SB 1988                                          First Engrossed
       
       
       
       
       
       
       
       
       20121988e1
       
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 381.79, F.S.;
    3         increasing the amount that may be available to the
    4         University of Florida and the University of Miami for
    5         brain and spinal cord injury research; amending s.
    6         383.15, F.S.; revising legislative intent relating to
    7         funding for regional perinatal intensive care centers;
    8         amending s. 409.8132, F.S.; revising a cross
    9         reference; amending s. 409.814, F.S.; deleting a
   10         prohibition preventing children who are eligible for
   11         coverage under a state health benefit plan from being
   12         eligible for services provided through the subsidized
   13         program; revising cross-references; requiring a
   14         completed application, including a clinical screening,
   15         for enrollment in the Children’s Medical Services
   16         Network; amending s. 409.902, F.S.; providing for the
   17         creation of an Internet-based system for determining
   18         eligibility for the Medicaid and Kidcare programs,
   19         contingent on the appropriation; providing system
   20         business objectives and requirements; requiring the
   21         Department of Children and Family Services to develop
   22         the system; requiring the system to be completed and
   23         implemented by specified dates; providing a governance
   24         structure pending implementation of the program,
   25         including an executive steering committee and a
   26         project management team; amending s. 409.905, F.S.;
   27         limiting the number of paid hospital emergency
   28         department visits for nonpregnant adults; authorizing
   29         the Agency for Health Care Administration to request
   30         approval by the Legislative Budget Commission of
   31         hospital rate adjustments; providing components for
   32         the agency’s plan to convert inpatient hospital rates
   33         to a prospective payment system; revising dates for
   34         submitting the plan and implementing the system;
   35         amending s. 409.908, F.S.; conforming a cross
   36         reference; authorizing the Agency for Health Care
   37         Administration to accept voluntary intergovernmental
   38         transfers of local taxes and other qualified revenue
   39         from counties, municipalities, or special taxing
   40         districts in order to fund certain costs; limiting the
   41         use of intergovernmental transfer funds for hospital
   42         reimbursements; prohibiting the inclusion of certain
   43         hospital costs in the capitation rates for prepaid
   44         health plans; providing for the inclusion of certain
   45         hospital costs in capitation rates for prepaid health
   46         plans if funded by intergovernmental transfers;
   47         incorporating a transferred provision; amending s.
   48         409.911, F.S.; updating references to data used for
   49         calculations in the disproportionate share program;
   50         repealing s. 409.9112, F.S., relating to the
   51         disproportionate share program for regional perinatal
   52         intensive care centers; amending s. 409.9113, F.S.;
   53         conforming a cross-reference; authorizing the agency
   54         to distribute moneys in the disproportionate share
   55         program for teaching hospitals; repealing s. 409.9117,
   56         F.S., relating to the primary care disproportionate
   57         share program; amending s. 409.912, F.S.; revising the
   58         conditions for contracting with certain managed care
   59         plans for behavioral health care services; deleting
   60         requirements for assigning certain MediPass recipients
   61         to managed care plans for behavioral health care
   62         services; requiring the assignment of recipients to
   63         provider service networks; amending s. 409.9121, F.S.;
   64         revising legislative findings relating to the Medicaid
   65         program; amending s. 409.9122, F.S.; providing
   66         criteria and procedures relating to recipient
   67         enrollment choice and assignment among Medicaid
   68         managed care plans and MediPass; deleting transferred
   69         provisions relating to school districts; amending s.
   70         409.9123, F.S.; revising provisions relating to the
   71         publication of quality measures for managed care
   72         plans; reenacting s. 409.9126, F.S., relating to
   73         children with special health care needs; amending s.
