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Senator Fasano moved the following amendment:

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     Senate Amendment (with title amendment)

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     Between lines 2560 and 2561,

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insert:

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     Section 41.  Subsection (18) of section 409.908, Florida

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Statutes, is amended to read:

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     409.908  Reimbursement of Medicaid providers.--Subject to

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specific appropriations, the agency shall reimburse Medicaid

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providers, in accordance with state and federal law, according to

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methodologies set forth in the rules of the agency and in policy

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manuals and handbooks incorporated by reference therein. These

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methodologies may include fee schedules, reimbursement methods

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based on cost reporting, negotiated fees, competitive bidding

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pursuant to s. 287.057, and other mechanisms the agency considers

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efficient and effective for purchasing services or goods on

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behalf of recipients. If a provider is reimbursed based on cost

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reporting and submits a cost report late and that cost report

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

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semester, then the provider's rate for that semester shall be

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retroactively calculated using the new cost report, and full

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payment at the recalculated rate shall be effected retroactively.

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Medicare-granted extensions for filing cost reports, if

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applicable, shall also apply to Medicaid cost reports. Payment

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for Medicaid compensable services made on behalf of Medicaid

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eligible persons is subject to the availability of moneys and any

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limitations or directions provided for in the General

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Appropriations Act or chapter 216. Further, nothing in this

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section shall be construed to prevent or limit the agency from

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adjusting fees, reimbursement rates, lengths of stay, number of

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visits, or number of services, or making any other adjustments

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necessary to comply with the availability of moneys and any

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limitations or directions provided for in the General

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Appropriations Act, provided the adjustment is consistent with

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legislative intent.

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     (18)  Unless otherwise provided for in the General

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Appropriations Act, a provider of transportation services shall

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be reimbursed the lesser of the amount billed by the provider or

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the Medicaid maximum allowable fee established by the agency,

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except when the agency has entered into a direct contract with

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the provider, or with a community transportation coordinator, for

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the provision of an all-inclusive service, or when services are

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provided pursuant to an agreement negotiated between the agency

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and the provider. The agency, as provided for in s. 427.0135,

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shall purchase transportation services through the community

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coordinated transportation system, if available, unless the

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agency, after consultation with the commission, determines that

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it cannot reach mutually acceptable contract terms with the

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commission. The agency may then contract for the same

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transportation services provided in a more cost-effective manner

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and of comparable or higher quality and standards determines a

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more cost-effective method for Medicaid clients. Nothing in this

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subsection shall be construed to limit or preclude the agency

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from contracting for services using a prepaid capitation rate or

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from establishing maximum fee schedules, individualized

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reimbursement policies by provider type, negotiated fees, prior

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authorization, competitive bidding, increased use of mass

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transit, or any other mechanism that the agency considers

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efficient and effective for the purchase of services on behalf of

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Medicaid clients, including implementing a transportation

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eligibility process. The agency shall not be required to contract

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with any community transportation coordinator or transportation

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operator that has been determined by the agency, the Department

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of Legal Affairs Medicaid Fraud Control Unit, or any other state

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or federal agency to have engaged in any abusive or fraudulent

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billing activities. The agency is authorized to competitively

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procure transportation services or make other changes necessary

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to secure approval of federal waivers needed to permit federal

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financing of Medicaid transportation services at the service

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matching rate rather than the administrative matching rate.

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Notwithstanding chapter 427, the agency is authorized to continue

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contracting for Medicaid nonemergency transportation services in

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agency service area 11 with managed care plans that were under

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contract for those services before July 1, 2004.

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     Section 42.  Subsections (8), (12), and (13) of section

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427.011, Florida Statutes, are amended to read:

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     427.011  Definitions.--For the purposes of ss. 427.011-

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427.017:

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     (8) "Purchasing agency" "Member department" means a

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department or agency whose head is an ex officio, nonvoting

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advisor to a member of the commission, or an agency that

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purchases transportation services for the transportation

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disadvantaged.

