Amendment
Bill No. CS/HB 7107

Amendment No. 987961

CHAMBER ACTION
Senate		House
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1	Representative Cruz offered the following:
2
3	Amendment
4	Remove lines 414-1494 and insert:
5	(a)  Region I, which shall consist of Bay, Calhoun,
6	Escambia, Gulf, Holmes, Jackson, Okaloosa, Santa Rosa, Walton,
7	and Washington Counties.
8	(b)  Region II, which shall consist of Franklin, Gadsden,
9	Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla Counties.
10	(c)  Region III, which shall consist of Alachua, Bradford,
11	Citrus, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
12	Marion, Putnam, Suwannee, and Union Counties.
13	(d)  Region IV, which shall consist of Baker, Clay, Duval,
14	Flagler, Nassau, St. Johns, and Volusia Counties Counties.
15	(e)  Region V, which shall consist of Hernando,
16	Hillsborough, Pasco, Pinellas, and Polk Counties.
17	(f)  Region VI, which shall consist of Brevard, Lake,
18	Orange, Osceola, Seminole, and Sumter Counties.
19	(g)  Region VII, which shall consist of DeSoto, Hardee,
20	Highlands, Manatee, and Sarasota Counties.
21	(h)  Region VIII, which shall consist of Indian River,
22	Martin, Okeechobee, Palm Beach, and St.Lucie Counties.
23	(i)  Region IX, which shall consist of Charlotte, Collier,
24	Glades, Hendry, and Lee Counties.
25	(j)  Region X, which shall consist of Broward County.
26	(k)  Region XI, which shall consist of Miami-Dade and
27	Monroe Counties.
28	(3)  QUALITY SELECTION CRITERIA.-
29	(a)  The invitation to negotiate must specify the criteria
30	and the relative weight of the criteria that will be used for
31	determining the acceptability of the reply and guiding the
32	selection of the organizations with which the agency negotiates.
33	In addition to criteria established by the agency, the agency
34	shall consider the following factors in the selection of
35	eligible plans:
36	1.  Accreditation by the National Committee for Quality
37	Assurance, the Joint Commission, or another nationally
38	recognized accrediting body.
39	2.  Experience serving similar populations, including the
40	organization's record in achieving specific quality standards
41	with similar populations.
42	3.  Availability and accessibility of primary care and
43	specialty physicians in the provider network.
44	4.  Establishment of community partnerships with providers
45	that create opportunities for reinvestment in community-based
46	services.
47	5.  Organization commitment to quality improvement and
48	documentation of achievements in specific quality improvement
49	projects, including active involvement by organization
50	leadership.
51	6.  Provision of additional benefits, particularly dental
52	care and disease management, and other initiatives that improve
53	health outcomes.
54	7.  Evidence that a qualified plan has written agreements
55	or signed contracts or has made substantial progress in
56	establishing relationships with providers before the plan
57	submitting a response.
58	8.  Comments submitted in writing by any enrolled Medicaid
59	provider relating to a specifically identified plan
60	participating in the procurement in the same region as the
61	submitting provider.
62	9.  The business relationship a qualified plan has with any
63	other qualified plan that responds to the invitation to
64	negotiate.
65
66	A qualified plan must disclose any business relationship it has
67	with any other qualified plan that responds to the invitation to
68	negotiate. The agency may not select plans in the same region
69	that have a business relationship with each other. Failure to
70	disclose any business relationship shall result in
71	disqualification from participation in any region for the first
72	full contract period after the discovery of the business
73	relationship by the agency. For the purpose of this section,
74	"business relationship" means an ownership or controlling
75	interest, an affiliate or subsidiary relationship, a common
76	parent, or any mutual interest in any limited partnership,
77	limited liability partnership, limited liability company, or
78	other entity or business association, including all wholly or
79	partially owned subsidiaries, majority-owned subsidiaries,
80	parent companies, or affiliates of such entities, business
81	associations, or other enterprises, that exists for the purpose
82	of making a profit.
83	(b)  After negotiations are conducted, the agency shall
84	select the eligible plans that are determined to be responsive
85	and provide the best value to the state. Preference shall be
86	given to plans that demonstrate the following:
87	1.  Signed contracts with primary and specialty physicians
88	in sufficient numbers to meet the specific standards established
89	pursuant to s. 409.967(2)(b).
90	2.  Well-defined programs for recognizing patient-centered
91	medical homes or accountable care organizations, and providing
92	for increased compensation for recognized medical homes or
93	accountable care organizations, as defined by the plan.
94	3.  Greater net economic benefit to Florida compared to
95	other bidders through employment of, or subcontracting with
96	firms that employ, Floridians in order to accomplish the
97	contract requirements. Contracts with such bidders shall specify
98	performance measures to evaluate the plan's employment-based
99	economic impact. Valuation of the net economic benefit may not
100	include employment of or subcontracts with providers.
101	(c)  To ensure managed care plan participation in Region I,
102	the agency shall award an additional contract to each plan with
103	a contract award in Region I. Such contract shall be in any
104	other region in which the plan submitted a responsive bid and
105	negotiates a rate acceptable to the agency.
106	(4)  ADMINISTRATIVE CHALLENGE.-Any eligible plan that
107	participates in an invitation to negotiate in more than one
108	region and is selected in at least one region may not begin
109	serving Medicaid recipients in any region for which it was
110	selected until all administrative challenges to procurements
111	required by this section to which the eligible plan is a party
112	have been finalized. If the number of plans selected is less
113	than the maximum amount of plans permitted in the region, the
114	agency may contract with other selected plans in the region not
115	participating in the administrative challenge before resolution
116	of the administrative challenge. For purposes of this
117	subsection, an administrative challenge is finalized if an order
118	granting voluntary dismissal with prejudice has been entered by
119	any court established under Article V of the State Constitution
120	or by the Division of Administrative Hearings, a final order has
121	been entered into by the agency and the deadline for appeal has
122	expired, a final order has been entered by the First District
123	Court of Appeal and the time to seek any available review by the
124	Florida Supreme Court has expired, or a final order has been
125	entered by the Florida Supreme Court and a warrant has been
126	issued.
127	Section 8.  Section 409.967, Florida Statutes, is created
128	to read:
129	409.967  Managed care plan accountability.-
130	(1)  The agency shall establish a 5-year contract with each
131	managed care plan selected through the procurement process
132	described in s. 409.966. A plan contract may not be renewed;
133	however, the agency may extend the terms of a plan contract to
134	cover any delays in transition to a new plan.
