Florida Senate - 2012                                    SB 1988
       
       
       
       By the Committee on Budget
       
       
       
       
       576-03468-12                                          20121988__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 383.15, F.S.;
    3         revising legislative intent relating to funding for
    4         regional perinatal intensive care centers; amending s.
    5         409.8132, F.S.; revising a cross-reference; amending
    6         s. 409.814, F.S.; deleting a prohibition preventing
    7         children who are eligible for coverage under a state
    8         health benefit plan from being eligible for services
    9         provided through the subsidized program; revising
   10         cross-references; requiring a completed application,
   11         including a clinical screening, for enrollment in the
   12         Children’s Medical Services Network; amending s.
   13         409.902, F.S.; providing for the creation an Internet
   14         based system for determining eligibility for the
   15         Medicaid and Kidcare programs, contingent on the
   16         appropriation; providing system business objectives
   17         and requirements; requiring the Department of Children
   18         and Family Services to develop the system; requiring
   19         the system to be completed and implemented by
   20         specified dates; providing a governance structure
   21         pending implementation of the program, including an
   22         executive steering committee and a project management
   23         team; amending s. 409.905, F.S.; limiting the number
   24         of paid hospital emergency department visits for
   25         nonpregnant adults; authorizing the Agency for Health
   26         Care Administration to request approval by the
   27         Legislative Budget Commission of hospital rate
   28         adjustments; providing components for the agency’s
   29         plan to convert inpatient hospital rates to a
   30         prospective payment system; revising dates for
   31         submitting the plan and implementing the system;
   32         amending 409.908, F.S.; conforming a cross-reference;
   33         authorizing the Agency for Health Care Administration
   34         to accept voluntary intergovernmental transfers of
   35         local taxes and other qualified revenue from counties,
   36         municipalities, or special taxing districts in order
   37         to fund certain costs; limiting the use of
   38         intergovernmental transfer funds for hospital
   39         reimbursements; prohibiting the inclusion of certain
   40         hospital costs in the capitation rates for prepaid
   41         health plans; providing for the inclusion of certain
   42         hospital costs in capitation rates for prepaid health
   43         plans if funded by intergovernmental transfers;
   44         incorporating a transferred provision; amending s.
   45         409.911, F.S.; updating references to data used for
   46         calculations in the disproportionate share program;
   47         repealing s. 409.9112, F.S., relating to the
   48         disproportionate share program for regional perinatal
   49         intensive care centers; amending s. 409.9113, F.S.;
   50         conforming a cross-reference; authorizing the agency
   51         to distribute moneys in the disproportionate share
   52         program for teaching hospitals; repealing s. 409.9117,
   53         F.S., relating to the primary care disproportionate
   54         share program; amending s. 409.912, F.S.; revising the
   55         conditions for contracting with certain managed care
   56         plans for behavioral health care services; deleting
   57         requirements for assigning certain MediPass recipients
   58         to managed care plans for behavioral health care
   59         services; requiring the assignment of recipients to
   60         provider service networks; amending s. 409.9121, F.S.;
   61         revising legislative findings relating to the Medicaid
   62         program; amending s. 409.9122, F.S.; providing
   63         criteria and procedures relating to recipient
   64         enrollment choice and assignment among Medicaid
   65         managed care plans and MediPass; deleting transferred
   66         provisions relating to school districts; amending s.
   67         409.9123, F.S.; revising provisions relating to the
   68         publication of quality measures for managed care
   69         plans; reenacting s. 409.9126, F.S., relating to
   70         children with special health care needs; amending s.
   71         409.915, F.S.; specifying criteria for determining a
   72         county’s eligible recipients; providing for payment of
   73         billings that have been denied by the county from the
   74         county’s tax revenues; providing for refunds;
   75         providing for the transfer of certain refunds to the
   76         Lawton Chiles Endowment Fund; amending ss. 409.979 and
   77         430.04, F.S.; deleting references to the Adult Day
   78         Health Care Waiver in provisions relating to Medicaid
   79         eligibility and duties and responsibilities of the
   80         Department of Elderly Affairs; amending s. 31, chapter
   81         2009-223, Laws of Florida, as amended, and
   82         redesignating that section as s. 409.9132, F.S.;
   83         expanding the home health agency monitoring pilot
   84         project statewide; amending s. 32, chapter 2009-223,
   85         Laws of Florida, and redesignating that section as s.
   86         409.9133, F.S.; expanding the comprehensive care
   87         management pilot project for home health services
   88         statewide and including private-duty nursing and
   89         personal care services; providing an additional site
   90         in Broward County for the Program of All-Inclusive
   91         Care for the Elderly; providing that a public hospital
   92         located in trauma service area 2 which has local funds
   93         available for intergovernmental transfers may have its
   94         reimbursement rates adjusted after a certain date;
   95         providing effective dates.
   96  
   97  Be It Enacted by the Legislature of the State of Florida:
   98  
   99         Section 1. Section 383.15, Florida Statutes, is amended to
  100  read:
  101         383.15 Legislative intent; perinatal intensive care
  102  services.—The Legislature finds and declares that many perinatal
  103  diseases and disabilities have debilitating, costly, and often
  104  fatal consequences if left untreated. Many of these debilitating
  105  conditions could be prevented or ameliorated if services were
  106  available to the public through a regional perinatal intensive
  107  care centers program. Perinatal intensive care services are
  108  critical to the well-being and development of a healthy society
  109  and represent a constructive, cost-beneficial, and essential
  110  investment in the future of our state. Therefore, it is the
  111  intent of the Legislature to develop a regional perinatal
  112  intensive care centers program. The Legislature further intends
  113  that development of such a regional perinatal intensive care
  114  centers program shall not reduce or dilute the current financial
  115  commitment of the state, as indicated through appropriation, to
  116  the existing regional perinatal intensive care centers. It is
  117  also the intent of the Legislature that any additional centers
  118  regional perinatal intensive care center authorized under s.
  119  383.19 after July 1, 1993, shall not receive payments under a
  120  disproportionate share program for regional perinatal intensive
  121  care centers authorized under chapter 409 s. 409.9112 unless
  122  specific appropriations are provided to expand such payments to
  123  additional hospitals.
  124         Section 2. Paragraph (b) of subsection (6) of section
  125  409.8132, Florida Statutes, is amended to read:
  126         409.8132 Medikids program component.—
  127         (6) ELIGIBILITY.—
  128         (b) The provisions of s. 409.814 apply 409.814(3), (4),
  129  (5), and (6) shall be applicable to the Medikids program.
  130         Section 3. Section 409.814, Florida Statutes, is amended to
  131  read:
  132         409.814 Eligibility.—A child who has not reached 19 years
  133  of age whose family income is equal to or below 200 percent of
  134  the federal poverty level is eligible for the Florida Kidcare
  135  program as provided in this section. For enrollment in the
  136  Children’s Medical Services Network, a complete application
  137  includes the medical or behavioral health screening. If,
  138  subsequently, an enrolled individual is determined to be
  139  ineligible for coverage, he or she must be immediately be
  140  disenrolled from the respective Florida Kidcare program
  141  component.
  142         (1) A child who is eligible for Medicaid coverage under s.
  143  409.903 or s. 409.904 must be enrolled in Medicaid and is not
  144  eligible to receive health benefits under any other health
  145  benefits coverage authorized under the Florida Kidcare program.
  146         (2) A child who is not eligible for Medicaid, but who is
  147  eligible for the Florida Kidcare program, may obtain health
  148  benefits coverage under any of the other components listed in s.
  149  409.813 if such coverage is approved and available in the county
  150  in which the child resides.
  151         (3) A Title XXI-funded child who is eligible for the
  152  Florida Kidcare program who is a child with special health care
  153  needs, as determined through a medical or behavioral screening
  154  instrument, is eligible for health benefits coverage from and
  155  shall be assigned to and may opt out of the Children’s Medical
  156  Services Network.
  157         (4) The following children are not eligible to receive
  158  Title XXI-funded premium assistance for health benefits coverage
  159  under the Florida Kidcare program, except under Medicaid if the
  160  child would have been eligible for Medicaid under s. 409.903 or
  161  s. 409.904 as of June 1, 1997:
  162         (a) A child who is eligible for coverage under a state
  163  health benefit plan on the basis of a family member’s employment
  164  with a public agency in the state.
  165         (a)(b) A child who is covered under a family member’s group
  166  health benefit plan or under other private or employer health
  167  insurance coverage, if the cost of the child’s participation is
  168  not greater than 5 percent of the family’s income. If a child is
  169  otherwise eligible for a subsidy under the Florida Kidcare
  170  program and the cost of the child’s participation in the family
  171  member’s health insurance benefit plan is greater than 5 percent
  172  of the family’s income, the child may enroll in the appropriate
  173  subsidized Kidcare program.
  174         (b)(c) A child who is seeking premium assistance for the
  175  Florida Kidcare program through employer-sponsored group
  176  coverage, if the child has been covered by the same employer’s
  177  group coverage during the 60 days before the family submitted
  178  prior to the family’s submitting an application for
  179  determination of eligibility under the program.
  180         (c)(d) A child who is an alien, but who does not meet the
  181  definition of qualified alien, in the United States.
  182         (d)(e) A child who is an inmate of a public institution or
  183  a patient in an institution for mental diseases.
  184         (e)(f) A child who is otherwise eligible for premium
  185  assistance for the Florida Kidcare program and has had his or
  186  her coverage in an employer-sponsored or private health benefit
  187  plan voluntarily canceled in the last 60 days, except those
  188  children whose coverage was voluntarily canceled for good cause,
  189  including, but not limited to, the following circumstances:
  190         1. The cost of participation in an employer-sponsored
  191  health benefit plan is greater than 5 percent of the family’s
  192  income;
  193         2. The parent lost a job that provided an employer
  194  sponsored health benefit plan for children;
  195         3. The parent who had health benefits coverage for the
  196  child is deceased;
  197         4. The child has a medical condition that, without medical
  198  care, would cause serious disability, loss of function, or
  199  death;
  200         5. The employer of the parent canceled health benefits
  201  coverage for children;
  202         6. The child’s health benefits coverage ended because the
  203  child reached the maximum lifetime coverage amount;
  204         7. The child has exhausted coverage under a COBRA
  205  continuation provision;
  206         8. The health benefits coverage does not cover the child’s
  207  health care needs; or
  208         9. Domestic violence led to loss of coverage.
  209         (5) A child who is otherwise eligible for the Florida
  210  Kidcare program and who has a preexisting condition that
  211  prevents coverage under another insurance plan as described in
  212  paragraph (4)(a) (4)(b) which would have disqualified the child
  213  for the Florida Kidcare program if the child were able to enroll
  214  in the plan is shall be eligible for Florida Kidcare coverage
  215  when enrollment is possible.
  216         (6) A child whose family income is above 200 percent of the
  217  federal poverty level or a child who is excluded under the
  218  provisions of subsection (4) may participate in the Florida
  219  Kidcare program as provided in s. 409.8132 or, if the child is
  220  ineligible for Medikids by reason of age, in the Florida Healthy
  221  Kids program, subject to the following provisions:
  222         (a) The family is not eligible for premium assistance
  223  payments and must pay the full cost of the premium, including
  224  any administrative costs.
  225         (b) The board of directors of the Florida Healthy Kids
  226  Corporation may offer a reduced benefit package to these
  227  children in order to limit program costs for such families.
  228         (7) Once a child is enrolled in the Florida Kidcare
  229  program, the child is eligible for coverage under the program
  230  for 12 months without a redetermination or reverification of
  231  eligibility, if the family continues to pay the applicable
  232  premium. Eligibility for program components funded through Title
  233  XXI of the Social Security Act terminates shall terminate when a
  234  child attains the age of 19. A child who has not attained the
  235  age of 5 and who has been determined eligible for the Medicaid
  236  program is eligible for coverage for 12 months without a
  237  redetermination or reverification of eligibility.
  238         (8) When determining or reviewing a child’s eligibility
  239  under the Florida Kidcare program, the applicant shall be
  240  provided with reasonable notice of changes in eligibility which
  241  may affect enrollment in one or more of the program components.
  242  If When a transition from one program component to another is
  243  authorized, there shall be cooperation between the program
  244  components and the affected family which promotes continuity of
  245  health care coverage. Any authorized transfers must be managed
  246  within the program’s overall appropriated or authorized levels
  247  of funding. Each component of the program shall establish a
  248  reserve to ensure that transfers between components will be
  249  accomplished within current year appropriations. These reserves
  250  shall be reviewed by each convening of the Social Services
  251  Estimating Conference to determine the adequacy of such reserves
  252  to meet actual experience.
