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The Committee on Health and Human Services Appropriations (Gaetz)

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recommended the following amendment:

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     Senate Amendment (with directory and title amendments)

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     Between line(s) 653 and 654,

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insert

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     (4)  The agency may contract with:

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     (b)  An entity that is providing comprehensive behavioral

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health care services to certain Medicaid recipients through a

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capitated, prepaid arrangement pursuant to the federal waiver

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provided for by s. 409.905(5). Such an entity must be licensed

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under chapter 624, chapter 636, or chapter 641 and must possess

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the clinical systems and operational competence to manage risk

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and provide comprehensive behavioral health care to Medicaid

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recipients. As used in this paragraph, the term "comprehensive

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behavioral health care services" means covered mental health and

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substance abuse treatment services that are available to Medicaid

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recipients. The secretary of the Department of Children and

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Family Services shall approve provisions of procurements related

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to children in the department's care or custody prior to

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enrolling such children in a prepaid behavioral health plan. Any

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contract awarded under this paragraph must be competitively

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procured. In developing the behavioral health care prepaid plan

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procurement document, the agency shall ensure that the

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procurement document requires the contractor to develop and

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implement a plan to ensure compliance with s. 394.4574 related to

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services provided to residents of licensed assisted living

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facilities that hold a limited mental health license. Except as

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provided in subparagraph 8., and except in counties where the

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Medicaid managed care pilot program is authorized pursuant to s.

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409.91211, the agency shall seek federal approval to contract

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with a single entity meeting these requirements to provide

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comprehensive behavioral health care services to all Medicaid

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recipients not enrolled in a Medicaid managed care plan

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authorized under s. 409.91211 or a Medicaid health maintenance

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

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managed care pilot program is authorized pursuant to s. 409.91211

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in one or more counties, the agency may procure a contract with a

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single entity to serve the remaining counties as an AHCA area or

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the remaining counties may be included with an adjacent AHCA area

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and shall be subject to this paragraph. Each entity must offer

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sufficient choice of providers in its network to ensure recipient

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access to care and the opportunity to select a provider with whom

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they are satisfied. The network shall include all public mental

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health hospitals. To ensure unimpaired access to behavioral

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health care services by Medicaid recipients, all contracts issued

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pursuant to this paragraph shall require 80 percent of the

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capitation paid to the managed care plan, including health

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maintenance organizations, to be expended for the provision of

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behavioral health care services. In the event the managed care

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plan expends less than 80 percent of the capitation paid pursuant

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to this paragraph for the provision of behavioral health care

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

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agency shall provide the managed care plan with a certification

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letter indicating the amount of capitation paid during each

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calendar year for the provision of behavioral health care

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services pursuant to this section. The agency may reimburse for

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substance abuse treatment services on a fee-for-service basis

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until the agency finds that adequate funds are available for

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capitated, prepaid arrangements.

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

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contracts with the entities providing comprehensive inpatient and

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outpatient mental health care services to Medicaid recipients in

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Hillsborough, Highlands, Hardee, Manatee, and Polk Counties, to

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include substance abuse treatment services.

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

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Children and Family Services shall execute a written agreement

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that requires collaboration and joint development of all policy,

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budgets, procurement documents, contracts, and monitoring plans

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that have an impact on the state and Medicaid community mental

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health and targeted case management programs.

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     3.  Except as provided in subparagraph 8., by July 1, 2006,

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the agency and the Department of Children and Family Services

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shall contract with managed care entities in each AHCA area

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except area 6 or arrange to provide comprehensive inpatient and

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outpatient mental health and substance abuse services through

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capitated prepaid arrangements to all Medicaid recipients who are

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eligible to participate in such plans under federal law and

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regulation. In AHCA areas where eligible individuals number less

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than 150,000, the agency shall contract with a single managed

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care plan to provide comprehensive behavioral health services to

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all recipients who are not enrolled in a Medicaid health

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maintenance organization or a Medicaid capitated managed care

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plan authorized under s. 409.91211. The agency may contract with

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more than one comprehensive behavioral health provider to provide

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care to recipients who are not enrolled in a Medicaid capitated

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managed care plan authorized under s. 409.91211 or a Medicaid

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health maintenance organization in AHCA areas where the eligible

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

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managed care pilot program is authorized pursuant to s. 409.91211

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in one or more counties, the agency may procure a contract with a

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single entity to serve the remaining counties as an AHCA area or

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the remaining counties may be included with an adjacent AHCA area

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and shall be subject to this paragraph. Contracts for

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comprehensive behavioral health providers awarded pursuant to

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this section shall be competitively procured. Both for-profit and

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not-for-profit corporations shall be eligible to compete. Managed

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care plans contracting with the agency under subsection (3) shall

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provide and receive payment for the same comprehensive behavioral

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health benefits as provided in AHCA rules, including handbooks

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incorporated by reference. In AHCA area 11, the agency shall

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contract with at least two comprehensive behavioral health care

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providers to provide behavioral health care to recipients in that

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area who are enrolled in, or assigned to, the MediPass program.

