Amendment
Bill No. CS/SB 1658

Amendment No. 892035

CHAMBER ACTION
Senate		House
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1	Representative Ambler offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Paragraph (c) is added to subsection (8) of
6	section 409.814, Florida Statutes, to read:
7	409.814  Eligibility.--A child who has not reached 19 years
8	of age whose family income is equal to or below 200 percent of
9	the federal poverty level is eligible for the Florida Kidcare
10	program as provided in this section. For enrollment in the
11	Children's Medical Services Network, a complete application
12	includes the medical or behavioral health screening. If,
13	subsequently, an individual is determined to be ineligible for
14	coverage, he or she must immediately be disenrolled from the
15	respective Florida Kidcare program component.
16	(8)  In determining the eligibility of a child, an assets
17	test is not required. Each applicant shall provide written
18	documentation during the application process and the
19	redetermination process, including, but not limited to, the
20	following:
21	(a)  Proof of family income, which must include a copy of
22	the applicant's most recent federal income tax return. In the
23	absence of a federal income tax return, an applicant may submit
24	wages and earnings statements (pay stubs), W-2 forms, or other
25	appropriate documents.
26	(b)  A statement from all family members that:
27	1.  Their employer does not sponsor a health benefit plan
28	for employees; or
29	2.  The potential enrollee is not covered by the employer-
30	sponsored health benefit plan because the potential enrollee is
31	not eligible for coverage, or, if the potential enrollee is
32	eligible but not covered, a statement of the cost to enroll the
33	potential enrollee in the employer-sponsored health benefit
34	plan.
35	(c)  Effective no later than January 1, 2010, verification
36	of the potential enrollee's or enrollee's citizenship status to
37	the extent required under Title XXI of the Social Security Act.
38	Section 2.  Paragraphs (g) and (q) of subsection (2) of
39	section 409.815, Florida Statutes, are amended, and paragraph
40	(w) is added to that subsection, to read:
41	409.815  Health benefits coverage; limitations.--
42	(2)  BENCHMARK BENEFITS.--In order for health benefits
43	coverage to qualify for premium assistance payments for an
44	eligible child under ss. 409.810-409.820, the health benefits
45	coverage, except for coverage under Medicaid and Medikids, must
46	include the following minimum benefits, as medically necessary.
47	(g)  Behavioral health services.--
48	1.  Mental health benefits include:
49	a.  Inpatient services, limited to not more than 30
50	inpatient days per contract year for psychiatric admissions, or
51	residential services in facilities licensed under s. 394.875(6)
52	or s. 395.003 in lieu of inpatient psychiatric admissions;
53	however, a minimum of 10 of the 30 days shall be available only
54	for inpatient psychiatric services when authorized by a
55	physician; and
56	b.  Outpatient services, including outpatient visits for
57	psychological or psychiatric evaluation, diagnosis, and
58	treatment by a licensed mental health professional, limited to a
59	maximum of 40 outpatient visits each contract year.
60	2.  Substance abuse services include:
61	a.  Inpatient services, limited to not more than 7
62	inpatient days per contract year for medical detoxification only
63	and 30 days of residential services; and
64	b.  Outpatient services, including evaluation, diagnosis,
65	and treatment by a licensed practitioner, limited to a maximum
66	of 40 outpatient visits per contract year.
67	3.  Effective October 1, 2009, covered services include
68	inpatient and outpatient services for mental and nervous
69	disorders as defined in the most recent edition of the
70	Diagnostic and Statistical Manual of Mental Disorders published
71	by the American Psychiatric Association. Such benefits include
72	psychological or psychiatric evaluation, diagnosis, and
73	treatment by a licensed mental health professional and
74	inpatient, outpatient, and residential treatment services for
75	the diagnosis and treatment of substance abuse disorders. Any
76	benefit limitations, including duration of services, number of
77	visits, or number of days for hospitalization or residential
78	services may not be any less favorable than those for physical
79	illnesses generally for the care and treatment of schizophrenia
80	and psychotic disorders, mood disorders, anxiety disorders,
81	substance abuse disorders, eating disorders, and childhood
82	attention deficit disorders. The program may also implement
83	appropriate financial incentives, peer review, utilization
84	requirements, and other methods used for the management of
85	benefits provided for other medical conditions in order to
86	reduce service costs and utilization without compromising
87	quality of care.
88	(q)  Dental services.--Effective October 1, 2009, dental
89	services shall be covered as required under federal law and may
90	also include those dental benefits provided to children by the
91	Florida Medicaid program under s. 409.906(6). Changes to the
92	dental benefit in order to comply with federal law are effective
93	October 1, 2009.
94	(w)  Reimbursement of federally qualified health centers
95	and rural health clinics.--Effective October 1, 2009, payments
96	for services provided to enrollees by federally qualified health
97	centers and rural health clinics under this section shall be
98	reimbursed using the Medicaid Prospective Payment System as
99	provided for under s. 2107(e)(1)(D) of the Social Security Act,
100	42 U.S.C. s. 1397gg(e)(1)(D), as added by Pub. L. No 105-33,
101	Title IV, s. 4901(a). If such services are paid for by health
102	insurers or health care providers under contract with the
103	Florida Healthy Kids Corporation, such entities are responsible
104	for this payment. The agency may seek any available federal
105	grants to assist with this transition.
106	Section 3.  Paragraph (c) of subsection (3) of section
107	409.818, Florida Statutes, is amended to read:
108	409.818  Administration.--In order to implement ss.
109	409.810-409.820, the following agencies shall have the following
110	duties:
111	(3)  The Agency for Health Care Administration, under the
112	authority granted in s. 409.914(1), shall:
113	(c)  Monitor compliance with quality assurance and access
114	standards developed under s. 409.820 and in accordance with s.
115	2103(f) of the Social Security Act, 42 U.S.C. s. 1397cc(f).
116
117	The agency is designated the lead state agency for Title XXI of
118	the Social Security Act for purposes of receipt of federal
119	funds, for reporting purposes, and for ensuring compliance with
120	federal and state regulations and rules.
