CS/HB 7047

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

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