1

The Committee on Health and Human Services Appropriations

2

(Peaden) recommended the following amendment:

3

4

     Senate Amendment (with title amendment)

5

     Delete everything after the enacting clause

6

and insert:

7

     Section 1.  Subsection (18) of section 409.908, Florida

8

Statutes, is amended to read:

9

     409.908  Reimbursement of Medicaid providers.--Subject to

10

specific appropriations, the agency shall reimburse Medicaid

11

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

12

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

13

manuals and handbooks incorporated by reference therein. These

14

methodologies may include fee schedules, reimbursement methods

15

based on cost reporting, negotiated fees, competitive bidding

16

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

17

efficient and effective for purchasing services or goods on

18

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

19

reporting and submits a cost report late and that cost report

20

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

21

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

22

retroactively calculated using the new cost report, and full

23

payment at the recalculated rate shall be effected retroactively.

24

Medicare-granted extensions for filing cost reports, if

25

applicable, shall also apply to Medicaid cost reports. Payment

26

for Medicaid compensable services made on behalf of Medicaid

27

eligible persons is subject to the availability of moneys and any

28

limitations or directions provided for in the General

29

Appropriations Act or chapter 216. Further, nothing in this

30

section shall be construed to prevent or limit the agency from

31

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

32

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

33

necessary to comply with the availability of moneys and any

34

limitations or directions provided for in the General

35

Appropriations Act, provided the adjustment is consistent with

36

legislative intent.

37

     (18)  Unless otherwise provided for in the General

38

Appropriations Act, a provider of transportation services shall

39

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

40

the Medicaid maximum allowable fee established by the agency,

41

except when the agency has entered into a direct contract with

42

the provider, or with a community transportation coordinator, for

43

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

44

provided pursuant to an agreement negotiated between the agency

45

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

46

shall purchase transportation services through the community

47

coordinated transportation system, if available, unless the

48

agency, after consultation with the commission, determines that

49

it cannot reach mutually acceptable contract terms with the

50

commission. The agency may then contract for the same

51

transportation services provided in a more cost-effective manner

52

and of comparable or higher quality and standards. determines a

53

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

54

subsection shall be construed to limit or preclude the agency

55

from contracting for services using a prepaid capitation rate or

56

from establishing maximum fee schedules, individualized

57

reimbursement policies by provider type, negotiated fees, prior

58

authorization, competitive bidding, increased use of mass

59

transit, or any other mechanism that the agency considers

60

efficient and effective for the purchase of services on behalf of

61

Medicaid clients, including implementing a transportation

62

eligibility process. The agency shall not be required to contract

63

with any community transportation coordinator or transportation

64

operator that has been determined by the agency, the Department

65

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

66

or federal agency to have engaged in any abusive or fraudulent

67

billing activities. The agency is authorized to competitively

68

procure transportation services or make other changes necessary

69

to secure approval of federal waivers needed to permit federal

70

financing of Medicaid transportation services at the service

71

matching rate rather than the administrative matching rate.

72

Notwithstanding chapter 427, the agency is authorized to continue

73

contracting for Medicaid nonemergency transportation services in

74

agency service area 11 with managed care plans that were under

75

contract for those services before July 1, 2004.

76

     Section 2.  Subsections (8), (12), and (13) of section

77

427.011, Florida Statutes, are amended to read:

78

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

79

427.017:

80

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

81

department or agency whose head is an ex officio, nonvoting

82

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

83

purchases transportation services for the transportation

84

disadvantaged.

85

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

86

funding resources available for providing transportation services

87

to the transportation disadvantaged and which is prepared

88

annually to cover a period of 1 state fiscal year.

89

     (12)(13) "Nonsponsored transportation disadvantaged

90

services" means transportation disadvantaged services that are

91

not sponsored or subsidized by any funding source other than the

92

Transportation Disadvantaged Trust Fund.

93

     Section 3.  Subsection (4) of section 427.012, Florida

94

Statutes, is amended to read:

95

     427.012  The Commission for the Transportation

96

Disadvantaged.--There is created the Commission for the

97

Transportation Disadvantaged in the Department of Transportation.

98

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

99

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

100

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

101

members present is necessary for any action taken by the

102

commission.