121	Section 4.  Subsections (1) and (2) of section 409.904,
122	Florida Statutes, are amended to read:
123	409.904  Optional payments for eligible persons.--The
124	agency may make payments for medical assistance and related
125	services on behalf of the following persons who are determined
126	to be eligible subject to the income, assets, and categorical
127	eligibility tests set forth in federal and state law. Payment on
128	behalf of these Medicaid eligible persons is subject to the
129	availability of moneys and any limitations established by the
130	General Appropriations Act or chapter 216.
131	(1)  Effective January 1, 2006, and subject to federal
132	waiver approval, a person who is age 65 or older or is
133	determined to be disabled, whose income is at or below 88
134	percent of the federal poverty level, whose assets do not exceed
135	established limitations, and who is not eligible for Medicare
136	or, if eligible for Medicare, is also eligible for and receiving
137	Medicaid-covered institutional care services, hospice services,
138	or home and community-based services. The agency shall seek
139	federal authorization through a waiver to provide this coverage.
140	This subsection expires June 30, 2010 2009.
141	(2)(a)  A family, a pregnant woman, a child under age 21, a
142	person age 65 or over, or a blind or disabled person, who would
143	be eligible under any group listed in s. 409.903(1), (2), or
144	(3), except that the income or assets of such family or person
145	exceed established limitations. For a family or person in one of
146	these coverage groups, medical expenses are deductible from
147	income in accordance with federal requirements in order to make
148	a determination of eligibility. A family or person eligible
149	under the coverage known as the "medically needy," is eligible
150	to receive the same services as other Medicaid recipients, with
151	the exception of services in skilled nursing facilities and
152	intermediate care facilities for the developmentally disabled.
153	This paragraph subsection expires June 30, 2010 2009.
154	(b)  Effective July 1, 2010 2009, a pregnant woman or a
155	child younger than 21 years of age who would be eligible under
156	any group listed in s. 409.903, except that the income or assets
157	of such group exceed established limitations. For a person in
158	one of these coverage groups, medical expenses are deductible
159	from income in accordance with federal requirements in order to
160	make a determination of eligibility. A person eligible under the
161	coverage known as the "medically needy" is eligible to receive
162	the same services as other Medicaid recipients, with the
163	exception of services in skilled nursing facilities and
164	intermediate care facilities for the developmentally disabled.
165	Section 5.  Subsection (4) and paragraph (c) of subsection
166	(5) of section 409.905, Florida Statutes, are amended to read:
167	409.905  Mandatory Medicaid services.--The agency may make
168	payments for the following services, which are required of the
169	state by Title XIX of the Social Security Act, furnished by
170	Medicaid providers to recipients who are determined to be
171	eligible on the dates on which the services were provided. Any
172	service under this section shall be provided only when medically
173	necessary and in accordance with state and federal law.
174	Mandatory services rendered by providers in mobile units to
175	Medicaid recipients may be restricted by the agency. Nothing in
176	this section shall be construed to prevent or limit the agency
177	from adjusting fees, reimbursement rates, lengths of stay,
178	number of visits, number of services, or any other adjustments
179	necessary to comply with the availability of moneys and any
180	limitations or directions provided for in the General
181	Appropriations Act or chapter 216.
182	(4)  HOME HEALTH CARE SERVICES.--The agency shall pay for
183	nursing and home health aide services, supplies, appliances, and
184	durable medical equipment, necessary to assist a recipient
185	living at home. An entity that provides services pursuant to
186	this subsection shall be licensed under part III of chapter 400.
187	These services, equipment, and supplies, or reimbursement
188	therefor, may be limited as provided in the General
189	Appropriations Act and do not include services, equipment, or
190	supplies provided to a person residing in a hospital or nursing
191	facility.
192	(a)  In providing home health care services, the agency may
193	require prior authorization of care based on diagnosis or
194	utilization rates. Prior authorization is required for home
195	health services visits not associated with a skilled nursing
196	visit if the home health agency's utilization rates exceed the
197	state average by 50 percent or more. The home health agency must
198	submit documentation that supports the recipient's diagnosis and
199	the recipient's plan of care to the agency when requesting prior
200	authorization.
201	(b)  The agency shall implement a comprehensive utilization
202	management program that requires prior authorization of all
203	private duty nursing services, an individualized treatment plan
204	that includes information about medication and treatment orders,
205	treatment goals, methods of care to be used, and plans for care
206	coordination by nurses and other health professionals. The
207	utilization management program shall also include a process for
208	periodically reviewing the ongoing use of private duty nursing
209	services. For a child, the assessment of need shall be based on
210	a child's condition, family support and care supplements, a
211	family's ability to provide care, and a family's and child's
212	schedule regarding work, school, sleep, and care for other
213	family dependents. When implemented, the private duty nursing
214	utilization management program shall replace the current
215	authorization program used by the Agency for Health Care
216	Administration and the Children's Medical Services program of
217	the Department of Health. The agency may competitively bid on a
218	contract to select a qualified organization to provide
219	utilization management of private duty nursing services. The
220	agency is authorized to seek federal waivers to implement this
221	initiative.
222	(c)  The agency may provide reimbursement only for those
223	home health services that are medically necessary and if:
224	1.  The services are ordered by a physician.
225	2.  The written prescription for services is signed and
226	dated by the recipient's physician before the development of a
227	plan of care and before any required request for prior
228	authorization.
229	3.  The physician ordering the services is not employed,
230	under contract with, or otherwise affiliated with the home
231	health agency rendering the services. However, this provision
232	does not apply to a home health agency affiliated with a
233	retirement community, of which the parent corporation or a
234	related legal entity owns a rural health clinic certified under
235	42 C.F.R., part 491, subpart A, ss. 1-11, a nursing home
236	licensed under part II of chapter 400, and apartments and
237	single-family homes for independent living.
238	4.  The physician ordering the services has examined the
239	recipient within 30 days before the initial request for services
240	and biannually thereafter.
241	5.  The written prescription for the services includes the
242	recipient's acute or chronic medical condition or diagnosis; the
243	home health service required, including the minimum skill level
244	required to perform the service; and the frequency and duration
245	of the services.
246	6.  The national provider identifier, Medicaid
247	identification number, or professional license number of the
248	physician ordering the services is listed on the written
249	prescription for the services, the claim for home health
250	reimbursement, and the prior authorization request.
251	(5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay for
252	all covered services provided for the medical care and treatment
253	of a recipient who is admitted as an inpatient by a licensed
254	physician or dentist to a hospital licensed under part I of
255	chapter 395. However, the agency shall limit the payment for
256	inpatient hospital services for a Medicaid recipient 21 years of
257	age or older to 45 days or the number of days necessary to
258	comply with the General Appropriations Act.