  253         (9) In determining the eligibility of a child, an assets
  254  test is not required. Each applicant shall provide documentation
  255  during the application process and the redetermination process,
  256  including, but not limited to, the following:
  257         (a) Each applicant’s Proof of family income, which must
  258  shall be verified electronically to determine financial
  259  eligibility for the Florida Kidcare program. Written
  260  documentation, which may include wages and earnings statements
  261  or pay stubs, W-2 forms, or a copy of the applicant’s most
  262  recent federal income tax return, is shall be required only if
  263  the electronic verification is not available or does not
  264  substantiate the applicant’s income.
  265         (b) Each applicant shall provide A statement from all
  266  applicable, employed family members that:
  267         1. Their employers do not sponsor health benefit plans for
  268  employees;
  269         2. The potential enrollee is not covered by an employer
  270  sponsored health benefit plan; or
  271         3. The potential enrollee is covered by an employer
  272  sponsored health benefit plan and the cost of the employer
  273  sponsored health benefit plan is more than 5 percent of the
  274  family’s income.
  275         (c) To enroll in the Children’s Medical Services Network, a
  276  completed application, including a clinical screening.
  277         (10) Subject to paragraph (4)(a) (4)(b), the Florida
  278  Kidcare program shall withhold benefits from an enrollee if the
  279  program obtains evidence that the enrollee is no longer
  280  eligible, submitted incorrect or fraudulent information in order
  281  to establish eligibility, or failed to provide verification of
  282  eligibility. The applicant or enrollee shall be notified that
  283  because of such evidence program benefits will be withheld
  284  unless the applicant or enrollee contacts a designated
  285  representative of the program by a specified date, which must be
  286  within 10 working days after the date of notice, to discuss and
  287  resolve the matter. The program shall make every effort to
  288  resolve the matter within a timeframe that will not cause
  289  benefits to be withheld from an eligible enrollee.
  290         (11) The following individuals may be subject to
  291  prosecution in accordance with s. 414.39:
  292         (a) An applicant obtaining or attempting to obtain benefits
  293  for a potential enrollee under the Florida Kidcare program if
  294  when the applicant knows or should have known that the potential
  295  enrollee does not qualify for the Florida Kidcare program.
  296         (b) An individual who assists an applicant in obtaining or
  297  attempting to obtain benefits for a potential enrollee under the
  298  Florida Kidcare program if when the individual knows or should
  299  have known that the potential enrollee does not qualify for the
  300  Florida Kidcare program.
  301         Section 4. Section 409.902, Florida Statutes, is amended to
  302  read:
  303         409.902 Designated single state agency; eligibility
  304  determinations payment requirements; program title; release of
  305  medical records.—
  306         (1) The Agency for Health Care Administration is designated
  307  as the single state agency authorized to make payments for
  308  medical assistance and related services under Title XIX of the
  309  Social Security Act. These payments shall be made, subject to
  310  any limitations or directions provided for in the General
  311  Appropriations Act, only for services included in the program,
  312  shall be made only on behalf of eligible individuals, and shall
  313  be made only to qualified providers in accordance with federal
  314  requirements for Title XIX of the Social Security Act and the
  315  provisions of state law. This program of medical assistance is
  316  designated the “Medicaid program.”
  317         (2) The Department of Children and Family Services is
  318  responsible for determining Medicaid eligibility determinations,
  319  including, but not limited to, policy, rules, and the agreement
  320  with the Social Security Administration for Medicaid eligibility
  321  determinations for Supplemental Security Income recipients, as
  322  well as the actual determination of eligibility. As a condition
  323  of Medicaid eligibility, subject to federal approval, the agency
  324  for Health Care Administration and the department must of
  325  Children and Family Services shall ensure that each recipient of
  326  Medicaid consents to the release of her or his medical records
  327  to the agency for Health Care Administration and the Medicaid
  328  Fraud Control Unit of the Department of Legal Affairs.
  329         (3)(2) Eligibility is restricted to United States citizens
  330  and to lawfully admitted noncitizens who meet the criteria
  331  provided in s. 414.095(3).
  332         (a) Citizenship or immigration status must be verified. For
  333  noncitizens, this includes verification of the validity of
  334  documents with the United States Citizenship and Immigration
  335  Services using the federal SAVE verification process.
  336         (b) State funds may not be used to provide medical services
  337  to individuals who do not meet the requirements of this
  338  subsection unless the services are necessary to treat an
  339  emergency medical condition or are for pregnant women. Such
  340  services are authorized only to the extent provided under
  341  federal law and in accordance with federal regulations as
  342  provided in 42 C.F.R. s. 440.255.
  343         (4) To the extent funds are appropriated, the department
  344  shall collaborate with the agency to develop an Internet-based
  345  system for determining eligibility for the Medicaid and Kidcare
  346  programs which complies with all applicable federal and state
  347  laws and requirements.
  348         (a) The system must accomplish the following primary
  349  business objectives:
  350         1. Provide individuals and families with a single access
  351  point to information that explains benefits, premiums, and cost
  352  sharing available through Medicaid, Kidcare, or any other state
  353  or federal health insurance exchange.
  354         2. Enable timely, accurate, and efficient enrollment of
  355  eligible persons into available assistance programs.
  356         3. Prevent eligibility fraud.
  357         4. Allow for detailed financial analysis of eligibility
  358  based cost drivers.
  359         (b) The system must include, but need not be limited to,
  360  the following business and functional requirements:
  361         1. Allowing for the completion and submission of an online
  362  application for determining eligibility which accepts the use of
  363  electronic signatures.
  364         2.Including a process that enables automatic enrollment of
  365  qualified individuals into Medicaid, Kidcare, or any other state
  366  or federal exchange that offers cost-sharing benefits for the
  367  purchase of health insurance.
  368         3.Allowing for the determination of Medicaid eligibility
  369  based on modified adjusted gross income by using information
  370  submitted in the application and information accessed and
  371  verified through automated and secure interfaces with authorized
  372  databases.
  373         4.Including the ability to determine specific categories
  374  of Medicaid eligibility and interface with the Florida Medicaid
  375  Management Information System to support such determination,
  376  using federally approved assessment methodologies, of state and
  377  federal financial participation rates for persons in each
  378  eligibility category.
  379         5.Allowing for the accurate and timely processing of
  380  eligibility claims and adjudications.
  381         6.Aligning with and incorporating all applicable state and
  382  federal laws, requirements, and standards, including the
  383  information technology security requirements established under
  384  s. 282.318 and the accessibility standards established under
  385  part II of chapter 282.
  386         7.Producing transaction data, reports, and performance
  387  information that contributes to an evaluation of the program,
  388  continuous improvement in business operations, and increased
  389  transparency and accountability.
  390         (c)The department shall develop the system subject to
  391  approval by the Legislative Budget Commission and as required by
  392  the General Appropriations Act for the 2012-2013 fiscal year.
  393         (d)The system must be completed by October 1, 2013, and
  394  ready for implementation by January 1, 2014.
  395         (e)The department shall implement the following project
  396  governance structure until the system is implemented:
  397         1.The director of the department’s Economic Self
  398  Sufficiency Services Program Office shall have overall
  399  responsibility for the project.
  400         2.The project shall be governed by an executive steering
  401  committee composed of three department staff members appointed
  402  by the Secretary of Children and Family Services; three agency
  403  staff members, including at least two state Medicaid program
  404  staff members, appointed by the Secretary of Health Care
  405  Administration; and one staff member from Children’s Medical
  406  Services within the Department of Health appointed by the
  407  Surgeon General.
  408         3.The executive steering committee shall have overall
  409  responsibility for ensuring that the project meets its primary
  410  business objectives and shall:
  411         a.Provide management direction and support to the project
  412  management team.
  413         b.Review and approve any changes to the project’s scope,
  414  schedule, and budget.
  415         c.Review, approve, and determine whether to proceed with
  416  any major deliverable project.
  417         d.Recommend suspension or termination of the project to
  418  the Governor, the President of the Senate, and the Speaker of
  419  the House of Representatives if the committee determines that
  420  the primary business objectives cannot be achieved.
  421         4.A project management team shall be appointed by and work
  422  under the direction of the executive steering committee. The
  423  project management team shall:
  424         a.Provide planning, management, and oversight of the
  425  project.
  426         b.Submit an operational work plan and provide quarterly
  427  updates to the plan to the executive steering committee. The
  428  plan must specify project milestones, deliverables, and
  429  expenditures.
  430         c.Submit written monthly project status reports to the
  431  executive steering committee.
  432         Section 5. Subsections (5) of section 409.905, Florida
  433  Statutes, is amended to read:
  434         409.905 Mandatory Medicaid services.—The agency may make
  435  payments for the following services, which are required of the
  436  state by Title XIX of the Social Security Act, furnished by
  437  Medicaid providers to recipients who are determined to be
  438  eligible on the dates on which the services were provided. Any
  439  service under this section shall be provided only when medically
  440  necessary and in accordance with state and federal law.
  441  Mandatory services rendered by providers in mobile units to
  442  Medicaid recipients may be restricted by the agency. Nothing in
  443  this section shall be construed to prevent or limit the agency
  444  from adjusting fees, reimbursement rates, lengths of stay,
  445  number of visits, number of services, or any other adjustments
  446  necessary to comply with the availability of moneys and any
  447  limitations or directions provided for in the General
  448  Appropriations Act or chapter 216.
  449         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
  450  all covered services provided for the medical care and treatment
  451  of a Medicaid recipient who is admitted as an inpatient by a
  452  licensed physician or dentist to a hospital licensed under part
  453  I of chapter 395. However, the agency shall limit the payment
  454  for inpatient hospital services for a nonpregnant Medicaid
  455  recipient 21 years of age or older to 45 days per fiscal year or
  456  the number of days necessary to comply with the General
  457  Appropriations Act. Effective August 1, 2012, the agency shall
  458  limit payment for hospital emergency department visits for a
  459  nonpregnant recipient 21 years of age or older to six visits per
  460  fiscal year.
  461         (a) The agency may is authorized to implement reimbursement
  462  and utilization management reforms in order to comply with any
  463  limitations or directions in the General Appropriations Act,
  464  which may include, but are not limited to: prior authorization
  465  for inpatient psychiatric days; prior authorization for
  466  nonemergency hospital inpatient admissions for individuals 21
  467  years of age and older; authorization of emergency and urgent
  468  care admissions within 24 hours after admission; enhanced
  469  utilization and concurrent review programs for highly utilized
  470  services; reduction or elimination of covered days of service;
  471  adjusting reimbursement ceilings for variable costs; adjusting
  472  reimbursement ceilings for fixed and property costs; and
  473  implementing target rates of increase. The agency may limit
  474  prior authorization for hospital inpatient services to selected
  475  diagnosis-related groups, based on an analysis of the cost and
  476  potential for unnecessary hospitalizations represented by
  477  certain diagnoses. Admissions for normal delivery and newborns
  478  are exempt from requirements for prior authorization
  479  requirements. In implementing the provisions of this section
  480  related to prior authorization, the agency must shall ensure
  481  that the process for authorization is accessible 24 hours per
  482  day, 7 days per week and authorization is automatically granted
  483  if when not denied within 4 hours after the request.
  484  Authorization procedures must include steps for the review of
  485  denials. Upon implementing the prior authorization program for
  486  hospital inpatient services, the agency shall discontinue its
  487  hospital retrospective review program.
  488         (b) A licensed hospital maintained primarily for the care
  489  and treatment of patients having mental disorders or mental
  490  diseases is not eligible to participate in the hospital
  491  inpatient portion of the Medicaid program except as provided
  492  under in federal law. However, the department shall apply for a
  493  waiver, within 9 months after June 5, 1991, designed to provide
  494  hospitalization services for mental health reasons to children
  495  and adults in the most cost-effective and lowest cost setting
  496  possible. Such waiver must shall include a request for the
  497  opportunity to pay for care in hospitals known under federal law
  498  as “institutions for mental disease” or “IMD’s.” The waiver
  499  proposal may not shall propose no additional aggregate cost to
  500  the state or Federal Government, and shall be conducted in
  501  Hillsborough County, Highlands County, Hardee County, Manatee
  502  County, and Polk County. The waiver proposal may incorporate
  503  competitive bidding for hospital services, comprehensive
  504  brokering, prepaid capitated arrangements, or other mechanisms
  505  deemed by the department to show promise in reducing the cost of
  506  acute care and increasing the effectiveness of preventive care.
  507  When developing the waiver proposal, the department shall take
  508  into account price, quality, accessibility, linkages of the
  509  hospital to community services and family support programs,
  510  plans of the hospital to ensure the earliest discharge possible,
  511  and the comprehensiveness of the mental health and other health
  512  care services offered by participating providers.
