Senate Bill sb0012Ce1

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    CS for SB 12-C                                 First Engrossed



  1                      A bill to be entitled

  2         An act relating to health care; amending s.

  3         393.0661, F.S.; providing for additional hours

  4         to be authorized under the personal care

  5         assistance services provided pursuant to a

  6         federal waiver program and administered by the

  7         Agency for Health Care Administration;

  8         repealing proviso language contained in

  9         Specific Appropriation 270 in chapter 2007-72,

10         Laws of Florida, to conform; amending s.

11         395.701, F.S.; clarifying provisions imposing

12         an assessment on hospital outpatient services;

13         specifying assessment amounts; amending s.

14         409.908, F.S.; deleting a provision providing

15         that an operator of a Medicaid nursing home may

16         qualify for an increased reimbursement rate due

17         to a change of ownership or licensed operator;

18         providing a limitation on the reimbursement

19         rates for Medicaid payments to nursing homes;

20         amending s. 409.912, F.S.; providing for

21         certain children who are eligible for Medicaid

22         and who reside within a specified service area

23         of the Agency for Health Care Administration to

24         be served under a service delivery mechanism

25         other than the HomeSafeNet system; amending s.

26         409.9122, F.S.; requiring that the agency give

27         certain providers priority with respect to the

28         assignment of enrollees under the Medicaid

29         managed prepaid health plan; deleting a

30         requirement that certain recipients of

31         comprehensive behavioral health services be


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    CS for SB 12-C                                 First Engrossed



 1         assigned to MediPass or a managed care plan;

 2         amending s. 409.91211, F.S.; clarifying the

 3         duties of the agency for implementing service

 4         delivery mechanisms for certain children who

 5         are eligible for Medicaid; providing effective

 6         dates.

 7  

 8  Be It Enacted by the Legislature of the State of Florida:

 9  

10         Section 1.  Paragraph (f) of subsection (3) of section

11  393.0661, Florida Statutes, is amended to read:

12         393.0661  Home and community-based services delivery

13  system; comprehensive redesign.--The Legislature finds that

14  the home and community-based services delivery system for

15  persons with developmental disabilities and the availability

16  of appropriated funds are two of the critical elements in

17  making services available. Therefore, it is the intent of the

18  Legislature that the Agency for Persons with Disabilities

19  shall develop and implement a comprehensive redesign of the

20  system.

21         (3)  The Agency for Health Care Administration, in

22  consultation with the agency, shall seek federal approval and

23  implement a four-tiered waiver system to serve clients with

24  developmental disabilities in the developmental disabilities

25  and family and supported living waivers. The agency shall

26  assign all clients receiving services through the

27  developmental disabilities waiver to a tier based on a valid

28  assessment instrument, client characteristics, and other

29  appropriate assessment methods. All services covered under the

30  current developmental disabilities waiver shall be available

31  to all clients in all tiers where appropriate, except as


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    CS for SB 12-C                                 First Engrossed



 1  otherwise provided in this subsection or in the General

 2  Appropriations Act.

 3         (f)  The agency shall seek federal waivers and amend

 4  contracts as necessary to make changes to services defined in

 5  federal waiver programs administered by the agency as follows:

 6         1.  Supported living coaching services shall not exceed

 7  20 hours per month for persons who also receive in-home

 8  support services.

 9         2.  Limited support coordination services shall be the

10  only type of support coordination service provided to persons

11  under the age of 18 who live in the family home.

12         3.  Personal care assistance services shall be limited

13  to no more than 180 hours per calendar month and shall not

14  include rate modifiers. Additional hours may be authorized for

15  persons who have intensive medical or adaptive needs and if

16  such hours are essential for avoiding institutionalization, or

17  for persons who possess behavioral problems that are

18  exceptional in intensity, duration, or frequency and present a

19  substantial risk of harming themselves or others. Additional

20  hours may be authorized only if a substantial change in

21  circumstances occurs for the individual.

22         4.  Residential habilitation services shall be limited

23  to 8 hours per day. Additional hours may be authorized for

24  persons who have intensive medical or adaptive needs and if

25  such hours are essential for avoiding institutionalization, or

26  for persons who possess behavioral problems that are

27  exceptional in intensity, duration, or frequency and present a

28  substantial risk of harming themselves or others. This

29  restriction shall be in effect until the four-tiered waiver

30  system is fully implemented.