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     (12) "Annual budget estimate" means a budget estimate of

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funding resources available for providing transportation services

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to the transportation disadvantaged and which is prepared

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annually to cover a period of 1 state fiscal year.

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     (12)(13) "Nonsponsored transportation disadvantaged

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services" means transportation disadvantaged services that are

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not sponsored or subsidized by any funding source other than the

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Transportation Disadvantaged Trust Fund.

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     Section 43.  Subsection (4) of section 427.012, Florida

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Statutes, is amended to read:

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     427.012  The Commission for the Transportation

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Disadvantaged.--There is created the Commission for the

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Transportation Disadvantaged in the Department of Transportation.

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     (4)  The commission shall meet at least quarterly, or more

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frequently at the call of the chairperson. Four Five members of

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the commission constitute a quorum, and a majority vote of the

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members present is necessary for any action taken by the

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commission.

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     Section 44.  Subsections (7), (8), (9), (14), and (26) of

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section 427.013, Florida Statutes, are amended, and subsection

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(29) is added to that section, to read:

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     427.013  The Commission for the Transportation

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Disadvantaged; purpose and responsibilities.--The purpose of the

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commission is to accomplish the coordination of transportation

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services provided to the transportation disadvantaged. The goal

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of this coordination is shall be to assure the cost-effective

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provision of transportation by qualified community transportation

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coordinators or transportation operators for the transportation

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disadvantaged without any bias or presumption in favor of

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multioperator systems or not-for-profit transportation operators

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over single operator systems or for-profit transportation

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operators. In carrying out this purpose, the commission shall:

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     (7) Unless otherwise provided by state or federal law,

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ensure Assure that all procedures, guidelines, and directives

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issued by purchasing agencies member departments are conducive to

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the coordination of transportation services.

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     (8)(a) Ensure Assure that purchasing agencies member

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departments purchase all trips within the coordinated system,

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unless they have fulfilled the requirements of s. 427.0135(3) and

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use a more cost-effective alternative provider that meets

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comparable quality and standards.

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     (b) Unless the purchasing agency has negotiated with the

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commission pursuant to the requirements of s. 427.0135(3),

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provide, by rule, criteria and procedures for purchasing agencies

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member departments to use if they wish to use an alternative

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provider. Agencies Departments must demonstrate either that the

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proposed alternative provider can provide a trip of comparable

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acceptable quality and standards for the clients at a lower cost

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than that provided within the coordinated system, or that the

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coordinated system cannot accommodate the agency's department's

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clients.

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     (9) Unless the purchasing agency has negotiated with the

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commission pursuant to the requirements of s. 427.0135(3),

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develop by rule standards for community transportation

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coordinators and any transportation operator or coordination

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contractor from whom service is purchased or arranged by the

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community transportation coordinator covering coordination,

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operation, safety, insurance, eligibility for service, costs, and

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utilization of transportation disadvantaged services. These

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standards and rules must include, but are not limited to:

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     (a) Inclusion, by rule, of acceptable ranges of trip costs

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for the various modes and types of transportation services

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provided.

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     (a)(b) Minimum performance standards for the delivery of

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services. These standards must be included in coordinator

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contracts and transportation operator contracts with clear

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penalties for repeated or continuing violations.

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     (b)(c) Minimum liability insurance requirements for all

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transportation services purchased, provided, or coordinated for

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the transportation disadvantaged through the community

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transportation coordinator.

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     (14) Consolidate, for each state agency, the annual budget

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estimates for transportation disadvantaged services, and the

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amounts of each agency's actual expenditures, together with the

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actual expenditures annual budget estimates of each official

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planning agency, local government, and directly federally funded

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agency and the amounts collected by each official planning agency

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issue a report.