  513         (c) The agency shall implement a methodology for
  514  establishing base reimbursement rates for each hospital based on
  515  allowable costs, as defined by the agency. Rates shall be
  516  calculated annually and take effect July 1 of each year based on
  517  the most recent complete and accurate cost report submitted by
  518  each hospital. Adjustments may not be made to the rates after
  519  September 30 of the state fiscal year in which the rate takes
  520  effect, except that the agency may request that adjustments be
  521  approved by the Legislative Budget Commission when needed due to
  522  insufficient commitments or collections of intergovernmental
  523  transfers under s. 409.908(1) or s. 409.908(4). Errors in cost
  524  reporting or calculation of rates discovered after September 30
  525  must be reconciled in a subsequent rate period. The agency may
  526  not make any adjustment to a hospital’s reimbursement rate more
  527  than 5 years after a hospital is notified of an audited rate
  528  established by the agency. The prohibition against requirement
  529  that the agency making may not make any adjustment to a
  530  hospital’s reimbursement rate more than 5 years after a hospital
  531  is notified of an audited rate established by the agency is
  532  remedial and applies shall apply to actions by providers
  533  involving Medicaid claims for hospital services. Hospital rates
  534  shall be subject to such limits or ceilings as may be
  535  established in law or described in the agency’s hospital
  536  reimbursement plan. Specific exemptions to the limits or
  537  ceilings may be provided in the General Appropriations Act.
  538         (d) The agency shall implement a comprehensive utilization
  539  management program for hospital neonatal intensive care stays in
  540  certain high-volume participating hospitals, select counties, or
  541  statewide, and replace existing hospital inpatient utilization
  542  management programs for neonatal intensive care admissions. The
  543  program shall be designed to manage the lengths of stay for
  544  children being treated in neonatal intensive care units and must
  545  seek the earliest medically appropriate discharge to the child’s
  546  home or other less costly treatment setting. The agency may
  547  competitively bid a contract for the selection of a qualified
  548  organization to provide neonatal intensive care utilization
  549  management services. The agency may seek federal waivers to
  550  implement this initiative.
  551         (e) The agency may develop and implement a program to
  552  reduce the number of hospital readmissions among the non
  553  Medicare population eligible in areas 9, 10, and 11.
  554         (f) The agency shall develop a plan to convert Medicaid
  555  inpatient hospital rates to a prospective payment system that
  556  categorizes each case into diagnosis-related groups (DRG) and
  557  assigns a payment weight based on the average resources used to
  558  treat Medicaid patients in that DRG. To the extent possible, the
  559  agency shall propose an adaptation of an existing prospective
  560  payment system, such as the one used by Medicare, and shall
  561  propose such adjustments as are necessary for the Medicaid
  562  population and to maintain budget neutrality for inpatient
  563  hospital expenditures.
  564         1. The plan must:
  565         a. Define and describe DRGs for inpatient hospital care
  566  specific to Medicaid in this state;
  567         b. Develop the use of resources needed for each DRG;
  568         c. Apply current statewide levels of funding to DRGs based
  569  on the associated resource value of DRGs. Current statewide
  570  funding levels shall be calculated both with and without the use
  571  of intergovernmental transfers;
  572         d. Calculate the current number of services provided in the
  573  Medicaid program based on DRGs defined under this subparagraph;
  574         e. Estimate the number of cases in each DRG for future
  575  years based on agency data and the official workload estimates
  576  of the Social Services Estimating Conference;
  577         f. Estimate potential funding for each hospital with a
  578  Medicaid provider agreement, based on the DRGs and estimated
  579  workload;
  580         g. Propose supplemental DRG payments to augment hospital
  581  reimbursements based on patient acuity and individual hospital
  582  characteristics, including classification as a children’s
  583  hospital, rural hospital, trauma center, burn unit, and other
  584  characteristics that could warrant higher reimbursements; and
  585         h. Estimate potential funding for each hospital with a
  586  Medicaid provider agreement for DRGs defined pursuant to this
  587  subparagraph and supplemental DRG payments using current funding
  588  levels, calculated both with and without the use of
  589  intergovernmental transfers.
  590         2. The agency, through a competitive procurement pursuant
  591  to chapter 287, shall engage a consultant with expertise and
  592  experience in the implementation of DRG systems for hospital
  593  reimbursement to develop the DRG plan under subparagraph 1.
  594         3. The agency shall submit the Medicaid DRG plan,
  595  identifying all steps necessary for the transition and any costs
  596  associated with plan implementation, to the Governor, the
  597  President of the Senate, and the Speaker of the House of
  598  Representatives no later than December 1, 2012 January 1, 2013.
  599  Upon receiving legislative authorization, the agency shall begin
  600  making the necessary changes to fiscal agent coding by June 1,
  601  2013, with a target date of November 1, 2013, for full
  602  implementation of the DRG system of hospital reimbursement. If,
  603  during implementation of this paragraph, the agency determines
  604  that these timeframes might not be achievable, the agency shall
  605  report to the Legislative Budget Commission the status of its
  606  implementation efforts, the reasons the timeframes might not be
  607  achievable, and proposals for new timeframes.
  608         Section 6. Paragraph (c) of subsection (1) of section
  609  409.908, Florida Statutes, is amended, paragraph (e) is added to
  610  that subsection, and subsections (4) and (21) of that section
  611  are amended, to read:
  612         409.908 Reimbursement of Medicaid providers.—Subject to
  613  specific appropriations, the agency shall reimburse Medicaid
  614  providers, in accordance with state and federal law, according
  615  to methodologies set forth in the rules of the agency and in
  616  policy manuals and handbooks incorporated by reference therein.
  617  These methodologies may include fee schedules, reimbursement
  618  methods based on cost reporting, negotiated fees, competitive
  619  bidding pursuant to s. 287.057, and other mechanisms the agency
  620  considers efficient and effective for purchasing services or
  621  goods on behalf of recipients. If a provider is reimbursed based
  622  on cost reporting and submits a cost report late and that cost
  623  report would have been used to set a lower reimbursement rate
  624  for a rate semester, then the provider’s rate for that semester
  625  shall be retroactively calculated using the new cost report, and
  626  full payment at the recalculated rate shall be effected
  627  retroactively. Medicare-granted extensions for filing cost
  628  reports, if applicable, shall also apply to Medicaid cost
  629  reports. Payment for Medicaid compensable services made on
  630  behalf of Medicaid eligible persons is subject to the
  631  availability of moneys and any limitations or directions
  632  provided for in the General Appropriations Act or chapter 216.
  633  Further, nothing in this section shall be construed to prevent
  634  or limit the agency from adjusting fees, reimbursement rates,
  635  lengths of stay, number of visits, or number of services, or
  636  making any other adjustments necessary to comply with the
  637  availability of moneys and any limitations or directions
  638  provided for in the General Appropriations Act, provided the
  639  adjustment is consistent with legislative intent.
  640         (1) Reimbursement to hospitals licensed under part I of
  641  chapter 395 must be made prospectively or on the basis of
  642  negotiation.
  643         (c) Hospitals that provide services to a disproportionate
  644  share of low-income Medicaid recipients, or that participate in
  645  the regional perinatal intensive care center program under
  646  chapter 383, or that participate in the statutory teaching
  647  hospital disproportionate share program may receive additional
  648  reimbursement. The total amount of payment for disproportionate
  649  share hospitals shall be fixed by the General Appropriations
  650  Act. The computation of these payments must be made in
  651  compliance with all federal regulations and the methodologies
  652  described in ss. 409.911, 409.9112, and 409.9113.
  653         (e) The agency may accept voluntary intergovernmental
  654  transfers of local taxes and other qualified revenue from
  655  counties, municipalities, or special taxing districts under
  656  paragraphs (a) and (b) or the General Appropriations Act for the
  657  purpose of funding the costs of special Medicaid payments to
  658  hospitals, the costs of exempting hospitals from reimbursement
  659  ceilings, or the costs of buying back hospital Medicaid trend
  660  adjustments authorized under the General Appropriations Act,
  661  except that the use of these intergovernmental transfers for
  662  fee-for-service payments to hospitals is limited to the
  663  proportionate use of such funds accepted by the agency under
  664  subsection (4). As used in this paragraph, the term
  665  “proportionate use” means that the use of intergovernmental
  666  transfer funds under this subsection must be in the same
  667  proportion to the use of such funds under subsection (4)
  668  relative to the need for funding hospital costs under each
  669  subsection.
  670         (4) Subject to any limitations or directions provided for
  671  in the General Appropriations Act, alternative health plans,
  672  health maintenance organizations, and prepaid health plans,
  673  including health maintenance organizations, prepaid provider
  674  service networks, and other capitated managed care plans, shall
  675  be reimbursed a fixed, prepaid amount negotiated, or
  676  competitively bid pursuant to s. 287.057, by the agency and
  677  prospectively paid to the provider monthly for each Medicaid
  678  recipient enrolled. The amount may not exceed the average amount
  679  the agency determines it would have paid, based on claims
  680  experience, for recipients in the same or similar category of
  681  eligibility. The agency shall calculate capitation rates on a
  682  regional basis and, beginning September 1, 1995, shall include
  683  age-band differentials in such calculations.
  684         (a) Effective September 1, 2012:
  685         1. The costs of special Medicaid payments to hospitals, the
  686  costs of exempting hospitals from reimbursement ceilings, and
  687  the costs of buying back hospital Medicaid trend adjustments
  688  authorized under the General Appropriations Act, which are
  689  funded through intergovernmental transfers, may not be included
  690  as inpatient or outpatient costs in the calculation of prepaid
  691  health plan capitations under this part. This provision must be
  692  construed so that inpatient hospital costs included in the
  693  calculation of prepaid health plan capitations are identical to
  694  those represented by county billing rates under s. 409.915.
  695         2. Prepaid health plans may not reimburse hospitals for the
  696  costs described in subparagraph 1., except that plans may
  697  contract with hospitals to pay inpatient per diems that are
  698  between 95 percent and 105 percent of the county billing rate.
  699  Hospitals and prepaid health plans may negotiate mutually
  700  acceptable higher rates for medically complex care.
  701         (b)Notwithstanding paragraph (a):
  702         1. In order to fund the inclusion of costs described in
  703  paragraph (a) in the calculation of capitations paid to prepaid
  704  health plans, the agency may accept voluntary intergovernmental
  705  transfers of local taxes and other qualified revenue from
  706  counties, municipalities, or special taxing districts. After
  707  securing commitments from counties, municipalities, or special
  708  taxing districts to contribute intergovernmental transfers for
  709  that purpose, the agency shall develop capitation payments for
  710  prepaid health plans which include the costs described in
  711  paragraph (a) if those components of the capitation are funded
  712  through intergovernmental transfers and not with general
  713  revenue. The rate-setting methodology must preserve federal
  714  matching funds for the intergovernmental transfers collected
  715  under this paragraph and result in actuarially sound rates. The
  716  agency has the discretion to perform this function using
  717  supplemental capitation payments.
  718         2. The amounts included in a prepaid health plan’s
  719  capitations or supplemental capitations under this paragraph for
  720  funding the costs described in paragraph (a) must be used
  721  exclusively by the prepaid health plan to enhance hospital
  722  payments and be calculated by the agency as accurately as
  723  possible to equal the costs described in paragraph (a) which the
  724  prepaid health plan actually incurs and for which
  725  intergovernmental transfers have been secured.
  726         (21) The agency shall reimburse school districts that which
  727  certify the state match pursuant to ss. 409.9071 and 1011.70 for
  728  the federal portion of the school district’s allowable costs to
  729  deliver the services, based on the reimbursement schedule. The
  730  school district shall determine the costs for delivering
  731  services as authorized in ss. 409.9071 and 1011.70 for which the
  732  state match will be certified.
  733         (a) School districts participating in the certified school
  734  match program pursuant to this subsection and s. 1011.70 shall
  735  be reimbursed by Medicaid, subject to the limitations of s.
  736  1011.70(1), for a Medicaid-eligible child participating in the
  737  services, as authorized under s. 1011.70 and as provided in s.
  738  409.9071, regardless of whether the child is enrolled in
  739  MediPass or a managed care plan. Managed care plans and school
  740  districts shall make good faith efforts to execute agreements
  741  regarding the coordinated provision of services authorized under
  742  s. 1011.70. County health departments delivering school-based
  743  services pursuant to ss. 381.0056 and 381.0057 shall be
  744  reimbursed by Medicaid for the federal share for a Medicaid
  745  eligible child who receives Medicaid-covered services in a
  746  school setting, regardless of whether the child is enrolled in
  747  MediPass or a managed care plan. Managed care plans and county
  748  health departments shall make good faith efforts to execute
  749  agreements regarding the coordinated provision of services to a
  750  Medicaid-eligible child. To ensure continuity of care for
  751  Medicaid patients, the agency, the Department of Health, and the
  752  Department of Education shall develop procedures for ensuring
  753  that a student’s managed care plan or MediPass primary care
  754  provider receives information relating to services provided in
  755  accordance with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
  756         (b) Reimbursement of school-based providers is contingent
  757  on such providers being enrolled as Medicaid providers and
  758  meeting the qualifications contained in 42 C.F.R. s. 440.110,
  759  unless otherwise waived by the federal Centers for Medicare and
  760  Medicaid Services Health Care Financing Administration. Speech
  761  therapy providers who are certified through the Department of
  762  Education pursuant to rule 6A-4.0176, Florida Administrative
  763  Code, are eligible for reimbursement for services that are
  764  provided on school premises. An Any employee of the school
  765  district who has been fingerprinted and has received a criminal
  766  background check in accordance with Department of Education
  767  rules and guidelines is shall be exempt from any agency
  768  requirements relating to criminal background checks.