31  


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    CS for SB 12-C                                 First Engrossed



 1         5.  Chore Services, nonresidential support services,

 2  and homemaker services shall be eliminated. The agency shall

 3  expand the definition of in-home support services to enable

 4  the provider of the service to include activities previously

 5  provided in these eliminated services.

 6         6.  Massage therapy and psychological assessment

 7  services shall be eliminated.

 8         7.  The agency shall conduct supplemental cost plan

 9  reviews to verify the medical necessity of authorized services

10  for plans that have increased by more than 8 percent during

11  either of the 2 preceding fiscal years.

12         8.  The agency shall implement a consolidated

13  residential habilitation rate structure to increase savings to

14  the state through a more cost-effective payment method and

15  establish uniform rates for intensive behavioral residential

16  habilitation services.

17         9.  Pending federal approval, the agency is authorized

18  to extend current support plans for clients receiving services

19  under Medicaid waivers for 1 year beginning July 1, 2007, or

20  from the date approved, whichever is later. Clients who have a

21  substantial change in circumstances which threatens their

22  health and safety may be reassessed during this year in order

23  to determine the necessity for a change in their support plan.

24         Section 2.  The following proviso associated with

25  Specific Appropriation 270 in chapter 2007-72, Laws of

26  Florida, is repealed: "Personal Care Assistance services shall

27  be limited to no more than 180 hours per calendar month and

28  shall not include rate modifiers. Additional hours may be

29  authorized only if a substantial change in circumstances

30  occurs for the individual."

31  


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    CS for SB 12-C                                 First Engrossed



 1         Section 3.  Subsection (2) of section 395.701, Florida

 2  Statutes, is amended to read:

 3         395.701  Annual assessments on net operating revenues

 4  for inpatient and outpatient services to fund public medical

 5  assistance; administrative fines for failure to pay

 6  assessments when due; exemption.--

 7         (2)(a)  There is imposed upon each hospital an

 8  assessment in an amount equal to 1.5 percent of the annual net

 9  operating revenue for inpatient services for each hospital,

10  such revenue to be determined by the agency, based on the

11  actual experience of the hospital as reported to the agency.

12  Within 6 months after the end of each hospital fiscal year,

13  the agency shall certify the amount of the assessment for each

14  hospital.  The assessment shall be payable to and collected by

15  the agency in equal quarterly amounts, on or before the first

16  day of each calendar quarter, beginning with the first full

17  calendar quarter that occurs after the agency certifies the

18  amount of the assessment for each hospital. All moneys

19  collected pursuant to this subsection shall be deposited into

20  the Public Medical Assistance Trust Fund.

21         (b)  There is imposed upon each hospital an assessment

22  in an amount equal to 1 percent of the annual net operating

23  revenue for outpatient services for each hospital, such

24  revenue to be determined by the agency, based on the actual

25  experience of the hospital as reported to the agency. While

26  prior year report worksheets may be reconciled to the

27  hospital's audited financial statements, no additional audited

28  financial components may be required for the purposes of

29  determining the amount of the assessment imposed pursuant to

30  this section other than those in effect on July 1, 2000.

31  Within 6 months after the end of each hospital fiscal year,


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    CS for SB 12-C                                 First Engrossed



 1  the agency shall certify the amount of the assessment for each

 2  hospital. The assessment shall be payable to and collected by

 3  the agency in equal quarterly amounts, on or before the first

 4  day of each calendar quarter, beginning with the first full

 5  calendar quarter that occurs after the agency certifies the

 6  amount of the assessment for each hospital. All moneys

 7  collected pursuant to this subsection shall be deposited into

 8  the Public Medical Assistance Trust Fund.

 9         (c)  The reduced assessment on hospital outpatient

10  services contained in section 16 of chapter 2000-256, Laws of

11  Florida, shall be imposed upon the annual net operating

12  revenue for outpatient services for each hospital for each

13  hospital fiscal year beginning on or after July 1, 2000. For

14  each hospital fiscal year beginning before July 1, 2000, an

15  assessment in an amount equal to 1.5 percent, as required by

16  s. 395.701, Florida Statutes (2000), shall be imposed. This

17  paragraph clarifies the law as it has existed since July 1,

18  2000.