135	(2)  The agency shall establish such contract requirements
136	as are necessary for the operation of the statewide managed care
137	program. In addition to any other provisions the agency may deem
138	necessary, the contract shall require:
139	(a)  Emergency services.-Managed care plans shall pay for
140	services required by ss. 395.1041 and 401.45 and rendered by a
141	noncontracted provider pursuant to s. 641.3155. Reimbursement
142	for services under this paragraph shall be the lesser of:
143	1.  The provider's charges;
144	2.  The usual and customary provider charges for similar
145	services in the community where the services were provided;
146	3.  The charge mutually agreed to by the entity and the
147	provider within 60 days after submittal of the claim; or
148	4.  The rate the agency would have paid on the first day of
149	the contract between the provider and the plan.
150	(b)  Access.-The agency shall establish specific standards
151	for the number, type, and regional distribution of providers in
152	managed care plan networks to ensure access to care for both
153	adults and children. Each plan must maintain a region-wide
154	network of providers in sufficient numbers to meet the access
155	standards for specific medical services for all recipients
156	enrolled in the plan. Consistent with the standards established
157	by the agency, provider networks may include providers located
158	outside the region. A plan may contract with a new hospital
159	facility before the date the hospital becomes operational if the
160	hospital has commenced construction, will be licensed and
161	operational by January 1, 2013, and a final order has issued in
162	any civil or administrative challenge. Each plan shall establish
163	and maintain an accurate and complete electronic database of
164	contracted providers, including information about licensure or
165	registration, locations and hours of operation, specialty
166	credentials and other certifications, specific performance
167	indicators, and such other information as the agency deems
168	necessary. The database shall be available online to both the
169	agency and the public and shall have the capability to compare
170	the availability of providers to network adequacy standards and
171	to accept and display feedback from each provider's patients.
172	Each plan shall submit quarterly reports to the agency
173	identifying the number of enrollees assigned to each primary
174	care provider.
175	(c)  Encounter data.-The agency shall maintain and operate
176	a Medicaid Encounter Data System to collect, process, store, and
177	report on covered services provided to all Medicaid recipients
178	enrolled in prepaid plans.
179	1.  Each prepaid plan must comply with the agency's
180	reporting requirements for the Medicaid Encounter Data System.
181	Prepaid plans must submit encounter data electronically in a
182	format that complies with the Health Insurance Portability and
183	Accountability Act provisions for electronic claims and in
184	accordance with deadlines established by the agency. Prepaid
185	plans must certify that the data reported is accurate and
186	complete.
187	2.  The agency is responsible for validating the data
188	submitted by the plans. The agency shall develop methods and
189	protocols for ongoing analysis of the encounter data that
190	adjusts for differences in characteristics of prepaid plan
191	enrollees to allow comparison of service utilization among plans
192	and against expected levels of use. The analysis shall be used
193	to identify possible cases of systemic underutilization or
194	denials of claims and inappropriate service utilization such as
195	higher-than-expected emergency department encounters. The
196	analysis shall provide periodic feedback to the plans and enable
197	the agency to establish corrective action plans when necessary.
198	One of the focus areas for the analysis shall be the use of
199	prescription drugs.
200	3.  The agency shall make encounter data available to those
201	plans accepting enrollees who are assigned to them from other
202	plans leaving a region.
203	(d)  Continuous improvement.-The agency shall establish
204	specific performance standards and expected milestones or
205	timelines for improving performance over the term of the
206	contract. By the end of the fourth year of the first contract
207	term, the agency shall issue a request for information to
208	determine whether cost savings could be achieved by contracting
209	for plan oversight and monitoring, including analysis of
210	encounter data, assessment of performance measures, and
211	compliance with other contractual requirements. Each managed
212	care plan shall establish an internal health care quality
213	improvement system, including enrollee satisfaction and
214	disenrollment surveys. The quality improvement system shall
215	include incentives and disincentives for network providers.
216	(e)  Program integrity.-Each managed care plan shall
217	establish program integrity functions and activities to reduce
218	the incidence of fraud and abuse, including, at a minimum:
219	1.  A provider credentialing system and ongoing provider
220	monitoring;
221	2.  An effective prepayment and postpayment review process
222	including, but not limited to, data analysis, system editing,
223	and auditing of network providers;
224	3.  Procedures for reporting instances of fraud and abuse
225	pursuant to chapter 641;
226	4.  Administrative and management arrangements or
227	procedures, including a mandatory compliance plan, designed to
228	prevent fraud and abuse; and
229	5.  Designation of a program integrity compliance officer.
230	(f)  Grievance resolution.-Each managed care plan shall
231	establish and the agency shall approve an internal process for
232	reviewing and responding to grievances from enrollees consistent
233	with the requirements of s. 641.511. Each plan shall submit
234	quarterly reports on the number, description, and outcome of
235	grievances filed by enrollees. The agency shall maintain a
236	process for provider service networks consistent with s.
237	408.7056.
238	(g)  Penalties.-Managed care plans that reduce enrollment
239	levels or leave a region before the end of the contract term
240	shall reimburse the agency for the cost of enrollment changes
241	and other transition activities, including the cost of
242	additional choice counseling services. If more than one plan
243	leaves a region at the same time, costs shall be shared by the
244	departing plans proportionate to their enrollments. In addition
245	to the payment of costs, departing provider services networks
246	shall pay a per enrollee penalty not to exceed 3 month's payment
247	and shall continue to provide services to the enrollee for 90
248	days or until the enrollee is enrolled in another plan,
249	whichever is sooner. In addition to payment of costs, all other
250	plans shall pay a penalty equal to 25 percent of the minimum
251	surplus requirement pursuant to s. 641.225(1). Plans shall
252	provide the agency notice no less than 180 days before
253	withdrawing from a region.
254	(h)  Prompt payment.-Managed care plans shall comply with
255	ss. 641.315, 641.3155, and 641.513.
256	(i)  Electronic claims.-Managed care plans shall accept
257	electronic claims in compliance with federal standards.
258	(j)  Fair payment.-Provider service networks must ensure
259	that no network provider with a controlling interest in the
260	network charges any Medicaid managed care plan more than the
261	amount paid to that provider by the provider service network for
262	the same service.
263	(3)  ACHIEVED SAVINGS REBATE.-
264	(a)  The agency shall establish and the prepaid plans shall
265	use a uniform method for annually reporting premium revenue,
266	medical and administrative costs, and income or losses, across
267	all Florida Medicaid prepaid plan lines of business in all
268	regions. The reports shall be due to the agency within 270 days
269	after the conclusion of the reporting period and the agency may
270	audit the reports. Achieved savings rebates shall be due within
271	30 days after the report is submitted. Except as provided in
272	paragraph (b), the achieved savings rebate will be established
273	by determining pretax income as a percentage of revenues and
274	applying the following income sharing ratios:
275	1.  One hundred percent of income up to and including 5
276	percent of revenue shall be retained by the plan.
277	2.  Fifty percent of income above 5 percent and up to 10
278	percent shall be retained by the plan, with the other 50 percent
279	refunded to the state.