  769         Section 7. Subsection (1), paragraphs (a) and (b) of
  770  subsection (2), and paragraph (d) of subsection (4) of section
  771  409.911, Florida Statutes, are amended to read:
  772         409.911 Disproportionate share program.—Subject to specific
  773  allocations established within the General Appropriations Act
  774  and any limitations established pursuant to chapter 216, the
  775  agency shall distribute, pursuant to this section, moneys to
  776  hospitals providing a disproportionate share of Medicaid or
  777  charity care services by making quarterly Medicaid payments as
  778  required. Notwithstanding the provisions of s. 409.915, counties
  779  are exempt from contributing toward the cost of this special
  780  reimbursement for hospitals serving a disproportionate share of
  781  low-income patients.
  782         (1) DEFINITIONS.—As used in this section, s. 409.9112, and
  783  the Florida Hospital Uniform Reporting System manual:
  784         (a) “Adjusted patient days” means the sum of acute care
  785  patient days and intensive care patient days as reported to the
  786  agency for Health Care Administration, divided by the ratio of
  787  inpatient revenues generated from acute, intensive, ambulatory,
  788  and ancillary patient services to gross revenues.
  789         (b) “Actual audited data” or “actual audited experience”
  790  means data reported to the agency for Health Care Administration
  791  which has been audited in accordance with generally accepted
  792  auditing standards by the agency or representatives under
  793  contract with the agency.
  794         (c) “Charity care” or “uncompensated charity care” means
  795  that portion of hospital charges reported to the agency for
  796  Health Care Administration for which there is no compensation,
  797  other than restricted or unrestricted revenues provided to a
  798  hospital by local governments or tax districts, regardless of
  799  the method of payment, for care provided to a patient whose
  800  family income for the 12 months preceding the determination is
  801  less than or equal to 200 percent of the federal poverty level,
  802  unless the amount of hospital charges due from the patient
  803  exceeds 25 percent of the annual family income. However, in no
  804  case shall the hospital charges for a patient whose family
  805  income exceeds four times the federal poverty level for a family
  806  of four may not be considered charity.
  807         (d) “Charity care days” means the sum of the deductions
  808  from revenues for charity care minus 50 percent of restricted
  809  and unrestricted revenues provided to a hospital by local
  810  governments or tax districts, divided by gross revenues per
  811  adjusted patient day.
  812         (e) “Hospital” means a health care institution licensed as
  813  a hospital pursuant to chapter 395, but does not include
  814  ambulatory surgical centers.
  815         (f) “Medicaid days” means the number of actual days
  816  attributable to Medicaid recipients patients as determined by
  817  the agency for Health Care Administration.
  818         (2) The agency for Health Care Administration shall use the
  819  following actual audited data to determine the Medicaid days and
  820  charity care to be used in calculating the disproportionate
  821  share payment:
  822         (a) The average of the 2004, 2005, and 2006 audited
  823  disproportionate share data to determine each hospital’s
  824  Medicaid days and charity care for the 2012-2013 2011-2012 state
  825  fiscal year.
  826         (b) If the agency for Health Care Administration does not
  827  have the prescribed 3 years of audited disproportionate share
  828  data as noted in paragraph (a) for a hospital, the agency shall
  829  use the average of the years of the audited disproportionate
  830  share data as noted in paragraph (a) which is available.
  831         (4) The following formulas shall be used to pay
  832  disproportionate share dollars to public hospitals:
  833         (d) Any nonstate government owned or operated hospital
  834  eligible for payments under this section on July 1, 2011,
  835  remains eligible for payments during the 2012-2013 2011-2012
  836  state fiscal year.
  837         Section 8. Section 409.9112, Florida Statutes, is repealed.
  838         Section 9. Section 409.9113, Florida Statutes, is amended
  839  to read:
  840         409.9113 Disproportionate share program for teaching
  841  hospitals.—In addition to the payments made under s. ss. 409.911
  842  and 409.9112, the agency shall make disproportionate share
  843  payments to teaching hospitals, as defined in s. 408.07, for
  844  their increased costs associated with medical education programs
  845  and for tertiary health care services provided to the indigent.
  846  This system of payments must conform to federal requirements and
  847  distribute funds in each fiscal year for which an appropriation
  848  is made by making quarterly Medicaid payments. Notwithstanding
  849  s. 409.915, counties are exempt from contributing toward the
  850  cost of this special reimbursement for hospitals serving a
  851  disproportionate share of low-income patients. For the 2011-2012
  852  state fiscal year, The agency shall distribute the moneys
  853  provided in the General Appropriations Act to statutorily
  854  defined teaching hospitals and family practice teaching
  855  hospitals, as defined in s. 395.805, pursuant to this section.
  856  The funds provided for statutorily defined teaching hospitals
  857  shall be distributed as provided in the General Appropriations
  858  Act. The funds provided for family practice teaching hospitals
  859  shall be distributed equally among family practice teaching
  860  hospitals.
  861         (1) On or before September 15 of each year, the agency
  862  shall calculate an allocation fraction to be used for
  863  distributing funds to statutory teaching hospitals. Subsequent
  864  to the end of each quarter of the state fiscal year, the agency
  865  shall distribute to each statutory teaching hospital an amount
  866  determined by multiplying one-fourth of the funds appropriated
  867  for this purpose by the Legislature times such hospital’s
  868  allocation fraction. The allocation fraction for each such
  869  hospital shall be determined by the sum of the following three
  870  primary factors, divided by three:
  871         (a) The number of nationally accredited graduate medical
  872  education programs offered by the hospital, including programs
  873  accredited by the Accreditation Council for Graduate Medical
  874  Education and the combined Internal Medicine and Pediatrics
  875  programs acceptable to both the American Board of Internal
  876  Medicine and the American Board of Pediatrics at the beginning
  877  of the state fiscal year preceding the date on which the
  878  allocation fraction is calculated. The numerical value of this
  879  factor is the fraction that the hospital represents of the total
  880  number of programs, where the total is computed for all
  881  statutory teaching hospitals.
  882         (b) The number of full-time equivalent trainees in the
  883  hospital, which comprises two components:
  884         1. The number of trainees enrolled in nationally accredited
  885  graduate medical education programs, as defined in paragraph
  886  (a). Full-time equivalents are computed using the fraction of
  887  the year during which each trainee is primarily assigned to the
  888  given institution, over the state fiscal year preceding the date
  889  on which the allocation fraction is calculated. The numerical
  890  value of this factor is the fraction that the hospital
  891  represents of the total number of full-time equivalent trainees
  892  enrolled in accredited graduate programs, where the total is
  893  computed for all statutory teaching hospitals.
  894         2. The number of medical students enrolled in accredited
  895  colleges of medicine and engaged in clinical activities,
  896  including required clinical clerkships and clinical electives.
  897  Full-time equivalents are computed using the fraction of the
  898  year during which each trainee is primarily assigned to the
  899  given institution, over the course of the state fiscal year
  900  preceding the date on which the allocation fraction is
  901  calculated. The numerical value of this factor is the fraction
  902  that the given hospital represents of the total number of full
  903  time equivalent students enrolled in accredited colleges of
  904  medicine, where the total is computed for all statutory teaching
  905  hospitals.
  906  
  907  The primary factor for full-time equivalent trainees is computed
  908  as the sum of these two components, divided by two.
  909         (c) A service index that comprises three components:
  910         1. The Agency for Health Care Administration Service Index,
  911  computed by applying the standard Service Inventory Scores
  912  established by the agency to services offered by the given
  913  hospital, as reported on Worksheet A-2 for the last fiscal year
  914  reported to the agency before the date on which the allocation
  915  fraction is calculated. The numerical value of this factor is
  916  the fraction that the given hospital represents of the total
  917  index values, where the total is computed for all statutory
  918  teaching hospitals.
  919         2. A volume-weighted service index, computed by applying
  920  the standard Service Inventory Scores established by the agency
  921  to the volume of each service, expressed in terms of the
  922  standard units of measure reported on Worksheet A-2 for the last
  923  fiscal year reported to the agency before the date on which the
  924  allocation factor is calculated. The numerical value of this
  925  factor is the fraction that the given hospital represents of the
  926  total volume-weighted service index values, where the total is
  927  computed for all statutory teaching hospitals.
  928         3. Total Medicaid payments to each hospital for direct
  929  inpatient and outpatient services during the fiscal year
  930  preceding the date on which the allocation factor is calculated.
  931  This includes payments made to each hospital for such services
  932  by Medicaid prepaid health plans, whether the plan was
  933  administered by the hospital or not. The numerical value of this
  934  factor is the fraction that each hospital represents of the
  935  total of such Medicaid payments, where the total is computed for
  936  all statutory teaching hospitals.
  937  
  938  The primary factor for the service index is computed as the sum
  939  of these three components, divided by three.
  940         (2) By October 1 of each year, the agency shall use the
  941  following formula to calculate the maximum additional
  942  disproportionate share payment for statutory teaching hospitals:
  943  
  944                           TAP = THAF x A                          
  945  
  946  Where:
  947         TAP = total additional payment.
  948         THAF = teaching hospital allocation factor.
  949         A = amount appropriated for a teaching hospital
  950  disproportionate share program.
  951         Section 10. Section 409.9117, Florida Statutes, is
  952  repealed.
  953         Section 11. Paragraphs (b) and (d) of subsection (4) of
  954  section 409.912, Florida Statutes, are amended to read:
  955         409.912 Cost-effective purchasing of health care.—The
  956  agency shall purchase goods and services for Medicaid recipients
  957  in the most cost-effective manner consistent with the delivery
  958  of quality medical care. To ensure that medical services are
  959  effectively utilized, the agency may, in any case, require a
  960  confirmation or second physician’s opinion of the correct
  961  diagnosis for purposes of authorizing future services under the
  962  Medicaid program. This section does not restrict access to
  963  emergency services or poststabilization care services as defined
  964  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  965  shall be rendered in a manner approved by the agency. The agency
  966  shall maximize the use of prepaid per capita and prepaid
  967  aggregate fixed-sum basis services when appropriate and other
  968  alternative service delivery and reimbursement methodologies,
  969  including competitive bidding pursuant to s. 287.057, designed
  970  to facilitate the cost-effective purchase of a case-managed
  971  continuum of care. The agency shall also require providers to
  972  minimize the exposure of recipients to the need for acute
  973  inpatient, custodial, and other institutional care and the
  974  inappropriate or unnecessary use of high-cost services. The
  975  agency shall contract with a vendor to monitor and evaluate the
  976  clinical practice patterns of providers in order to identify
  977  trends that are outside the normal practice patterns of a
  978  provider’s professional peers or the national guidelines of a
  979  provider’s professional association. The vendor must be able to
  980  provide information and counseling to a provider whose practice
  981  patterns are outside the norms, in consultation with the agency,
  982  to improve patient care and reduce inappropriate utilization.
  983  The agency may mandate prior authorization, drug therapy
  984  management, or disease management participation for certain
  985  populations of Medicaid beneficiaries, certain drug classes, or
  986  particular drugs to prevent fraud, abuse, overuse, and possible
  987  dangerous drug interactions. The Pharmaceutical and Therapeutics
  988  Committee shall make recommendations to the agency on drugs for
  989  which prior authorization is required. The agency shall inform
  990  the Pharmaceutical and Therapeutics Committee of its decisions
  991  regarding drugs subject to prior authorization. The agency is
  992  authorized to limit the entities it contracts with or enrolls as
  993  Medicaid providers by developing a provider network through
  994  provider credentialing. The agency may competitively bid single
  995  source-provider contracts if procurement of goods or services
  996  results in demonstrated cost savings to the state without
  997  limiting access to care. The agency may limit its network based
  998  on the assessment of beneficiary access to care, provider
  999  availability, provider quality standards, time and distance
 1000  standards for access to care, the cultural competence of the
 1001  provider network, demographic characteristics of Medicaid
 1002  beneficiaries, practice and provider-to-beneficiary standards,
 1003  appointment wait times, beneficiary use of services, provider
 1004  turnover, provider profiling, provider licensure history,
 1005  previous program integrity investigations and findings, peer
 1006  review, provider Medicaid policy and billing compliance records,
 1007  clinical and medical record audits, and other factors. Providers
 1008  are not entitled to enrollment in the Medicaid provider network.