19         Section 4.  Paragraph (b) of subsection (2) and

20  paragraph (d) of subsection (13) of section 409.908, Florida

21  Statutes, are amended to read:

22         409.908  Reimbursement of Medicaid providers.--Subject

23  to specific appropriations, the agency shall reimburse

24  Medicaid providers, in accordance with state and federal law,

25  according to methodologies set forth in the rules of the

26  agency and in policy manuals and handbooks incorporated by

27  reference therein.  These methodologies may include fee

28  schedules, reimbursement methods based on cost reporting,

29  negotiated fees, competitive bidding pursuant to s. 287.057,

30  and other mechanisms the agency considers efficient and

31  effective for purchasing services or goods on behalf of


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    CS for SB 12-C                                 First Engrossed



 1  recipients. If a provider is reimbursed based on cost

 2  reporting and submits a cost report late and that cost report

 3  would have been used to set a lower reimbursement rate for a

 4  rate semester, then the provider's rate for that semester

 5  shall be retroactively calculated using the new cost report,

 6  and full payment at the recalculated rate shall be effected

 7  retroactively. Medicare-granted extensions for filing cost

 8  reports, if applicable, shall also apply to Medicaid cost

 9  reports. Payment for Medicaid compensable services made on

10  behalf of Medicaid eligible persons is subject to the

11  availability of moneys and any limitations or directions

12  provided for in the General Appropriations Act or chapter 216.

13  Further, nothing in this section shall be construed to prevent

14  or limit the agency from adjusting fees, reimbursement rates,

15  lengths of stay, number of visits, or number of services, or

16  making any other adjustments necessary to comply with the

17  availability of moneys and any limitations or directions

18  provided for in the General Appropriations Act, provided the

19  adjustment is consistent with legislative intent.

20         (2)

21         (b)  Subject to any limitations or directions provided

22  for in the General Appropriations Act, the agency shall

23  establish and implement a Florida Title XIX Long-Term Care

24  Reimbursement Plan (Medicaid) for nursing home care in order

25  to provide care and services in conformance with the

26  applicable state and federal laws, rules, regulations, and

27  quality and safety standards and to ensure that individuals

28  eligible for medical assistance have reasonable geographic

29  access to such care.

30         1.  Changes of ownership or of licensed operator may or

31  may not qualify for increases in reimbursement rates


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    CS for SB 12-C                                 First Engrossed



 1  associated with the change of ownership or of licensed

 2  operator. The agency may amend the Title XIX Long Term Care

 3  Reimbursement Plan to provide that the initial nursing home

 4  reimbursement rates, for the operating, patient care, and MAR

 5  components, associated with related and unrelated party

 6  changes of ownership or licensed operator filed on or after

 7  September 1, 2001, are equivalent to the previous owner's

 8  reimbursement rate.

 9         1.2.  The agency shall amend the long-term care

10  reimbursement plan and cost reporting system to create direct

11  care and indirect care subcomponents of the patient care

12  component of the per diem rate. These two subcomponents

13  together shall equal the patient care component of the per

14  diem rate. Separate cost-based ceilings shall be calculated

15  for each patient care subcomponent. The direct care

16  subcomponent of the per diem rate shall be limited by the

17  cost-based class ceiling, and the indirect care subcomponent

18  may be limited by the lower of the cost-based class ceiling,

19  the target rate class ceiling, or the individual provider

20  target.

21         2.3.  The direct care subcomponent shall include

22  salaries and benefits of direct care staff providing nursing

23  services including registered nurses, licensed practical

24  nurses, and certified nursing assistants who deliver care

25  directly to residents in the nursing home facility. This

26  excludes nursing administration, minimum data set, and care

27  plan coordinators, staff development, and staffing

28  coordinator.

29         3.4.  All other patient care costs shall be included in

30  the indirect care cost subcomponent of the patient care per

31  diem rate. There shall be no costs directly or indirectly


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    CS for SB 12-C                                 First Engrossed



 1  allocated to the direct care subcomponent from a home office

 2  or management company.