259	(c)  The Agency for Health Care Administration shall adjust
260	a hospital's current inpatient per diem rate to reflect the cost
261	of serving the Medicaid population at that institution if:
262	1.  The hospital experiences an increase in Medicaid
263	caseload by more than 25 percent in any year, primarily
264	resulting from the closure of a hospital in the same service
265	area occurring after July 1, 1995;
266	2.  The hospital's Medicaid per diem rate is at least 25
267	percent below the Medicaid per patient cost for that year; or
268	3.  The hospital is located in a county that has six five
269	or fewer acute care bed hospitals, began offering obstetrical
270	services on or after September 1999, and has submitted a request
271	in writing to the agency for a rate adjustment after July 1,
272	2000, but before September 30, 2000, in which case such
273	hospital's Medicaid inpatient per diem rate shall be adjusted to
274	cost, effective July 1, 2002.
275
276	No later than October 1 of each year, the agency must provide
277	estimated costs for any adjustment in a hospital inpatient per
278	diem pursuant to this paragraph to the Executive Office of the
279	Governor, the House of Representatives General Appropriations
280	Committee, and the Senate Appropriations Committee. Before the
281	agency implements a change in a hospital's inpatient per diem
282	rate pursuant to this paragraph, the Legislature must have
283	specifically appropriated sufficient funds in the General
284	Appropriations Act to support the increase in cost as estimated
285	by the agency.
286	Section 6.  Subsection (23) of section 409.906, Florida
287	Statutes, is amended to read:
288	409.906  Optional Medicaid services.--Subject to specific
289	appropriations, the agency may make payments for services which
290	are optional to the state under Title XIX of the Social Security
291	Act and are furnished by Medicaid providers to recipients who
292	are determined to be eligible on the dates on which the services
293	were provided. Any optional service that is provided shall be
294	provided only when medically necessary and in accordance with
295	state and federal law. Optional services rendered by providers
296	in mobile units to Medicaid recipients may be restricted or
297	prohibited by the agency. Nothing in this section shall be
298	construed to prevent or limit the agency from adjusting fees,
299	reimbursement rates, lengths of stay, number of visits, or
300	number of services, or making any other adjustments necessary to
301	comply with the availability of moneys and any limitations or
302	directions provided for in the General Appropriations Act or
303	chapter 216. If necessary to safeguard the state's systems of
304	providing services to elderly and disabled persons and subject
305	to the notice and review provisions of s. 216.177, the Governor
306	may direct the Agency for Health Care Administration to amend
307	the Medicaid state plan to delete the optional Medicaid service
308	known as "Intermediate Care Facilities for the Developmentally
309	Disabled." Optional services may include:
310	(23)  VISUAL SERVICES.--The agency may pay for visual
311	examinations, eyeglasses, and eyeglass repairs for a recipient
312	if they are prescribed by a licensed physician specializing in
313	diseases of the eye or by a licensed optometrist. Eyeglass
314	frames Eyeglasses for adult recipients shall be limited to one
315	pair two pairs per year per recipient every 2 years, except a
316	second third pair may be provided during that period after prior
317	authorization. Eyeglass lenses for adult recipients shall be
318	limited to one pair per year and may only be provided after
319	prior authorization.
320	Section 7.  Subsection (6) of section 409.9082, Florida
321	Statutes, as created by chapter 2009-4, Laws of Florida, is
322	amended, and paragraph (d) is added to subsection (3) of that
323	section, to read:
324	409.9082  Quality assessment on nursing home facility
325	providers; exemptions; purpose; federal approval required;
326	remedies.--
327	(3)
328	(d)  The agency may exempt a qualified public nursing
329	facility that is not owned or operated by the state from the
330	quality assessment or apply a lower quality assessment rate to
331	that facility if the facility's total annual census days for
332	indigent care exceed 25 percent of the facility's total annual
333	census days.
334	(6)  The quality assessment shall terminate and the agency
335	shall discontinue the imposition, assessment, and collection of
336	the nursing facility quality assessment if any of the following
337	occur:
338	(a)  the agency does not obtain necessary federal approval
339	for the nursing home facility quality assessment or the payment
340	rates required by subsection (4); or
341	(b)  The weighted average Medicaid rate paid to nursing
342	home facilities is reduced below the weighted average Medicaid
343	rate to nursing home facilities in effect on December 31, 2008,
344	plus any future annual amount of the quality assessment and the
345	applicable matching federal funds.
346
347	Upon termination of the quality assessment, all collected
348	assessment revenues, less any amounts expended by the agency,
349	shall be returned on a pro rata basis to the nursing facilities
350	that paid them.
351	Section 8.  Section 409.9083, Florida Statutes, is created
352	to read:
353	409.9083  Quality assessment on privately operated
354	intermediate care facilities for the developmentally disabled;
355	exemptions; purpose; federal approval required; remedies.--
356	(1)  As used in this section, the term:
357	(a)  "Intermediate care facility for the developmentally
358	disabled" or "ICF/DD" means a privately operated intermediate
359	care facility for the developmentally disabled licensed under
360	part VIII of chapter 400.
361	(b)  "Net patient service revenue" means gross revenues
362	from services provided to ICF/DD facility residents, less
363	reductions from gross revenue resulting from an inability to
364	collect payment of charges. Net patient service revenue excludes
365	nonresident care revenues such as gain or loss on asset
366	disposal, prior year revenue, donations, and physician billings,
367	and all outpatient revenues. Reductions from gross revenue
368	include bad debts; contractual adjustments; uncompensated care;
369	administrative, courtesy, and policy discounts and adjustments;
370	and other such revenue deductions.
371	(c)  "Resident day" means a calendar day of care provided
372	to an ICF/DD facility resident, including the day of admission
373	and excluding the day of discharge, except that, when admission
374	and discharge occur on the same day, 1 day of care exists.
375	(2)  Effective October 1, 2009, there is imposed upon each
376	intermediate care facility for the developmentally disabled a
377	quality assessment. The aggregated amount of assessments for all
378	ICF/DDs in a given year shall be an amount not exceeding the
379	maximum percentage allowed under federal law of the total
380	aggregate net patient service revenue of assessed facilities.
381	The agency shall calculate the quality assessment rate annually
382	on a per-resident-day basis as reported by the facilities. The
383	per-resident-day assessment rate shall be uniform. Each facility
384	shall report monthly to the agency its total number of resident
385	days and shall remit an amount equal to the assessment rate
386	times the reported number of days. The agency shall collect, and
387	each facility shall pay, the quality assessment each month. The
388	agency shall collect the assessment from facility providers no
389	later than the 15th of the next succeeding calendar month. The
390	agency shall notify providers of the quality assessment rate and
391	provide a standardized form to complete and submit with
392	payments. The collection of the quality assessment shall
393	commence no sooner than 15 days after the agency's initial
394	payment to the facilities that implement the increased Medicaid
395	rates containing the elements prescribed in subsection (3) and
396	monthly thereafter. Intermediate care facilities for the
397	developmentally disabled may increase their rates to incorporate
398	the assessment but may not create a separate line-item charge
399	for the purpose of passing through the assessment to residents.