   74         409.915, F.S.; specifying criteria for determining a
   75         county’s eligible recipients; providing for payment of
   76         billings that have been denied by the county from the
   77         county’s tax revenues; providing for refunds;
   78         providing for the transfer of certain refunds to the
   79         Lawton Chiles Endowment Fund; amending ss. 409.979 and
   80         430.04, F.S.; deleting references to the Adult Day
   81         Health Care Waiver in provisions relating to Medicaid
   82         eligibility and duties and responsibilities of the
   83         Department of Elderly Affairs; amending s. 31, chapter
   84         2009-223, Laws of Florida, as amended, and
   85         redesignating that section as s. 409.9132, F.S.;
   86         expanding the home health agency monitoring pilot
   87         project statewide; amending s. 32, chapter 2009-223,
   88         Laws of Florida, and redesignating that section as s.
   89         409.9133, F.S.; expanding the comprehensive care
   90         management pilot project for home health services
   91         statewide and including private-duty nursing and
   92         personal care services; providing an additional site
   93         in Broward County for the Program of All-Inclusive
   94         Care for the Elderly; providing that a public hospital
   95         located in trauma service area 2 which has local funds
   96         available for intergovernmental transfers may have its
   97         reimbursement rates adjusted after a certain date;
   98         providing effective dates.
   99  
  100  Be It Enacted by the Legislature of the State of Florida:
  101  
  102         Section 1. Subsection (3) of section 381.79, Florida
  103  Statutes, is amended to read:
  104         381.79 Brain and Spinal Cord Injury Program Trust Fund.—
  105         (3) Annually, 5 percent of the revenues deposited monthly
  106  into in the fund pursuant to s. 318.21(2)(d) shall be
  107  appropriated to the University of Florida and 5 percent to the
  108  University of Miami for spinal cord injury and brain injury
  109  research. The amount to be distributed to the universities shall
  110  be calculated based on the deposits into the fund for each
  111  quarter in the fiscal year, but may not exceed $750,000 $500,000
  112  per university per year. Funds distributed under this subsection
  113  shall be made in quarterly payments at the end of each quarter
  114  during the fiscal year.
  115         Section 2. Section 383.15, Florida Statutes, is amended to
  116  read:
  117         383.15 Legislative intent; perinatal intensive care
  118  services.—The Legislature finds and declares that many perinatal
  119  diseases and disabilities have debilitating, costly, and often
  120  fatal consequences if left untreated. Many of these debilitating
  121  conditions could be prevented or ameliorated if services were
  122  available to the public through a regional perinatal intensive
  123  care centers program. Perinatal intensive care services are
  124  critical to the well-being and development of a healthy society
  125  and represent a constructive, cost-beneficial, and essential
  126  investment in the future of our state. Therefore, it is the
  127  intent of the Legislature to develop a regional perinatal
  128  intensive care centers program. The Legislature further intends
  129  that development of such a regional perinatal intensive care
  130  centers program shall not reduce or dilute the current financial
  131  commitment of the state, as indicated through appropriation, to
  132  the existing regional perinatal intensive care centers. It is
  133  also the intent of the Legislature that any additional centers
  134  regional perinatal intensive care center authorized under s.
  135  383.19 after July 1, 1993, shall not receive payments under a
  136  disproportionate share program for regional perinatal intensive
  137  care centers authorized under chapter 409 s. 409.9112 unless
  138  specific appropriations are provided to expand such payments to
  139  additional hospitals.
  140         Section 3. Paragraph (b) of subsection (6) of section
  141  409.8132, Florida Statutes, is amended to read:
  142         409.8132 Medikids program component.—
  143         (6) ELIGIBILITY.—
  144         (b) The provisions of s. 409.814 apply 409.814(3), (4),
  145  (5), and (6) shall be applicable to the Medikids program.
  146         Section 4. Section 409.814, Florida Statutes, is amended to
  147  read:
  148         409.814 Eligibility.—A child who has not reached 19 years
  149  of age whose family income is equal to or below 200 percent of
  150  the federal poverty level is eligible for the Florida Kidcare
  151  program as provided in this section. For enrollment in the
  152  Children’s Medical Services Network, a complete application
  153  includes the medical or behavioral health screening. If,
  154  subsequently, an enrolled individual is determined to be
  155  ineligible for coverage, he or she must be immediately be
  156  disenrolled from the respective Florida Kidcare program
  157  component.