 1009  The agency shall determine instances in which allowing Medicaid
 1010  beneficiaries to purchase durable medical equipment and other
 1011  goods is less expensive to the Medicaid program than long-term
 1012  rental of the equipment or goods. The agency may establish rules
 1013  to facilitate purchases in lieu of long-term rentals in order to
 1014  protect against fraud and abuse in the Medicaid program as
 1015  defined in s. 409.913. The agency may seek federal waivers
 1016  necessary to administer these policies.
 1017         (4) The agency may contract with:
 1018         (b) An entity that is providing comprehensive behavioral
 1019  health care services to certain Medicaid recipients through a
 1020  capitated, prepaid arrangement pursuant to the federal waiver
 1021  provided for by s. 409.905(5). Such entity must be licensed
 1022  under chapter 624, chapter 636, or chapter 641, or authorized
 1023  under paragraph (c) or paragraph (d), and must possess the
 1024  clinical systems and operational competence to manage risk and
 1025  provide comprehensive behavioral health care to Medicaid
 1026  recipients. As used in this paragraph, the term “comprehensive
 1027  behavioral health care services” means covered mental health and
 1028  substance abuse treatment services that are available to
 1029  Medicaid recipients. The secretary of the Department of Children
 1030  and Family Services shall approve provisions of procurements
 1031  related to children in the department’s care or custody before
 1032  enrolling such children in a prepaid behavioral health plan. Any
 1033  contract awarded under this paragraph must be competitively
 1034  procured. In developing the behavioral health care prepaid plan
 1035  procurement document, the agency must shall ensure that the
 1036  procurement document requires the contractor to develop and
 1037  implement a plan that ensures to ensure compliance with s.
 1038  394.4574 related to services provided to residents of licensed
 1039  assisted living facilities that hold a limited mental health
 1040  license. Except as provided in subparagraph 5., and except in
 1041  counties where the Medicaid managed care pilot program is
 1042  authorized pursuant to s. 409.91211, the agency shall seek
 1043  federal approval to contract with a single entity meeting these
 1044  requirements to provide comprehensive behavioral health care
 1045  services to all Medicaid recipients not enrolled in a Medicaid
 1046  managed care plan authorized under s. 409.91211, a provider
 1047  service network authorized under paragraph (d), or a Medicaid
 1048  health maintenance organization in an AHCA area. In an AHCA area
 1049  where the Medicaid managed care pilot program is authorized
 1050  pursuant to s. 409.91211 in one or more counties, the agency may
 1051  procure a contract with a single entity to serve the remaining
 1052  counties as an AHCA area or the remaining counties may be
 1053  included with an adjacent AHCA area and are subject to this
 1054  paragraph. Each entity must offer a sufficient choice of
 1055  providers in its network to ensure recipient access to care and
 1056  the opportunity to select a provider with whom they are
 1057  satisfied. The network must shall include all public mental
 1058  health hospitals. To ensure unimpaired access to behavioral
 1059  health care services by Medicaid recipients, all contracts
 1060  issued pursuant to this paragraph must require 80 percent of the
 1061  capitation paid to the managed care plan, including health
 1062  maintenance organizations and capitated provider service
 1063  networks, to be expended for the provision of behavioral health
 1064  care services. If the managed care plan expends less than 80
 1065  percent of the capitation paid for the provision of behavioral
 1066  health care services, the difference shall be returned to the
 1067  agency. The agency shall provide the plan with a certification
 1068  letter indicating the amount of capitation paid during each
 1069  calendar year for behavioral health care services pursuant to
 1070  this section. The agency may reimburse for substance abuse
 1071  treatment services on a fee-for-service basis until the agency
 1072  finds that adequate funds are available for capitated, prepaid
 1073  arrangements.
 1074         1. The agency shall modify the contracts with the entities
 1075  providing comprehensive inpatient and outpatient mental health
 1076  care services to Medicaid recipients in Hillsborough, Highlands,
 1077  Hardee, Manatee, and Polk Counties, to include substance abuse
 1078  treatment services.
 1079         2. Except as provided in subparagraph 5., the agency and
 1080  the Department of Children and Family Services shall contract
 1081  with managed care entities in each AHCA area except area 6 or
 1082  arrange to provide comprehensive inpatient and outpatient mental
 1083  health and substance abuse services through capitated prepaid
 1084  arrangements to all Medicaid recipients who are eligible to
 1085  participate in such plans under federal law and regulation. In
 1086  AHCA areas where eligible individuals number less than 150,000,
 1087  the agency shall contract with a single managed care plan to
 1088  provide comprehensive behavioral health services to all
 1089  recipients who are not enrolled in a Medicaid health maintenance
 1090  organization, a provider service network authorized under
 1091  paragraph (d), or a Medicaid capitated managed care plan
 1092  authorized under s. 409.91211. The agency may contract with more
 1093  than one comprehensive behavioral health provider to provide
 1094  care to recipients who are not enrolled in a Medicaid capitated
 1095  managed care plan authorized under s. 409.91211, a provider
 1096  service network authorized under paragraph (d), or a Medicaid
 1097  health maintenance organization in AHCA areas where the eligible
 1098  population exceeds 150,000. In an AHCA area where the Medicaid
 1099  managed care pilot program is authorized pursuant to s.
 1100  409.91211 in one or more counties, the agency may procure a
 1101  contract with a single entity to serve the remaining counties as
 1102  an AHCA area or the remaining counties may be included with an
 1103  adjacent AHCA area and shall be subject to this paragraph.
 1104  Contracts for comprehensive behavioral health providers awarded
 1105  pursuant to this section shall be competitively procured. Both
 1106  for-profit and not-for-profit corporations are eligible to
 1107  compete. Managed care plans contracting with the agency under
 1108  subsection (3) or paragraph (d) shall provide and receive
 1109  payment for the same comprehensive behavioral health benefits as
 1110  provided in AHCA rules, including handbooks incorporated by
 1111  reference. In AHCA area 11, prior to any fiscal year for which
 1112  the agency expects the number of MediPass enrollees in that area
 1113  to exceed 150,000, the agency shall seek to contract with at
 1114  least two comprehensive behavioral health care providers to
 1115  provide behavioral health care to recipients in that area who
 1116  are enrolled in, or assigned to, the MediPass program, and the
 1117  agency must offer one. One of the behavioral health care
 1118  contracts to must be with the existing public hospital-operated
 1119  provider service network pilot project, as described in
 1120  paragraph (d), for the purpose of demonstrating the cost
 1121  effectiveness of the provision of quality mental health services
 1122  through a public hospital-operated managed care model. Payment
 1123  shall be at an agreed-upon capitated rate to ensure cost
 1124  savings. Of the recipients in area 11 who are assigned to
 1125  MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those
 1126  MediPass-enrolled recipients shall be assigned to the existing
 1127  provider service network in area 11 for their behavioral care.
 1128         3. Children residing in a statewide inpatient psychiatric
 1129  program, or in a Department of Juvenile Justice or a Department
 1130  of Children and Family Services residential program approved as
 1131  a Medicaid behavioral health overlay services provider may not
 1132  be included in a behavioral health care prepaid health plan or
 1133  any other Medicaid managed care plan pursuant to this paragraph.
 1134         4. Traditional community mental health providers under
 1135  contract with the Department of Children and Family Services
 1136  pursuant to part IV of chapter 394, child welfare providers
 1137  under contract with the Department of Children and Family
 1138  Services in areas 1 and 6, and inpatient mental health providers
 1139  licensed pursuant to chapter 395 must be offered an opportunity
 1140  to accept or decline a contract to participate in a any provider
 1141  network for prepaid behavioral health services.
 1142         5. All Medicaid-eligible children, except children in area
 1143  1 and children in Highlands County, Hardee County, Polk County,
 1144  or Manatee County of area 6, which that are open for child
 1145  welfare services in the statewide automated child welfare
 1146  information system, shall receive their behavioral health care
 1147  services through a specialty prepaid plan operated by community
 1148  based lead agencies through a single agency or formal agreements
 1149  among several agencies. The agency shall work with the specialty
 1150  plan to develop clinically effective, evidence-based
 1151  alternatives as a downward substitution for the statewide
 1152  inpatient psychiatric program and similar residential care and
 1153  institutional services. The specialty prepaid plan must result
 1154  in savings to the state comparable to savings achieved in other
 1155  Medicaid managed care and prepaid programs. Such plan must
 1156  provide mechanisms to maximize state and local revenues. The
 1157  specialty prepaid plan shall be developed by the agency and the
 1158  Department of Children and Family Services. The agency may seek
 1159  federal waivers to implement this initiative. Medicaid-eligible
 1160  children whose cases are open for child welfare services in the
 1161  statewide automated child welfare information system and who
 1162  reside in AHCA area 10 shall be enrolled in a capitated provider
 1163  service network or other capitated managed care plan, which, in
 1164  coordination with available community-based care providers
 1165  specified in s. 409.1671, must shall provide sufficient medical,
 1166  developmental, and behavioral health services to meet the needs
 1167  of these children.
 1168  
 1169  This paragraph expires October 1, 2014.
 1170         (d)1. A provider service network, which may be reimbursed
 1171  on a fee-for-service or prepaid basis. Prepaid provider service
 1172  networks shall receive per-member, per-month payments. A
 1173  provider service network that does not choose to be a prepaid
 1174  plan shall receive fee-for-service rates with a shared savings
 1175  settlement. The fee-for-service option shall be available to a
 1176  provider service network only for the first 2 years of the
 1177  plan’s operation or until the contract year beginning September
 1178  1, 2014, whichever is later. The agency shall annually conduct
 1179  cost reconciliations to determine the amount of cost savings
 1180  achieved by fee-for-service provider service networks for the
 1181  dates of service in the period being reconciled. Only payments
 1182  for covered services for dates of service within the
 1183  reconciliation period and paid within 6 months after the last
 1184  date of service in the reconciliation period shall be included.
 1185  The agency shall perform the necessary adjustments for the
 1186  inclusion of claims incurred but not reported within the
 1187  reconciliation for claims that could be received and paid by the
 1188  agency after the 6-month claims processing time lag. The agency
 1189  shall provide the results of the reconciliations to the fee-for
 1190  service provider service networks within 45 days after the end
 1191  of the reconciliation period. The fee-for-service provider
 1192  service networks shall review and provide written comments or a
 1193  letter of concurrence to the agency within 45 days after receipt
 1194  of the reconciliation results. This reconciliation shall be
 1195  considered final.
 1196         2. A provider service network that which is reimbursed by
 1197  the agency on a prepaid basis is shall be exempt from parts I
 1198  and III of chapter 641, but must comply with the solvency
 1199  requirements in s. 641.2261(2) and meet appropriate financial
 1200  reserve, quality assurance, and patient rights requirements as
 1201  established by the agency.
 1202         3. The agency shall assign Medicaid recipients assigned to
 1203  a provider service network in accordance with s. 409.9122 or s.
 1204  409.91211, as applicable shall be chosen equally from those who
 1205  would otherwise have been assigned to prepaid plans and
 1206  MediPass. The agency may is authorized to seek federal Medicaid
 1207  waivers as necessary to implement the provisions of this
 1208  section. This subparagraph expires October 1, 2014.
 1209         4. A provider service network is a network established or
 1210  organized and operated by a health care provider, or group of
 1211  affiliated health care providers, including minority physician
 1212  networks and emergency room diversion programs that meet the
 1213  requirements of s. 409.91211, which provides a substantial
 1214  proportion of the health care items and services under a
 1215  contract directly through the provider or affiliated group of
 1216  providers and may make arrangements with physicians or other
 1217  health care professionals, health care institutions, or any
 1218  combination of such individuals or institutions to assume all or
 1219  part of the financial risk on a prospective basis for the
 1220  provision of basic health services by the physicians, by other
 1221  health professionals, or through the institutions. The health
 1222  care providers must have a controlling interest in the governing
 1223  body of the provider service network organization.
 1224         Section 12. Section 409.9121, Florida Statutes, is amended
 1225  to read:
 1226         409.9121 Legislative findings and intent.—The Legislature
 1227  hereby finds that the Medicaid program has experienced an annual
 1228  growth rate of approximately 28 percent per year for the past 5
 1229  years, and is consuming more than half of all new general
 1230  revenue growth. The present Medicaid system must be reoriented
 1231  to emphasize, to the maximum extent possible, the delivery of
 1232  health care through entities and mechanisms that which are
 1233  designed to contain costs, to emphasize preventive and primary
 1234  care, and to promote access and continuity of care. The
 1235  Legislature further finds that the concept of “managed care”
 1236  best encompasses these multiple goals. The Legislature also
 1237  finds that, with the cooperation of the physician community,
 1238  MediPass, the Medicaid primary care case management program, is
 1239  responsible for ensuring that there is a sufficient supply of
 1240  primary care to provide access to preventive and primary care
 1241  services to Medicaid recipients. Therefore, the Legislature
 1242  declares its intent that the Medicaid program require, to the
 1243  maximum extent practicable and permitted by federal law, that
 1244  all Medicaid recipients be enrolled in a managed care program.