 3         4.5.  On July 1 of each year, the agency shall report

 4  to the Legislature direct and indirect care costs, including

 5  average direct and indirect care costs per resident per

 6  facility and direct care and indirect care salaries and

 7  benefits per category of staff member per facility.

 8         5.6.  In order to offset the cost of general and

 9  professional liability insurance, the agency shall amend the

10  plan to allow for interim rate adjustments to reflect

11  increases in the cost of general or professional liability

12  insurance for nursing homes. This provision shall be

13  implemented to the extent existing appropriations are

14  available.

15  

16  It is the intent of the Legislature that the reimbursement

17  plan achieve the goal of providing access to health care for

18  nursing home residents who require large amounts of care while

19  encouraging diversion services as an alternative to nursing

20  home care for residents who can be served within the

21  community. The agency shall base the establishment of any

22  maximum rate of payment, whether overall or component, on the

23  available moneys as provided for in the General Appropriations

24  Act. The agency may base the maximum rate of payment on the

25  results of scientifically valid analysis and conclusions

26  derived from objective statistical data pertinent to the

27  particular maximum rate of payment.

28         (13)  Medicare premiums for persons eligible for both

29  Medicare and Medicaid coverage shall be paid at the rates

30  established by Title XVIII of the Social Security Act.  For

31  Medicare services rendered to Medicaid-eligible persons,


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    CS for SB 12-C                                 First Engrossed



 1  Medicaid shall pay Medicare deductibles and coinsurance as

 2  follows:

 3         (d)  Notwithstanding paragraphs (a)-(c):

 4         1.  Medicaid payments for Nursing Home Medicare part A

 5  coinsurance shall be limited to the lesser of the Medicare

 6  coinsurance amount or the Medicaid nursing home per diem rate

 7  less any amounts paid by Medicare, but only up to the amount

 8  of Medicare coinsurance. The Medicaid per diem rate shall be

 9  the rate in effect for the dates of service of the crossover

10  claims and may not be subsequently adjusted due to subsequent

11  per diem rate adjustments.

12         2.  Medicaid shall pay all deductibles and coinsurance

13  for Medicare-eligible recipients receiving freestanding end

14  stage renal dialysis center services.

15         3.  Medicaid payments for general hospital inpatient

16  services shall be limited to the Medicare deductible per spell

17  of illness.  Medicaid shall make no payment toward coinsurance

18  for Medicare general hospital inpatient services.

19         4.  Medicaid shall pay all deductibles and coinsurance

20  for Medicare emergency transportation services provided by

21  ambulances licensed pursuant to chapter 401.

22         Section 5.  Paragraph (b) of subsection (4) of section

23  409.912, Florida Statutes, is amended to read:

24         409.912  Cost-effective purchasing of health care.--The

25  agency shall purchase goods and services for Medicaid

26  recipients in the most cost-effective manner consistent with

27  the delivery of quality medical care. To ensure that medical

28  services are effectively utilized, the agency may, in any

29  case, require a confirmation or second physician's opinion of

30  the correct diagnosis for purposes of authorizing future

31  services under the Medicaid program. This section does not


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    CS for SB 12-C                                 First Engrossed



