HB 5105

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

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