280	3.  One hundred percent of income above 10 percent of
281	revenue shall be refunded to the state.
282	(b)  A plan that meets or exceeds agency-defined quality
283	measures in the reporting period may retain an additional 1
284	percent of revenue.
285	(c)  The following expenses may not be included in
286	calculating income to the plan:
287	1.  Payment of achieved savings rebates.
288	2.  Any financial incentive payments made to the plan
289	outside of the capitation rate.
290	3.  Any financial disincentive payments levied by the state
291	or federal governments.
292	4.  Expenses associated with lobbying activities.
293	5.  Administrative, reinsurance, and outstanding claims
294	expenses in excess of actuarially sound maximum amounts set by
295	the agency.
296	6.  Any payment made pursuant to paragraph (f).
297	(d)  Prepaid plans that incur a loss in the first contract
298	year may apply the full amount of the loss as an offset to
299	income in the second contract year.
300	(e)  If, after an audit or other reconciliation, the agency
301	determines that a prepaid plan owes an additional rebate, the
302	plan shall have 30 days after notification to make the payment.
303	Upon failure to timely pay the rebate, the agency shall withhold
304	future payments to the plan until the entire amount is recouped.
305	If the agency determines that a prepaid plan has made an
306	overpayment, the agency shall return the overpayment within 30
307	days.
308	(f)  In addition to the reporting required by paragraph
309	(a), prepaid plans shall annually submit a report, consistent
310	with paragraph (a), which is specific to enrollees with
311	developmental disabilities. The agency shall compare each plan's
312	expenditures to the plan's aggregate premiums for this
313	population. The difference between aggregate premiums and
314	expenditures shall be shared equally between the plan and the
315	state. The state share shall be returned to the Medicaid
316	appropriation to serve people on the wait list for home and
317	community-based services provided through individual budgets.
318	Section 9.  Section 409.968, Florida Statutes, is created
319	to read:
320	409.968  Managed care plan payments.-
321	(1)  Prepaid plans shall receive per-member, per-month
322	payments negotiated pursuant to the procurements described in s.
323	409.966. Payments shall be risk-adjusted rates based on
324	historical utilization and spending data, projected forward, and
325	adjusted to reflect the eligibility category, geographic area,
326	and clinical risk profile of the recipients.
327	(2)  Provider service networks may be prepaid plans and
328	receive per-member, per-month payments negotiated pursuant to
329	the procurement process described in s. 409.966. Provider
330	service networks that choose not to be prepaid plans shall
331	receive fee-for-service rates with a shared savings settlement.
332	The fee-for-service option shall be available to a provider
333	service network only for the first 5 years of its operation in a
334	given region. The agency shall annually conduct cost
335	reconciliations to determine the amount of cost savings achieved
336	by fee-for-service provider service networks for the dates of
337	service within the period being reconciled. Only payments for
338	covered services for dates of service within the reconciliation
339	period and paid within 6 months after the last date of service
340	in the reconciliation period shall be included. The agency shall
341	perform the necessary adjustments for the inclusion of claims
342	incurred but not reported within the reconciliation period for
343	claims that could be received and paid by the agency after the
344	6-month claims processing time lag. The agency shall provide the
345	results of the reconciliations to the fee-for-service provider
346	service networks within 45 days after the end of the
347	reconciliation period. The fee-for-service provider service
348	networks shall review and provide written comments or a letter
349	of concurrence to the agency within 45 days after receipt of the
350	reconciliation results. This reconciliation shall be considered
351	final.
352	Section 10.  Section 409.969, Florida Statutes, is created
353	to read:
354	409.969  Enrollment; choice counseling; automatic
355	assignment; disenrollment.-
356	(1)  ENROLLMENT.-All Medicaid recipients shall be enrolled
357	in a managed care plan unless specifically exempted under this
358	part. Each recipient shall have a choice of plans and may select
359	any available plan unless that plan is restricted by contract to
360	a specific population that does not include the recipient.
361	Medicaid recipients shall have 30 days in which to make a choice
362	of plans. All recipients shall be offered choice counseling
363	services in accordance with this section.
364	(2)  CHOICE COUNSELING.-The agency shall provide choice
365	counseling for Medicaid recipients. The agency may contract for
366	the provision of choice counseling. Any such contract shall be
367	with a vendor that employs Floridians to accomplish the contract
368	requirements and shall be for a period of 5 years. The agency
369	may renew a contract for an additional 5-year period; however,
370	before renewal of the contract the agency shall hold at least
371	one public meeting in each of the regions covered by the choice
372	counseling vendor. The agency may extend the term of the
373	contract to cover any delays in transition to a new contractor.
374	Printed choice information and choice counseling shall be
375	offered in the native or preferred language of the recipient,
376	consistent with federal requirements. The manner and method of
377	choice counseling shall be modified as necessary to ensure
378	culturally competent, effective communication with people from
379	diverse cultural backgrounds. The agency shall maintain a record
380	of the recipients who receive such services, identifying the
381	scope and method of the services provided. The agency shall make
382	available clear and easily understandable choice information to
383	Medicaid recipients that includes:
384	(a)  An explanation that each recipient has the right to
385	choose a managed care plan at the time of enrollment in Medicaid
386	and again at regular intervals set by the agency, and that if a
387	recipient does not choose a plan, the agency will assign the
388	recipient to a plan according to the criteria specified in this
389	section.
390	(b)  A list and description of the benefits provided in
391	each managed care plan.
392	(c)  An explanation of benefit limits.
393	(d)  A current list of providers participating in the
394	network, including location and contact information.
395	(e)  Managed care plan performance data.
396	(3)  DISENROLLMENT; GRIEVANCES.-After a recipient has
397	enrolled in a managed care plan, the recipient shall have 90
398	days to voluntarily disenroll and select another plan. After 90
399	days, no further changes may be made except for good cause. For
400	purposes of this section, the term "good cause" includes, but is
401	not limited to, poor quality of care, lack of access to
402	necessary specialty services, an unreasonable delay or denial of
403	service, or fraudulent enrollment. The agency must make a
404	determination as to whether good cause exists. The agency may
405	require a recipient to use the plan's grievance process before
406	the agency's determination of good cause, except in cases in
407	which immediate risk of permanent damage to the recipient's
408	health is alleged.
409	(a)  The managed care plan internal grievance process, when
410	used, must be completed in time to permit the recipient to
411	disenroll by the first day of the second month after the month
412	the disenrollment request was made. If the result of the
413	grievance process is approval of an enrollee's request to
414	disenroll, the agency is not required to make a determination in
415	the case.
416	(b)  The agency must make a determination and take final
417	action on a recipient's request so that disenrollment occurs no
418	later than the first day of the second month after the month the
419	request was made. If the agency fails to act within the
420	specified timeframe, the recipient's request to disenroll is
421	deemed to be approved as of the date agency action was required.