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One of the behavioral health care contracts shall be with the

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existing provider service network pilot project, as described in

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paragraph (d), for the purpose of demonstrating the cost-

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effectiveness of the provision of quality mental health services

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through a public hospital-operated managed care model. Payment

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shall be at an agreed-upon capitated rate to ensure cost savings.

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Of the recipients in area 11 who are assigned to MediPass under

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the provisions of s. 409.9122(2)(k), a minimum of 50,000 of those

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MediPass-enrolled recipients shall be assigned to the existing

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provider service network in area 11 for their behavioral care.

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

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submit a plan to the Governor, the President of the Senate, and

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the Speaker of the House of Representatives which provides for

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the full implementation of capitated prepaid behavioral health

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care in all areas of the state.

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     a.  Implementation shall begin in 2003 in those AHCA areas

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of the state where the agency is able to establish sufficient

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capitation rates.

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     b.  If the agency determines that the proposed capitation

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rate in any area is insufficient to provide appropriate services,

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the agency may adjust the capitation rate to ensure that care

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will be available. The agency and the department may use existing

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general revenue to address any additional required match but may

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not over-obligate existing funds on an annualized basis.

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     c.  Subject to any limitations provided for in the General

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Appropriations Act, the agency, in compliance with appropriate

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federal authorization, shall develop policies and procedures that

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allow for certification of local and state funds.

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     5.  Children residing in a statewide inpatient psychiatric

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

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of Children and Family Services residential program approved as a

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Medicaid behavioral health overlay services provider shall not be

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included in a behavioral health care prepaid health plan or any

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other Medicaid managed care plan pursuant to this paragraph.

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

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agency shall in its procurement document require an entity

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providing only comprehensive behavioral health care services to

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prevent the displacement of indigent care patients by enrollees

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in the Medicaid prepaid health plan providing behavioral health

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care services from facilities receiving state funding to provide

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indigent behavioral health care, to facilities licensed under

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chapter 395 which do not receive state funding for indigent

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behavioral health care, or reimburse the unsubsidized facility

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for the cost of behavioral health care provided to the displaced

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indigent care patient.

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     7.  Traditional community mental health providers under

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contract with the Department of Children and Family Services

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

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contract with the Department of Children and Family Services in

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areas 1 and 6, and inpatient mental health providers licensed

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pursuant to chapter 395 must be offered an opportunity to accept

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or decline a contract to participate in any provider network for

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prepaid behavioral health services.

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

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children, except children in areas 1 and Highland, Hardee, Polk,

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and Manatee counties of area 6, whose cases are open for child

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welfare services in the HomeSafeNet system, shall be enrolled in

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MediPass or in Medicaid fee-for-service and all their behavioral

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health care services including inpatient, outpatient psychiatric,

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community mental health, and case management shall be reimbursed

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on a fee-for-service basis. Beginning July 1, 2005, such

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children, who are open for child welfare services in the

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HomeSafeNet system, shall receive their behavioral health care

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services through a specialty prepaid plan operated by community-

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based lead agencies either through a single agency or formal

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agreements among several agencies. The specialty prepaid plan

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must result in savings to the state comparable to savings

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achieved in other Medicaid managed care and prepaid programs.

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Such plan must provide mechanisms to maximize state and local

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revenues. The specialty prepaid plan shall be developed by the

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agency and the Department of Children and Family Services. The

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agency is authorized to seek any federal waivers to implement

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this initiative. Medicaid-eligible children whose cases are open

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for child welfare services in the HomeSafeNet system and who

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

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upon the development of a service delivery mechanism for children

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who reside in area 10 as specified in s. 409.91211(3)(dd).

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====== D I R E C T O R Y  C L A U S E  A M E N D M E N T =====

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And the directory clause is amended as follows:

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     Delete line(s) 590-591

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and insert:

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     Section 8.  Paragraph (b) of subsection (4), paragraph (a)

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of subsection (39), and subsection (42) of section 409.912,

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Florida Statutes, are amended to read:

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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(s) 31, after the second semicolon,

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insert:

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specifying certain counties that are exempt from the

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requirement of enrolling Medicaid eligible children in

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MediPass or Medicaid fee-for-service and behavioral health

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care services;

4/1/2008  10:05:00 AM     603-06317-08