 1245         Section 13. Subsections (1), (2), (4), (5), and (12) of
 1246  section 409.9122, Florida Statutes, are amended to read:
 1247         409.9122 Mandatory Medicaid managed care enrollment;
 1248  programs and procedures.—
 1249         (1) It is the intent of the Legislature that Medicaid
 1250  managed care the MediPass program be cost-effective, provide
 1251  quality health care, and improve access to health services, and
 1252  that the program be implemented statewide. Medicaid managed care
 1253  shall consist of the enrollment of Medicaid recipients in the
 1254  MediPass program or managed care plans for comprehensive medical
 1255  services. This subsection expires October 1, 2014.
 1256         (2)(a) The agency shall enroll all Medicaid recipients in a
 1257  managed care plan or MediPass all Medicaid recipients, except
 1258  those Medicaid recipients who are: in an institution,; enrolled
 1259  in the Medicaid medically needy program,; or eligible for both
 1260  Medicaid and Medicare. Upon enrollment, recipients may
 1261  individuals will be able to change their managed care option
 1262  during the 90-day opt out period required by federal Medicaid
 1263  regulations. The agency may is authorized to seek the necessary
 1264  Medicaid state plan amendment to implement this policy. However,
 1265         (a) To the extent permitted by federal law, the agency may
 1266  enroll a recipient in a managed care plan or MediPass a Medicaid
 1267  recipient who is exempt from mandatory managed care enrollment
 1268  if, provided that:
 1269         1. The recipient’s decision to enroll in a managed care
 1270  plan or MediPass is voluntary;
 1271         2. If The recipient chooses to enroll in a managed care
 1272  plan and, the agency has determined that the managed care plan
 1273  provides specific programs and services that which address the
 1274  special health needs of the recipient; and
 1275         3. The agency receives any necessary waivers from the
 1276  federal Centers for Medicare and Medicaid Services.
 1277  
 1278  School districts participating in the certified school match
 1279  program pursuant to ss. 409.908(21) and 1011.70 shall be
 1280  reimbursed by Medicaid, subject to the limitations of s.
 1281  1011.70(1), for a Medicaid-eligible child participating in the
 1282  services as authorized in s. 1011.70, as provided for in s.
 1283  409.9071, regardless of whether the child is enrolled in
 1284  MediPass or a managed care plan. Managed care plans shall make a
 1285  good faith effort to execute agreements with school districts
 1286  regarding the coordinated provision of services authorized under
 1287  s. 1011.70. County health departments delivering school-based
 1288  services pursuant to ss. 381.0056 and 381.0057 shall be
 1289  reimbursed by Medicaid for the federal share for a Medicaid
 1290  eligible child who receives Medicaid-covered services in a
 1291  school setting, regardless of whether the child is enrolled in
 1292  MediPass or a managed care plan. Managed care plans shall make a
 1293  good faith effort to execute agreements with county health
 1294  departments regarding the coordinated provision of services to a
 1295  Medicaid-eligible child. To ensure continuity of care for
 1296  Medicaid patients, the agency, the Department of Health, and the
 1297  Department of Education shall develop procedures for ensuring
 1298  that a student’s managed care plan or MediPass provider receives
 1299  information relating to services provided in accordance with ss.
 1300  381.0056, 381.0057, 409.9071, and 1011.70.
 1301         (b) A Medicaid recipient may shall not be enrolled in or
 1302  assigned to a managed care plan or MediPass unless the managed
 1303  care plan or MediPass has complied with the quality-of-care
 1304  standards specified in paragraphs (3)(a) and (b), respectively.
 1305         (c) A Medicaid recipient eligible for managed care
 1306  enrollment recipients shall have a choice of managed care
 1307  options plans or MediPass. The Agency for Health Care
 1308  Administration, the Department of Health, the Department of
 1309  Children and Family Services, and the Department of Elderly
 1310  Affairs shall cooperate to ensure that each Medicaid recipient
 1311  receives clear and easily understandable information that meets
 1312  the following requirements:
 1313         1. Explains the concept of managed care, including
 1314  MediPass.
 1315         2. Provides information on the comparative performance of
 1316  managed care options available to the recipient plans and
 1317  MediPass in the areas of quality, credentialing, preventive
 1318  health programs, network size and availability, and patient
 1319  satisfaction.
 1320         3. Explains where additional information on each managed
 1321  care option plan and MediPass in the recipient’s area can be
 1322  obtained.
 1323         4. Explains that recipients have the right to choose their
 1324  managed care coverage at the time they first enroll in Medicaid
 1325  and again at regular intervals set by the agency. However, if a
 1326  recipient does not choose a managed care option plan or
 1327  MediPass, the agency shall will assign the recipient to a
 1328  managed care plan or MediPass according to the criteria
 1329  specified in this section.
 1330         5. Explains the recipient’s right to complain, file a
 1331  grievance, or change his or her managed care option as specified
 1332  in this section plans or MediPass providers if the recipient is
 1333  not satisfied with the managed care plan or MediPass.
 1334         (d) The agency shall develop a mechanism for providing
 1335  information to Medicaid recipients for the purpose of choosing
 1336  making a managed care option plan or MediPass selection.
 1337  Examples of such mechanisms may include, but are not be limited
 1338  to, interactive information systems, mailings, and mass
 1339  marketing materials. Managed care plans and MediPass providers
 1340  may not provide are prohibited from providing inducements to
 1341  Medicaid recipients to select their plans or prejudice from
 1342  prejudicing Medicaid recipients against other managed care plans
 1343  or MediPass providers.
 1344         (e) Medicaid recipients who are already enrolled in a
 1345  managed care plan or MediPass shall be offered the opportunity
 1346  to change managed care plans or MediPass providers, as
 1347  applicable, on a staggered basis, as defined by the agency. All
 1348  Medicaid recipients shall have 30 days in which to choose a
 1349  managed care option make a choice of managed care plans or
 1350  MediPass providers. Those Medicaid recipients who do not make a
 1351  choice shall be assigned in accordance with paragraph (f). To
 1352  facilitate continuity of care, for a Medicaid recipient who is
 1353  also a recipient of Supplemental Security Income (SSI), prior to
 1354  assigning the SSI recipient to a managed care plan or MediPass,
 1355  the agency shall determine whether the SSI recipient has an
 1356  ongoing relationship with a MediPass provider or managed care
 1357  plan, and if so, the agency shall assign the SSI recipient to
 1358  that MediPass provider or managed care plan. Those SSI
 1359  recipients who do not have such a provider relationship shall be
 1360  assigned to a managed care plan or MediPass provider in
 1361  accordance with paragraph (f).
 1362         1. During the 30-day choice period:
 1363         a. A recipient residing in a county in which two or more
 1364  managed care plans are eligible to accept Medicaid enrollees,
 1365  including a recipient who was enrolled in MediPass at the
 1366  commencement of his or her 30-day choice period, shall choose
 1367  from those managed care plans. A recipient may opt out of his or
 1368  her choice and choose a different managed care plan during the
 1369  90-day opt out period.
 1370         b. A recipient residing in a county in which only one
 1371  managed care plan is eligible to accept Medicaid enrollees shall
 1372  choose the managed care plan or a MediPass provider. A recipient
 1373  who chooses the managed care plan may opt out of the plan and
 1374  choose a MediPass provider during the 90-day opt out period.
 1375         c. A recipient residing in a county in which no managed
 1376  care plan is accepting Medicaid enrollees shall choose a
 1377  MediPass provider.
 1378         2. For the purposes of recipient choice, if a managed care
 1379  plan reaches its enrollment capacity, as determined by the
 1380  agency, the plan may not accept additional Medicaid enrollees
 1381  until the agency determines that the plan’s enrollment is
 1382  sufficiently less than its enrollment capacity, due to a decline
 1383  in enrollment or by an increase in enrollment capacity. If a
 1384  managed care plan notifies the agency of its intent to exit a
 1385  county, the plan may not accept additional Medicaid enrollees in
 1386  that county before the exit date.
 1387         3. As used in this paragraph, when referring to recipient
 1388  choice, the term “managed care plans” includes health
 1389  maintenance organizations, exclusive provider organizations,
 1390  provider service networks, minority physician networks,
 1391  Children’s Medical Services Networks, and pediatric emergency
 1392  department diversion programs authorized by this chapter or the
 1393  General Appropriations Act.
 1394         4. The agency shall seek federal waiver authority or a
 1395  state plan amendment consistent with 42 U.S.C. 1396u-2(a)(1), as
 1396  needed, to implement this paragraph.
 1397         (f) If a Medicaid recipient does not choose a managed care
 1398  option:
 1399         1. If the recipient resides in a county in which two or
 1400  more managed care plans are accepting Medicaid enrollees, the
 1401  agency shall assign the recipient, including a recipient who was
 1402  enrolled in MediPass at the commencement of his or her 30-day
 1403  choice period, to one of those managed care plans. A recipient
 1404  assigned to a managed care plan under this subparagraph may opt
 1405  out of the managed care plan and enroll in a different managed
 1406  care plan during the 90-day opt out period. The agency shall
 1407  seek to make assignments among the managed care plans on an even
 1408  basis under the criteria in subparagraph 6.
 1409         2. If the recipient resides in a county in which only one
 1410  managed care plan is accepting Medicaid enrollees, the agency
 1411  shall assign the recipient, including a recipient who was
 1412  enrolled in MediPass at the commencement of his or her 30-day
 1413  choice period, to the managed care plan. A recipient assigned to
 1414  a managed care plan under this subparagraph may opt out of the
 1415  managed care plan and choose a MediPass provider during the 90
 1416  day opt out period.
 1417         3. If the recipient resides in a county in which no managed
 1418  care plan is accepting Medicaid enrollees, the agency shall
 1419  assign the recipient to a MediPass provider.
 1420         4. For the purpose of assignment, if a managed care plan
 1421  reaches its enrollment capacity, as determined by the agency,
 1422  the plan may not accept additional Medicaid enrollees until the
 1423  agency determines that the plan’s enrollment is sufficiently
 1424  less than its enrollment capacity, due to a decline in
 1425  enrollment or by an increase in enrollment capacity. If a
 1426  managed care plan notifies the agency of its intent to exit a
 1427  county, the agency may not assign additional Medicaid enrollees
 1428  to the plan in that county before the exit date. plan or
 1429  MediPass provider, the agency shall assign the Medicaid
 1430  recipient to a managed care plan or MediPass provider. Medicaid
 1431  recipients eligible for managed care plan enrollment who are
 1432  subject to mandatory assignment but who fail to make a choice
 1433  shall be assigned to managed care plans until an enrollment of
 1434  35 percent in MediPass and 65 percent in managed care plans, of
 1435  all those eligible to choose managed care, is achieved. Once
 1436  this enrollment is achieved, the assignments shall be divided in
 1437  order to maintain an enrollment in MediPass and managed care
 1438  plans which is in a 35 percent and 65 percent proportion,
 1439  respectively. Thereafter, assignment of Medicaid recipients who
 1440  fail to make a choice shall be based proportionally on the
 1441  preferences of recipients who have made a choice in the previous
 1442  period. Such proportions shall be revised at least quarterly to
 1443  reflect an update of the preferences of Medicaid recipients. The
 1444  agency shall disproportionately assign Medicaid-eligible
 1445  recipients who are required to but have failed to make a choice
 1446  of managed care plan or MediPass to the Children’s Medical
 1447  Services Network as defined in s. 391.021, exclusive provider
 1448  organizations, provider service networks, minority physician
 1449  networks, and pediatric emergency department diversion programs
 1450  authorized by this chapter or the General Appropriations Act, in
 1451  such manner as the agency deems appropriate, until the agency
 1452  has determined that the networks and programs have sufficient
 1453  numbers to be operated economically.
 1454         5. As used in For purposes of this paragraph, when
 1455  referring to assignment, the term “managed care plans” includes
 1456  health maintenance organizations, exclusive provider
 1457  organizations, provider service networks, minority physician
 1458  networks, Children’s Medical Services Network, and pediatric
 1459  emergency department diversion programs authorized by this
 1460  chapter or the General Appropriations Act.
 1461         6. When making assignments, the agency shall consider take
 1462  into account the following criteria, as applicable:
 1463         a.1.Whether a managed care plan has sufficient network
 1464  capacity to meet the need of members.