422	Recipients who disagree with the agency's finding that good
423	cause does not exist for disenrollment shall be advised of their
424	right to pursue a Medicaid fair hearing to dispute the agency's
425	finding.
426	(c)  Medicaid recipients enrolled in a managed care plan
427	after the 90-day period shall remain in the plan for the
428	remainder of the 12-month period. After 12 months, the recipient
429	may select another plan. However, nothing shall prevent a
430	Medicaid recipient from changing providers within the plan
431	during that period.
432	(d)  On the first day of the month after receiving notice
433	from a recipient that the recipient has moved to another region,
434	the agency shall automatically disenroll the recipient from the
435	managed care plan the recipient is currently enrolled in and
436	treat the recipient as if the recipient is a new Medicaid
437	enrollee. At that time, the recipient may choose another plan
438	pursuant to the enrollment process established in this section.
439	(e)  The agency must monitor plan disenrollment throughout
440	the contract term to identify any discriminatory practices.
441	Section 11.  Section 409.97, Florida Statutes, is created
442	to read:
443	409.97  State and local Medicaid partnerships.-
444	(1)  INTERGOVERNMENTAL TRANSFERS.-In addition to the
445	contributions required pursuant to s. 409.915, beginning in the
446	2014-2015 fiscal year, the agency may accept voluntary transfers
447	of local taxes and other qualified revenue from counties,
448	municipalities, and special taxing districts. Such transfers
449	must be contributed to advance the general goals of the Florida
450	Medicaid program without restriction and must be executed
451	pursuant to a contract between the agency and the local funding
452	source. Contracts executed before October 31 shall result in
453	contributions to Medicaid for that same state fiscal year.
454	Contracts executed between November 1 and June 30 shall result
455	in contributions for the following state fiscal year. Based on
456	the date of the signed contracts, the agency shall allocate to
457	the low-income pool the first contributions received up to the
458	limit established by subsection (2). No more than 40 percent of
459	the low-income pool funding shall come from any single funding
460	source. Contributions in excess of the low-income pool shall be
461	allocated to the disproportionate share programs defined in ss.
462	409.911(3) and 409.9113 and to hospital rates pursuant to
463	subsection (4). The local funding source shall designate in the
464	contract which Medicaid providers ensure access to care for low-
465	income and uninsured people within the applicable jurisdiction
466	and are eligible for low-income pool funding. Eligible providers
467	may include both hospitals and primary care providers.
468	(2)  LOW-INCOME POOL.-The agency shall establish and
469	maintain a low-income pool in a manner authorized by federal
470	waiver. The low-income pool is created to compensate a network
471	of providers designated pursuant to subsection (1). Funding of
472	the low-income pool shall be limited to the maximum amount
473	permitted by federal waiver minus a percentage specified in the
474	General Appropriations Act. The low-income pool must be used to
475	support enhanced access to services by offsetting shortfalls in
476	Medicaid reimbursement, paying for otherwise uncompensated care,
477	and financing coverage for the uninsured. The low-income pool
478	shall be distributed in periodic payments to the Access to Care
479	Partnership throughout the fiscal year. Distribution of low-
480	income pool funds by the Access to Care Partnership to
481	participating providers may be made through capitated payments,
482	fees for services, or contracts for specific deliverables. The
483	agency shall include the distribution amount for each provider
484	in the contract with the Access to Care Partnership pursuant to
485	subsection (3). Regardless of the method of distribution,
486	providers participating in the Access to Care Partnership shall
487	receive payments such that the aggregate benefit in the
488	jurisdiction of each local funding source, as defined in
489	subsection (1), equals the amount of the contribution plus a
490	factor specified in the General Appropriations Act.
491	(3)  ACCESS TO CARE PARTNERSHIP.-The agency shall contract
492	with an administrative services organization that has operating
493	agreements with all health care facilities, programs, and
494	providers supported with local taxes or certified public
495	expenditures and designated pursuant to subsection (1). The
496	contract shall provide for enhanced access to care for Medicaid,
497	low-income, and uninsured Floridians. The partnership shall be
498	responsible for an ongoing program of activities that provides
499	needed, but uncovered or undercompensated, health services to
500	Medicaid enrollees and persons receiving charity care, as
501	defined in s. 409.911. Accountability for services rendered
502	under this contract must be based on the number of services
503	provided to unduplicated qualified beneficiaries, the total
504	units of service provided to these persons, and the
505	effectiveness of services provided as measured by specific
506	standards of care. The agency shall seek such plan amendments or
507	waivers as may be necessary to authorize the implementation of
508	the low-income pool as the Access to Care Partnership pursuant
509	to this section.
510	(4)  HOSPITAL RATE DISTRIBUTION.-
511	(a)  The agency is authorized to implement a tiered
512	hospital rate system to enhance Medicaid payments to all
513	hospitals when resources for the tiered rates are available from
514	general revenue and such contributions pursuant to subsection
515	(1) as are authorized under the General Appropriations Act.
516	1.  Tier 1 hospitals are statutory rural hospitals as
517	defined in s. 395.602, statutory teaching hospitals as defined
518	in s. 408.07(45), and specialty children's hospitals as defined
519	in s. 395.002(28).
520	2.  Tier 2 hospitals are community hospitals not included
521	in Tier 1 that provided more than 9 percent of the hospital's
522	total inpatient days to Medicaid patients and charity patients,
523	as defined in s. 409.911, and are located in the jurisdiction of
524	a local funding source pursuant to subsection (1).
525	3.  Tier 3 hospitals include all community hospitals.
526	(b)  When rates are increased pursuant to this section, the
527	Total Tier Allocation (TTA) shall be distributed as follows:
528	1.  Tier 1 (T1A) = 0.35 x TTA.
529	2.  Tier 2 (T2A) = 0.35 x TTA.
530	3.  Tier 3 (T3A) = 0.30 x TTA.
531	(c)  The tier allocation shall be distributed as a
532	percentage increase to the hospital specific base rate (HSBR)
533	established pursuant to s. 409.905(5)(c). The increase in each
534	tier shall be calculated according to the proportion of tier-
535	specific allocation to the total estimated inpatient spending
536	(TEIS) for all hospitals in each tier:
537	1.  Tier 1 percent increase (T1PI) = T1A/Tier 1 total
538	estimated inpatient spending (T1TEIS).
539	2.  Tier 2 percent increase (T2PI) = T2A /Tier 2 total
540	estimated inpatient spending (T2TEIS).
541	3.  Tier 3 percent increase (T3PI) = T3A/ Tier 3 total
542	estimated inpatient spending (T3TEIS).
543	(d)  The hospital-specific tiered rate (HSTR) shall be
544	calculated as follows:
545	1.  For hospitals in Tier 3: HSTR = (1 + T3PI) x HSBR.