400	(3)  The purpose of the facility quality assessment is to
401	ensure continued quality of care. Collected assessment funds
402	shall be used to obtain federal financial participation through
403	the Medicaid program to make Medicaid payments for ICF/DD
404	services up to the amount of the Medicaid rates for such
405	facilities as calculated in accordance with the approved state
406	Medicaid plan in effect on April 1, 2008. The quality assessment
407	and federal matching funds shall be used exclusively for the
408	following purposes and in the following order of priority:
409	(a)  To reimburse the Medicaid share of the quality
410	assessment as a pass-through, Medicaid-allowable cost.
411	(b)  To increase each privately operated ICF/DD Medicaid
412	rate, as needed, by an amount that restores the rate reductions
413	implemented on October 1, 2008.
414	(c)  To increase each ICF/DD Medicaid rate, as needed, by
415	an amount that restores any rate reductions for the 2008-2009
416	fiscal year.
417	(d)  To increase payments to such facilities to fund
418	covered services to Medicaid beneficiaries.
419	(4)  The agency shall seek necessary federal approval in
420	the form of state plan amendments in order to implement the
421	provisions of this section.
422	(5)(a)  The quality assessment shall terminate and the
423	agency shall discontinue the imposition, assessment, and
424	collection of the quality assessment if the agency does not
425	obtain necessary federal approval for the facility quality
426	assessment or the payment rates required by subsection (3).
427	(b)  Upon termination of the quality assessment, all
428	collected assessment revenues, less any amounts expended by the
429	agency, shall be returned on a pro rata basis to the facilities
430	that paid such assessments.
431	(6)  The agency may seek any of the following remedies for
432	failure of any ICF/DD provider to timely pay its assessment:
433	(a)  Withholding any medical assistance reimbursement
434	payments until the assessment amount is recovered.
435	(b)  Suspending or revoking the facility's license.
436	(c)  Imposing a fine of up to $1,000 per day for each
437	delinquent payment, not to exceed the amount of the assessment.
438	(7)  The agency shall adopt rules necessary to administer
439	this section.
440	(8)  This section is repealed October 1, 2011.
441	Section 9.  Paragraph (a) of subsection (2) of section
442	409.911, Florida Statutes, is amended to read:
443	409.911  Disproportionate share program.--Subject to
444	specific allocations established within the General
445	Appropriations Act and any limitations established pursuant to
446	chapter 216, the agency shall distribute, pursuant to this
447	section, moneys to hospitals providing a disproportionate share
448	of Medicaid or charity care services by making quarterly
449	Medicaid payments as required. Notwithstanding the provisions of
450	s. 409.915, counties are exempt from contributing toward the
451	cost of this special reimbursement for hospitals serving a
452	disproportionate share of low-income patients.
453	(2)  The Agency for Health Care Administration shall use
454	the following actual audited data to determine the Medicaid days
455	and charity care to be used in calculating the disproportionate
456	share payment:
457	(a)  The average of the 2003, 2004, and 2005 2002, 2003,
458	and 2004 audited disproportionate share data to determine each
459	hospital's Medicaid days and charity care for the 2009-2010
460	2008-2009 state fiscal year.
461	Section 10.  Section 409.9112, Florida Statutes, is amended
462	to read:
463	409.9112  Disproportionate share program for regional
464	perinatal intensive care centers.--
465	(1)  In addition to the payments made under s. 409.911, the
466	Agency for Health Care Administration shall design and implement
467	a system of making disproportionate share payments to those
468	hospitals that participate in the regional perinatal intensive
469	care center program established pursuant to chapter 383. This
470	system of payments shall conform with federal requirements and
471	shall distribute funds in each fiscal year for which an
472	appropriation is made by making quarterly Medicaid payments.
473	Notwithstanding the provisions of s. 409.915, counties are
474	exempt from contributing toward the cost of this special
475	reimbursement for hospitals serving a disproportionate share of
476	low-income patients. For the state fiscal year 2009-2010 2008-
477	2009, the agency shall not distribute moneys under the regional
478	perinatal intensive care centers disproportionate share program.
479	(2)(1)  The following formula shall be used by the agency
480	to calculate the total amount earned for hospitals that
481	participate in the regional perinatal intensive care center
482	program:
483
484	TAE = HDSP/THDSP
485
486	Where:
487	TAE = total amount earned by a regional perinatal intensive
488	care center.
489	HDSP = the prior state fiscal year regional perinatal
490	intensive care center disproportionate share payment to the
491	individual hospital.
492	THDSP = the prior state fiscal year total regional
493	perinatal intensive care center disproportionate share payments
494	to all hospitals.
495	(3)(2)  The total additional payment for hospitals that
496	participate in the regional perinatal intensive care center
497	program shall be calculated by the agency as follows:
498
499	TAP = TAE x TA
500
501	Where:
502	TAP = total additional payment for a regional perinatal
503	intensive care center.
504	TAE = total amount earned by a regional perinatal intensive
505	care center.
506	TA = total appropriation for the regional perinatal
507	intensive care center disproportionate share program.
508	(4)(3)  In order to receive payments under this section, a
509	hospital must be participating in the regional perinatal
510	intensive care center program pursuant to chapter 383 and must
511	meet the following additional requirements:
512	(a)  Agree to conform to all departmental and agency
513	requirements to ensure high quality in the provision of
514	services, including criteria adopted by departmental and agency
515	rule concerning staffing ratios, medical records, standards of
516	care, equipment, space, and such other standards and criteria as
517	the department and agency deem appropriate as specified by rule.
518	(b)  Agree to provide information to the department and
519	agency, in a form and manner to be prescribed by rule of the
520	department and agency, concerning the care provided to all
521	patients in neonatal intensive care centers and high-risk
522	maternity care.
523	(c)  Agree to accept all patients for neonatal intensive
524	care and high-risk maternity care, regardless of ability to pay,
525	on a functional space-available basis.
526	(d)  Agree to develop arrangements with other maternity and
527	neonatal care providers in the hospital's region for the
528	appropriate receipt and transfer of patients in need of
529	specialized maternity and neonatal intensive care services.
530	(e)  Agree to establish and provide a developmental
531	evaluation and services program for certain high-risk neonates,
532	as prescribed and defined by rule of the department.