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     (26)  Develop a quality assurance and management review

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program to monitor, based upon approved commission standards,

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services contracted for by an agency, and those provided by a

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community transportation operator pursuant to s. 427.0155. Staff

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of the quality assurance and management review program shall

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function independently and be directly responsible to the

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executive director.

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     (29) Incur expenses for the purchase of advertisements,

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marketing services, and promotional items.

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     Section 45.  Section 427.0135, Florida Statutes, is amended

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to read:

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     427.0135 Purchasing agencies Member departments; duties and

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responsibilities.--Each purchasing agency member department, in

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carrying out the policies and procedures of the commission,

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shall:

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     (1)(a) Use the coordinated transportation system for

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provision of services to its clients, unless each department or

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purchasing agency meets the criteria outlined in rule or statute

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to use an alternative provider.

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     (b) Subject to the provisions of s. 409.908(18), the

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Medicaid agency shall purchase transportation services through

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the community coordinated transportation system unless a more

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cost-effective method is determined by the agency for Medicaid

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clients or unless otherwise limited or directed by the General

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Appropriations Act.

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     (2) Pay the rates established in the service plan or

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negotiated statewide contract, unless the purchasing agency has

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completed the procedure for using an alternative provider and

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demonstrated that a proposed alternative provider can provide a

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more cost-effective transportation service of comparable quality

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and standards or unless the agency has satisfied the requirements

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of subsection (3).

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     (3) Not procure transportation disadvantaged services

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without initially negotiating with the commission, as provided in

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s. 287.057(5)(f)13., or unless otherwise authorized by statute.

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If the purchasing agency, after consultation with the commission,

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determines that it cannot reach mutually acceptable contract

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terms with the commission, the purchasing agency may contract for

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the same transportation services provided in a more cost-

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effective manner and of comparable or higher quality and

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standards. The Medicaid agency shall implement this subsection in

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a manner consistent with s. 409.908(18) and as otherwise limited

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or directed by the General Appropriations Act.

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     (4) Identify in the legislative budget request provided to

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the Governor each year for the General Appropriations Act the

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specific amount of money the purchasing agency will allocate to

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provide transportation disadvantaged services.

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     (5)(2) Provide the commission, by September 15 of each

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year, an accounting of all funds spent as well as how many trips

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were purchased with agency funds.

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     (6)(3) Assist communities in developing coordinated

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transportation systems designed to serve the transportation

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disadvantaged. However, a purchasing agency member department may

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not serve as the community transportation coordinator in any

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designated service area.

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     (7)(4) Ensure Assure that its rules, procedures,

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guidelines, and directives are conducive to the coordination of

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transportation funds and services for the transportation

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disadvantaged.

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     (8)(5) Provide technical assistance, as needed, to

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community transportation coordinators or transportation operators

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or participating agencies.

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     Section 46.  Subsections (2) and (3) of section 427.015,

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Florida Statutes, are amended to read:

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     427.015  Function of the metropolitan planning organization

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or designated official planning agency in coordinating

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transportation for the transportation disadvantaged.--

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     (2)  Each metropolitan planning organization or designated

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official planning agency shall recommend to the commission a

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single community transportation coordinator. However, a

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purchasing agency member department may not serve as the

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community transportation coordinator in any designated service

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area. The coordinator may provide all or a portion of needed

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transportation services for the transportation disadvantaged but

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shall be responsible for the provision of those coordinated

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services. Based on approved commission evaluation criteria, the

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coordinator shall subcontract or broker those services that are

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more cost-effectively and efficiently provided by subcontracting

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or brokering. The performance of the coordinator shall be

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evaluated based on the commission's approved evaluation criteria

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by the coordinating board at least annually. A copy of the

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evaluation shall be submitted to the metropolitan planning

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organization or the designated official planning agency, and the

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commission. The recommendation or termination of any community

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transportation coordinator shall be subject to approval by the

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commission.