  158         (1) A child who is eligible for Medicaid coverage under s.
  159  409.903 or s. 409.904 must be enrolled in Medicaid and is not
  160  eligible to receive health benefits under any other health
  161  benefits coverage authorized under the Florida Kidcare program.
  162         (2) A child who is not eligible for Medicaid, but who is
  163  eligible for the Florida Kidcare program, may obtain health
  164  benefits coverage under any of the other components listed in s.
  165  409.813 if such coverage is approved and available in the county
  166  in which the child resides.
  167         (3) A Title XXI-funded child who is eligible for the
  168  Florida Kidcare program who is a child with special health care
  169  needs, as determined through a medical or behavioral screening
  170  instrument, is eligible for health benefits coverage from and
  171  shall be assigned to and may opt out of the Children’s Medical
  172  Services Network.
  173         (4) The following children are not eligible to receive
  174  Title XXI-funded premium assistance for health benefits coverage
  175  under the Florida Kidcare program, except under Medicaid if the
  176  child would have been eligible for Medicaid under s. 409.903 or
  177  s. 409.904 as of June 1, 1997:
  178         (a) A child who is eligible for coverage under a state
  179  health benefit plan on the basis of a family member’s employment
  180  with a public agency in the state.
  181         (a)(b) A child who is covered under a family member’s group
  182  health benefit plan or under other private or employer health
  183  insurance coverage, if the cost of the child’s participation is
  184  not greater than 5 percent of the family’s income. If a child is
  185  otherwise eligible for a subsidy under the Florida Kidcare
  186  program and the cost of the child’s participation in the family
  187  member’s health insurance benefit plan is greater than 5 percent
  188  of the family’s income, the child may enroll in the appropriate
  189  subsidized Kidcare program.
  190         (b)(c) A child who is seeking premium assistance for the
  191  Florida Kidcare program through employer-sponsored group
  192  coverage, if the child has been covered by the same employer’s
  193  group coverage during the 60 days before the family submitted
  194  prior to the family’s submitting an application for
  195  determination of eligibility under the program.
  196         (c)(d) A child who is an alien, but who does not meet the
  197  definition of qualified alien, in the United States.
  198         (d)(e) A child who is an inmate of a public institution or
  199  a patient in an institution for mental diseases.
  200         (e)(f) A child who is otherwise eligible for premium
  201  assistance for the Florida Kidcare program and has had his or
  202  her coverage in an employer-sponsored or private health benefit
  203  plan voluntarily canceled in the last 60 days, except those
  204  children whose coverage was voluntarily canceled for good cause,
  205  including, but not limited to, the following circumstances:
  206         1. The cost of participation in an employer-sponsored
  207  health benefit plan is greater than 5 percent of the family’s
  208  income;
  209         2. The parent lost a job that provided an employer
  210  sponsored health benefit plan for children;
  211         3. The parent who had health benefits coverage for the
  212  child is deceased;
  213         4. The child has a medical condition that, without medical
  214  care, would cause serious disability, loss of function, or
  215  death;
  216         5. The employer of the parent canceled health benefits
  217  coverage for children;
  218         6. The child’s health benefits coverage ended because the
  219  child reached the maximum lifetime coverage amount;
  220         7. The child has exhausted coverage under a COBRA
  221  continuation provision;
  222         8. The health benefits coverage does not cover the child’s
  223  health care needs; or
  224         9. Domestic violence led to loss of coverage.
  225         (5) A child who is otherwise eligible for the Florida
  226  Kidcare program and who has a preexisting condition that
  227  prevents coverage under another insurance plan as described in
  228  paragraph (4)(a) (4)(b) which would have disqualified the child
  229  for the Florida Kidcare program if the child were able to enroll
  230  in the plan is shall be eligible for Florida Kidcare coverage
  231  when enrollment is possible.