546	2.  For hospitals in Tier 2: HSTR = (1 + T2PI) x HSBR.
547	3.  For hospitals in Tier 1: HSTR = (1 + T1PI) x HSBR.
548	Section 12.  Section 409.971, Florida Statutes, is created
549	to read:
550	409.971  Managed medical assistance program.-The agency
551	shall make payments for primary and acute medical assistance and
552	related services using a managed care model. By January 1, 2013,
553	the agency shall begin implementation of the statewide managed
554	medical assistance program, with full implementation in all
555	regions by October 1, 2014.
556	Section 13.  Section 409.972, Florida Statutes, is created
557	to read:
558	409.972  Mandatory and voluntary enrollment.-
559	(1)  Persons eligible for the program known as "medically
560	needy" pursuant to s. 409.904(2)(a) shall enroll in managed care
561	plans. Medically needy recipients shall meet the share of the
562	cost by paying the plan premium, up to the share of the cost
563	amount, contingent upon federal approval.
564	(2)  The following Medicaid-eligible persons are exempt
565	from mandatory managed care enrollment required by s. 409.965,
566	and may voluntarily choose to participate in the managed medical
567	assistance program:
568	(a)  Medicaid recipients who have other creditable health
569	care coverage, excluding Medicare.
570	(b)  Medicaid recipients residing in residential commitment
571	facilities operated through the Department of Juvenile Justice
572	or mental health treatment facilities as defined by s.
573	394.455(32).
574	(c)  Persons eligible for refugee assistance.
575	(d)  Medicaid recipients who are residents of a
576	developmental disability center, including Sunland Center in
577	Marianna and Tacachale in Gainesville.
578	(3)  Persons eligible for Medicaid but exempt from
579	mandatory participation who do not choose to enroll in managed
580	care shall be served in the Medicaid fee-for-service program as
581	provided in part III of this chapter.
582	Section 14.  Section 409.973, Florida Statutes, is created
583	to read:
584	409.973  Benefits.-
585	(1)  MINIMUM BENEFITS.-Managed care plans shall cover, at a
586	minimum, the following services:
587	(a)  Advanced registered nurse practitioner services.
588	(b)  Ambulatory surgical treatment center services.
589	(c)  Birthing center services.
590	(d)  Chiropractic services.
591	(e)  Dental services.
592	(f)  Early periodic screening diagnosis and treatment
593	services for recipients under age 21.
594	(g)  Emergency services.
595	(h)  Family planning services and supplies.
596	(i)  Healthy start services.
597	(j)  Hearing services.
598	(k)  Home health agency services.
599	(l)  Hospice services.
600	(m)  Hospital inpatient services.
601	(n)  Hospital outpatient services.
602	(o)  Laboratory and imaging services.
603	(p)  Medical supplies, equipment, prostheses, and orthoses.
604	(q)  Mental health services.
605	(r)  Nursing care.
606	(s)  Optical services and supplies.
607	(t)  Optometrist services.
608	(u)  Physical, occupational, respiratory, and speech
609	therapy services.
610	(v)  Physician services, including physician assistant
611	services.
612	(w)  Podiatric services.
613	(x)  Prescription drugs.
614	(y)  Renal dialysis services.
615	(z)  Respiratory equipment and supplies.
616	(aa)  Rural health clinic services.
617	(bb)  Substance abuse treatment services.
618	(cc)  Transportation to access covered services.
619	(2)  CUSTOMIZED BENEFITS.-Managed care plans may customize
620	benefit packages for nonpregnant adults, vary cost-sharing
621	provisions, and provide coverage for additional services. The
622	agency shall evaluate the proposed benefit packages to ensure
623	services are sufficient to meet the needs of the plan's
624	enrollees and to verify actuarial equivalence.
625	(3)  HEALTHY BEHAVIORS.-Each plan operating in the managed
626	medical assistance program shall establish a program to
627	encourage and reward healthy behaviors.
628	(4)  PRIMARY CARE INITIATIVE.-Each plan operating in the
629	managed medical assistance program shall establish a program to
630	encourage enrollees to establish a relationship with their
631	primary care provider. Each plan shall:
632	(a)  Within 30 days after enrollment, provide information
633	to each enrollee on the importance of and procedure for
634	selecting a primary care physician, and thereafter automatically
635	assign to a primary care provider any enrollee who fails to
636	choose a primary care provider.
637	(b)  Within 90 days after selection of or assignment to a
638	primary care provider, provide information to each enrollee on
639	the importance of scheduling a wellness screening with the
640	enrollee's primary care physician.
641	(c)  Report to the agency the number of enrollees assigned
642	to each primary care provider within the plan's network.
643	(d)  Report to the agency the number of enrollees who have
644	not had an appointment with their primary care provider within
645	their first year of enrollment.
646	(e)  Report to the agency the number of emergency room
647	visits by enrollees who have not had a least one appointment
648	with their primary care provider.
649	Section 15.  Section 409.974, Florida Statutes, is created
650	to read:
651	409.974  Eligible plans.-
652	(1)  ELIGIBLE PLAN SELECTION.-The agency shall select
653	eligible plans through the procurement process described in s.
654	409.966. The agency shall notice invitations to negotiate no
655	later than January 1, 2013.
656	(a)  The agency shall procure two plans for Region I. At
657	least one plan shall be a provider service network, if any
658	provider service network submits a responsive bid.
659	(b)  The agency shall procure two plans for Region II. At
660	least one plan shall be a provider service network, if any
661	provider service network submits a responsive bid.
662	(c)  The agency shall procure at least two plans and no
663	more than four plans for Region III. At least one plan shall be
664	a provider service network, if any provider service network
665	submits a responsive bid.
666	(d)  The agency shall procure at least two plans and no
667	more than four plans for Region IV. At least one plan shall be a
668	provider service network, if any provider service network
669	submits a responsive bid.
670	(e)  The agency shall procure at least four plans and no
671	more than eight plans for Region V. At least two plans shall be
672	provider service networks, if any two provider service networks
673	submit responsive bids.
674	(f)  The agency shall procure at least four plans and no
675	more than seven plans for Region VI. At least two plans shall be
676	provider service networks, if any two provider service networks
677	submit responsive bids.
678	(g)  The agency shall procure two plans for Region VII. At
679	least one plan shall be a provider service network, if any
680	provider service network submits a responsive bid.
681	(h)  The agency shall procure at least two plans and no
682	more than four plans for Region VIII. At least one plan shall be
683	a provider service network, if any provider service network
684	submits a responsive bid.
685	(i)  The agency shall procure three plans for Region IX. At
686	least one plan shall be a provider service network, if any
687	provider service network submits a responsive bid.