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     (3)  Each metropolitan planning organization or designated

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official planning agency shall request each local government in

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its jurisdiction to provide the actual expenditures an estimate

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of all local and direct federal funds to be expended for

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transportation for the disadvantaged. The metropolitan planning

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organization or designated official planning agency shall

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consolidate this information into a single report and forward it,

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by September 15 the beginning of each fiscal year, to the

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commission.

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     Section 47.  Subsection (7) of section 427.0155, Florida

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Statutes, is amended to read:

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     427.0155  Community transportation coordinators; powers and

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duties.--Community transportation coordinators shall have the

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following powers and duties:

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     (7)  In cooperation with the coordinating board and pursuant

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to criteria developed by the Commission for the Transportation

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Disadvantaged, establish eligibility guidelines and priorities

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with regard to the recipients of nonsponsored transportation

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disadvantaged services that are purchased with Transportation

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Disadvantaged Trust Fund moneys.

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     Section 48.  Subsection (4) of section 427.0157, Florida

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Statutes, is amended to read:

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     427.0157  Coordinating boards; powers and duties.--The

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purpose of each coordinating board is to develop local service

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needs and to provide information, advice, and direction to the

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community transportation coordinators on the coordination of

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services to be provided to the transportation disadvantaged. The

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commission shall, by rule, establish the membership of

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coordinating boards. The members of each board shall be appointed

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by the metropolitan planning organization or designated official

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planning agency. The appointing authority shall provide each

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board with sufficient staff support and resources to enable the

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board to fulfill its responsibilities under this section. Each

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board shall meet at least quarterly and shall:

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     (4)  Assist the community transportation coordinator in

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establishing eligibility guidelines and priorities with regard to

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the recipients of nonsponsored transportation disadvantaged

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services that are purchased with Transportation Disadvantaged

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Trust Fund moneys.

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     Section 49.  Subsections (2) and (3) of section 427.0158,

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Florida Statutes, are amended to read:

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     427.0158  School bus and public transportation.--

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     (2)  The school boards shall cooperate in the utilization of

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their vehicles to enhance coordinated disadvantaged

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transportation disadvantaged services by providing the

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information as requested by the community transportation

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coordinator required by this section and by allowing the use of

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their vehicles at actual cost upon request when those vehicles

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are available for such use and are not transporting students.

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Semiannually, no later than October 1 and April 30, a designee

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from the local school board shall provide the community

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transportation coordinator with copies to the coordinated

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transportation board, the following information for vehicles not

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scheduled 100 percent of the time for student transportation use:

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     (a) The number and type of vehicles by adult capacity,

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including days and times, that the vehicles are available for

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coordinated transportation disadvantaged services;

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     (b) The actual cost per mile by vehicle type available;

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     (c) The actual driver cost per hour;

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     (d) Additional actual cost associated with vehicle use

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outside the established workday or workweek of the entity; and

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     (e) Notification of lead time required for vehicle use.

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     (3)  The public transit fixed route or fixed schedule system

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shall cooperate in the utilization of its regular service to

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enhance coordinated transportation disadvantaged services by

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providing the information as requested by the community

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transportation coordinator required by this section. Annually, no

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later than October 1, a designee from the local public transit

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fixed route or fixed schedule system shall provide The community

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transportation coordinator may request, without limitation, with

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copies to the coordinated transportation board, the following

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information:

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     (a)  A copy of all current schedules, route maps, system

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map, and fare structure;

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     (b)  A copy of the current charter policy;

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     (c)  A copy of the current charter rates and hour

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requirements; and

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     (d)  Required notification time to arrange for a charter.

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     Section 50.  Subsection (4) is added to section 427.0159,

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Florida Statutes, to read:

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     427.0159  Transportation Disadvantaged Trust Fund.--

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     (4) A purchasing agency may deposit funds into the

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Transportation Disadvantaged Trust Fund for the commission to

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implement, manage, and administer the purchasing agency's

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transportation disadvantaged funds, as defined in s. 427.011(10).