533	(f)  Agree to sponsor a program of continuing education in
534	perinatal care for health care professionals within the region
535	of the hospital, as specified by rule.
536	(g)  Agree to provide backup and referral services to the
537	department's county health departments and other low-income
538	perinatal providers within the hospital's region, including the
539	development of written agreements between these organizations
540	and the hospital.
541	(h)  Agree to arrange for transportation for high-risk
542	obstetrical patients and neonates in need of transfer from the
543	community to the hospital or from the hospital to another more
544	appropriate facility.
545	(5)(4)  Hospitals which fail to comply with any of the
546	conditions in subsection (4) (3) or the applicable rules of the
547	department and agency shall not receive any payments under this
548	section until full compliance is achieved. A hospital which is
549	not in compliance in two or more consecutive quarters shall not
550	receive its share of the funds. Any forfeited funds shall be
551	distributed by the remaining participating regional perinatal
552	intensive care center program hospitals.
553	Section 11.  Section 409.9113, Florida Statutes, is amended
554	to read:
555	409.9113  Disproportionate share program for teaching
556	hospitals.--
557	(1)  In addition to the payments made under ss. 409.911 and
558	409.9112, the Agency for Health Care Administration shall make
559	disproportionate share payments to statutorily defined teaching
560	hospitals for their increased costs associated with medical
561	education programs and for tertiary health care services
562	provided to the indigent. This system of payments shall conform
563	with federal requirements and shall distribute funds in each
564	fiscal year for which an appropriation is made by making
565	quarterly Medicaid payments. Notwithstanding s. 409.915,
566	counties are exempt from contributing toward the cost of this
567	special reimbursement for hospitals serving a disproportionate
568	share of low-income patients. For the state fiscal year 2009-
569	2010 2008-2009, the agency shall distribute the moneys provided
570	in the General Appropriations Act to statutorily defined
571	teaching hospitals and family practice teaching hospitals under
572	the teaching hospital disproportionate share program. The funds
573	provided for statutorily defined teaching hospitals shall be
574	distributed in the same proportion as the state fiscal year
575	2003-2004 teaching hospital disproportionate share funds were
576	distributed or as otherwise provided in the General
577	Appropriations Act. The funds provided for family practice
578	teaching hospitals shall be distributed equally among family
579	practice teaching hospitals.
580	(2)(1)  On or before September 15 of each year, the Agency
581	for Health Care Administration shall calculate an allocation
582	fraction to be used for distributing funds to state statutory
583	teaching hospitals. Subsequent to the end of each quarter of the
584	state fiscal year, the agency shall distribute to each statutory
585	teaching hospital, as defined in s. 408.07, an amount determined
586	by multiplying one-fourth of the funds appropriated for this
587	purpose by the Legislature times such hospital's allocation
588	fraction. The allocation fraction for each such hospital shall
589	be determined by the sum of three primary factors, divided by
590	three. The primary factors are:
591	(a)  The number of nationally accredited graduate medical
592	education programs offered by the hospital, including programs
593	accredited by the Accreditation Council for Graduate Medical
594	Education and the combined Internal Medicine and Pediatrics
595	programs acceptable to both the American Board of Internal
596	Medicine and the American Board of Pediatrics at the beginning
597	of the state fiscal year preceding the date on which the
598	allocation fraction is calculated. The numerical value of this
599	factor is the fraction that the hospital represents of the total
600	number of programs, where the total is computed for all state
601	statutory teaching hospitals.
602	(b)  The number of full-time equivalent trainees in the
603	hospital, which comprises two components:
604	1.  The number of trainees enrolled in nationally
605	accredited graduate medical education programs, as defined in
606	paragraph (a). Full-time equivalents are computed using the
607	fraction of the year during which each trainee is primarily
608	assigned to the given institution, over the state fiscal year
609	preceding the date on which the allocation fraction is
610	calculated. The numerical value of this factor is the fraction
611	that the hospital represents of the total number of full-time
612	equivalent trainees enrolled in accredited graduate programs,
613	where the total is computed for all state statutory teaching
614	hospitals.
615	2.  The number of medical students enrolled in accredited
616	colleges of medicine and engaged in clinical activities,
617	including required clinical clerkships and clinical electives.
618	Full-time equivalents are computed using the fraction of the
619	year during which each trainee is primarily assigned to the
620	given institution, over the course of the state fiscal year
621	preceding the date on which the allocation fraction is
622	calculated. The numerical value of this factor is the fraction
623	that the given hospital represents of the total number of full-
624	time equivalent students enrolled in accredited colleges of
625	medicine, where the total is computed for all state statutory
626	teaching hospitals.
627
628	The primary factor for full-time equivalent trainees is computed
629	as the sum of these two components, divided by two.
630	(c)  A service index that comprises three components:
631	1.  The Agency for Health Care Administration Service
632	Index, computed by applying the standard Service Inventory
633	Scores established by the Agency for Health Care Administration
634	to services offered by the given hospital, as reported on
635	Worksheet A-2 for the last fiscal year reported to the agency
636	before the date on which the allocation fraction is calculated.
637	The numerical value of this factor is the fraction that the
638	given hospital represents of the total Agency for Health Care
639	Administration Service Index values, where the total is computed
640	for all state statutory teaching hospitals.
641	2.  A volume-weighted service index, computed by applying
642	the standard Service Inventory Scores established by the Agency
643	for Health Care Administration to the volume of each service,
644	expressed in terms of the standard units of measure reported on
645	Worksheet A-2 for the last fiscal year reported to the agency
646	before the date on which the allocation factor is calculated.
647	The numerical value of this factor is the fraction that the
648	given hospital represents of the total volume-weighted service
649	index values, where the total is computed for all state
650	statutory teaching hospitals.
651	3.  Total Medicaid payments to each hospital for direct
652	inpatient and outpatient services during the fiscal year
653	preceding the date on which the allocation factor is calculated.
654	This includes payments made to each hospital for such services
655	by Medicaid prepaid health plans, whether the plan was
656	administered by the hospital or not. The numerical value of this
657	factor is the fraction that each hospital represents of the
658	total of such Medicaid payments, where the total is computed for
659	all state statutory teaching hospitals.
660
661	The primary factor for the service index is computed as the sum
662	of these three components, divided by three.
663	(3)(2)  By October 1 of each year, the agency shall use the
664	following formula to calculate the maximum additional
665	disproportionate share payment for statutorily defined teaching
666	hospitals:
667
668	TAP = THAF x A
669
670	Where:
671	TAP = total additional payment.
672	THAF = teaching hospital allocation factor.
673	A = amount appropriated for a teaching hospital
674	disproportionate share program.
