217	before the date on which the allocation factor is calculated.
218	The numerical value of this factor is the fraction that the
219	given hospital represents of the total volume-weighted service
220	index values, where the total is computed for all state
221	statutory teaching hospitals.
222	3.  Total Medicaid payments to each hospital for direct
223	inpatient and outpatient services during the fiscal year
224	preceding the date on which the allocation factor is calculated.
225	This includes payments made to each hospital for such services
226	by Medicaid prepaid health plans, whether the plan was
227	administered by the hospital or not. The numerical value of this
228	factor is the fraction that each hospital represents of the
229	total of such Medicaid payments, where the total is computed for
230	all state statutory teaching hospitals.
231
232	The primary factor for the service index is computed as the sum
233	of these three components, divided by three.
234	(2)  By October 1 of each year, the agency shall use the
235	following formula to calculate the maximum additional
236	disproportionate share payment for statutorily defined teaching
237	hospitals:
238
239	TAP = THAF x A
240
241	Where:
242	TAP = total additional payment.
243	THAF = teaching hospital allocation factor.
244	A = amount appropriated for a teaching hospital
245	disproportionate share program.
246	Section 4.  Section 409.9117, Florida Statutes, is amended
247	to read:
248	409.9117  Primary care disproportionate share program.--For
249	the state fiscal year 2007-2008 2006-2007, the agency shall not
250	distribute moneys under the primary care disproportionate share
251	program.
252	(1)  If federal funds are available for disproportionate
253	share programs in addition to those otherwise provided by law,
254	there shall be created a primary care disproportionate share
255	program.
256	(2)  The following formula shall be used by the agency to
257	calculate the total amount earned for hospitals that participate
258	in the primary care disproportionate share program:
259
260	TAE = HDSP/THDSP
261
262	Where:
263	TAE = total amount earned by a hospital participating in
264	the primary care disproportionate share program.
265	HDSP = the prior state fiscal year primary care
266	disproportionate share payment to the individual hospital.
267	THDSP = the prior state fiscal year total primary care
268	disproportionate share payments to all hospitals.
269	(3)  The total additional payment for hospitals that
270	participate in the primary care disproportionate share program
271	shall be calculated by the agency as follows:
272
273	TAP = TAE x TA
274
275	Where:
276	TAP = total additional payment for a primary care hospital.
277	TAE = total amount earned by a primary care hospital.
278	TA = total appropriation for the primary care
279	disproportionate share program.
280	(4)  In the establishment and funding of this program, the
281	agency shall use the following criteria in addition to those
282	specified in s. 409.911, payments may not be made to a hospital
283	unless the hospital agrees to:
284	(a)  Cooperate with a Medicaid prepaid health plan, if one
285	exists in the community.
286	(b)  Ensure the availability of primary and specialty care
287	physicians to Medicaid recipients who are not enrolled in a
288	prepaid capitated arrangement and who are in need of access to
289	such physicians.
290	(c)  Coordinate and provide primary care services free of
291	charge, except copayments, to all persons with incomes up to 100
292	percent of the federal poverty level who are not otherwise
293	covered by Medicaid or another program administered by a
294	governmental entity, and to provide such services based on a
295	sliding fee scale to all persons with incomes up to 200 percent
296	of the federal poverty level who are not otherwise covered by
297	Medicaid or another program administered by a governmental
298	entity, except that eligibility may be limited to persons who
299	reside within a more limited area, as agreed to by the agency
300	and the hospital.
301	(d)  Contract with any federally qualified health center,
302	if one exists within the agreed geopolitical boundaries,
303	concerning the provision of primary care services, in order to
304	guarantee delivery of services in a nonduplicative fashion, and
305	to provide for referral arrangements, privileges, and
306	admissions, as appropriate. The hospital shall agree to provide
307	at an onsite or offsite facility primary care services within 24
308	hours to which all Medicaid recipients and persons eligible
309	under this paragraph who do not require emergency room services
310	are referred during normal daylight hours.
311	(e)  Cooperate with the agency, the county, and other
312	entities to ensure the provision of certain public health
313	services, case management, referral and acceptance of patients,
314	and sharing of epidemiological data, as the agency and the
315	hospital find mutually necessary and desirable to promote and
316	protect the public health within the agreed geopolitical
317	boundaries.
318	(f)  In cooperation with the county in which the hospital
319	resides, develop a low-cost, outpatient, prepaid health care
320	program to persons who are not eligible for the Medicaid
321	program, and who reside within the area.