688	(j)  The agency shall procure at least two plans and no
689	more than four plans for Region X. At least one plan shall be a
690	provider service network, if any provider service network
691	submits a responsive bid.
692	(k)  The agency shall procure at least five plans and no
693	more than nine plans for Region XI. At least two plans shall be
694	provider service networks, if any two provider service networks
695	submit a responsive bid.
696
697	If no provider service network submits a responsive bid, the
698	agency shall procure no more than one less than the maximum
699	number of eligible plans permitted in that region. Within 12
700	months after the initial invitation to negotiate, the agency
701	shall attempt to procure a provider service network. The agency
702	shall notice another invitation to negotiate only with provider
703	service networks in such region where no provider service
704	network has been selected.
705	(2)  QUALITY SELECTION CRITERIA.-In addition to the
706	criteria established in s. 409.966, the agency shall consider
707	evidence that an eligible plan has written agreements or signed
708	contracts or has made substantial progress in establishing
709	relationships with providers before the plan submitting a
710	response. The agency shall evaluate and give special weight to
711	evidence of signed contracts with essential providers as defined
712	by the agency pursuant to s. 409.975(2). The agency shall
713	exercise a preference for plans with a provider network in which
714	over 10 percent of the providers use electronic health records,
715	as defined in s. 408.051. When all other factors are equal, the
716	agency shall consider whether the organization has a contract to
717	provide managed long-term care services in the same region and
718	shall exercise a preference for such plans.
719	(3)  SPECIALTY PLANS.-Participation by specialty plans
720	shall be subject to the procurement requirements and regional
721	plan number limits of this section. However, a specialty plan
722	whose target population includes no more than 10 percent of the
723	enrollees of that region is not subject to the regional plan
724	number limits of this section.
725	(4)  CHILDREN'S MEDICAL SERVICES NETWORK.-Participation by
726	the Children's Medical Services Network shall be pursuant to a
727	single, statewide contract with the agency that is not subject
728	to the procurement requirements or regional plan number limits
729	of this section. The Children's Medical Services Network must
730	meet all other plan requirements for the managed medical
731	assistance program.
732	Section 16.  Section 409.975, Florida Statutes, is created
733	to read:
734	409.975  Managed care plan accountability.-In addition to
735	the requirements of s. 409.967, plans and providers
736	participating in the managed medical assistance program shall
737	comply with the requirements of this section.
738	(1)  PROVIDER NETWORKS.-Managed care plans must develop and
739	maintain provider networks that meet the medical needs of their
740	enrollees in accordance with standards established pursuant to
741	409.967(2)(b). Except as provided in this section, managed care
742	plans may limit the providers in their networks based on
743	credentials, quality indicators, and price.
744	(a)  Plans must include all providers in the region that
745	are classified by the agency as essential Medicaid providers,
746	unless the agency approves, in writing, an alternative
747	arrangement for securing the types of services offered by the
748	essential providers. Providers are essential for serving
749	Medicaid enrollees if they offer services that are not available
750	from any other provider within a reasonable access standard, or
751	if they provided a substantial share of the total units of a
752	particular service used by Medicaid patients within the region
753	during the last 3 years and the combined capacity of other
754	service providers in the region is insufficient to meet the
755	total needs of the Medicaid patients. The agency may not
756	classify physicians and other practitioners as essential
757	providers. The agency, at a minimum, shall determine which
758	providers in the following categories are essential Medicaid
759	providers:
760	1.  Federally qualified health centers.
761	2.  Statutory teaching hospitals as defined in s.
762	408.07(45).
763	3.  Hospitals that are trauma centers as defined in s.
764	395.4001(14).
765	4.  Hospitals located at least 25 miles from any other
766	hospital with similar services.
767
768	Managed care plans that have not contracted with all essential
769	providers in the region as of the first date of recipient
770	enrollment, or with whom an essential provider has terminated
771	its contract, must negotiate in good faith with such essential
772	providers for 1 year or until an agreement is reached, whichever
773	is first. Payments for services rendered by a nonparticipating
774	essential provider shall be made at the applicable Medicaid rate
775	as of the first day of the contract between the agency and the
776	plan. A rate schedule for all essential providers shall be
777	attached to the contract between the agency and the plan. After
778	1 year, managed care plans that are unable to contract with
779	essential providers shall notify the agency and propose an
780	alternative arrangement for securing the essential services for
781	Medicaid enrollees. The arrangement must rely on contracts with
782	other participating providers, regardless of whether those
783	providers are located within the same region as the
784	nonparticipating essential service provider. If the alternative
785	arrangement is approved by the agency, payments to
786	nonparticipating essential providers after the date of the
787	agency's approval shall equal 90 percent of the applicable
788	Medicaid rate. If the alternative arrangement is not approved by
789	the agency, payment to nonparticipating essential providers
790	shall equal 110 percent of the applicable Medicaid rate.
791	(b)  Certain providers are statewide resources and
792	essential providers for all managed care plans in all regions.
793	All managed care plans must include these essential providers in
794	their networks. Statewide essential providers include:
795	1.  Faculty plans of Florida medical schools.
796	2.  Regional perinatal intensive care centers as defined in
797	s. 383.16(2).
798	3.  Hospitals licensed as specialty children's hospitals as
799	defined in s. 395.002(28).
800
801	Managed care plans that have not contracted with all statewide
802	essential providers in all regions as of the first date of
803	recipient enrollment must continue to negotiate in good faith.
804	Payments to physicians on the faculty of nonparticipating
805	Florida medical schools shall be made at the applicable Medicaid
806	rate. Payments for services rendered by a regional perinatal
807	intensive care centers shall be made at the applicable Medicaid
808	rate as of the first day of the contract between the agency and
809	the plan. Payments to nonparticipating specialty children's
810	hospitals shall equal the highest rate established by contract
811	between that provider and any other Medicaid managed care plan.
812	(c)  After 12 months of active participation in a plan's
813	network, the plan may exclude any essential provider from the
814	network for failure to meet quality or performance criteria. If
815	the plan excludes an essential provider from the plan, the plan
816	must provide written notice to all recipients who have chosen
817	that provider for care. The notice shall be provided at least 30
818	days before the effective date of the exclusion.
819	(d)  Each managed care plan must offer a network contract
820	to each home medical equipment and supplies provider in the
821	region which meets quality and fraud prevention and detection
822	standards established by the plan and which agrees to accept the
823	lowest price previously negotiated between the plan and another
824	such provider.
825	(2)  FLORIDA MEDICAL SCHOOLS QUALITY NETWORK.-The agency
826	shall contract with a single organization representing medical
827	schools and graduate medical education programs in the state for
828	the purpose of establishing an active and ongoing program to
829	improve clinical outcomes in all managed care plans. Contracted
830	activities must support greater clinical integration for
831	Medicaid enrollees through interdependent and cooperative
832	efforts of all providers participating in managed care plans.