675	Section 12.  Section 409.9117, Florida Statutes, is amended
676	to read:
677	409.9117  Primary care disproportionate share program.--
678	(1)  For the state fiscal year 2009-2010 2008-2009, the
679	agency shall not distribute moneys under the primary care
680	disproportionate share program.
681	(2)(1)  If federal funds are available for disproportionate
682	share programs in addition to those otherwise provided by law,
683	there shall be created a primary care disproportionate share
684	program.
685	(3)(2)  The following formula shall be used by the agency
686	to calculate the total amount earned for hospitals that
687	participate in the primary care disproportionate share program:
688
689	TAE = HDSP/THDSP
690
691	Where:
692	TAE = total amount earned by a hospital participating in
693	the primary care disproportionate share program.
694	HDSP = the prior state fiscal year primary care
695	disproportionate share payment to the individual hospital.
696	THDSP = the prior state fiscal year total primary care
697	disproportionate share payments to all hospitals.
698	(4)(3)  The total additional payment for hospitals that
699	participate in the primary care disproportionate share program
700	shall be calculated by the agency as follows:
701
702	TAP = TAE x TA
703
704	Where:
705	TAP = total additional payment for a primary care hospital.
706	TAE = total amount earned by a primary care hospital.
707	TA = total appropriation for the primary care
708	disproportionate share program.
709	(5)(4)  In the establishment and funding of this program,
710	the agency shall use the following criteria in addition to those
711	specified in s. 409.911, payments may not be made to a hospital
712	unless the hospital agrees to:
713	(a)  Cooperate with a Medicaid prepaid health plan, if one
714	exists in the community.
715	(b)  Ensure the availability of primary and specialty care
716	physicians to Medicaid recipients who are not enrolled in a
717	prepaid capitated arrangement and who are in need of access to
718	such physicians.
719	(c)  Coordinate and provide primary care services free of
720	charge, except copayments, to all persons with incomes up to 100
721	percent of the federal poverty level who are not otherwise
722	covered by Medicaid or another program administered by a
723	governmental entity, and to provide such services based on a
724	sliding fee scale to all persons with incomes up to 200 percent
725	of the federal poverty level who are not otherwise covered by
726	Medicaid or another program administered by a governmental
727	entity, except that eligibility may be limited to persons who
728	reside within a more limited area, as agreed to by the agency
729	and the hospital.
730	(d)  Contract with any federally qualified health center,
731	if one exists within the agreed geopolitical boundaries,
732	concerning the provision of primary care services, in order to
733	guarantee delivery of services in a nonduplicative fashion, and
734	to provide for referral arrangements, privileges, and
735	admissions, as appropriate. The hospital shall agree to provide
736	at an onsite or offsite facility primary care services within 24
737	hours to which all Medicaid recipients and persons eligible
738	under this paragraph who do not require emergency room services
739	are referred during normal daylight hours.
740	(e)  Cooperate with the agency, the county, and other
741	entities to ensure the provision of certain public health
742	services, case management, referral and acceptance of patients,
743	and sharing of epidemiological data, as the agency and the
744	hospital find mutually necessary and desirable to promote and
745	protect the public health within the agreed geopolitical
746	boundaries.
747	(f)  In cooperation with the county in which the hospital
748	resides, develop a low-cost, outpatient, prepaid health care
749	program to persons who are not eligible for the Medicaid
750	program, and who reside within the area.
751	(g)  Provide inpatient services to residents within the
752	area who are not eligible for Medicaid or Medicare, and who do
753	not have private health insurance, regardless of ability to pay,
754	on the basis of available space, except that nothing shall
755	prevent the hospital from establishing bill collection programs
756	based on ability to pay.
757	(h)  Work with the Florida Healthy Kids Corporation, the
758	Florida Health Care Purchasing Cooperative, and business health
759	coalitions, as appropriate, to develop a feasibility study and
760	plan to provide a low-cost comprehensive health insurance plan
761	to persons who reside within the area and who do not have access
762	to such a plan.
763	(i)  Work with public health officials and other experts to
764	provide community health education and prevention activities
765	designed to promote healthy lifestyles and appropriate use of
766	health services.
767	(j)  Work with the local health council to develop a plan
768	for promoting access to affordable health care services for all
769	persons who reside within the area, including, but not limited
770	to, public health services, primary care services, inpatient
771	services, and affordable health insurance generally.
772
773	Any hospital that fails to comply with any of the provisions of
774	this subsection, or any other contractual condition, may not
775	receive payments under this section until full compliance is
776	achieved.
777	Section 13.  Paragraph (g) is added to subsection (5) of
778	section 409.912, Florida Statutes, and subsections (54) and (55)
779	are added to that section, to read:
780	409.912  Cost-effective purchasing of health care.--The
781	agency shall purchase goods and services for Medicaid recipients
782	in the most cost-effective manner consistent with the delivery
783	of quality medical care. To ensure that medical services are
784	effectively utilized, the agency may, in any case, require a
785	confirmation or second physician's opinion of the correct
786	diagnosis for purposes of authorizing future services under the
787	Medicaid program. This section does not restrict access to
788	emergency services or poststabilization care services as defined
789	in 42 C.F.R. part 438.114. Such confirmation or second opinion
790	shall be rendered in a manner approved by the agency. The agency
791	shall maximize the use of prepaid per capita and prepaid
792	aggregate fixed-sum basis services when appropriate and other
793	alternative service delivery and reimbursement methodologies,
794	including competitive bidding pursuant to s. 287.057, designed
795	to facilitate the cost-effective purchase of a case-managed
796	continuum of care. The agency shall also require providers to
797	minimize the exposure of recipients to the need for acute
798	inpatient, custodial, and other institutional care and the
799	inappropriate or unnecessary use of high-cost services. The
800	agency shall contract with a vendor to monitor and evaluate the
801	clinical practice patterns of providers in order to identify
802	trends that are outside the normal practice patterns of a
803	provider's professional peers or the national guidelines of a
804	provider's professional association. The vendor must be able to
805	provide information and counseling to a provider whose practice
806	patterns are outside the norms, in consultation with the agency,
807	to improve patient care and reduce inappropriate utilization.