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     Section 51.  Paragraph (b) of subsection (1) and subsection

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(2) of section 427.016, Florida Statutes, are amended to read:

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     427.016  Expenditure of local government, state, and federal

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funds for the transportation disadvantaged.--

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     (1)

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     (b) Nothing in This subsection does not shall be construed

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to limit or preclude a purchasing the Medicaid agency from

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establishing maximum fee schedules, individualized reimbursement

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policies by provider type, negotiated fees, competitive bidding,

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or any other mechanism, including contracting after initial

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negotiation with the commission, which that the agency considers

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more cost-effective and of comparable or higher quality and

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standards than those of the commission efficient and effective

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for the purchase of services on behalf of its Medicaid clients if

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it has fulfilled the requirements of s. 427.0135(3) or the

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procedure for using an alternative provider. State and local

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agencies shall not contract for any transportation disadvantaged

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services, including Medicaid reimbursable transportation

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services, with any community transportation coordinator or

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transportation operator that has been determined by the Agency

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for Health Care Administration, the Department of Legal Affairs

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Medicaid Fraud Control Unit, or any state or federal agency to

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have engaged in any abusive or fraudulent billing activities.

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     (2) Each year, each agency, whether or not it is an ex

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officio, nonvoting advisor to a member of the Commission for the

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Transportation Disadvantaged, shall identify in the legislative

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budget request provided to the Governor for the General

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Appropriations Act inform the commission in writing, before the

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beginning of each fiscal year, of the specific amount of any

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money the agency will allocate allocated for the provision of

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transportation disadvantaged services. Additionally, each state

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agency shall, by September 15 of each year, provide the

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commission with an accounting of the actual amount of funds

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expended and the total number of trips purchased.

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================ T I T L E  A M E N D M E N T ================

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And the title is amended as follows:

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     On line 167, after the first semicolon,

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insert:

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amending s. 409.908, F.S.; authorizing the Agency for

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Health Care Administration to continue to contract for

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Medicaid nonemergency transportation services in a

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specified agency service area with managed care plans

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under certain conditions; amending s. 427.011, F.S.;

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revising definitions; defining the term "purchasing

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agency"; amending s. 427.012, F.S.; revising the number of

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members required for a quorum at a meeting of the

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Commission for the Transportation Disadvantaged; amending

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s. 427.013, F.S.; revising responsibilities of the

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commission; deleting a requirement that the commission

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establish by rule acceptable ranges of trip costs;

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removing a provision for functioning and oversight of the

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quality assurance and management review program; requiring

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the commission to incur expenses for promotional services

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and items; amending s. 427.0135, F.S.; revising and

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creating duties and responsibilities for agencies that

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purchase transportation services for the transportation

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disadvantaged; providing requirements for the payment of

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rates; requiring an agency to negotiate with the

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commission before procuring transportation disadvantaged

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services; requiring an agency to identify its allocation

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for transportation disadvantaged services in its

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legislative budget request; amending s. 427.015, F.S.;

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revising provisions relating to the function of the

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metropolitan planning organization or designated official

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planning agency; amending s. 427.0155, F.S.; revising

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duties of community transportation coordinators; amending

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s. 427.0157, F.S.; revising duties of coordinating boards;

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amending s. 427.0158, F.S.; deleting provisions requiring

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the school board to provide information relating to school

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buses to the transportation coordinator; providing for the

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transportation coordinator to request certain information

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regarding public transportation; amending s. 427.0159,

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F.S.; revising provisions relating to the Transportation

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Disadvantaged Trust Fund; providing for the deposit of

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funds by an agency purchasing transportation services;

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amending s. 427.016, F.S.; providing for construction and

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application of specified provisions to certain acts of a

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purchasing agency in lieu of the Medicaid agency;

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requiring that an agency identify the allocation of funds

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for transportation disadvantaged services in its

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legislative budget request;

4/30/2008  8:39:00 AM     11-09098-08