833	The agency shall support these activities with certified public
834	expenditures and any earned federal matching funds and shall
835	seek any plan amendments or waivers necessary to comply with
836	this subsection. To be eligible to participate in the quality
837	network, a medical school must contract with each managed care
838	plan in its region.
839	(3)  PERFORMANCE MEASUREMENT.-Each managed care plan shall
840	monitor the quality and performance of each participating
841	provider. At the beginning of the contract period, each plan
842	shall notify all its network providers of the metrics used by
843	the plan for evaluating the provider's performance and
844	determining continued participation in the network.
845	(4)  MOMCARE NETWORK.-
846	(a)  The agency shall contract with an administrative
847	services organization representing all Healthy Start Coalitions
848	providing risk appropriate care coordination and other services
849	in accordance with a federal waiver and pursuant to s. 409.906.
850	The contract shall require the network of coalitions to provide
851	choice counseling, education, risk-reduction and case management
852	services, and quality assurance for all enrollees of the waiver.
853	The agency shall evaluate the impact of the MomCare network by
854	monitoring each plan's performance on specific measures to
855	determine the adequacy, timeliness, and quality of services for
856	pregnant women and infants. The agency shall support this
857	contract with certified public expenditures of general revenue
858	appropriated for Healthy Start services and any earned federal
859	matching funds.
860	(b)  Each managed care plan shall establish specific
861	programs and procedures to improve pregnancy outcomes and infant
862	health, including, but not limited to, coordination with the
863	Healthy Start program, immunization programs, and referral to
864	the Special Supplemental Nutrition Program for Women, Infants,
865	and Children, and the Children's Medical Services program for
866	children with special health care needs. Each plan's programs
867	and procedures shall include agreements with each local Healthy
868	Start Coalition in the region to provide risk-appropriate care
869	coordination for pregnant women and infants, consistent with
870	agency policies and the MomCare network.
871	(5)  TRANSPORTATION.-Nonemergency transportation services
872	shall be provided pursuant to a single, statewide contract
873	between the agency and the Commission for the Transportation
874	Disadvantaged. The agency shall establish performance standards
875	in the contract and shall evaluate the performance of the
876	Commission for the Transportation Disadvantaged. For the
877	purposes of this subsection, the term "nonemergency
878	transportation" does not include transportation by ambulance and
879	any medical services received during transport.
880	(6)  SCREENING RATE.-After the end of the second contract
881	year, each managed care plan shall achieve an annual Early and
882	Periodic Screening, Diagnosis, and Treatment Service screening
883	rate of at least 80 percent of those recipients continuously
884	enrolled for at least 8 months.
885	(7)  PROVIDER PAYMENT.-Managed care plan and hospitals
886	shall negotiate mutually acceptable rates, methods, and terms of
887	payment. For rates, methods, and terms of payment negotiated
888	after the contract between the agency and the plan is executed,
889	plans shall pay hospitals, at a minimum, the rate the agency
890	would have paid on the first day of the contract between the
891	provider and the plan. Such payments to hospitals may not exceed
892	120 percent of the rate the agency would have paid on the first
893	day of the contract between the provider and the plan, unless
894	specifically approved by the agency. Payment rates may be
895	updated periodically.
896	(8)  MEDICALLY NEEDY ENROLLEES.-Each managed care plan
897	shall accept any medically needy recipient who selects or is
898	assigned to the plan and provide that recipient with continuous
899	enrollment for 12 months. After the first month of qualifying as
900	a medically needy recipient and enrolling in a plan, and
901	contingent upon federal approval, the enrollee shall pay the
902	plan a portion of the monthly premium equal to the enrollee's
903	share of the cost as determined by the department. The agency
904	shall pay any remaining portion of the monthly premium. Plans
905	are not obligated to pay claims for medically needy patients for
906	services provided before enrollment in the plan. Medically needy
907	patients are responsible for payment of incurred claims that are
908	used to determine eligibility. Plans must provide a grace period
909	of at least 90 days before disenrolling recipients who fail to
910	pay their shares of the premium.
911	Section 17.  Section 409.976, Florida Statutes, is created
912	to read:
913	409.976  Managed care plan payment.-In addition to the
914	payment provisions of s. 409.968, the agency shall provide
915	payment to plans in the managed medical assistance program
916	pursuant to this section.
917	(1)  Prepaid payment rates shall be negotiated between the
918	agency and the eligible plans as part of the procurement process
919	described in s. 409.966.
920	(2)  The agency shall establish payment rates for statewide
921	inpatient psychiatric programs. Payments to managed care plans
922	shall be reconciled to reimburse actual payments to statewide
923	inpatient psychiatric programs.
924	Section 18.  Section 409.977, Florida Statutes, is created
925	to read:
926	409.977  Choice counseling and enrollment.-
927	(1)  CHOICE COUNSELING.-In addition to the choice
928	counseling information required by s. 409.969, the agency shall
929	make available clear and easily understandable choice
930	information to Medicaid recipients that includes information
931	about the cost-sharing requirements of each managed care plan.
932	(2)  AUTOMATIC ENROLLMENT.-The agency shall automatically
933	enroll into a managed care plan those Medicaid recipients who do
934	not voluntarily choose a plan pursuant to s. 409.969. The agency
935	shall automatically enroll recipients in plans that meet or
936	exceed the performance or quality standards established pursuant
937	to s. 409.967 and may not automatically enroll recipients in a
938	plan that is deficient in those performance or quality
939	standards. When a specialty plan is available to accommodate a
940	specific condition or diagnosis of a recipient, the agency shall
941	assign the recipient to that plan. In the first year of the
942	first contract term only, if a recipient was previously enrolled
943	in a plan that is still available in the region, the agency
944	shall automatically enroll the recipient in that plan unless an
945	applicable specialty plan is available. Except as otherwise
946	provided in this part, the agency may not engage in practices
947	that are designed to favor one managed care plan over another.
948	When automatically enrolling recipients in managed care plans,
949	the agency shall automatically enroll based on the following
950	criteria:
951	(a)  Whether the plan has sufficient network capacity to
952	meet the needs of the recipients.
953	(b)  Whether the recipient has previously received services
954	from one of the plan's primary care providers.
955	(c)  Whether primary care providers in one plan are more
956	geographically accessible to the recipient's residence than
957	those in other plans.
958	(3)  OPT-OUT OPTION.-The agency shall develop a process to
959	enable any recipient with access to employer-sponsored health
960	care coverage to opt out of all managed care plans and to use
961	Medicaid financial assistance to pay for the recipient's share
962	of the cost in such employer-sponsored coverage. Contingent upon
963	federal approval, the agency shall also enable recipients with
964	access to other insurance or related products providing access
965	to health care services created pursuant to state law, including
966	any product available under the Florida Health Choices Program,
967	or any health exchange, to opt out. The amount of financial
968	assistance provided for each recipient may not exceed the amount
969	of the Medicaid premium that would have been paid to a managed
970	care plan for that recipient.
