1

A bill to be entitled

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An act relating to transportation services for the

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

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authorizing the Agency for Health Care Administration to

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continue to contract for Medicaid nonemergency

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transportation services in a specified agency service area

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with managed care plans under certain conditions; amending

8

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

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

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the number of members required for a quorum at a meeting

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of the Commission for the Transportation Disadvantaged;

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

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the 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; providing an effective date.

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47

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

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49

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

50

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 2.  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 3.  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 4.  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 5.  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 6.  Subsections (2) and (3) of section 427.015,

268

Florida Statutes, are amended to read:

269

     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

289

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,

298

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

299

commission.

300

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

301

Statutes, is amended to read:

302

     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

308

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.

311

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

312

Statutes, is amended to read:

313

     427.0157  Coordinating boards; powers and duties.--The

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purpose of each coordinating board is to develop local service

315

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

320

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

323

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.

330

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

331

Florida Statutes, are amended to read:

332

     427.0158  School bus and public transportation.--

333

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

334

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

337

coordinator required by this section and by allowing the use of

338

their vehicles at actual cost upon request when those vehicles

339

are available for such use and are not transporting students.

340

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

341

from the local school board shall provide the community

342

transportation coordinator with copies to the coordinated

343

transportation board, the following information for vehicles not

344

scheduled 100 percent of the time for student transportation use:

345

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

346

including days and times, that the vehicles are available for

347

coordinated transportation disadvantaged services;

348

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

349

     (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

352

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

353

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

354

shall cooperate in the utilization of its regular service to

355

enhance coordinated transportation disadvantaged services by

356

providing the information as requested by the community

357

transportation coordinator required by this section. Annually, no

358

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

359

fixed route or fixed schedule system shall provide The community

360

transportation coordinator may request, without limitation, with

361

copies to the coordinated transportation board, the following

362

information:

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

364

map, and fare structure;

365

     (b)  A copy of the current charter policy;

366

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

367

requirements; and

368

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

369

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

370

Florida Statutes, to read:

371

     427.0159  Transportation Disadvantaged Trust Fund.--

372

     (4) A purchasing agency may deposit funds into the

373

Transportation Disadvantaged Trust Fund for the commission to

374

implement, manage, and administer the purchasing agency's

375

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

376

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

377

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

378

     427.016  Expenditure of local government, state, and federal

379

funds for the transportation disadvantaged.--

380

     (1)

381

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

382

to limit or preclude a purchasing the Medicaid agency from

383

establishing maximum fee schedules, individualized reimbursement

384

policies by provider type, negotiated fees, competitive bidding,

385

or any other mechanism, including contracting after initial

386

negotiation with the commission, which that the agency considers

387

more cost-effective and of comparable or higher quality and

388

standards than those of the commission efficient and effective

389

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

390

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

391

procedure for using an alternative provider. State and local

392

agencies shall not contract for any transportation disadvantaged

393

services, including Medicaid reimbursable transportation

394

services, with any community transportation coordinator or

395

transportation operator that has been determined by the Agency

396

for Health Care Administration, the Department of Legal Affairs

397

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

398

have engaged in any abusive or fraudulent billing activities.

399

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

400

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

401

Transportation Disadvantaged, shall identify in the legislative

402

budget request provided to the Governor for the General

403

Appropriations Act inform the commission in writing, before the

404

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

405

money the agency will allocate allocated for the provision of

406

transportation disadvantaged services. Additionally, each state

407

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

408

commission with an accounting of the actual amount of funds

409

expended and the total number of trips purchased.

410

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