808	The agency may mandate prior authorization, drug therapy
809	management, or disease management participation for certain
810	populations of Medicaid beneficiaries, certain drug classes, or
811	particular drugs to prevent fraud, abuse, overuse, and possible
812	dangerous drug interactions. The Pharmaceutical and Therapeutics
813	Committee shall make recommendations to the agency on drugs for
814	which prior authorization is required. The agency shall inform
815	the Pharmaceutical and Therapeutics Committee of its decisions
816	regarding drugs subject to prior authorization. The agency is
817	authorized to limit the entities it contracts with or enrolls as
818	Medicaid providers by developing a provider network through
819	provider credentialing. The agency may competitively bid single-
820	source-provider contracts if procurement of goods or services
821	results in demonstrated cost savings to the state without
822	limiting access to care. The agency may limit its network based
823	on the assessment of beneficiary access to care, provider
824	availability, provider quality standards, time and distance
825	standards for access to care, the cultural competence of the
826	provider network, demographic characteristics of Medicaid
827	beneficiaries, practice and provider-to-beneficiary standards,
828	appointment wait times, beneficiary use of services, provider
829	turnover, provider profiling, provider licensure history,
830	previous program integrity investigations and findings, peer
831	review, provider Medicaid policy and billing compliance records,
832	clinical and medical record audits, and other factors. Providers
833	shall not be entitled to enrollment in the Medicaid provider
834	network. The agency shall determine instances in which allowing
835	Medicaid beneficiaries to purchase durable medical equipment and
836	other goods is less expensive to the Medicaid program than long-
837	term rental of the equipment or goods. The agency may establish
838	rules to facilitate purchases in lieu of long-term rentals in
839	order to protect against fraud and abuse in the Medicaid program
840	as defined in s. 409.913. The agency may seek federal waivers
841	necessary to administer these policies.
842	(5)  The Agency for Health Care Administration, in
843	partnership with the Department of Elderly Affairs, shall create
844	an integrated, fixed-payment delivery program for Medicaid
845	recipients who are 60 years of age or older or dually eligible
846	for Medicare and Medicaid. The Agency for Health Care
847	Administration shall implement the integrated program initially
848	on a pilot basis in two areas of the state. The pilot areas
849	shall be Area 7 and Area 11 of the Agency for Health Care
850	Administration. Enrollment in the pilot areas shall be on a
851	voluntary basis and in accordance with approved federal waivers
852	and this section. The agency and its program contractors and
853	providers shall not enroll any individual in the integrated
854	program because the individual or the person legally responsible
855	for the individual fails to choose to enroll in the integrated
856	program. Enrollment in the integrated program shall be
857	exclusively by affirmative choice of the eligible individual or
858	by the person legally responsible for the individual. The
859	integrated program must transfer all Medicaid services for
860	eligible elderly individuals who choose to participate into an
861	integrated-care management model designed to serve Medicaid
862	recipients in the community. The integrated program must combine
863	all funding for Medicaid services provided to individuals who
864	are 60 years of age or older or dually eligible for Medicare and
865	Medicaid into the integrated program, including funds for
866	Medicaid home and community-based waiver services; all Medicaid
867	services authorized in ss. 409.905 and 409.906, excluding funds
868	for Medicaid nursing home services unless the agency is able to
869	demonstrate how the integration of the funds will improve
870	coordinated care for these services in a less costly manner; and
871	Medicare coinsurance and deductibles for persons dually eligible
872	for Medicaid and Medicare as prescribed in s. 409.908(13).
873	(g)  The implementation of the integrated, fixed-payment
874	delivery program created under this subsection is subject to an
875	appropriation in the General Appropriations Act.
876	(54)  The agency shall develop and implement a home health
877	agency monitoring pilot project in Miami-Dade County by January
878	1, 2010. The agency shall contract with a vendor to verify the
879	utilization and the delivery of home health services and provide
880	an electronic billing interface for home health services. The
881	contract must require the creation of a program to submit claims
882	for the home health services electronically. The program must
883	verify visits for the delivery of home health services
884	telephonically using voice biometrics. The agency may seek
885	amendments to the Medicaid state plan and waivers of federal
886	laws, as necessary, to implement the pilot project.
887	Notwithstanding s. 287.057(5)(f), the agency must award the
888	contract through the competitive solicitation process. The
889	agency shall submit a report to the Governor, the President of
890	the Senate, and the Speaker of the House of Representatives
891	evaluating the pilot project by February 1, 2011.
892	(55)  The agency shall implement a comprehensive care
893	management pilot project in Miami-Dade County for home health
894	services by January 1, 2010, which includes face-to-face
895	assessments by a state-licensed nurse, consultation with
896	physicians ordering services to substantiate the medical
897	necessity for services, and onsite or desk reviews of
898	recipients' medical records. The agency may enter into a
899	contract with a qualified organization to implement the pilot
900	project. The agency may seek amendments to the Medicaid state
901	plan and waivers of federal laws, as necessary, to implement the
902	pilot project.
903	Section 14.  Paragraph (e) of subsection (3) and subsection
904	(12) of section 409.91211, Florida Statutes, are amended to
905	read:
906	409.91211  Medicaid managed care pilot program.--
907	(3)  The agency shall have the following powers, duties,
908	and responsibilities with respect to the pilot program:
909	(e)  To implement policies and guidelines for phasing in
910	financial risk for approved provider service networks over a 5-
911	year 3-year period. These policies and guidelines must include
912	an option for a provider service network to be paid fee-for-
913	service rates. For any provider service network established in a
914	managed care pilot area, the option to be paid fee-for-service
915	rates shall include a savings-settlement mechanism that is
916	consistent with s. 409.912(44). This model shall be converted to
917	a risk-adjusted capitated rate no later than the beginning of
918	the sixth fourth year of operation, and may be converted earlier
919	at the option of the provider service network. Federally
920	qualified health centers may be offered an opportunity to accept
921	or decline a contract to participate in any provider network for
922	prepaid primary care services.
923	(12)  For purposes of this section, the term "capitated
924	managed care plan" includes health insurers authorized under
925	chapter 624, exclusive provider organizations authorized under
926	chapter 627, health maintenance organizations authorized under
927	chapter 641, the Children's Medical Services Network under
928	chapter 391, and provider service networks that elect to be paid
929	fee-for-service for up to 5 3 years as authorized under this
930	section.
931	Section 15.  Subsection (18) is added to section 430.04,
932	Florida Statutes, to read:
933	430.04  Duties and responsibilities of the Department of
934	Elderly Affairs.--The Department of Elderly Affairs shall:
935	(18)  Administer all Medicaid waivers and programs relating
936	to elders and their appropriations. The waivers include, but are
937	not limited to, the following:
938	(a)  Alzheimer's Dementia-Specific Medicaid Waiver as
939	defined in s. 430.502(7),(8), and (9).
