Senate Bill sb1116e1
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1 A bill to be entitled
2 An act relating to health care; amending s.
3 409.911, F.S.; providing for the calculation of
4 payments made to hospitals serving a
5 disproportionate share of low-income patients;
6 amending s. 409.9112, F.S.; prohibiting the
7 Agency for Health Care Administration from
8 distributing moneys under the regional
9 perinatal intensive care centers
10 disproportionate share program for the
11 2007-2008 fiscal year; amending s. 409.9113,
12 F.S.; requiring the agency to distribute moneys
13 provided in the General Appropriations Act to
14 statutorily defined teaching hospitals and
15 family practice teaching hospitals under the
16 teaching hospital disproportionate share
17 program for the 2007-2008 fiscal year; amending
18 s. 409.9117, F.S.; prohibiting the agency from
19 distributing moneys under the primary care
20 disproportionate share program for the
21 2007-2008 fiscal year; amending s. 409.912,
22 F.S.; providing an exception to behavioral
23 health care services delivered through a
24 specialty prepaid plan for certain specified
25 children; amending s. 409.91211, F.S.;
26 requiring the Agency for Health Care
27 Administration to implement delivery mechanisms
28 to provide Medicaid services to
29 Medicaid-eligible children who are open for
30 child welfare services in the HomeSafeNet
31 system; requiring that the services be
1
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1 sufficient to meet the medical, developmental,
2 behavioral, and emotional needs of the
3 children; directing the agency to implement the
4 service delivery by a specified date; providing
5 an effective date.
6
7 Be It Enacted by the Legislature of the State of Florida:
8
9 Section 1. Paragraph (a) of subsection (2) of section
10 409.911, Florida Statutes, is amended to read:
11 409.911 Disproportionate share program.--Subject to
12 specific allocations established within the General
13 Appropriations Act and any limitations established pursuant to
14 chapter 216, the agency shall distribute, pursuant to this
15 section, moneys to hospitals providing a disproportionate
16 share of Medicaid or charity care services by making quarterly
17 Medicaid payments as required. Notwithstanding the provisions
18 of s. 409.915, counties are exempt from contributing toward
19 the cost of this special reimbursement for hospitals serving a
20 disproportionate share of low-income patients.
21 (2) The Agency for Health Care Administration shall
22 use the following actual audited data to determine the
23 Medicaid days and charity care to be used in calculating the
24 disproportionate share payment:
25 (a) The average of the 2000, 2001, and 2002, and 2003
26 audited disproportionate share data to determine each
27 hospital's Medicaid days and charity care for the 2007-2008
28 2006-2007 state fiscal year.
29 Section 2. Section 409.9112, Florida Statutes, is
30 amended to read:
31
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1 409.9112 Disproportionate share program for regional
2 perinatal intensive care centers.--In addition to the payments
3 made under s. 409.911, the Agency for Health Care
4 Administration shall design and implement a system of making
5 disproportionate share payments to those hospitals that
6 participate in the regional perinatal intensive care center
7 program established pursuant to chapter 383. This system of
8 payments shall conform with federal requirements and shall
9 distribute funds in each fiscal year for which an
10 appropriation is made by making quarterly Medicaid payments.
11 Notwithstanding the provisions of s. 409.915, counties are
12 exempt from contributing toward the cost of this special
13 reimbursement for hospitals serving a disproportionate share
14 of low-income patients. For the state fiscal year 2007-2008
15 2005-2006, the agency shall not distribute moneys under the
16 regional perinatal intensive care centers disproportionate
17 share program.
18 (1) The following formula shall be used by the agency
19 to calculate the total amount earned for hospitals that
20 participate in the regional perinatal intensive care center
21 program:
22
23 TAE = HDSP/THDSP
24
25 Where:
26 TAE = total amount earned by a regional perinatal
27 intensive care center.