 1  restrict access to emergency services or poststabilization

 2  care services as defined in 42 C.F.R. part 438.114. Such

 3  confirmation or second opinion shall be rendered in a manner

 4  approved by the agency. The agency shall maximize the use of

 5  prepaid per capita and prepaid aggregate fixed-sum basis

 6  services when appropriate and other alternative service

 7  delivery and reimbursement methodologies, including

 8  competitive bidding pursuant to s. 287.057, designed to

 9  facilitate the cost-effective purchase of a case-managed

10  continuum of care. The agency shall also require providers to

11  minimize the exposure of recipients to the need for acute

12  inpatient, custodial, and other institutional care and the

13  inappropriate or unnecessary use of high-cost services. The

14  agency shall contract with a vendor to monitor and evaluate

15  the clinical practice patterns of providers in order to

16  identify trends that are outside the normal practice patterns

17  of a provider's professional peers or the national guidelines

18  of a provider's professional association. The vendor must be

19  able to provide information and counseling to a provider whose

20  practice patterns are outside the norms, in consultation with

21  the agency, to improve patient care and reduce inappropriate

22  utilization. The agency may mandate prior authorization, drug

23  therapy management, or disease management participation for

24  certain populations of Medicaid beneficiaries, certain drug

25  classes, or particular drugs to prevent fraud, abuse, overuse,

26  and possible dangerous drug interactions. The Pharmaceutical

27  and Therapeutics Committee shall make recommendations to the

28  agency on drugs for which prior authorization is required. The

29  agency shall inform the Pharmaceutical and Therapeutics

30  Committee of its decisions regarding drugs subject to prior

31  authorization. The agency is authorized to limit the entities


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    CS for SB 12-C                                 First Engrossed



 1  it contracts with or enrolls as Medicaid providers by

 2  developing a provider network through provider credentialing.

 3  The agency may competitively bid single-source-provider

 4  contracts if procurement of goods or services results in

 5  demonstrated cost savings to the state without limiting access

 6  to care. The agency may limit its network based on the

 7  assessment of beneficiary access to care, provider

 8  availability, provider quality standards, time and distance

 9  standards for access to care, the cultural competence of the

10  provider network, demographic characteristics of Medicaid

11  beneficiaries, practice and provider-to-beneficiary standards,

12  appointment wait times, beneficiary use of services, provider

13  turnover, provider profiling, provider licensure history,

14  previous program integrity investigations and findings, peer

15  review, provider Medicaid policy and billing compliance

16  records, clinical and medical record audits, and other

17  factors. Providers shall not be entitled to enrollment in the

18  Medicaid provider network. The agency shall determine

19  instances in which allowing Medicaid beneficiaries to purchase

20  durable medical equipment and other goods is less expensive to

21  the Medicaid program than long-term rental of the equipment or

22  goods. The agency may establish rules to facilitate purchases

23  in lieu of long-term rentals in order to protect against fraud

24  and abuse in the Medicaid program as defined in s. 409.913.

25  The agency may seek federal waivers necessary to administer

26  these policies.

27         (4)  The agency may contract with:

28         (b)  An entity that is providing comprehensive

29  behavioral health care services to certain Medicaid recipients

30  through a capitated, prepaid arrangement pursuant to the

31  federal waiver provided for by s. 409.905(5). Such an entity


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    CS for SB 12-C                                 First Engrossed



 1  must be licensed under chapter 624, chapter 636, or chapter

 2  641 and must possess the clinical systems and operational

 3  competence to manage risk and provide comprehensive behavioral

 4  health care to Medicaid recipients. As used in this paragraph,

 5  the term "comprehensive behavioral health care services" means

 6  covered mental health and substance abuse treatment services

 7  that are available to Medicaid recipients. The secretary of

 8  the Department of Children and Family Services shall approve

 9  provisions of procurements related to children in the

10  department's care or custody prior to enrolling such children

11  in a prepaid behavioral health plan. Any contract awarded

12  under this paragraph must be competitively procured. In

13  developing the behavioral health care prepaid plan procurement

14  document, the agency shall ensure that the procurement

15  document requires the contractor to develop and implement a

16  plan to ensure compliance with s. 394.4574 related to services

17  provided to residents of licensed assisted living facilities

18  that hold a limited mental health license. Except as provided

19  in subparagraph 8., and except in counties where the Medicaid

20  managed care pilot program is authorized pursuant to s.

21  409.91211, the agency shall seek federal approval to contract

22  with a single entity meeting these requirements to provide

23  comprehensive behavioral health care services to all Medicaid

24  recipients not enrolled in a Medicaid managed care plan

25  authorized under s. 409.91211 or a Medicaid health maintenance

26  organization in an AHCA area. In an AHCA area where the

27  Medicaid managed care pilot program is authorized pursuant to

28  s. 409.91211 in one or more counties, the agency may procure a

29  contract with a single entity to serve the remaining counties

30  as an AHCA area or the remaining counties may be included with

31  an adjacent AHCA area and shall be subject to this paragraph.