322	(g)  Provide inpatient services to residents within the
323	area who are not eligible for Medicaid or Medicare, and who do
324	not have private health insurance, regardless of ability to pay,
325	on the basis of available space, except that nothing shall
326	prevent the hospital from establishing bill collection programs
327	based on ability to pay.
328	(h)  Work with the Florida Healthy Kids Corporation, the
329	Florida Health Care Purchasing Cooperative, and business health
330	coalitions, as appropriate, to develop a feasibility study and
331	plan to provide a low-cost comprehensive health insurance plan
332	to persons who reside within the area and who do not have access
333	to such a plan.
334	(i)  Work with public health officials and other experts to
335	provide community health education and prevention activities
336	designed to promote healthy lifestyles and appropriate use of
337	health services.
338	(j)  Work with the local health council to develop a plan
339	for promoting access to affordable health care services for all
340	persons who reside within the area, including, but not limited
341	to, public health services, primary care services, inpatient
342	services, and affordable health insurance generally.
343
344	Any hospital that fails to comply with any of the provisions of
345	this subsection, or any other contractual condition, may not
346	receive payments under this section until full compliance is
347	achieved.
348	Section 5.  Subsection (26) is added to section 409.906,
349	Florida Statutes, to read:
350	409.906  Optional Medicaid services.--Subject to specific
351	appropriations, the agency may make payments for services which
352	are optional to the state under Title XIX of the Social Security
353	Act and are furnished by Medicaid providers to recipients who
354	are determined to be eligible on the dates on which the services
355	were provided. Any optional service that is provided shall be
356	provided only when medically necessary and in accordance with
357	state and federal law. Optional services rendered by providers
358	in mobile units to Medicaid recipients may be restricted or
359	prohibited by the agency. Nothing in this section shall be
360	construed to prevent or limit the agency from adjusting fees,
361	reimbursement rates, lengths of stay, number of visits, or
362	number of services, or making any other adjustments necessary to
363	comply with the availability of moneys and any limitations or
364	directions provided for in the General Appropriations Act or
365	chapter 216. If necessary to safeguard the state's systems of
366	providing services to elderly and disabled persons and subject
367	to the notice and review provisions of s. 216.177, the Governor
368	may direct the Agency for Health Care Administration to amend
369	the Medicaid state plan to delete the optional Medicaid service
370	known as "Intermediate Care Facilities for the Developmentally
371	Disabled." Optional services may include:
372	(26)  ANESTHESIOLOGIST ASSISTANT SERVICES.--The agency may
373	pay for all services provided to a recipient by an
374	anesthesiologist assistant licensed under s. 458.3475 or s.
375	459.023. Reimbursement for such services must be not less than
376	80 percent of the reimbursement that would be paid to a
377	physician who provided the same services.
378	Section 6.  Subsection (36) of section 393.063, Florida
379	Statutes, is amended to read:
380	393.063  Definitions.--For the purposes of this chapter,
381	the term:
382	(36)  "Support coordinator" means a person who is
383	designated by or under contract with the agency to serve as case
384	manager for assist individuals served in programs administered
385	by the agency, including, but not limited to, Medicaid waiver
386	programs, and to identify individuals' families in identifying
387	their capacities, needs, and resources, as well as finding and
388	gaining access to necessary supports and services; coordinating
389	the delivery of supports and services; advocating on behalf of
390	the individual and family; maintaining relevant records; and
391	monitoring and evaluating the delivery of supports and services.
392	A support coordinator is responsible for assisting the agency in
393	meeting the needs of individuals served while managing
394	expenditures within available resources to determine the extent
395	to which they meet the needs and expectations identified by the
396	individual, family, and others who participated in the
397	development of the support plan.
398	Section 7.  Paragraph (c) is added to subsection (1) of
399	section 393.0661, Florida Statutes, to read:
400	393.0661  Home and community-based services delivery
401	system; comprehensive redesign.--The Legislature finds that the
402	home and community-based services delivery system for persons
403	with developmental disabilities and the availability of
404	appropriated funds are two of the critical elements in making
405	services available. Therefore, it is the intent of the
406	Legislature that the Agency for Persons with Disabilities shall
407	develop and implement a comprehensive redesign of the system.
408	(1)  The redesign of the home and community-based services
409	system shall include, at a minimum, all actions necessary to
410	achieve an appropriate rate structure, client choice within a
411	specified service package, appropriate assessment strategies, an
412	efficient billing process that contains reconciliation and
413	monitoring components, a redefined role for support coordinators
414	that avoids potential conflicts of interest, and ensures that
415	family/client budgets are linked to levels of need.