28 HDSP = the prior state fiscal year regional perinatal
29 intensive care center disproportionate share payment to the
30 individual hospital.
31
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1 THDSP = the prior state fiscal year total regional
2 perinatal intensive care center disproportionate share
3 payments to all hospitals.
4
5 (2) The total additional payment for hospitals that
6 participate in the regional perinatal intensive care center
7 program shall be calculated by the agency as follows:
8
9 TAP = TAE x TA
10
11 Where:
12 TAP = total additional payment for a regional perinatal
13 intensive care center.
14 TAE = total amount earned by a regional perinatal
15 intensive care center.
16 TA = total appropriation for the regional perinatal
17 intensive care center disproportionate share program.
18
19 (3) In order to receive payments under this section, a
20 hospital must be participating in the regional perinatal
21 intensive care center program pursuant to chapter 383 and must
22 meet the following additional requirements:
23 (a) Agree to conform to all departmental and agency
24 requirements to ensure high quality in the provision of
25 services, including criteria adopted by departmental and
26 agency rule concerning staffing ratios, medical records,
27 standards of care, equipment, space, and such other standards
28 and criteria as the department and agency deem appropriate as
29 specified by rule.
30 (b) Agree to provide information to the department and
31 agency, in a form and manner to be prescribed by rule of the
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1 department and agency, concerning the care provided to all
2 patients in neonatal intensive care centers and high-risk
3 maternity care.
4 (c) Agree to accept all patients for neonatal
5 intensive care and high-risk maternity care, regardless of
6 ability to pay, on a functional space-available basis.
7 (d) Agree to develop arrangements with other maternity
8 and neonatal care providers in the hospital's region for the
9 appropriate receipt and transfer of patients in need of
10 specialized maternity and neonatal intensive care services.
11 (e) Agree to establish and provide a developmental
12 evaluation and services program for certain high-risk
13 neonates, as prescribed and defined by rule of the department.
14 (f) Agree to sponsor a program of continuing education
15 in perinatal care for health care professionals within the
16 region of the hospital, as specified by rule.
17 (g) Agree to provide backup and referral services to
18 the department's county health departments and other
19 low-income perinatal providers within the hospital's region,
20 including the development of written agreements between these
21 organizations and the hospital.
22 (h) Agree to arrange for transportation for high-risk
23 obstetrical patients and neonates in need of transfer from the
24 community to the hospital or from the hospital to another more
25 appropriate facility.
26 (4) Hospitals which fail to comply with any of the
27 conditions in subsection (3) or the applicable rules of the
28 department and agency shall not receive any payments under
29 this section until full compliance is achieved. A hospital
30 which is not in compliance in two or more consecutive quarters
31 shall not receive its share of the funds. Any forfeited funds
5
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1 shall be distributed by the remaining participating regional
2 perinatal intensive care center program hospitals.
3 Section 3. Section 409.9113, Florida Statutes, is
4 amended to read:
5 409.9113 Disproportionate share program for teaching
6 hospitals.--In addition to the payments made under ss. 409.911
7 and 409.9112, the Agency for Health Care Administration shall
8 make disproportionate share payments to statutorily defined
9 teaching hospitals for their increased costs associated with
10 medical education programs and for tertiary health care
11 services provided to the indigent. This system of payments
12 shall conform with federal requirements and shall distribute
13 funds in each fiscal year for which an appropriation is made
14 by making quarterly Medicaid payments. Notwithstanding s.
15 409.915, counties are exempt from contributing toward the cost
16 of this special reimbursement for hospitals serving a
17 disproportionate share of low-income patients. For the state
18 fiscal year 2007-2008 2006-2007, the agency shall distribute
19 the moneys provided in the General Appropriations Act to
20 statutorily defined teaching hospitals and family practice
21 teaching hospitals under the teaching hospital
22 disproportionate share program. The funds provided for
23 statutorily defined teaching hospitals shall be distributed in
24 the same proportion as the state fiscal year 2003-2004
25 teaching hospital disproportionate share funds were
26 distributed. The funds provided for family practice teaching
27 hospitals shall be distributed equally among family practice
28 teaching hospitals.