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    CS for SB 12-C                                 First Engrossed



 1  Each entity must offer sufficient choice of providers in its

 2  network to ensure recipient access to care and the opportunity

 3  to select a provider with whom they are satisfied. The network

 4  shall include all public mental health hospitals. To ensure

 5  unimpaired access to behavioral health care services by

 6  Medicaid recipients, all contracts issued pursuant to this

 7  paragraph shall require 80 percent of the capitation paid to

 8  the managed care plan, including health maintenance

 9  organizations, to be expended for the provision of behavioral

10  health care services. In the event the managed care plan

11  expends less than 80 percent of the capitation paid pursuant

12  to this paragraph for the provision of behavioral health care

13  services, the difference shall be returned to the agency. The

14  agency shall provide the managed care plan with a

15  certification letter indicating the amount of capitation paid

16  during each calendar year for the provision of behavioral

17  health care services pursuant to this section. The agency may

18  reimburse for substance abuse treatment services on a

19  fee-for-service basis until the agency finds that adequate

20  funds are available for capitated, prepaid arrangements.

21         1.  By January 1, 2001, the agency shall modify the

22  contracts with the entities providing comprehensive inpatient

23  and outpatient mental health care services to Medicaid

24  recipients in Hillsborough, Highlands, Hardee, Manatee, and

25  Polk Counties, to include substance abuse treatment services.

26         2.  By July 1, 2003, the agency and the Department of

27  Children and Family Services shall execute a written agreement

28  that requires collaboration and joint development of all

29  policy, budgets, procurement documents, contracts, and

30  monitoring plans that have an impact on the state and Medicaid

31  community mental health and targeted case management programs.


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    CS for SB 12-C                                 First Engrossed



 1         3.  Except as provided in subparagraph 8., by July 1,

 2  2006, the agency and the Department of Children and Family

 3  Services shall contract with managed care entities in each

 4  AHCA area except area 6 or arrange to provide comprehensive

 5  inpatient and outpatient mental health and substance abuse

 6  services through capitated prepaid arrangements to all

 7  Medicaid recipients who are eligible to participate in such

 8  plans under federal law and regulation. In AHCA areas where

 9  eligible individuals number less than 150,000, the agency

10  shall contract with a single managed care plan to provide

11  comprehensive behavioral health services to all recipients who

12  are not enrolled in a Medicaid health maintenance organization

13  or a Medicaid capitated managed care plan authorized under s.

14  409.91211. The agency may contract with more than one

15  comprehensive behavioral health provider to provide care to

16  recipients who are not enrolled in a Medicaid capitated

17  managed care plan authorized under s. 409.91211 or a Medicaid

18  health maintenance organization in AHCA areas where the

19  eligible population exceeds 150,000. In an AHCA area where the

20  Medicaid managed care pilot program is authorized pursuant to

21  s. 409.91211 in one or more counties, the agency may procure a

22  contract with a single entity to serve the remaining counties

23  as an AHCA area or the remaining counties may be included with

24  an adjacent AHCA area and shall be subject to this paragraph.

25  Contracts for comprehensive behavioral health providers

26  awarded pursuant to this section shall be competitively

27  procured. Both for-profit and not-for-profit corporations

28  shall be eligible to compete. Managed care plans contracting

29  with the agency under subsection (3) shall provide and receive

30  payment for the same comprehensive behavioral health benefits

31  as provided in AHCA rules, including handbooks incorporated by


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    CS for SB 12-C                                 First Engrossed



 1  reference. In AHCA area 11, the agency shall contract with at

 2  least two comprehensive behavioral health care providers to

 3  provide behavioral health care to recipients in that area who

 4  are enrolled in, or assigned to, the MediPass program. One of

 5  the behavioral health care contracts shall be with the

 6  existing provider service network pilot project, as described

 7  in paragraph (d), for the purpose of demonstrating the

 8  cost-effectiveness of the provision of quality mental health

 9  services through a public hospital-operated managed care

10  model. Payment shall be at an agreed-upon capitated rate to

11  ensure cost savings. Of the recipients in area 11 who are

12  assigned to MediPass under the provisions of s.

13  409.9122(2)(k), a minimum of 50,000 of those MediPass-enrolled

14  recipients shall be assigned to the existing provider service

15  network in area 11 for their behavioral care.

