Amendment
Bill No. 0012C

Amendment No. 372419

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.  Paragraph (f) of subsection (3) of section
6	393.0661, Florida Statutes, is amended to read:
7	393.0661  Home and community-based services delivery
8	system; comprehensive redesign.--The Legislature finds that the
9	home and community-based services delivery system for persons
10	with developmental disabilities and the availability of
11	appropriated funds are two of the critical elements in making
12	services available. Therefore, it is the intent of the
13	Legislature that the Agency for Persons with Disabilities shall
14	develop and implement a comprehensive redesign of the system.
15	(3)  The Agency for Health Care Administration, in
16	consultation with the agency, shall seek federal approval and
17	implement a four-tiered waiver system to serve clients with
18	developmental disabilities in the developmental disabilities and
19	family and supported living waivers. The agency shall assign all
20	clients receiving services through the developmental
21	disabilities waiver to a tier based on a valid assessment
22	instrument, client characteristics, and other appropriate
23	assessment methods. All services covered under the current
24	developmental disabilities waiver shall be available to all
25	clients in all tiers where appropriate, except as otherwise
26	provided in this subsection or in the General Appropriations
27	Act.
28	(f)  The agency shall seek federal waivers and amend
29	contracts as necessary to make changes to services defined in
30	federal waiver programs administered by the agency as follows:
31	1.  Supported living coaching services shall not exceed 20
32	hours per month for persons who also receive in-home support
33	services.
34	2.  Limited support coordination services shall be the only
35	type of support coordination service provided to persons under
36	the age of 18 who live in the family home.
37	3.  Personal care assistance services shall be limited to
38	no more than 180 hours per calendar month and shall not include
39	rate modifiers. Additional hours may be authorized for persons
40	who have intensive physical, medical, or adaptive needs if such
41	hours are essential for avoiding institutionalization only if a
42	substantial change in circumstances occurs for the individual.
43	4.  Residential habilitation services shall be limited to 8
44	hours per day. Additional hours may be authorized for persons
45	who have intensive medical or adaptive needs and if such hours
46	are essential for avoiding institutionalization, or for persons
47	who possess behavioral problems that are exceptional in
48	intensity, duration, or frequency and present a substantial risk
49	of harming themselves or others. This restriction shall be in
50	effect until the four-tiered waiver system is fully implemented.
51	5.  Chore Services, nonresidential support services, and
52	homemaker services shall be eliminated. The agency shall expand
53	the definition of in-home support services to enable the
54	provider of the service to include activities previously
55	provided in these eliminated services.
56	6.  Massage therapy and psychological assessment services
57	shall be eliminated.
58	7.  The agency shall conduct supplemental cost plan reviews
59	to verify the medical necessity of authorized services for plans
60	that have increased by more than 8 percent during either of the
61	2 preceding fiscal years.
62	8.  The agency shall implement a consolidated residential
63	habilitation rate structure to increase savings to the state
64	through a more cost-effective payment method and establish
65	uniform rates for intensive behavioral residential habilitation
66	services.
67	9.  Pending federal approval, the agency is authorized to
68	extend current support plans for clients receiving services
69	under Medicaid waivers for 1 year beginning July 1, 2007, or
70	from the date approved, whichever is later. Clients who have a
71	substantial change in circumstances which threatens their health
72	and safety may be reassessed during this year in order to
73	determine the necessity for a change in their support plan.
74	Section 2.  The following proviso associated with Specific
75	Appropriation 270 in chapter 2007-72, Laws of Florida, is
76	amended to read:
77
78	Personal Care Assistance services shall be limited to no more
79	than 180 hours per calendar month and shall not include rate
80	modifiers. Additional hours may be authorized for persons who
81	have intensive physical, medical, or adaptive needs if such
82	hours are essential for avoiding institutionalization only if a
83	substantial change in circumstances occurs for the individual.
84	Section 3.  Paragraph (k) of subsection (2) of section
85	409.9122, Florida Statutes, is amended to read:
86	409.9122  Mandatory Medicaid managed care enrollment;
87	programs and procedures.--
88	(2)
89	(k)  When a Medicaid recipient does not choose a managed
90	care plan or MediPass provider, the agency shall assign the
91	Medicaid recipient to a managed care plan, except in those
92	counties in which there are fewer than two managed care plans
93	accepting Medicaid enrollees, in which case assignment shall be
94	to a managed care plan or a MediPass provider. Medicaid
95	recipients in counties with fewer than two managed care plans
96	accepting Medicaid enrollees who are subject to mandatory
97	assignment but who fail to make a choice shall be assigned to
98	managed care plans until an enrollment of 35 percent in MediPass
99	and 65 percent in managed care plans, of all those eligible to
100	choose managed care, is achieved. Once that enrollment is
101	achieved, the assignments shall be divided in order to maintain
102	an enrollment in MediPass and managed care plans which is in a
103	35 percent and 65 percent proportion, respectively. In service
104	areas 1 and 6 of the Agency for Health Care Administration where
105	the agency is contracting for the provision of comprehensive
106	behavioral health services through a capitated prepaid
107	arrangement, recipients who fail to make a choice shall be
108	assigned equally to MediPass or a managed care plan. For
109	purposes of this paragraph, when referring to assignment, the
110	term "managed care plans" includes exclusive provider
111	organizations, provider service networks, Children's Medical
112	Services Network, minority physician networks, and pediatric
113	emergency department diversion programs authorized by this
114	chapter or the General Appropriations Act. When making
115	assignments, the agency shall take into account the following
116	criteria:
117	1.  A managed care plan has sufficient network capacity to
118	meet the need of members.
119	2.  The managed care plan or MediPass has previously
120	enrolled the recipient as a member, or one of the managed care
121	plan's primary care providers or MediPass providers has
122	previously provided health care to the recipient.
123	3.  The agency has knowledge that the member has previously
124	expressed a preference for a particular managed care plan or
125	MediPass provider as indicated by Medicaid fee-for-service
126	claims data, but has failed to make a choice.
127	4.  The managed care plan's or MediPass primary care
128	providers are geographically accessible to the recipient's
129	residence.
130	5.  The agency has authority to make mandatory assignments
131	based on quality of service and performance of managed care
132	plans.
133	Section 4.  This act shall take effect March 1, 2008.
134
135	======= T I T L E  A M E N D M E N T ==========
136	Remove the entire title and insert:
137	A bill to be entitled
138	An act relating to Medicaid; amending s. 393.0661, F.S.;
139	providing for additional hours to be authorized under the
140	personal care assistance services provided pursuant to a
141	federal waiver program and administered by the Agency for
142	Persons with Disabilities; amending a specified portion of
143	proviso in Specific Appropriation 270 in chapter 2007-72,
144	Laws of Florida; amending s. 409.9122, F.S.; revising the
145	method for assigning Medicaid recipients to managed care
146	plans in service areas 1 and 6; providing an effective
147	date.

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