29 (1) On or before September 15 of each year, the Agency
30 for Health Care Administration shall calculate an allocation
31 fraction to be used for distributing funds to state statutory
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1 teaching hospitals. Subsequent to the end of each quarter of
2 the state fiscal year, the agency shall distribute to each
3 statutory teaching hospital, as defined in s. 408.07, an
4 amount determined by multiplying one-fourth of the funds
5 appropriated for this purpose by the Legislature times such
6 hospital's allocation fraction. The allocation fraction for
7 each such hospital shall be determined by the sum of three
8 primary factors, divided by three. The primary factors are:
9 (a) The number of nationally accredited graduate
10 medical education programs offered by the hospital, including
11 programs accredited by the Accreditation Council for Graduate
12 Medical Education and the combined Internal Medicine and
13 Pediatrics programs acceptable to both the American Board of
14 Internal Medicine and the American Board of Pediatrics at the
15 beginning of the state fiscal year preceding the date on which
16 the allocation fraction is calculated. The numerical value of
17 this factor is the fraction that the hospital represents of
18 the total number of programs, where the total is computed for
19 all state statutory teaching hospitals.
20 (b) The number of full-time equivalent trainees in the
21 hospital, which comprises two components:
22 1. The number of trainees enrolled in nationally
23 accredited graduate medical education programs, as defined in
24 paragraph (a). Full-time equivalents are computed using the
25 fraction of the year during which each trainee is primarily
26 assigned to the given institution, over the state fiscal year
27 preceding the date on which the allocation fraction is
28 calculated. The numerical value of this factor is the fraction
29 that the hospital represents of the total number of full-time
30 equivalent trainees enrolled in accredited graduate programs,
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1 where the total is computed for all state statutory teaching
2 hospitals.
3 2. The number of medical students enrolled in
4 accredited colleges of medicine and engaged in clinical
5 activities, including required clinical clerkships and
6 clinical electives. Full-time equivalents are computed using
7 the fraction of the year during which each trainee is
8 primarily assigned to the given institution, over the course
9 of the state fiscal year preceding the date on which the
10 allocation fraction is calculated. The numerical value of this
11 factor is the fraction that the given hospital represents of
12 the total number of full-time equivalent students enrolled in
13 accredited colleges of medicine, where the total is computed
14 for all state statutory teaching hospitals.
15
16 The primary factor for full-time equivalent trainees is
17 computed as the sum of these two components, divided by two.
18 (c) A service index that comprises three components:
19 1. The Agency for Health Care Administration Service
20 Index, computed by applying the standard Service Inventory
21 Scores established by the Agency for Health Care
22 Administration to services offered by the given hospital, as
23 reported on Worksheet A-2 for the last fiscal year reported to
24 the agency before the date on which the allocation fraction is
25 calculated. The numerical value of this factor is the
26 fraction that the given hospital represents of the total
27 Agency for Health Care Administration Service Index values,
28 where the total is computed for all state statutory teaching
29 hospitals.
30 2. A volume-weighted service index, computed by
31 applying the standard Service Inventory Scores established by
8
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1 the Agency for Health Care Administration to the volume of
2 each service, expressed in terms of the standard units of
3 measure reported on Worksheet A-2 for the last fiscal year
4 reported to the agency before the date on which the allocation
5 factor is calculated. The numerical value of this factor is
6 the fraction that the given hospital represents of the total
7 volume-weighted service index values, where the total is
8 computed for all state statutory teaching hospitals.
9 3. Total Medicaid payments to each hospital for direct
10 inpatient and outpatient services during the fiscal year
11 preceding the date on which the allocation factor is
12 calculated. This includes payments made to each hospital for
13 such services by Medicaid prepaid health plans, whether the
14 plan was administered by the hospital or not. The numerical
15 value of this factor is the fraction that each hospital
16 represents of the total of such Medicaid payments, where the
17 total is computed for all state statutory teaching hospitals.
