| 1 | A bill to be entitled |
| 2 | An act relating to Medicaid managed care; amending s. |
| 3 | 409.9122, F.S.; revising the method for assigning Medicaid |
| 4 | recipients to managed care plans in service areas 1 and 6; |
| 5 | providing an effective date. |
| 6 |
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| 7 | Be It Enacted by the Legislature of the State of Florida: |
| 8 |
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| 9 | Section 1. Paragraph (k) of subsection (2) of section |
| 10 | 409.9122, Florida Statutes, is amended to read: |
| 11 | 409.9122 Mandatory Medicaid managed care enrollment; |
| 12 | programs and procedures.-- |
| 13 | (2) |
| 14 | (k) When a Medicaid recipient does not choose a managed |
| 15 | care plan or MediPass provider, the agency shall assign the |
| 16 | Medicaid recipient to a managed care plan, except in those |
| 17 | counties in which there are fewer than two managed care plans |
| 18 | accepting Medicaid enrollees, in which case assignment shall be |
| 19 | to a managed care plan or a MediPass provider. Medicaid |
| 20 | recipients in counties with fewer than two managed care plans |
| 21 | accepting Medicaid enrollees who are subject to mandatory |
| 22 | assignment but who fail to make a choice shall be assigned to |
| 23 | managed care plans until an enrollment of 35 percent in MediPass |
| 24 | and 65 percent in managed care plans, of all those eligible to |
| 25 | choose managed care, is achieved. Once that enrollment is |
| 26 | achieved, the assignments shall be divided in order to maintain |
| 27 | an enrollment in MediPass and managed care plans which is in a |
| 28 | 35 percent and 65 percent proportion, respectively. In service |
| 29 | areas 1 and 6 of the Agency for Health Care Administration where |
| 30 | the agency is contracting for the provision of comprehensive |
| 31 | behavioral health services through a capitated prepaid |
| 32 | arrangement, recipients who fail to make a choice shall be |
| 33 | assigned equally to MediPass or a managed care plan. For |
| 34 | purposes of this paragraph, when referring to assignment, the |
| 35 | term "managed care plans" includes exclusive provider |
| 36 | organizations, provider service networks, Children's Medical |
| 37 | Services Network, minority physician networks, and pediatric |
| 38 | emergency department diversion programs authorized by this |
| 39 | chapter or the General Appropriations Act. When making |
| 40 | assignments, the agency shall take into account the following |
| 41 | criteria: |
| 42 | 1. A managed care plan has sufficient network capacity to |
| 43 | meet the need of members. |
| 44 | 2. The managed care plan or MediPass has previously |
| 45 | enrolled the recipient as a member, or one of the managed care |
| 46 | plan's primary care providers or MediPass providers has |
| 47 | previously provided health care to the recipient. |
| 48 | 3. The agency has knowledge that the member has previously |
| 49 | expressed a preference for a particular managed care plan or |
| 50 | MediPass provider as indicated by Medicaid fee-for-service |
| 51 | claims data, but has failed to make a choice. |
| 52 | 4. The managed care plan's or MediPass primary care |
| 53 | providers are geographically accessible to the recipient's |
| 54 | residence. |
| 55 | 5. The agency has authority to make mandatory assignments |
| 56 | based on quality of service and performance of managed care |
| 57 | plans. |
| 58 | Section 2. This act shall take effect March 1, 2008. |