416	(c)  By December 1, 2007, the Agency for Persons with
417	Disabilities, in consultation with the Agency for Health Care
418	Administration, shall create a model service delivery system
419	pilot project for persons with developmental disabilities who
420	receive services under the developmental disabilities waiver
421	program administered by the Agency for Persons with
422	Disabilities. Persons with developmental disabilities who
423	receive services under the family and supported living waiver
424	program or the consumer-directed care plus waiver program
425	administered by the Agency for Persons with Disabilities may
426	also be included in the system if the agency determines that
427	such inclusion is feasible and will improve coordination of care
428	and management of costs. The system must transfer and combine
429	all services funded by Medicaid waiver programs and services
430	funded only by the state, including room and board and supported
431	living payments, for individuals who participate in the system.
432	The pilot project shall document increased client outcomes that
433	are known to be associated with a valid needs assessment of the
434	level of need of the client, rate setting based on the level of
435	need, and encouragement of the use of community-centered
436	services and supports. The pilot project shall implement strong
437	utilization control, such as capped rates, in order to ensure
438	predictable and controlled annual costs. Medicaid service
439	delivery, including, but not limited to, service authorization,
440	care management, and monitoring shall be managed locally through
441	the area office of the Agency for Persons with Disabilities in
442	order to encourage provider development. Support coordination
443	services shall be available to individuals participating in the
444	pilot program.
445	1.  The Legislature intends that the service delivery
446	system provide recipients in Medicaid waiver programs with a
447	coordinated system of services, increased cost predictability,
448	and a stabilized rate of increase in Medicaid expenditures while
449	ensuring:
450	a.  Consumer choice.
451	b.  Opportunities for consumer-directed services.
452	c.  Access to medically necessary services.
453	d.  Coordination of community-based services.
454	e.  Reductions in the unnecessary use of services.
455	2.  The Agency for Persons with Disabilities shall
456	implement the system on a pilot basis in Area 1 and may conduct
457	a similar pilot in an urban area of the Agency for Persons with
458	Disabilities, in consultation with the Agency for Health Care
459	Administration. After completion of the development phase of the
460	system, attainment of necessary federal approval, selection of
461	qualified providers, and rate setting, the Agency for Persons
462	with Disabilities shall delegate administration of the system to
463	the administrator of the agency's local area office. The Agency
464	for Persons with Disabilities shall set standards for qualified
465	providers and provide quality assurance, monitoring oversight,
466	and other duties necessary for the system. The enrollment of
467	Medicaid waiver recipients into the system in pilot areas shall
468	be mandatory.
469	3.  The local area office shall administer the pilot
470	program and shall be responsible for ensuring that the costs of
471	the program do not exceed the amount of funds allocated for the
472	program. The agency area administrator shall also:
473	a.  Identify the needs of the recipients using a
474	standardized assessment process approved by the agency.
475	b.  Allow a recipient to select any provider that has been
476	qualified by the agency, provided that the service offered by
477	the provider is appropriate to meet the needs of the recipient.
478	c.  Make a good faith effort to select qualified providers
479	currently providing Medicaid waiver services for the agency in
480	the pilot area.
481	d.  Develop and use a service provider qualification system
482	approved by the agency that describes the quality of care
483	standards that providers of service to persons with
484	developmental disabilities must meet in order to provide
485	services within the pilot area.
486	e.  Exclude, when feasible, chronically poor-performing
487	providers and facilities as determined by the agency.
488	f.  Demonstrate a quality assurance system and a
489	performance improvement system that are satisfactory to the
490	agency.
491	4.  The agency must ensure that the rate-setting
492	methodology for the system reflects the intent to provide
493	quality care in the least restrictive setting appropriate for
494	the recipient and provide for choice by the recipient. The
495	agency may choose to limit financial risk for the pilot area
496	operating the system to cover high-cost recipients or to address
497	the catastrophic care needs of recipients enrolled in the
498	system.