18
19 The primary factor for the service index is computed as the
20 sum of these three components, divided by three.
21 (2) By October 1 of each year, the agency shall use
22 the following formula to calculate the maximum additional
23 disproportionate share payment for statutorily defined
24 teaching hospitals:
25
26 TAP = THAF x A
27
28 Where:
29 TAP = total additional payment.
30 THAF = teaching hospital allocation factor.
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1 A = amount appropriated for a teaching hospital
2 disproportionate share program.
3 Section 4. Section 409.9117, Florida Statutes, is
4 amended to read:
5 409.9117 Primary care disproportionate share
6 program.--For the state fiscal year 2007-2008 2006-2007, the
7 agency shall not distribute moneys under the primary care
8 disproportionate share program.
9 (1) If federal funds are available for
10 disproportionate share programs in addition to those otherwise
11 provided by law, there shall be created a primary care
12 disproportionate share program.
13 (2) The following formula shall be used by the agency
14 to calculate the total amount earned for hospitals that
15 participate in the primary care disproportionate share
16 program:
17
18 TAE = HDSP/THDSP
19
20 Where:
21 TAE = total amount earned by a hospital participating
22 in the primary care disproportionate share program.
23 HDSP = the prior state fiscal year primary care
24 disproportionate share payment to the individual hospital.
25 THDSP = the prior state fiscal year total primary care
26 disproportionate share payments to all hospitals.
27
28 (3) The total additional payment for hospitals that
29 participate in the primary care disproportionate share program
30 shall be calculated by the agency as follows:
31
10
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1 TAP = TAE x TA
2
3 Where:
4 TAP = total additional payment for a primary care
5 hospital.
6 TAE = total amount earned by a primary care hospital.
7 TA = total appropriation for the primary care
8 disproportionate share program.
9
10 (4) In the establishment and funding of this program,
11 the agency shall use the following criteria in addition to
12 those specified in s. 409.911, payments may not be made to a
13 hospital unless the hospital agrees to:
14 (a) Cooperate with a Medicaid prepaid health plan, if
15 one exists in the community.
16 (b) Ensure the availability of primary and specialty
17 care physicians to Medicaid recipients who are not enrolled in
18 a prepaid capitated arrangement and who are in need of access
19 to such physicians.
20 (c) Coordinate and provide primary care services free
21 of charge, except copayments, to all persons with incomes up
22 to 100 percent of the federal poverty level who are not
23 otherwise covered by Medicaid or another program administered
24 by a governmental entity, and to provide such services based
25 on a sliding fee scale to all persons with incomes up to 200
26 percent of the federal poverty level who are not otherwise
27 covered by Medicaid or another program administered by a
28 governmental entity, except that eligibility may be limited to
29 persons who reside within a more limited area, as agreed to by
30 the agency and the hospital.
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1 (d) Contract with any federally qualified health
2 center, if one exists within the agreed geopolitical
3 boundaries, concerning the provision of primary care services,
4 in order to guarantee delivery of services in a nonduplicative
5 fashion, and to provide for referral arrangements, privileges,
6 and admissions, as appropriate. The hospital shall agree to
7 provide at an onsite or offsite facility primary care services
8 within 24 hours to which all Medicaid recipients and persons
9 eligible under this paragraph who do not require emergency
10 room services are referred during normal daylight hours.
11 (e) Cooperate with the agency, the county, and other
12 entities to ensure the provision of certain public health
13 services, case management, referral and acceptance of
14 patients, and sharing of epidemiological data, as the agency
15 and the hospital find mutually necessary and desirable to
16 promote and protect the public health within the agreed
17 geopolitical boundaries.