940	(b)  Assisted Living for the Elderly Medicaid Waiver.
941	(c)  Aged and Disabled Adult Medicaid Waiver.
942	(d)  Adult Day Health Care Waiver.
943	(e)  Consumer-directed care program as defined in s.
944	409.221.
945	(f)  Program of All-inclusive Care for the Elderly.
946	(g)  Long-term care community-based diversion pilot
947	projects as defined in s. 430.705.
948	(h)  Channeling Services Waiver for Frail Elders.
949	Section 16.  Section 430.707, Florida Statutes, is amended
950	to read:
951	430.707  Contracts.--
952	(1)  The department, in consultation with the agency, shall
953	select and contract with managed care organizations and, on a
954	prepaid basis, with other qualified providers as defined in s.
955	430.703(7) to provide long-term care within community diversion
956	pilot project areas. All providers shall report quarterly to the
957	department regarding the entity's compliance with all the
958	financial and quality assurance requirements of the contract.
959	(2)  The department, in consultation with the agency, may
960	contract with entities that which have submitted an application
961	as a community nursing home diversion project as of July 1,
962	1998, to provide benefits pursuant to the "Program of All-
963	inclusive Care for the Elderly" as established in Pub. L. No.
964	105-33. For the purposes of this community nursing home
965	diversion project, such entities are shall be exempt from the
966	requirements of chapter 641, if the entity is a private,
967	nonprofit, superior-rated nursing home and if with at least 50
968	percent of its residents are eligible for Medicaid. The agency,
969	in consultation with the department, shall accept and forward to
970	the Centers for Medicare and Medicaid Services an application
971	for expansion of the pilot project from an entity that provides
972	benefits pursuant to the Program of All-inclusive Care for the
973	Elderly and that is in good standing with the agency, the
974	department, and the Centers for Medicare and Medicaid Services.
975	Section 17.  This act shall take effect July 1, 2009.
976
977
978	-----------------------------------------------------
979	T I T L E  A M E N D M E N T
980	Remove the entire title and insert:
981	A bill to be entitled
982	An act relating to health care; amending s. 409.814, F.S.;
983	providing Florida Kidcare eligibility determination
984	requirements; amending s. 409.815, F.S.; revising
985	mandatory benefit requirements for behavioral health and
986	dental services; providing reimbursement requirements for
987	federally qualified health centers and rural health
988	clinics; amending s. 409.818, F.S.; requiring the Agency
989	for Health Care Administration to monitor the compliance
990	and quality of health insurance plans in the Florida
991	Kidcare program as required by federal law; amending s.
992	409.904, F.S.; revising the expiration date of provisions
993	authorizing the federal waiver for certain persons age 65
994	and over or who have a disability; revising the expiration
995	date of provisions authorizing a specified medically needy
996	program; amending s. 409.905, F.S., relating to mandatory
997	Medicaid services; requiring prior authorization for
998	certain home health services; requiring home health
999	agencies to submit certain supporting documentation when
1000	requesting prior authorization; establishing reimbursement
1001	requirements for home health services; providing an
1002	exemption for certain home health agencies; revising
1003	conditions for adjustment of a hospital's inpatient per
1004	diem rate; amending s. 409.906, F.S., relating to optional
1005	Medicaid services; providing limitations on the provision
1006	of adult vision services; amending s. 409.9082, F.S.;
1007	authorizing the agency to exempt certain nursing home
1008	facility providers from quality assessments or apply a
1009	lower assessment rate to the facility; modifying
1010	circumstances requiring discontinuance of the quality
1011	assessment on nursing home facility providers; creating s.
1012	409.9083, F.S.; providing definitions; providing for a
1013	quality assessment to be imposed upon privately operated
1014	intermediate care facility providers for the
1015	developmentally disabled; requiring the agency to
1016	calculate the quality assessment rate annually; providing
1017	requirements for reporting and collecting the assessment;
1018	specifying the purposes of the assessment and an order of
1019	priority; requiring that the agency seek federal
1020	authorization to implement the act; specifying
1021	circumstances requiring discontinuance of the quality
1022	assessment; authorizing the agency to impose certain
1023	penalties against providers that fail to pay the
1024	assessment; requiring the agency to adopt rules; providing
1025	for future repeal; amending s. 409.911, F.S.; revising the
1026	share data used to calculate disproportionate share
1027	payments to hospitals; amending s. 409.9112, F.S.;
1028	revising the time period during which the agency is
1029	prohibited from distributing disproportionate share
1030	payments to regional perinatal intensive care centers;
1031	amending s. 409.9113, F.S.; requiring the agency to
1032	distribute moneys provided in the General Appropriations
1033	Act to statutorily defined teaching hospitals and family
1034	practice teaching hospitals under the teaching hospital
1035	disproportionate share program for the 2009-2010 fiscal
1036	year; amending s. 409.9117, F.S.; prohibiting the agency
1037	from distributing moneys under the primary care
1038	disproportionate share program for the 2009-2010 fiscal
1039	year; amending s. 409.912, F.S.; providing that the
1040	continuance of the integrated fixed-payment delivery pilot
1041	program for certain elderly or dually eligible recipients
1042	is contingent upon an appropriation; creating a pilot
1043	project in Miami-Dade County to monitor the delivery of
1044	home health services and provide for electronic claims for
1045	home health services; authorizing the agency to seek
1046	amendments to the state plan and waivers of federal law to
1047	implement the project; requiring the agency to award
1048	contracts based on a competitive solicitation process;
1049	requiring a report to the Governor and Legislature;
1050	creating a comprehensive care management pilot project in
1051	Miami-Dade County for home health services; authorizing
1052	the agency to seek amendments to the state plan and
1053	waivers of federal law to implement the project; amending
1054	s. 409.91211, F.S.; revising the date when provider
1055	service networks convert from fee-for-service to
1056	capitation rates; amending s. 430.04, F.S.; requiring the
1057	Department of Elderly Affairs to administer all Medicaid
1058	waivers and programs relating to elders and their
1059	appropriations; amending s. 430.707, F.S.; requiring the
1060	agency, in consultation with the Department of Elderly
1061	Affairs, to accept and forward to the Centers for Medicare
1062	and Medicaid Services an application for expansion of a
1063	pilot project from an entity that provides certain
1064	benefits under a federal program; providing an effective
1065	date.

CODING: Words stricken are deletions; words underlined are additions.