499	5.  Within 24 months after implementation, the agency shall
500	contract for a comprehensive evaluation of the system. The
501	evaluation must include assessments of cost savings, cost-
502	effectiveness, recipient outcomes, consumer choice, access to
503	services, coordination of care, and quality of care. The
504	evaluation shall include, but not be limited to, an assessment
505	of the following aspects:
506	a.  A study of the funding patterns of the cost-prediction
507	methodology before and after implementation of the pilot
508	program;
509	b.  A study of the service utilization patterns of the
510	cost-prediction methodology before and after implementation of
511	the pilot program;
512	c.  The accuracy of the cost-prediction methodology in
513	explaining and predicting funding levels for individuals
514	receiving each of the three waivers in the pilot areas;
515	d.  The accuracy of the cost-prediction methodology and a
516	plan for dealing with cases involving individuals with the
517	highest and lowest support needs and funding levels;
518	e.  A survey of consumer satisfaction regarding consumer
519	choice, scope of services, and proposed funding levels generated
520	by the cost-prediction methodology in the pilot areas;
521	f.  The applicability of the cost-prediction  methodology
522	to explain and predict funding levels for all individuals
523	receiving the waivers;
524	g.  The robustness of the cost-prediction methodology to
525	withstand appeals and grievances; and
526	h.  A systematic comparison of the outcomes in both pilot
527	areas and the different models that are demonstrated.
528	6.  Each pilot area shall form an advisory committee that
529	includes representatives from the stakeholder community,
530	including persons with disabilities, family members of persons
531	with disabilities, members of disability advocacy groups, and
532	representatives of program service providers to provide feedback
533	and monitor the implementation of the pilot program on at least
534	a quarterly basis.
535	7.  The Agency for Persons with Disabilities shall form an
536	advisory committee that includes representatives from the
537	stakeholder community, including persons with disabilities,
538	family members of persons with disabilities, members of
539	disability advocacy groups, and representatives of program
540	service providers to provide feedback and monitor the
541	implementation of the pilot program from a statewide
542	perspective.
543	8.  The advisory committees shall submit reports evaluating
544	the progress of the pilot programs to the President of the
545	Senate and the Speaker of the House of Representatives on a
546	quarterly basis.
547	9.  The agency shall submit a report that describes the
548	administrative or legal barriers to the implementation and
549	operation of the system, including recommendations regarding
550	statewide expansion of the system and a recommendation for the
551	model service delivery system to be implemented statewide, to
552	the Governor, the President of the Senate, and the Speaker of
553	the House of Representatives no later than December 31, 2008.
554	10.  The agency, in coordination with the Agency for Health
555	Care Administration, may seek federal waivers or Medicaid state
556	plan amendments and adopt rules as necessary to administer the
557	system on a pilot basis. The agency must receive specific
558	authorization from the Legislature prior to expanding beyond the
559	area one pilot designated for the implementation of this system.
560	Further expansion of this pilot project requires approval by the
561	Legislature.
562	Section 8.  The sum of $250,000 in nonrecurring funds from
563	the General Revenue Fund and $250,000 in nonrecurring funds from
564	the Administrative Trust Fund are appropriated to the Agency for
565	Persons with Disabilities to implement the provisions of this
566	act.
567	Section 9.  This act shall take effect July 1, 2007.
568
569	======= T I T L E  A M E N D M E N T ==========
570	Remove the entire title and insert:
571	A bill to be entitled
572	An act relating to health care; amending s. 409.911, F.S.;
573	revising the method for calculating disproportionate share
574	payments to hospitals; amending s. 409.9112, F.S.;
575	revising the time period during which the Agency for
576	Health Care Administration is prohibited from distributing
577	disproportionate share payments to regional perinatal
578	intensive care centers; amending s. 409.9113, F.S.;
579	revising the time period for distribution of
580	disproportionate share payments to teaching hospitals;
581	amending s. 409.9117, F.S.; revising the time period
582	during which the agency is prohibited from distributing
583	certain moneys under the primary care disproportionate
584	share program; amending s. 409.906, F.S.; authorizing the
585	agency to pay for certain services provided by an
586	anesthesiologist assistant; amending s. 393.063, F.S.;
587	revising the definition of the term "support coordinator";
588	amending s. 393.0661, F.S.; requiring the Agency for
589	Persons with Disabilities, in consultation with the Agency
590	for Health Care Administration, to implement federal
591	waivers to create a model service delivery system pilot
592	project for Medicaid recipients with developmental
593	disabilities; providing legislative intent; providing for
594	implementation of the system on a pilot basis in certain
595	areas of the state; providing for administration of the
596	system by the Agency for Persons with Disabilities;
597	providing requirements for selection of service providers
598	to operate the system; providing for mandatory enrollment
599	in pilot areas; requiring an evaluation of the system;
600	providing for the formation of local and statewide
601	advisory committees; requiring the committees to submit
602	quarterly reports to the Legislature; requiring the agency
603	to submit a report to the Governor and Legislature;
604	authorizing the agency to seek federal waivers or Medicaid
605	state plan amendments and adopt rules; requiring the
606	agency to receive specific authorization from the
607	Legislature before expanding the system; providing
608	appropriations; providing an effective date.

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