18 (f) In cooperation with the county in which the
19 hospital resides, develop a low-cost, outpatient, prepaid
20 health care program to persons who are not eligible for the
21 Medicaid program, and who reside within the area.
22 (g) Provide inpatient services to residents within the
23 area who are not eligible for Medicaid or Medicare, and who do
24 not have private health insurance, regardless of ability to
25 pay, on the basis of available space, except that nothing
26 shall prevent the hospital from establishing bill collection
27 programs based on ability to pay.
28 (h) Work with the Florida Healthy Kids Corporation,
29 the Florida Health Care Purchasing Cooperative, and business
30 health coalitions, as appropriate, to develop a feasibility
31 study and plan to provide a low-cost comprehensive health
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1 insurance plan to persons who reside within the area and who
2 do not have access to such a plan.
3 (i) Work with public health officials and other
4 experts to provide community health education and prevention
5 activities designed to promote healthy lifestyles and
6 appropriate use of health services.
7 (j) Work with the local health council to develop a
8 plan for promoting access to affordable health care services
9 for all persons who reside within the area, including, but not
10 limited to, public health services, primary care services,
11 inpatient services, and affordable health insurance generally.
12
13 Any hospital that fails to comply with any of the provisions
14 of this subsection, or any other contractual condition, may
15 not receive payments under this section until full compliance
16 is achieved.
17 Section 5. Paragraph (b) of subsection (4) of section
18 409.912, Florida Statutes, is amended to read:
19 409.912 Cost-effective purchasing of health care.--The
20 agency shall purchase goods and services for Medicaid
21 recipients in the most cost-effective manner consistent with
22 the delivery of quality medical care. To ensure that medical
23 services are effectively utilized, the agency may, in any
24 case, require a confirmation or second physician's opinion of
25 the correct diagnosis for purposes of authorizing future
26 services under the Medicaid program. This section does not
27 restrict access to emergency services or poststabilization
28 care services as defined in 42 C.F.R. part 438.114. Such
29 confirmation or second opinion shall be rendered in a manner
30 approved by the agency. The agency shall maximize the use of
31 prepaid per capita and prepaid aggregate fixed-sum basis
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1 services when appropriate and other alternative service
2 delivery and reimbursement methodologies, including
3 competitive bidding pursuant to s. 287.057, designed to
4 facilitate the cost-effective purchase of a case-managed
5 continuum of care. The agency shall also require providers to
6 minimize the exposure of recipients to the need for acute
7 inpatient, custodial, and other institutional care and the
8 inappropriate or unnecessary use of high-cost services. The
9 agency shall contract with a vendor to monitor and evaluate
10 the clinical practice patterns of providers in order to
11 identify trends that are outside the normal practice patterns
12 of a provider's professional peers or the national guidelines
13 of a provider's professional association. The vendor must be
14 able to provide information and counseling to a provider whose
15 practice patterns are outside the norms, in consultation with
16 the agency, to improve patient care and reduce inappropriate
17 utilization. The agency may mandate prior authorization, drug
18 therapy management, or disease management participation for
19 certain populations of Medicaid beneficiaries, certain drug
20 classes, or particular drugs to prevent fraud, abuse, overuse,
21 and possible dangerous drug interactions. The Pharmaceutical
22 and Therapeutics Committee shall make recommendations to the
23 agency on drugs for which prior authorization is required. The
24 agency shall inform the Pharmaceutical and Therapeutics
25 Committee of its decisions regarding drugs subject to prior
26 authorization. The agency is authorized to limit the entities
27 it contracts with or enrolls as Medicaid providers by
28 developing a provider network through provider credentialing.
