Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. PCS (371496) for SB 12-C
Barcode 401328
CHAMBER ACTION
Senate House
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11 The Committee on Health and Human Services Appropriations
12 (Peaden) recommended the following amendment:
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14 Senate Amendment (with title amendment)
15 On page 11, line 17, through
16 page 14, line 8, delete those lines
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18 and insert:
19 Section 3. Subsection (13) of section 409.9122,
20 Florida Statutes, is amended to read:
21 409.9122 Mandatory Medicaid managed care enrollment;
22 programs and procedures.--
23 (13) Effective July 1, 2003, the agency shall adjust
24 the enrollee assignment process of Medicaid managed prepaid
25 health plans for those Medicaid managed prepaid plans
26 operating in Miami-Dade County which have executed a contract
27 with the agency for a minimum of 8 consecutive years in order
28 for the Medicaid managed prepaid plan to maintain a minimum
29 enrollment level of 15,000 members per month. When assigning
30 enrollees pursuant to this subsection, the agency shall give
31 priority to providers that initially qualified under this
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. PCS (371496) for SB 12-C
Barcode 401328
1 subsection until such providers reach and maintain an
2 enrollment level of 15,000 members per month. A prepaid health
3 plan that has a statewide Medicaid enrollment of 25,000 or
4 more members is not eligible for enrollee assignments under
5 this subsection.
6 Section 4. Effective March 1, 2008, paragraph (k) of
7 subsection (2) of section 409.9122, Florida Statutes, is
8 amended to read:
9 409.9122 Mandatory Medicaid managed care enrollment;
10 programs and procedures.--
11 (2)
12 (k) When a Medicaid recipient does not choose a
13 managed care plan or MediPass provider, the agency shall
14 assign the Medicaid recipient to a managed care plan, except
15 in those counties in which there are fewer than two managed
16 care plans accepting Medicaid enrollees, in which case
17 assignment shall be to a managed care plan or a MediPass
18 provider. Medicaid recipients in counties with fewer than two
19 managed care plans accepting Medicaid enrollees who are
20 subject to mandatory assignment but who fail to make a choice
21 shall be assigned to managed care plans until an enrollment of
22 35 percent in MediPass and 65 percent in managed care plans,
23 of all those eligible to choose managed care, is achieved.
24 Once that enrollment is achieved, the assignments shall be
25 divided in order to maintain an enrollment in MediPass and
26 managed care plans which is in a 35 percent and 65 percent
27 proportion, respectively. In service areas 1 and 6 of the
28 Agency for Health Care Administration where the agency is
29 contracting for the provision of comprehensive behavioral
30 health services through a capitated prepaid arrangement,
31 recipients who fail to make a choice shall be assigned equally
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. PCS (371496) for SB 12-C
Barcode 401328
1 to MediPass or a managed care plan. For purposes of this
2 paragraph, when referring to assignment, the term "managed
3 care plans" includes exclusive provider organizations,
4 provider service networks, Children's Medical Services
5 Network, minority physician networks, and pediatric emergency
6 department diversion programs authorized by this chapter or
7 the General Appropriations Act. When making assignments, the
8 agency shall take into account the following criteria:
9 1. A managed care plan has sufficient network capacity
10 to meet the need of members.
11 2. The managed care plan or MediPass has previously
12 enrolled the recipient as a member, or one of the managed care
13 plan's primary care providers or MediPass providers has
14 previously provided health care to the recipient.
15 3. The agency has knowledge that the member has
16 previously expressed a preference for a particular managed
17 care plan or MediPass provider as indicated by Medicaid
18 fee-for-service claims data, but has failed to make a choice.
19 4. The managed care plan's or MediPass primary care
20 providers are geographically accessible to the recipient's
21 residence.
22 5. The agency has authority to make mandatory
23 assignments based on quality of service and performance of
24 managed care plans.
25 Section 5. Paragraph (dd) of subsection (3) of section
26 409.91211, Florida Statutes, is amended to read:
27 409.91211 Medicaid managed care pilot program.--
28 (3) The agency shall have the following powers,
29 duties, and responsibilities with respect to the pilot
30 program:
31 (dd) To implement develop and recommend service
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. PCS (371496) for SB 12-C
Barcode 401328
1 delivery mechanisms within capitated managed care plans to
2 provide Medicaid services as specified in ss. 409.905 and
3 409.906 to Medicaid-eligible children whose cases are open for
4 child welfare services in the HomeSafeNet system in foster
5 care. These services must be coordinated with community-based
6 care providers as specified in s. 409.1671 s. 409.1675, where
7 available, and be sufficient to meet the medical,
8 developmental, behavioral, and emotional needs of these
9 children. These service delivery mechanisms must be
10 implemented no later than July 1, 2008, in AHCA area 10 in
11 order for the children in AHCA area 10 to remain exempt from
12 the statewide plan under s. 409.912(4)(b)8.
13 Section 6. Except as otherwise expressly provided in
14 this act, this act shall take effect upon becoming a law.
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18 And the title is amended as follows:
19 On page 1, lines 12-23, delete those lines
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21 and insert:
22 F.S.; requiring that the agency give certain
23 providers priority with respect to the
24 assignment of enrollees under the Medicaid
25 managed prepaid health plan; deleting a
26 requirement that certain recipients of
27 comprehensive behavioral health services be
28 assigned to MediPass or a managed care plan;
29 amending s. 409.91211, F.S.; clarifying the
30 duties of the agency for implementing service
31 delivery mechanisms for certain children who
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. PCS (371496) for SB 12-C
Barcode 401328
1 are eligible for Medicaid; providing effective
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