16         4.  By October 1, 2003, the agency and the department

17  shall submit a plan to the Governor, the President of the

18  Senate, and the Speaker of the House of Representatives which

19  provides for the full implementation of capitated prepaid

20  behavioral health care in all areas of the state.

21         a.  Implementation shall begin in 2003 in those AHCA

22  areas of the state where the agency is able to establish

23  sufficient capitation rates.

24         b.  If the agency determines that the proposed

25  capitation rate in any area is insufficient to provide

26  appropriate services, the agency may adjust the capitation

27  rate to ensure that care will be available. The agency and the

28  department may use existing general revenue to address any

29  additional required match but may not over-obligate existing

30  funds on an annualized basis.

31  


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    CS for SB 12-C                                 First Engrossed



 1         c.  Subject to any limitations provided for in the

 2  General Appropriations Act, the agency, in compliance with

 3  appropriate federal authorization, shall develop policies and

 4  procedures that allow for certification of local and state

 5  funds.

 6         5.  Children residing in a statewide inpatient

 7  psychiatric program, or in a Department of Juvenile Justice or

 8  a Department of Children and Family Services residential

 9  program approved as a Medicaid behavioral health overlay

10  services provider shall not be included in a behavioral health

11  care prepaid health plan or any other Medicaid managed care

12  plan pursuant to this paragraph.

13         6.  In converting to a prepaid system of delivery, the

14  agency shall in its procurement document require an entity

15  providing only comprehensive behavioral health care services

16  to prevent the displacement of indigent care patients by

17  enrollees in the Medicaid prepaid health plan providing

18  behavioral health care services from facilities receiving

19  state funding to provide indigent behavioral health care, to

20  facilities licensed under chapter 395 which do not receive

21  state funding for indigent behavioral health care, or

22  reimburse the unsubsidized facility for the cost of behavioral

23  health care provided to the displaced indigent care patient.

24         7.  Traditional community mental health providers under

25  contract with the Department of Children and Family Services

26  pursuant to part IV of chapter 394, child welfare providers

27  under contract with the Department of Children and Family

28  Services in areas 1 and 6, and inpatient mental health

29  providers licensed pursuant to chapter 395 must be offered an

30  opportunity to accept or decline a contract to participate in

31  any provider network for prepaid behavioral health services.


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    CS for SB 12-C                                 First Engrossed



 1         8.  For fiscal year 2004-2005, all Medicaid eligible

 2  children, except children in areas 1 and 6, whose cases are

 3  open for child welfare services in the HomeSafeNet system,

 4  shall be enrolled in MediPass or in Medicaid fee-for-service

 5  and all their behavioral health care services including

 6  inpatient, outpatient psychiatric, community mental health,

 7  and case management shall be reimbursed on a fee-for-service

 8  basis. Beginning July 1, 2005, such children, who are open for

 9  child welfare services in the HomeSafeNet system, shall

10  receive their behavioral health care services through a

11  specialty prepaid plan operated by community-based lead

12  agencies either through a single agency or formal agreements

13  among several agencies. The specialty prepaid plan must result

14  in savings to the state comparable to savings achieved in

15  other Medicaid managed care and prepaid programs. Such plan

16  must provide mechanisms to maximize state and local revenues.

17  The specialty prepaid plan shall be developed by the agency

18  and the Department of Children and Family Services. The agency

19  is authorized to seek any federal waivers to implement this

20  initiative. Medicaid-eligible children whose cases are open

21  for child welfare services in the HomeSafeNet system and who

22  reside in AHCA area 10 are exempt from the specialty prepaid

23  plan upon the development of a service delivery mechanism for

24  children who reside in area 10 as specified in s.

25  409.91211(3)(dd).

26         Section 6.  Subsection (13) of section 409.9122,

27  Florida Statutes, is amended to read:

28         409.9122  Mandatory Medicaid managed care enrollment;

29  programs and procedures.--

30         (13)  Effective July 1, 2003, the agency shall adjust

31  the enrollee assignment process of Medicaid managed prepaid


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    CS for SB 12-C                                 First Engrossed



 1  health plans for those Medicaid managed prepaid plans

 2  operating in Miami-Dade County which have executed a contract

 3  with the agency for a minimum of 8 consecutive years in order

 4  for the Medicaid managed prepaid plan to maintain a minimum

 5  enrollment level of 15,000 members per month. When assigning

 6  enrollees pursuant to this subsection, the agency shall give

 7  priority to providers that initially qualified under this

 8  subsection until such providers reach and maintain an

 9  enrollment level of 15,000 members per month. A prepaid health

10  plan that has a statewide Medicaid enrollment of 25,000 or

11  more members is not eligible for enrollee assignments under

12  this subsection.