103

     Section 4.  Subsections (7), (8), (9), (14), and (26) of

104

section 427.013, Florida Statutes, are amended, and subsection

105

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

106

     427.013  The Commission for the Transportation

107

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

108

commission is to accomplish the coordination of transportation

109

services provided to the transportation disadvantaged. The goal

110

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

111

provision of transportation by qualified community transportation

112

coordinators or transportation operators for the transportation

113

disadvantaged without any bias or presumption in favor of

114

multioperator systems or not-for-profit transportation operators

115

over single operator systems or for-profit transportation

116

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

117

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

118

ensure Assure that all procedures, guidelines, and directives

119

issued by purchasing agencies member departments are conducive to

120

the coordination of transportation services.

121

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

122

departments purchase all trips within the coordinated system,

123

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

124

use a more cost-effective alternative provider that meets

125

comparable quality and standards.

126

     (b) Unless the purchasing agency has negotiated with the

127

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

128

provide, by rule, criteria and procedures for purchasing agencies

129

member departments to use if they wish to use an alternative

130

provider. Agencies Departments must demonstrate either that the

131

proposed alternative provider can provide a trip of comparable

132

acceptable quality and standards for the clients at a lower cost

133

than that provided within the coordinated system, or that the

134

coordinated system cannot accommodate the agency's department's

135

clients.

136

     (9) Unless the purchasing agency has negotiated with the

137

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

138

develop by rule standards for community transportation

139

coordinators and any transportation operator or coordination

140

contractor from whom service is purchased or arranged by the

141

community transportation coordinator covering coordination,

142

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

143

utilization of transportation disadvantaged services. These

144

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

145

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

146

for the various modes and types of transportation services

147

provided.

148

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

149

services. These standards must be included in coordinator

150

contracts and transportation operator contracts with clear

151

penalties for repeated or continuing violations.

152

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

153

transportation services purchased, provided, or coordinated for

154

the transportation disadvantaged through the community

155

transportation coordinator.

156

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

157

estimates for transportation disadvantaged services, and the

158

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

159

actual expenditures annual budget estimates of each official

160

planning agency, local government, and directly federally funded

161

agency and the amounts collected by each official planning agency

162

issue a report.

163

     (26)  Develop a quality assurance and management review

164

program to monitor, based upon approved commission standards,

165

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

166

community transportation operator pursuant to s. 427.0155. Staff

167

of the quality assurance and management review program shall

168

function independently and be directly responsible to the

169

executive director.

170

     (29) Incur expenses for the purchase of advertisements,

171

marketing services, and promotional items.

172

     Section 5.  Section 427.0135, Florida Statutes, is amended

173

to read:

174

     427.0135 Purchasing agencies Member departments; duties and

175

responsibilities.--Each purchasing agency member department, in

176

carrying out the policies and procedures of the commission,

177

shall:

178

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

179

provision of services to its clients, unless each department or

180

purchasing agency meets the criteria outlined in rule or statute

181

to use an alternative provider.

182

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

183

Medicaid agency shall purchase transportation services through

184

the community coordinated transportation system unless a more

185

cost-effective method is determined by the agency for Medicaid

186

clients or unless otherwise limited or directed by the General

187

Appropriations Act.

188

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

189

negotiated statewide contract, unless the purchasing agency has

190

completed the procedure for using an alternative provider and

191

demonstrated that a proposed alternative provider can provide a

192

more cost-effective transportation service of comparable quality

193

and standards or unless the agency has satisfied the requirements

194

of subsection (3).

195

     (3) Not procure transportation disadvantaged services

196

without initially negotiating with the commission, as provided in

197

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

198

If the purchasing agency, after consultation with the commission,

199

determines that it cannot reach mutually acceptable contract

200

terms with the commission, the purchasing agency may contract for

201

the same transportation services provided in a more cost-

202

effective manner and of comparable or higher quality and

203

standards. The Medicaid agency shall implement this subsection in

204

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

205

or directed by the General Appropriations Act.

206

     (4) Identify in the legislative budget request provided to

207

the Governor each year for the General Appropriations Act the

208

specific amount of money the purchasing agency will allocate to

209

provide transportation disadvantaged services.

210

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

211

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

212

were purchased with agency funds.