971	Section 19.  Section 409.978, Florida Statutes, is created
972	to read:
973	409.978  Long-term care managed care program.-
974	(1)  Pursuant to s. 409.963, the agency shall administer
975	the long-term care managed care program described in ss.
976	409.978-409.985, but may delegate specific duties and
977	responsibilities for the program to the Department of Elderly
978	Affairs and other state agencies. By July 1, 2012, the agency
979	shall begin implementation of the statewide long-term care
980	managed care program, with full implementation in all regions by
981	October 1, 2013.
982	(2)  The agency shall make payments for long-term care,
983	including home and community-based services, using a managed
984	care model. Unless otherwise specified, the provisions of ss.
985	409.961-409.97 apply to the long-term care managed care program.
986	(3)  The Department of Elderly Affairs shall assist the
987	agency to develop specifications for use in the invitation to
988	negotiate and the model contract, determine clinical eligibility
989	for enrollment in managed long-term care plans, monitor plan
990	performance and measure quality of service delivery, assist
991	clients and families to address complaints with the plans,
992	facilitate working relationships between plans and providers
993	serving elders and disabled adults, and perform other functions
994	specified in a memorandum of agreement.
995	Section 20.  Section 409.979, Florida Statutes, is created
996	to read:
997	409.979  Eligibility.-
998	(1)  Medicaid recipients who meet all of the following
999	criteria are eligible to receive long-term care services and
1000	must receive long-term care services by participating in the
1001	long-term care managed care program. The recipient must be:
1002	(a)  Sixty-five years of age or older or eligible for
1003	Medicaid by reason of a disability.
1004	(b)  Determined by the Comprehensive Assessment Review and
1005	Evaluation for Long-Term Care Services (CARES) Program to
1006	require nursing facility care as defined in s. 409.985(3).
1007	(2)  Medicaid recipients who, on the date long-term care
1008	managed care plans become available in their region, reside in a
1009	nursing home facility or are enrolled in one of the following
1010	long-term care Medicaid waiver programs are eligible to
1011	participate in the long-term care managed care program for up to
1012	24 months without being reevaluated for their need of nursing
1013	facility care as defined in s. 409.985(3):
1014	(a)  The Assisted Living for the Frail Elderly Waiver.
1015	(b)  The Aged and Disabled Adult Waiver.
1016	(c)  The Adult Day Health Care Waiver.
1017	(d)  The Consumer-Directed Care Plus Program as described
1018	in s. 409.221.
1019	(e)  The Program of All-inclusive Care for the Elderly.
1020	(f)  The long-term care community-based diversion pilot
1021	project as described in s. 430.705.
1022	(g)  The Channeling Services Waiver for Frail Elders.
1023	(3)  The Department of Elderly Affairs shall make offers
1024	for enrollment to eligible individuals based on a wait-list
1025	prioritization and subject to availability of funds. Before
1026	enrollment offers, the department shall determine that
1027	sufficient funds exist to support additional enrollment into
1028	plans.
1029	Section 21.  Section 409.98, Florida Statutes, is created
1030	to read:
1031	409.98  Benefits.-Long-term care plans shall cover, at a
1032	minimum, the following:
1033	(1)  Nursing facility care.
1034	(2)  Services provided in assisted living facilities.
1035	(3)  Hospice.
1036	(4)  Adult day care.
1037	(5)  Medical equipment and supplies, including incontinence
1038	supplies.
1039	(6)  Personal care.
1040	(7)  Home accessibility adaptation.
1041	(8)  Behavior management.
1042	(9)  Home-delivered meals.
1043	(10)  Case management.
1044	(11)  Therapies:
1045	(a)  Occupational therapy.
1046	(b)  Speech therapy.
1047	(c)  Respiratory therapy.
1048	(d)  Physical therapy.
1049	(12)  Intermittent and skilled nursing.
1050	(13)  Medication administration.
1051	(14)  Medication management.
1052	(15)  Nutritional assessment and risk reduction.
1053	(16)  Caregiver training.
1054	(17)  Respite care.
1055	(18)  Transportation.
1056	(19)  Personal emergency response system.
1057	Section 22.  Section 409.981, Florida Statutes, is created
1058	to read:
1059	409.981  Eligible plans.-
1060	(1)  ELIGIBLE PLANS.-Provider service networks must be
1061	long-term care provider service networks. Other eligible plans
1062	may either be long-term care plans or comprehensive long-term
1063	care plans.
1064	(2)  ELIGIBLE PLAN SELECTION.-The agency shall select
1065	eligible plans through the procurement process described in s.
1066	409.966. The agency shall provide notice of invitations to
1067	negotiate no later than July 1, 2012.
1068	(a)  The agency shall procure two plans for Region I. At
1069	least one plan shall be a provider service network, if any
1070	provider service network submits a responsive bid.
1071	(b)  The agency shall procure two plans for Region II. At
1072	least one plan shall be a provider service network, if any
1073	provider service network submits a responsive bid.
1074	(c)  The agency shall procure at least two plans and no
1075	more than four plans for Region III. At least one plan shall be
1076	a provider service network, if any provider service network
1077	submits a responsive bid.
1078	(d)  The agency shall procure at least two plans and no
1079	more than four plans for Region IV. At least one plan shall be a
1080	provider service network, if any provider service network
1081	submits a responsive bid.
1082	(e)  The agency shall procure at least four plans and no
1083	more than eight plans for Region V. At least two plans shall be
1084	provider service networks, if any two provider service networks
1085	submit responsive bids.
1086	(f)  The agency shall procure at least four plans and no
1087	more than seven plans for Region VI. At least two plans shall be
1088	provider service networks, if any two provider service networks
1089	submit responsive bids.
1090	(g)  The agency shall procure two plans for Region VII. At
1091	least one plan shall be a provider service network, if any
1092	provider service network submits a responsive bid.
1093	(h)  The agency shall procure at least two plans and no
1094	more than four plans for Region VIII. At least one plan shall be
1095	a provider service network, if any provider service network
1096	submits a responsive bid.
1097	(i)  The agency shall procure three plans for Region IX. At
1098	least one plan shall be a provider service network, if any
1099	provider service network submits a responsive bid.
1100	(j)  The agency shall procure at least two plans and no
1101	more than four plans for Region X. At least one plan shall be a
1102	provider service network, if any provider service network
1103	submits a responsive bid.
1104	(k)  The agency shall procure at least five plans and no
1105	more than nine plans for Region XI. At least two plans shall be
1106	provider service networks, if any two provider service networks
1107	submit a responsive bid.
1108
1109

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