Florida Senate - 2011 SENATOR AMENDMENT
Bill No. CS/CS/HB 119, 1st Eng.
Barcode 256010
LEGISLATIVE ACTION
Senate . House
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Floor: 1J/AD/2R . Floor: RC
05/06/2011 07:05 PM . 05/06/2011 10:48 PM
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Senator Garcia moved the following:
1 Senate Amendment to Amendment (258560) (with title
2 amendment)
3
4 Between lines 2937 and 2938
5 insert:
6 Section 74. Section 409.981, Florida Statutes, is created
7 to read:
8 409.981 Eligible long-term care plans.—
9 (1) ELIGIBLE PLANS.—Provider service networks must be long
10 term care provider service networks. Other eligible plans may be
11 long-term care plans or comprehensive long-term care plans.
12 (2) ELIGIBLE PLAN SELECTION.—The agency shall select
13 eligible plans through the procurement process described in s.
14 409.966. The agency shall provide notice of invitations to
15 negotiate by July 1, 2012. The agency shall procure:
16 (a) Two plans for Region 1. At least one plan must be a
17 provider service network if any provider service networks submit
18 a responsive bid.
19 (b) Two plans for Region 2. At least one plan must be a
20 provider service network if any provider service networks submit
21 a responsive bid.
22 (c) At least three plans and up to five plans for Region 3.
23 At least one plan must be a provider service network if any
24 provider service networks submit a responsive bid.
25 (d) At least three plans and up to five plans for Region 4.
26 At least one plan must be a provider service network if any
27 provider service network submits a responsive bid.
28 (e) At least two plans and up to 4 plans for Region 5. At
29 least one plan must be a provider service network if any
30 provider service networks submit a responsive bid.
31 (f) At least four plans and up to seven plans for Region 6.
32 At least one plan must be a provider service network if any
33 provider service networks submit a responsive bid.
34 (g) At least three plans and up to 6 plans for Region 7. At
35 least one plan must be a provider service networks if any
36 provider service networks submit a responsive bid.
37 (h) At least two plans and up to four plans for Region 8.
38 At least one plan must be a provider service network if any
39 provider service networks submit a responsive bid.
40 (i) At least two plans and up to four plans for Region 9.
41 At least one plan must be a provider service network if any
42 provider service networks submit a responsive bid.
43 (j) At least two plans and up to four plans for Region 10.
44 At least one plan must be a provider service network if any
45 provider service networks submit a responsive bid.
46 (k) At least five plans and up to ten plans for Region 11.
47 At least one plan must be a provider service network if any
48 provider service networks submit a responsive bid.
49
50 If no provider service network submits a responsive bid in a
51 region other than Region 1 or Region 2, the agency shall procure
52 no more than one less than the maximum number of eligible plans
53 permitted in that region. Within 12 months after the initial
54 invitation to negotiate, the agency shall attempt to procure a
55 provider service network. The agency shall notice another
56 invitation to negotiate only with provider service networks in
57 regions where no provider service network has been selected.
58 (3) QUALITY SELECTION CRITERIA.—In addition to the criteria
59 established in s. 409.966, the agency shall consider the
60 following factors in the selection of eligible plans:
61 (a) Evidence of the employment of executive managers with
62 expertise and experience in serving aged and disabled persons
63 who require long-term care.
64 (b) Whether a plan has established a network of service
65 providers dispersed throughout the region and in sufficient
66 numbers to meet specific service standards established by the
67 agency for specialty services for persons receiving home and
68 community-based care.
69 (c) Whether a plan is proposing to establish a
70 comprehensive long-term care plan and whether the eligible plan
71 has a contract to provide managed medical assistance services in
72 the same region.
73 (d) Whether a plan offers consumer-directed care services
74 to enrollees pursuant to s. 409.221.
75 (e) Whether a plan is proposing to provide home and
76 community-based services in addition to the minimum benefits
77 required by s. 409.98.
78 (4) PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY.