213

     (6)(3) Assist communities in developing coordinated

214

transportation systems designed to serve the transportation

215

disadvantaged. However, a purchasing agency member department may

216

not serve as the community transportation coordinator in any

217

designated service area.

218

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

219

guidelines, and directives are conducive to the coordination of

220

transportation funds and services for the transportation

221

disadvantaged.

222

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

223

community transportation coordinators or transportation operators

224

or participating agencies.

225

     Section 6.  Subsections (2) and (3) of section 427.015,

226

Florida Statutes, are amended to read:

227

     427.015  Function of the metropolitan planning organization

228

or designated official planning agency in coordinating

229

transportation for the transportation disadvantaged.--

230

     (2)  Each metropolitan planning organization or designated

231

official planning agency shall recommend to the commission a

232

single community transportation coordinator. However, a

233

purchasing agency member department may not serve as the

234

community transportation coordinator in any designated service

235

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

236

transportation services for the transportation disadvantaged but

237

shall be responsible for the provision of those coordinated

238

services. Based on approved commission evaluation criteria, the

239

coordinator shall subcontract or broker those services that are

240

more cost-effectively and efficiently provided by subcontracting

241

or brokering. The performance of the coordinator shall be

242

evaluated based on the commission's approved evaluation criteria

243

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

244

evaluation shall be submitted to the metropolitan planning

245

organization or the designated official planning agency, and the

246

commission. The recommendation or termination of any community

247

transportation coordinator shall be subject to approval by the

248

commission.

249

     (3)  Each metropolitan planning organization or designated

250

official planning agency shall request each local government in

251

its jurisdiction to provide the actual expenditures an estimate

252

of all local and direct federal funds to be expended for

253

transportation for the disadvantaged. The metropolitan planning

254

organization or designated official planning agency shall

255

consolidate this information into a single report and forward it,

256

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

257

commission.

258

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

259

Statutes, is amended to read:

260

     427.0155  Community transportation coordinators; powers and

261

duties.--Community transportation coordinators shall have the

262

following powers and duties:

263

     (7)  In cooperation with the coordinating board and pursuant

264

to criteria developed by the Commission for the Transportation

265

Disadvantaged, establish eligibility guidelines and priorities

266

with regard to the recipients of nonsponsored transportation

267

disadvantaged services that are purchased with Transportation

268

Disadvantaged Trust Fund moneys.

269

     Section 8.  Subsection (4) of section 427.0157, Florida

270

Statutes, is amended to read:

271

     427.0157  Coordinating boards; powers and duties.--The

272

purpose of each coordinating board is to develop local service

273

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

274

community transportation coordinators on the coordination of

275

services to be provided to the transportation disadvantaged. The

276

commission shall, by rule, establish the membership of

277

coordinating boards. The members of each board shall be appointed

278

by the metropolitan planning organization or designated official

279

planning agency. The appointing authority shall provide each

280

board with sufficient staff support and resources to enable the

281

board to fulfill its responsibilities under this section. Each

282

board shall meet at least quarterly and shall:

283

     (4)  Assist the community transportation coordinator in

284

establishing eligibility guidelines and priorities with regard to

285

the recipients of nonsponsored transportation disadvantaged

286

services that are purchased with Transportation Disadvantaged

287

Trust Fund moneys.

288

     Section 9.  Subsections (2) and (3) of section 427.0158,

289

Florida Statutes, are amended to read:

290

     427.0158  School bus and public transportation.--

291

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

292

their vehicles to enhance coordinated disadvantaged

293

transportation disadvantaged services by providing the

294

information as requested by the community transportation

295

coordinator required by this section and by allowing the use of

296

their vehicles at actual cost upon request when those vehicles

297

are available for such use and are not transporting students.