13         Section 7.  Effective March 1, 2008, paragraph (k) of

14  subsection (2) of section 409.9122, Florida Statutes, is

15  amended to read:

16         409.9122  Mandatory Medicaid managed care enrollment;

17  programs and procedures.--

18         (2)

19         (k)  When a Medicaid recipient does not choose a

20  managed care plan or MediPass provider, the agency shall

21  assign the Medicaid recipient to a managed care plan, except

22  in those counties in which there are fewer than two managed

23  care plans accepting Medicaid enrollees, in which case

24  assignment shall be to a managed care plan or a MediPass

25  provider. Medicaid recipients in counties with fewer than two

26  managed care plans accepting Medicaid enrollees who are

27  subject to mandatory assignment but who fail to make a choice

28  shall be assigned to managed care plans until an enrollment of

29  35 percent in MediPass and 65 percent in managed care plans,

30  of all those eligible to choose managed care, is achieved.

31  Once that enrollment is achieved, the assignments shall be


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    CS for SB 12-C                                 First Engrossed



 1  divided in order to maintain an enrollment in MediPass and

 2  managed care plans which is in a 35 percent and 65 percent

 3  proportion, respectively. In service areas 1 and 6 of the

 4  Agency for Health Care Administration where the agency is

 5  contracting for the provision of comprehensive behavioral

 6  health services through a capitated prepaid arrangement,

 7  recipients who fail to make a choice shall be assigned equally

 8  to MediPass or a managed care plan. For purposes of this

 9  paragraph, when referring to assignment, the term "managed

10  care plans" includes exclusive provider organizations,

11  provider service networks, Children's Medical Services

12  Network, minority physician networks, and pediatric emergency

13  department diversion programs authorized by this chapter or

14  the General Appropriations Act. When making assignments, the

15  agency shall take into account the following criteria:

16         1.  A managed care plan has sufficient network capacity

17  to meet the need of members.

18         2.  The managed care plan or MediPass has previously

19  enrolled the recipient as a member, or one of the managed care

20  plan's primary care providers or MediPass providers has

21  previously provided health care to the recipient.

22         3.  The agency has knowledge that the member has

23  previously expressed a preference for a particular managed

24  care plan or MediPass provider as indicated by Medicaid

25  fee-for-service claims data, but has failed to make a choice.

26         4.  The managed care plan's or MediPass primary care

27  providers are geographically accessible to the recipient's

28  residence.

29         5.  The agency has authority to make mandatory

30  assignments based on quality of service and performance of

31  managed care plans.


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    CS for SB 12-C                                 First Engrossed



 1         Section 8.  Paragraph (dd) of subsection (3) of section

 2  409.91211, Florida Statutes, is amended to read:

 3         409.91211  Medicaid managed care pilot program.--

 4         (3)  The agency shall have the following powers,

 5  duties, and responsibilities with respect to the pilot

 6  program:

 7         (dd)  To implement develop and recommend service

 8  delivery mechanisms within capitated managed care plans to

 9  provide Medicaid services as specified in ss. 409.905 and

10  409.906 to Medicaid-eligible children whose cases are open for

11  child welfare services in the HomeSafeNet system in foster

12  care. These services must be coordinated with community-based

13  care providers as specified in s. 409.1671 s. 409.1675, where

14  available, and be sufficient to meet the medical,

15  developmental, behavioral, and emotional needs of these

16  children. These service delivery mechanisms must be

17  implemented no later than July 1, 2008, in AHCA area 10 in

18  order for the children in AHCA area 10 to remain exempt from

19  the statewide plan under s. 409.912(4)(b)8.

20         Section 9.  Except as otherwise expressly provided in

21  this act, this act shall take effect upon becoming a law.

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  


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