79 Participation by the Program of All-Inclusive Care for the
80 Elderly (PACE) shall be pursuant to a contract with the agency
81 and not subject to the procurement requirements or regional plan
82 number limits of this section. PACE plans may continue to
83 provide services to individuals at such levels and enrollment
84 caps as authorized by the General Appropriations Act.
85 (5) MEDICARE PLANS.—Participation by a Medicare Advantage
86 Preferred Provider Organization, Medicare Advantage Provider
87 sponsored Organization, Medicare Advantage Special Needs Plan,
88 Medicare Advantage health maintenance organizations, or Medicare
89 Advantage coordinated care plans shall be pursuant to a contract
90 with the agency and not subject to the procurement requirements
91 if the plan’s Medicaid enrollees consist exclusively of
92 recipients who are deemed dually eligible for Medicaid and
93 Medicare services. Otherwise, Medicare Advantage Preferred
94 Provider Organizations, Medicare Advantage Provider-Sponsored
95 Organizations, Medicare Advantage Special Needs Plans, Medicare
96 Advantage health maintenance organizations, and Medicare
97 Advantage coordinated care plans are subject to all procurement
98 requirements.
99 Section 75. Section 409.984, Florida Statutes, is created
100 to read:
101 409.984 Enrollment in a long-term care managed care plan.—
102 (1) The agency shall automatically enroll into a long-term
103 care managed care plan those Medicaid recipients who do not
104 voluntarily choose a plan pursuant to s. 409.969. The agency
105 shall automatically enroll recipients in plans that meet or
106 exceed the performance or quality standards established pursuant
107 to s. 409.967 and may not automatically enroll recipients in a
108 plan that is deficient in those performance or quality
109 standards. If a recipient is deemed dually eligible for Medicaid
110 and Medicare services and is currently receiving Medicare
111 services from an entity qualified under 42 C.F.R. part 422 as a
112 Medicare Advantage Preferred Provider Organization, Medicare
113 Advantage Provider-sponsored Organization, Medicare Advantage
114 Special Needs Plan, Medicare Advantage health maintenance
115 organization, or Medicare Advantage coordinated care plan, the
116 agency shall automatically enroll the recipient in such plan for
117 Medicaid services if the plan is currently participating in the
118 long-term care managed care program. Except as otherwise
119 provided in this part, the agency may not engage in practices
120 that are designed to favor one managed care plan over another.
121 (1) When automatically enrolling recipients in plans, the
122 agency shall take into account the following criteria:
123 (a) Whether the plan has sufficient network capacity to
124 meet the needs of the recipients.
125 (b) Whether the recipient has previously received services
126 from one of the plan’s home and community-based service
127 providers.
128 (c) Whether the home and community-based providers in one
129 plan are more geographically accessible to the recipient’s
130 residence than those in other plans.
131 (3) Notwithstanding s. 409.969(3)(c), if a recipient is
132 referred for hospice services, the recipient has 30 days during
133 which the recipient may select to enroll in another managed care
134 plan to access the hospice provider of the recipient’s choice.
135 (4) If a recipient is referred for placement in a nursing
136 home or assisted living facility, the plan must inform the
137 recipient of any facilities within the plan that have specific
138 cultural or religious affiliations and, if requested by the
139 recipient, make a reasonable effort to place the recipient in
140 the facility of the recipient’s choice.
141
142 ================= T I T L E A M E N D M E N T ================
143 And the title is amended as follows:
144 Delete line 4902
145 and insert:
146 psychiatric facility; creating s. 409.981, F.S.;
147 providing criteria for eligible plans; designating
148 regions for plan implementation throughout the state;
149 providing criteria for the selection of plans to
150 participate in the long-term care managed care
151 program; providing that participation by the Program
152 of All-Inclusive Care for the Elderly and certain
153 Medicare plans is pursuant to an agency contract and
154 not subject to procurement; creating s. 409.984, F.S.;
155 providing criteria for automatic assignments of plan
156 enrollees who fail to choose a plan; providing for
157 hospice selection within a specified timeframe;
158 providing for a choice of residential setting under
159 certain circumstances; amending s. 429.07, F.S.;