 1465         b.2.Whether the managed care plan or MediPass has
 1466  previously enrolled the recipient as a member, or one of the
 1467  managed care plan’s primary care providers or a MediPass primary
 1468  care provider providers has previously provided health care to
 1469  the recipient.
 1470         c.3.Whether the agency has knowledge that the recipient
 1471  member has previously expressed a preference for a particular
 1472  managed care plan or MediPass primary care provider as indicated
 1473  by Medicaid fee-for-service claims data, but has failed to make
 1474  a choice.
 1475         d.4.Whether the managed care plan’s or MediPass primary
 1476  care providers are geographically accessible to the recipient’s
 1477  residence.
 1478         e. If the recipient was already enrolled in a managed care
 1479  plan at the commencement of his or her 30-day choice period and
 1480  fails to choose a different option, the recipient must remain
 1481  enrolled in that same managed care plan.
 1482         f. To facilitate continuity of care for a Medicaid
 1483  recipient who is also a recipient of Supplemental Security
 1484  Income (SSI), before assigning the SSI recipient, the agency
 1485  shall determine whether the SSI recipient has an ongoing
 1486  relationship with a managed care plan or a MediPass primary care
 1487  provider, and if so, the agency shall assign the SSI recipient
 1488  to that managed care plan or MediPass provider, as applicable.
 1489  However, if the recipient has an ongoing relationship with a
 1490  MediPass primary care provider who is included in the provider
 1491  network of one or more managed care plans, the agency shall
 1492  assign the recipient to one of those managed care plans.
 1493         g. If the recipient is diagnosed with HIV/AIDS and resides
 1494  in Broward County, Miami-Dade County, or Palm Beach County, the
 1495  agency shall assign the Medicaid recipient to a managed care
 1496  plan that is a health maintenance organization authorized under
 1497  chapter 641, that was under contract with the agency on July 1,
 1498  2011, and that offers a delivery system in partnership with a
 1499  university-based teaching and research-oriented organization
 1500  specializing in providing health care services and treatment for
 1501  individuals diagnosed with HIV/AIDS. Recipients not diagnosed
 1502  with HIV/AIDS may not be assigned under this paragraph to a
 1503  managed care plan that specializes in HIV/AIDS.
 1504         7. The agency shall seek federal waiver authority or a
 1505  state plan amendment consistent with 42 U.S.C. 1396u-2(a)(4)(D),
 1506  as needed, to implement this paragraph.
 1507         (g) When more than one managed care plan or MediPass
 1508  provider meets the criteria specified in paragraph (f), the
 1509  agency shall make recipient assignments consecutively by family
 1510  unit.
 1511         (h) The agency may not engage in practices that are
 1512  designed to favor one managed care plan over another or that are
 1513  designed to influence Medicaid recipients to enroll in MediPass
 1514  rather than in a managed care plan or to enroll in a managed
 1515  care plan rather than in MediPass, as applicable. This
 1516  subsection does not prohibit the agency from reporting on the
 1517  performance of MediPass or any managed care plan, as measured by
 1518  performance criteria developed by the agency.
 1519         (i) After a recipient has made his or her selection or has
 1520  been enrolled in a managed care plan or MediPass, the recipient
 1521  shall have 90 days to exercise the opportunity to voluntarily
 1522  disenroll and select another managed care option plan or
 1523  MediPass. After 90 days, no further changes may be made except
 1524  for good cause. Good cause includes, but is not limited to, poor
 1525  quality of care, lack of access to necessary specialty services,
 1526  an unreasonable delay or denial of service, or fraudulent
 1527  enrollment. The agency shall develop criteria for good cause
 1528  disenrollment for chronically ill and disabled populations who
 1529  are assigned to managed care plans if more appropriate care is
 1530  available through the MediPass program. The agency must make a
 1531  determination as to whether good cause exists. However, the
 1532  agency may require a recipient to use the managed care plan’s or
 1533  MediPass grievance process prior to the agency’s determination
 1534  of good cause, except in cases in which immediate risk of
 1535  permanent damage to the recipient’s health is alleged. The
 1536  grievance process, if used when utilized, must be completed in
 1537  time to permit the recipient to disenroll by the first day of
 1538  the second month after the month the disenrollment request was
 1539  made. If the managed care plan or MediPass, as a result of the
 1540  grievance process, approves an enrollee’s request to disenroll,
 1541  the agency is not required to make a determination in the case.
 1542  The agency must make a determination and take final action on a
 1543  recipient’s request so that disenrollment occurs by no later
 1544  than the first day of the second month after the month the
 1545  request was made. If the agency fails to act within the
 1546  specified timeframe, the recipient’s request to disenroll is
 1547  deemed to be approved as of the date agency action was required.
 1548  Recipients who disagree with the agency’s finding that good
 1549  cause does not exist for disenrollment shall be advised of their
 1550  right to pursue a Medicaid fair hearing to dispute the agency’s
 1551  finding.
 1552         (j) Consistent with 42 U.S.C. 1396u-2(a)(4)(A) or under
 1553  federal waiver authority, as needed, the agency shall apply for
 1554  a federal waiver from the Centers for Medicare and Medicaid
 1555  Services to lock eligible Medicaid recipients into a managed
 1556  care plan or MediPass for 12 months after an open enrollment
 1557  period, except for the 90-day opt out period and good cause
 1558  disenrollment. After 12 months’ enrollment, a recipient may
 1559  select another managed care plan or MediPass provider. However,
 1560  nothing shall prevent a Medicaid recipient may not be prevented
 1561  from changing primary care providers within the managed care
 1562  plan or MediPass program, as applicable, during the 12-month
 1563  period.
 1564         (k) The agency shall maintain MediPass provider networks in
 1565  all counties, including those counties in which two or more
 1566  managed care plans are accepting Medicaid enrollees. When a
 1567  Medicaid recipient does not choose a managed care plan or
 1568  MediPass provider, the agency shall assign the Medicaid
 1569  recipient to a managed care plan, except in those counties in
 1570  which there are fewer than two managed care plans accepting
 1571  Medicaid enrollees, in which case assignment shall be to a
 1572  managed care plan or a MediPass provider. Medicaid recipients in
 1573  counties with fewer than two managed care plans accepting
 1574  Medicaid enrollees who are subject to mandatory assignment but
 1575  who fail to make a choice shall be assigned to managed care
 1576  plans until an enrollment of 35 percent in MediPass and 65
 1577  percent in managed care plans, of all those eligible to choose
 1578  managed care, is achieved. Once that enrollment is achieved, the
 1579  assignments shall be divided in order to maintain an enrollment
 1580  in MediPass and managed care plans which is in a 35 percent and
 1581  65 percent proportion, respectively. For purposes of this
 1582  paragraph, when referring to assignment, the term “managed care
 1583  plans” includes exclusive provider organizations, provider
 1584  service networks, Children’s Medical Services Network, minority
 1585  physician networks, and pediatric emergency department diversion
 1586  programs authorized by this chapter or the General
 1587  Appropriations Act. When making assignments, the agency shall
 1588  take into account the following criteria:
 1589         1. A managed care plan has sufficient network capacity to
 1590  meet the need of members.
 1591         2. The managed care plan or MediPass has previously
 1592  enrolled the recipient as a member, or one of the managed care
 1593  plan’s primary care providers or MediPass providers has
 1594  previously provided health care to the recipient.
 1595         3. The agency has knowledge that the member has previously
 1596  expressed a preference for a particular managed care plan or
 1597  MediPass provider as indicated by Medicaid fee-for-service
 1598  claims data, but has failed to make a choice.
 1599         4. The managed care plan’s or MediPass primary care
 1600  providers are geographically accessible to the recipient’s
 1601  residence.
 1602         5. The agency has authority to make mandatory assignments
 1603  based on quality of service and performance of managed care
 1604  plans.
 1605         (l) If the Medicaid recipient is diagnosed with HIV/AIDS
 1606  and resides in Broward County, Miami-Dade County, or Palm Beach
 1607  County, the agency shall assign the Medicaid recipient to a
 1608  managed care plan that is a health maintenance organization
 1609  authorized under chapter 641, is under contract with the agency
 1610  on July 1, 2011, and which offers a delivery system through a
 1611  university-based teaching and research-oriented organization
 1612  that specializes in providing health care services and treatment
 1613  for individuals diagnosed with HIV/AIDS.
 1614         (l)(m) Notwithstanding the provisions of chapter 287, the
 1615  agency may, at its discretion, renew cost-effective contracts
 1616  for choice counseling services once or more for such periods as
 1617  the agency may decide. However, all such renewals may not
 1618  combine to exceed a total period longer than the term of the
 1619  original contract.
 1620  
 1621  This subsection expires October 1, 2014.
 1622         (4)(a) Each female recipient may select as her primary care
 1623  provider an obstetrician/gynecologist who has agreed to
 1624  participate within a managed care plan’s provider network or as
 1625  a MediPass primary care case manager, as applicable.
 1626         (b) The agency shall establish a complaints and grievance
 1627  process to assist Medicaid recipients enrolled in the MediPass
 1628  program to resolve complaints and grievances. The agency shall
 1629  investigate reports of quality-of-care grievances which remain
 1630  unresolved to the satisfaction of the enrollee.
 1631  
 1632  This subsection expires October 1, 2014.
 1633         (5)(a) The agency shall work cooperatively with the Social
 1634  Security Administration to identify recipients beneficiaries who
 1635  are jointly eligible for Medicare and Medicaid and shall develop
 1636  cooperative programs to encourage these recipients beneficiaries
 1637  to enroll in a Medicare participating health maintenance
 1638  organization or prepaid health plans.
 1639         (b) The agency shall work cooperatively with the Department
 1640  of Elderly Affairs to assess the potential cost-effectiveness of
 1641  providing managed care enrollment MediPass to recipients
 1642  beneficiaries who are jointly eligible for Medicare and Medicaid
 1643  on a voluntary choice basis. If the agency determines that
 1644  enrollment of these recipients beneficiaries in managed care
 1645  MediPass has the potential for being cost-effective for the
 1646  state, the agency shall offer managed care enrollment MediPass
 1647  to these recipients beneficiaries on a voluntary choice basis in
 1648  the counties where managed care is available MediPass operates.
 1649  
 1650  This subsection expires October 1, 2014.
 1651         (12) The agency shall include in its calculation of the
 1652  hospital inpatient component of a Medicaid health maintenance
 1653  organization’s capitation rate any special payments, including,
 1654  but not limited to, upper payment limit or disproportionate
 1655  share hospital payments, made to qualifying hospitals through
 1656  the fee-for-service program. The agency may seek federal waiver
 1657  approval or state plan amendment as needed to implement this
 1658  adjustment. This subsection expires September 1, 2012.
 1659         Section 14. Section 409.9123, Florida Statutes, is amended
 1660  to read:
 1661         409.9123 Quality-of-care reporting.—In order to promote
 1662  competition between Medicaid managed care plans and MediPass
 1663  based on quality-of-care indicators, The agency shall annually
 1664  develop and publish a set of measures of managed care plan
 1665  performance based on quality-of-care indicators. This
 1666  information shall be made available to each Medicaid recipient
 1667  who makes a choice of a managed care plan in her or his area.
 1668  This information must shall be easily understandable to the
 1669  Medicaid recipient and shall use nationally recognized standards
 1670  wherever possible. In formulating this information, the agency
 1671  shall, at a minimum, consider take into account at least the
 1672  following:
 1673         (1) The recommendations of the National Committee for
 1674  Quality Assurance Medicaid HEDIS Task Force.
 1675         (2) Requirements and recommendations of the Centers for
 1676  Medicare and Medicaid Services Health Care Financing
 1677  Administration.
 1678         (3) Recommendations of the managed care industry.
 1679         Section 15. For the purpose of incorporating the amendment
 1680  made by this act to section 409.9122, Florida Statutes, in a
 1681  reference thereto, subsection (1) of section 409.9126, Florida
 1682  Statutes, is reenacted to read:
 1683         409.9126 Children with special health care needs.—
 1684         (1) Except as provided in subsection (4), children eligible
 1685  for Children’s Medical Services who receive Medicaid benefits,
 1686  and other Medicaid-eligible children with special health care
 1687  needs, shall be exempt from the provisions of s. 409.9122 and
 1688  shall be served through the Children’s Medical Services network
 1689  established in chapter 391.
 1690         Section 16. Effective upon this act becoming a law,
 1691  subsections (4) through (6) of section 409.915, Florida
 1692  Statutes, are amended, and subsections (7) through (11) are
 1693  added to that section, to read:
 1694         409.915 County contributions to Medicaid.—Although the
 1695  state is responsible for the full portion of the state share of
 1696  the matching funds required for the Medicaid program, in order
 1697  to acquire a certain portion of these funds, the state shall
 1698  charge the counties for certain items of care and service as
 1699  provided in this section.