29 The agency may competitively bid single-source-provider
30 contracts if procurement of goods or services results in
31 demonstrated cost savings to the state without limiting access
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1 to care. The agency may limit its network based on the
2 assessment of beneficiary access to care, provider
3 availability, provider quality standards, time and distance
4 standards for access to care, the cultural competence of the
5 provider network, demographic characteristics of Medicaid
6 beneficiaries, practice and provider-to-beneficiary standards,
7 appointment wait times, beneficiary use of services, provider
8 turnover, provider profiling, provider licensure history,
9 previous program integrity investigations and findings, peer
10 review, provider Medicaid policy and billing compliance
11 records, clinical and medical record audits, and other
12 factors. Providers shall not be entitled to enrollment in the
13 Medicaid provider network. The agency shall determine
14 instances in which allowing Medicaid beneficiaries to purchase
15 durable medical equipment and other goods is less expensive to
16 the Medicaid program than long-term rental of the equipment or
17 goods. The agency may establish rules to facilitate purchases
18 in lieu of long-term rentals in order to protect against fraud
19 and abuse in the Medicaid program as defined in s. 409.913.
20 The agency may seek federal waivers necessary to administer
21 these policies.
22 (4) The agency may contract with:
23 (b) An entity that is providing comprehensive
24 behavioral health care services to certain Medicaid recipients
25 through a capitated, prepaid arrangement pursuant to the
26 federal waiver provided for by s. 409.905(5). Such an entity
27 must be licensed under chapter 624, chapter 636, or chapter
28 641 and must possess the clinical systems and operational
29 competence to manage risk and provide comprehensive behavioral
30 health care to Medicaid recipients. As used in this paragraph,
31 the term "comprehensive behavioral health care services" means
15
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1 covered mental health and substance abuse treatment services
2 that are available to Medicaid recipients. The secretary of
3 the Department of Children and Family Services shall approve
4 provisions of procurements related to children in the
5 department's care or custody prior to enrolling such children
6 in a prepaid behavioral health plan. Any contract awarded
7 under this paragraph must be competitively procured. In
8 developing the behavioral health care prepaid plan procurement
9 document, the agency shall ensure that the procurement
10 document requires the contractor to develop and implement a
11 plan to ensure compliance with s. 394.4574 related to services
12 provided to residents of licensed assisted living facilities
13 that hold a limited mental health license. Except as provided
14 in subparagraph 8., and except in counties where the Medicaid
15 managed care pilot program is authorized pursuant to s.
16 409.91211, the agency shall seek federal approval to contract
17 with a single entity meeting these requirements to provide
18 comprehensive behavioral health care services to all Medicaid
19 recipients not enrolled in a Medicaid managed care plan
20 authorized under s. 409.91211 or a Medicaid health maintenance
21 organization in an AHCA area. In an AHCA area where the
22 Medicaid managed care pilot program is authorized pursuant to
23 s. 409.91211 in one or more counties, the agency may procure a
24 contract with a single entity to serve the remaining counties
25 as an AHCA area or the remaining counties may be included with
26 an adjacent AHCA area and shall be subject to this paragraph.
27 Each entity must offer sufficient choice of providers in its
28 network to ensure recipient access to care and the opportunity
29 to select a provider with whom they are satisfied. The network
30 shall include all public mental health hospitals. To ensure
31 unimpaired access to behavioral health care services by
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1 Medicaid recipients, all contracts issued pursuant to this
2 paragraph shall require 80 percent of the capitation paid to
3 the managed care plan, including health maintenance
4 organizations, to be expended for the provision of behavioral
5 health care services. In the event the managed care plan
6 expends less than 80 percent of the capitation paid pursuant
7 to this paragraph for the provision of behavioral health care
8 services, the difference shall be returned to the agency. The
9 agency shall provide the managed care plan with a
10 certification letter indicating the amount of capitation paid
11 during each calendar year for the provision of behavioral
12 health care services pursuant to this section. The agency may
13 reimburse for substance abuse treatment services on a
14 fee-for-service basis until the agency finds that adequate
15 funds are available for capitated, prepaid arrangements.