298

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

299

from the local school board shall provide the community

300

transportation coordinator with copies to the coordinated

301

transportation board, the following information for vehicles not

302

scheduled 100 percent of the time for student transportation use:

303

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

304

including days and times, that the vehicles are available for

305

coordinated transportation disadvantaged services;

306

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

307

     (c) The actual driver cost per hour;

308

     (d) Additional actual cost associated with vehicle use

309

outside the established workday or workweek of the entity; and

310

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

311

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

312

shall cooperate in the utilization of its regular service to

313

enhance coordinated transportation disadvantaged services by

314

providing the information as requested by the community

315

transportation coordinator required by this section. Annually, no

316

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

317

fixed route or fixed schedule system shall provide The community

318

transportation coordinator may request, without limitation, with

319

copies to the coordinated transportation board, the following

320

information:

321

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

322

map, and fare structure;

323

     (b)  A copy of the current charter policy;

324

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

325

requirements; and

326

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

327

     Section 10.  Subsection (4) is added to section 427.0159,

328

Florida Statutes, to read:

329

     427.0159  Transportation Disadvantaged Trust Fund.--

330

     (4) A purchasing agency may deposit funds into the

331

Transportation Disadvantaged Trust Fund for the commission to

332

implement, manage, and administer the purchasing agency's

333

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

334

     Section 11.  Paragraph (b) of subsection (1) and subsection

335

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

336

     427.016  Expenditure of local government, state, and federal

337

funds for the transportation disadvantaged.--

338

     (1)

339

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

340

to limit or preclude a purchasing the Medicaid agency from

341

establishing maximum fee schedules, individualized reimbursement

342

policies by provider type, negotiated fees, competitive bidding,

343

or any other mechanism, including contracting after initial

344

negotiation with the commission, which that the agency considers

345

more cost-effective and of comparable or higher quality and

346

standards than those of the commission efficient and effective

347

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

348

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

349

procedure for using an alternative provider. State and local

350

agencies shall not contract for any transportation disadvantaged

351

services, including Medicaid reimbursable transportation

352

services, with any community transportation coordinator or

353

transportation operator that has been determined by the Agency

354

for Health Care Administration, the Department of Legal Affairs

355

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

356

have engaged in any abusive or fraudulent billing activities.

357

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

358

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

359

Transportation Disadvantaged, shall identify in the legislative

360

budget request provided to the Governor for the General

361

Appropriations Act inform the commission in writing, before the

362

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

363

money the agency will allocate allocated for the provision of

364

transportation disadvantaged services. Additionally, each state

365

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

366

commission with an accounting of the actual amount of funds

367

expended and the total number of trips purchased.

368

     Section 12.  This act shall take effect July 1, 2008.

369

370

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

371

And the title is amended as follows:

372

373

     Delete everything before the enacting clause

374

and insert:

375

A bill to be entitled

376

An act relating to transportation services for the

377

transportation disadvantaged; amending s. 409.908, F.S.;

378

authorizing the Agency for Health Care Administration to

379

continue to contract for Medicaid nonemergency

380

transportation services in a specified agency service area

381

with managed care plans under certain conditions; amending

382

s. 427.011, F.S.; revising definitions; defining the term

383

"purchasing agency"; amending s. 427.012, F.S.; revising

384

the number of members required for a quorum at a meeting

385

of the Commission for the Transportation Disadvantaged;

386

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

387

the commission; deleting a requirement that the commission

388

establish by rule acceptable ranges of trip costs;

389

removing a provision for functioning and oversight of the

390

quality assurance and management review program; requiring

391

the commission to incur expenses for promotional services

392

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

393

creating duties and responsibilities for agencies that

394

purchase transportation services for the transportation

395

disadvantaged; providing requirements for the payment of

396

rates; requiring an agency to negotiate with the

397

commission before procuring transportation disadvantaged

398

services; requiring an agency to identify its allocation

399

for transportation disadvantaged services in its

400

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

401

revising provisions relating to the function of the

402

metropolitan planning organization or designated official

403

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

404

duties of community transportation coordinators; amending

405

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

406

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

407

the school board to provide information relating to school

408

buses to the transportation coordinator; providing for the

409

transportation coordinator to request certain information

410

regarding public transportation; amending s. 427.0159,

411

F.S.; revising provisions relating to the Transportation

412

Disadvantaged Trust Fund; providing for the deposit of

413

funds by an agency purchasing transportation services;

414

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

415

application of specified provisions to certain acts of a

416

purchasing agency in lieu of the Medicaid agency;

417

requiring that an agency identify the allocation of funds

418

for transportation disadvantaged services in its

419

legislative budget request; providing an effective date.

4/21/2008  10:00:00 AM     603-08136-08