 1700         (4) Each county shall contribute pay into the General
 1701  Revenue Fund, unallocated, its pro rata share of the total
 1702  county participation based upon statements rendered by the
 1703  agency in consultation with the counties. The agency shall
 1704  render such statements monthly based on each county’s eligible
 1705  recipients. For purposes of this section, each county’s eligible
 1706  recipients shall be determined by the recipients’ address
 1707  information contained in the federally approved Medicaid
 1708  eligibility system within the Department of Children and Family
 1709  Services. The process developed under subsection (10) may be
 1710  used for cases in which the Medicaid eligibility system’s
 1711  address information may indicate a need for revision.
 1712         (5) The Department of Financial Services shall withhold
 1713  from the cigarette tax receipts or any other funds to be
 1714  distributed to the counties the individual county share that has
 1715  not been remitted within 60 days after billing.
 1716         (5)(6) In any county in which a special taxing district or
 1717  authority is located which will benefit from the medical
 1718  assistance programs covered by this section, the board of county
 1719  commissioners may divide the county’s financial responsibility
 1720  for this purpose proportionately, and each such district or
 1721  authority must furnish its share to the board of county
 1722  commissioners in time for the board to comply with the
 1723  provisions of subsection (3). Any appeal of the proration made
 1724  by the board of county commissioners must be made to the
 1725  Department of Financial Services, which shall then set the
 1726  proportionate share of each party.
 1727         (6)(7) Counties are exempt from contributing toward the
 1728  cost of new exemptions on inpatient ceilings for statutory
 1729  teaching hospitals, specialty hospitals, and community hospital
 1730  education program hospitals that came into effect July 1, 2000,
 1731  and for special Medicaid payments that came into effect on or
 1732  after July 1, 2000.
 1733         (7) By September 1, 2012, the agency shall certify to the
 1734  Department of Revenue, for each county, an amount equal to 85
 1735  percent of each county’s billings through April 30, 2012, which
 1736  remain unpaid.
 1737         (8)(a)Beginning with the October 2012 distribution, the
 1738  Department of Revenue shall reduce each county’s distributions
 1739  pursuant to s. 218.26 by one thirty-sixth of the amount
 1740  certified by the agency under subsection (7) for that county.
 1741  However, the amount of the reduction may not exceed 50 percent
 1742  of each county’s distribution. If, after 36 months, the
 1743  reductions for each county do not equal the total amount
 1744  initially certified by the agency, the Department of Revenue
 1745  shall continue to reduce each distribution by up to 50 percent
 1746  until the total amount certified is reached. The amounts by
 1747  which the distributions are reduced shall be transferred to the
 1748  General Revenue Fund.
 1749         (b) As an assurance to holders of bonds issued before the
 1750  effective date of this act to which distributions made pursuant
 1751  to s. 218.26 are pledged, or bonds issued to refund such bonds
 1752  which mature no later than the bonds they refunded and which
 1753  result in a reduction of debt service payable in each fiscal
 1754  year, the amount available for distribution to a county shall
 1755  remain as provided by law and continue to be subject to any lien
 1756  or claim on behalf of the bondholders. The Department of Revenue
 1757  must ensure that any reduction in amounts distributed pursuant
 1758  to paragraph (a) does not reduce the amount of distribution to a
 1759  county below the amount necessary for the payment of principal
 1760  and interest on the bonds and the amount necessary to comply
 1761  with any covenant under the bond resolution or other documents
 1762  relating to the issuance of the bonds.
 1763         (9)(a)Beginning May 1, 2012, and each month thereafter,
 1764  the agency shall certify to the Department of Revenue the amount
 1765  of the monthly statement rendered to each county pursuant to
 1766  subsection (4). The department shall reduce each county’s
 1767  monthly distribution pursuant to s. 218.61 by the amount
 1768  certified. The amounts by which the distributions are reduced
 1769  shall be transferred to the General Revenue Fund.
 1770         (b) As an assurance to holders of bonds issued before the
 1771  effective date of this act to which distributions made pursuant
 1772  to s. 218.61 are pledged, or bonds issued to refund such bonds
 1773  which mature no later than the bonds they refunded and which
 1774  result in a reduction of debt service payable in each fiscal
 1775  year, the amount available for distribution to a county shall
 1776  remain as provided by law and continue to be subject to any lien
 1777  or claim on behalf of the bondholders. The Department of Revenue
 1778  must ensure that any reductions in amounts distributed pursuant
 1779  to paragraph (a) does not reduce the amount of distribution to a
 1780  county below the amount necessary for the payment of principal
 1781  and interest on the bonds and the amount necessary to comply
 1782  with any covenant under the bond resolution or other documents
 1783  relating to the issuance of the bonds.
 1784         (10)The Department of Revenue shall pay certified refund
 1785  requests in accordance with a process developed by the agency
 1786  and the department which:
 1787         (a)Allows counties to submit to the agency written
 1788  requests for refunds of any amounts by which the distributions
 1789  were reduced as provided in subsection (9) and which set forth
 1790  the reasons for the refund requests.
 1791         (b)Requires the agency to make a determination as to
 1792  whether a refund request is appropriate and should be approved,
 1793  in which case the agency shall certify the amount of the refund
 1794  to the department.
 1795         (c)Requires the department to issue the refund for the
 1796  certified amount to the county from the General Revenue Fund.
 1797         (11) Beginning in the 2013-2014 fiscal year and each year
 1798  thereafter until the 2020-2021 fiscal year, the Chief Financial
 1799  Officer shall transfer from the General Revenue Fund to the
 1800  Lawton Chiles Endowment Fund an amount equal to the amounts
 1801  transferred to the General Revenue Fund in the previous fiscal
 1802  year pursuant to subsections (8) and (9), reduced by the amount
 1803  of refunds paid pursuant to subsection (10), which are in excess
 1804  of the official estimate for medical hospital fees for such
 1805  previous fiscal year adopted by the Revenue Estimating
 1806  Conference on January 12, 2012, as reflected in the conference’s
 1807  workpapers. By July 20 of each year, the Office of Economic and
 1808  Demographic Research shall certify the amount to be transferred
 1809  to the Chief Financial Officer. Such transfers must be made
 1810  before July 31 of each year until the total transfers for all
 1811  years equal $265 million. The Office of Economic and Demographic
 1812  Research shall publish the official estimates reflected in the
 1813  conference’s workpapers on its website.
 1814         Section 17. Subsection (2) of section 409.979, Florida
 1815  Statutes, is amended to read:
 1816         409.979 Eligibility.—
 1817         (2) Medicaid recipients who, on the date long-term care
 1818  managed care plans become available in their region, reside in a
 1819  nursing home facility or are enrolled in one of the following
 1820  long-term care Medicaid waiver programs are eligible to
 1821  participate in the long-term care managed care program for up to
 1822  12 months without being reevaluated for their need for nursing
 1823  facility care as defined in s. 409.985(3):
 1824         (a) The Assisted Living for the Frail Elderly Waiver.
 1825         (b) The Aged and Disabled Adult Waiver.
 1826         (c) The Adult Day Health Care Waiver.
 1827         (c)(d) The Consumer-Directed Care Plus Program as described
 1828  in s. 409.221.
 1829         (d)(e) The Program of All-inclusive Care for the Elderly.
 1830         (e)(f) The long-term care community-based diversion pilot
 1831  project as described in s. 430.705.
 1832         (f)(g) The Channeling Services Waiver for Frail Elders.
 1833         Section 18. Subsection (15) of section 430.04, Florida
 1834  Statutes, is amended to read:
 1835         430.04 Duties and responsibilities of the Department of
 1836  Elderly Affairs.—The Department of Elderly Affairs shall:
 1837         (15) Administer all Medicaid waivers and programs relating
 1838  to elders and their appropriations. The waivers include, but are
 1839  not limited to:
 1840         (a) The Assisted Living for the Frail Elderly Waiver.
 1841         (b) The Aged and Disabled Adult Waiver.
 1842         (c) The Adult Day Health Care Waiver.
 1843         (c)(d) The Consumer-Directed Care Plus Program as defined
 1844  in s. 409.221.
 1845         (d)(e) The Program of All-inclusive Care for the Elderly.
 1846         (e)(f) The Long-Term Care Community-Based Diversion Pilot
 1847  Project as described in s. 430.705.
 1848         (f)(g) The Channeling Services Waiver for Frail Elders.
 1849  
 1850  The department shall develop a transition plan for recipients
 1851  receiving services in long-term care Medicaid waivers for elders
 1852  or disabled adults on the date eligible plans become available
 1853  in each recipient’s region defined in s. 409.981(2) to enroll
 1854  those recipients in eligible plans. This subsection expires
 1855  October 1, 2014.
 1856         Section 19. Section 31 of chapter 2009-223, Laws of
 1857  Florida, as amended by section 44 of chapter 2010-151, Laws of
 1858  Florida, is redesignated as section 409.9132, Florida Statutes,
 1859  and amended to read:
 1860         409.9132 Section 31. Pilot project to monitor home health
 1861  services.—The agency for Health Care Administration shall expand
 1862  the develop and implement a home health agency monitoring pilot
 1863  project in Miami-Dade County on a statewide basis effective July
 1864  1, 2012, except in counties in which the program will not be
 1865  cost-effective, as determined by the agency by January 1, 2010.
 1866  The agency shall contract with a vendor to verify the
 1867  utilization and delivery of home health services and provide an
 1868  electronic billing interface for home health services. The
 1869  contract must require the creation of a program to submit claims
 1870  electronically for the delivery of home health services. The
 1871  program must verify telephonically visits for the delivery of
 1872  home health services using voice biometrics. The agency may seek
 1873  amendments to the Medicaid state plan and waivers of federal
 1874  laws, as necessary, to implement or expand the pilot project.
 1875  Notwithstanding s. 287.057(3)(f), Florida Statutes, the agency
 1876  must award the contract through the competitive solicitation
 1877  process and may use the current contract to expand the home
 1878  health agency monitoring pilot project to include additional
 1879  counties as authorized under this section. The agency shall
 1880  submit a report to the Governor, the President of the Senate,
 1881  and the Speaker of the House of Representatives evaluating the
 1882  pilot project by February 1, 2011.
 1883         Section 20. Section 32 of chapter 2009-223, Laws of
 1884  Florida, is redesignated as section 409.9133, Florida Statutes,
 1885  and amended to read:
 1886         409.9133 Section 32. Pilot project for home health care
 1887  management.—The agency for Health Care Administration shall
 1888  expand the implement a comprehensive care management pilot
 1889  project for home health services statewide and include private
 1890  duty nursing and personal care services effective July 1, 2012,
 1891  except in counties in which the program will not be cost
 1892  effective, as determined by the agency by January 1, 2010. The
 1893  program must include, which includes face-to-face assessments by
 1894  a nurse licensed pursuant to chapter 464, Florida Statutes,
 1895  consultation with physicians ordering services to substantiate
 1896  the medical necessity for services, and on-site or desk reviews
 1897  of recipients’ medical records in Miami-Dade County. The agency
 1898  may enter into a contract with a qualified organization to
 1899  implement or expand the pilot project. The agency may use the
 1900  current contract to expand the comprehensive care management
 1901  pilot project to include the additional services and counties
 1902  authorized under this section. The agency may seek amendments to
 1903  the Medicaid state plan and waivers of federal laws, as
 1904  necessary, to implement or expand the pilot project.
 1905         Section 21. Notwithstanding s. 430.707, Florida Statutes,
 1906  and subject to federal approval of an additional site for the
 1907  Program of All-Inclusive Care for the Elderly (PACE), the Agency
 1908  for Health Care Administration shall contract with a current
 1909  PACE organization authorized to provide PACE services in
 1910  Southeast Florida to develop and operate a PACE program in
 1911  Broward County to serve frail elders who reside in Broward
 1912  County. The organization shall be exempt from chapter 641,
 1913  Florida Statutes. The agency, in consultation with the
 1914  Department of Elderly Affairs and subject to an appropriation,
 1915  shall approve up to 150 initial enrollee slots in the Broward
 1916  program established by the organization.
 1917         Section 22. Effective upon this act becoming a law and for
 1918  the 2011-2012 state fiscal year only, a public hospital located
 1919  in trauma service area 2 which has local funds available for
 1920  intergovernmental transfers that allow for exemptions from
 1921  inpatient and outpatient reimbursement limitations may,
 1922  notwithstanding s. 409.905(5)(c), Florida Statues, have its
 1923  reimbursement rates adjusted after September 30 of the state
 1924  fiscal year in which the rates take effect.
 1925         Section 23. Except as otherwise expressly provided in this
 1926  act and except for this section, which shall take effect upon
 1927  this act becoming a law, this act shall take effect July 1.
 1928  2012.