16 1. By January 1, 2001, the agency shall modify the
17 contracts with the entities providing comprehensive inpatient
18 and outpatient mental health care services to Medicaid
19 recipients in Hillsborough, Highlands, Hardee, Manatee, and
20 Polk Counties, to include substance abuse treatment services.
21 2. By July 1, 2003, the agency and the Department of
22 Children and Family Services shall execute a written agreement
23 that requires collaboration and joint development of all
24 policy, budgets, procurement documents, contracts, and
25 monitoring plans that have an impact on the state and Medicaid
26 community mental health and targeted case management programs.
27 3. Except as provided in subparagraph 8., by July 1,
28 2006, the agency and the Department of Children and Family
29 Services shall contract with managed care entities in each
30 AHCA area except area 6 or arrange to provide comprehensive
31 inpatient and outpatient mental health and substance abuse
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1 services through capitated prepaid arrangements to all
2 Medicaid recipients who are eligible to participate in such
3 plans under federal law and regulation. In AHCA areas where
4 eligible individuals number less than 150,000, the agency
5 shall contract with a single managed care plan to provide
6 comprehensive behavioral health services to all recipients who
7 are not enrolled in a Medicaid health maintenance organization
8 or a Medicaid capitated managed care plan authorized under s.
9 409.91211. The agency may contract with more than one
10 comprehensive behavioral health provider to provide care to
11 recipients who are not enrolled in a Medicaid capitated
12 managed care plan authorized under s. 409.91211 or a Medicaid
13 health maintenance organization in AHCA areas where the
14 eligible population exceeds 150,000. In an AHCA area where the
15 Medicaid managed care pilot program is authorized pursuant to
16 s. 409.91211 in one or more counties, the agency may procure a
17 contract with a single entity to serve the remaining counties
18 as an AHCA area or the remaining counties may be included with
19 an adjacent AHCA area and shall be subject to this paragraph.
20 Contracts for comprehensive behavioral health providers
21 awarded pursuant to this section shall be competitively
22 procured. Both for-profit and not-for-profit corporations
23 shall be eligible to compete. Managed care plans contracting
24 with the agency under subsection (3) shall provide and receive
25 payment for the same comprehensive behavioral health benefits
26 as provided in AHCA rules, including handbooks incorporated by
27 reference. In AHCA area 11, the agency shall contract with at
28 least two comprehensive behavioral health care providers to
29 provide behavioral health care to recipients in that area who
30 are enrolled in, or assigned to, the MediPass program. One of
31 the behavioral health care contracts shall be with the
18
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1 existing provider service network pilot project, as described
2 in paragraph (d), for the purpose of demonstrating the
3 cost-effectiveness of the provision of quality mental health
4 services through a public hospital-operated managed care
5 model. Payment shall be at an agreed-upon capitated rate to
6 ensure cost savings. Of the recipients in area 11 who are
7 assigned to MediPass under the provisions of s.
8 409.9122(2)(k), a minimum of 50,000 of those MediPass-enrolled
9 recipients shall be assigned to the existing provider service
10 network in area 11 for their behavioral care.
11 4. By October 1, 2003, the agency and the department
12 shall submit a plan to the Governor, the President of the
13 Senate, and the Speaker of the House of Representatives which
14 provides for the full implementation of capitated prepaid
15 behavioral health care in all areas of the state.
16 a. Implementation shall begin in 2003 in those AHCA
17 areas of the state where the agency is able to establish
18 sufficient capitation rates.
19 b. If the agency determines that the proposed
20 capitation rate in any area is insufficient to provide
21 appropriate services, the agency may adjust the capitation
22 rate to ensure that care will be available. The agency and the
23 department may use existing general revenue to address any
24 additional required match but may not over-obligate existing
25 funds on an annualized basis.
26 c. Subject to any limitations provided for in the
27 General Appropriations Act, the agency, in compliance with
28 appropriate federal authorization, shall develop policies and
29 procedures that allow for certification of local and state
30 funds.
31
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1 5. Children residing in a statewide inpatient
2 psychiatric program, or in a Department of Juvenile Justice or
3 a Department of Children and Family Services residential
4 program approved as a Medicaid behavioral health overlay
5 services provider shall not be included in a behavioral health
6 care prepaid health plan or any other Medicaid managed care
7 plan pursuant to this paragraph.
8 6. In converting to a prepaid system of delivery, the
9 agency shall in its procurement document require an entity
10 providing only comprehensive behavioral health care services
11 to prevent the displacement of indigent care patients by
12 enrollees in the Medicaid prepaid health plan providing
13 behavioral health care services from facilities receiving
14 state funding to provide indigent behavioral health care, to
15 facilities licensed under chapter 395 which do not receive
16 state funding for indigent behavioral health care, or
17 reimburse the unsubsidized facility for the cost of behavioral
18 health care provided to the displaced indigent care patient.
19 7. Traditional community mental health providers under
20 contract with the Department of Children and Family Services
21 pursuant to part IV of chapter 394, child welfare providers
22 under contract with the Department of Children and Family
23 Services in areas 1 and 6, and inpatient mental health
24 providers licensed pursuant to chapter 395 must be offered an
25 opportunity to accept or decline a contract to participate in
26 any provider network for prepaid behavioral health services.
27 8. For fiscal year 2004-2005, all Medicaid eligible
28 children, except children in areas 1 and 6, whose cases are
29 open for child welfare services in the HomeSafeNet system,
30 shall be enrolled in MediPass or in Medicaid fee-for-service
31 and all their behavioral health care services including
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CS for SB 1116 First Engrossed
1 inpatient, outpatient psychiatric, community mental health,
2 and case management shall be reimbursed on a fee-for-service
3 basis. Beginning July 1, 2005, such children, who are open for
4 child welfare services in the HomeSafeNet system, shall
5 receive their behavioral health care services through a
6 specialty prepaid plan operated by community-based lead
7 agencies either through a single agency or formal agreements
8 among several agencies. The specialty prepaid plan must result
9 in savings to the state comparable to savings achieved in
10 other Medicaid managed care and prepaid programs. Such plan
11 must provide mechanisms to maximize state and local revenues.
12 The specialty prepaid plan shall be developed by the agency
13 and the Department of Children and Family Services. The agency
14 is authorized to seek any federal waivers to implement this
15 initiative. Medicaid-eligible children whose cases are open
16 for child welfare services in the HomeSafeNet system and who
17 reside in AHCA Area 10 are exempt from the plan upon
18 development of a service delivery system for Area 10 children
19 in the reform area under the conditions set forth in s.
20 409.91211(3)(dd).
21 Section 6. Paragraph (dd) of subsection (3) of section
22 409.91211, Florida Statutes, is amended to read:
23 409.91211 Medicaid managed care pilot program.--
24 (3) The agency shall have the following powers,
25 duties, and responsibilities with respect to the pilot
26 program:
27 (dd) To implement develop and recommend service
28 delivery mechanisms within a provider service network or
29 capitated managed care plan plans to provide Medicaid services
30 as specified in ss. 409.905 and 409.906 to Medicaid-eligible
31 children who are open for child welfare services in the
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1 HomeSafeNet system in foster care. These services must be
2 coordinated with community-based care providers as specified
3 in s. 409.1671 s. 409.1675, where available, and be sufficient
4 to meet the medical, developmental, behavioral, and emotional
5 needs of these children. Covered behavioral health services
6 must include all services currently included in the specialty
7 prepaid plan as implemented under s. 409.912(4)(b). These
8 service-delivery mechanisms must be implemented no later than
9 July 1, 2008, in AHCA Area 10 in order for the children in
10 AHCA Area 10 to remain exempt from the statewide plan under s.
11 409.912(4)(b)8.
12 Section 7. This act shall take effect July 1, 2007.
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