  232         (6) A child whose family income is above 200 percent of the
  233  federal poverty level or a child who is excluded under the
  234  provisions of subsection (4) may participate in the Florida
  235  Kidcare program as provided in s. 409.8132 or, if the child is
  236  ineligible for Medikids by reason of age, in the Florida Healthy
  237  Kids program, subject to the following provisions:
  238         (a) The family is not eligible for premium assistance
  239  payments and must pay the full cost of the premium, including
  240  any administrative costs.
  241         (b) The board of directors of the Florida Healthy Kids
  242  Corporation may offer a reduced benefit package to these
  243  children in order to limit program costs for such families.
  244         (7) Once a child is enrolled in the Florida Kidcare
  245  program, the child is eligible for coverage under the program
  246  for 12 months without a redetermination or reverification of
  247  eligibility, if the family continues to pay the applicable
  248  premium. Eligibility for program components funded through Title
  249  XXI of the Social Security Act terminates shall terminate when a
  250  child attains the age of 19. A child who has not attained the
  251  age of 5 and who has been determined eligible for the Medicaid
  252  program is eligible for coverage for 12 months without a
  253  redetermination or reverification of eligibility.
  254         (8) When determining or reviewing a child’s eligibility
  255  under the Florida Kidcare program, the applicant shall be
  256  provided with reasonable notice of changes in eligibility which
  257  may affect enrollment in one or more of the program components.
  258  If When a transition from one program component to another is
  259  authorized, there shall be cooperation between the program
  260  components and the affected family which promotes continuity of
  261  health care coverage. Any authorized transfers must be managed
  262  within the program’s overall appropriated or authorized levels
  263  of funding. Each component of the program shall establish a
  264  reserve to ensure that transfers between components will be
  265  accomplished within current year appropriations. These reserves
  266  shall be reviewed by each convening of the Social Services
  267  Estimating Conference to determine the adequacy of such reserves
  268  to meet actual experience.
  269         (9) In determining the eligibility of a child, an assets
  270  test is not required. Each applicant shall provide documentation
  271  during the application process and the redetermination process,
  272  including, but not limited to, the following:
  273         (a) Each applicant’s Proof of family income, which must
  274  shall be verified electronically to determine financial
  275  eligibility for the Florida Kidcare program. Written
  276  documentation, which may include wages and earnings statements
  277  or pay stubs, W-2 forms, or a copy of the applicant’s most
  278  recent federal income tax return, is shall be required only if
  279  the electronic verification is not available or does not
  280  substantiate the applicant’s income.
  281         (b) Each applicant shall provide A statement from all
  282  applicable, employed family members that:
  283         1. Their employers do not sponsor health benefit plans for
  284  employees;
  285         2. The potential enrollee is not covered by an employer
  286  sponsored health benefit plan; or
  287         3. The potential enrollee is covered by an employer
  288  sponsored health benefit plan and the cost of the employer
  289  sponsored health benefit plan is more than 5 percent of the
  290  family’s income.
  291         (c) To enroll in the Children’s Medical Services Network, a
  292  completed application, including a clinical screening.
  293         (10) Subject to paragraph (4)(a) (4)(b), the Florida
  294  Kidcare program shall withhold benefits from an enrollee if the
  295  program obtains evidence that the enrollee is no longer
  296  eligible, submitted incorrect or fraudulent information in order
  297  to establish eligibility, or failed to provide verification of
  298  eligibility. The applicant or enrollee shall be notified that
  299  because of such evidence program benefits will be withheld
  300  unless the applicant or enrollee contacts a designated
  301  representative of the program by a specified date, which must be
  302  within 10 working days after the date of notice, to discuss and
  303  resolve the matter. The program shall make every effort to
  304  resolve the matter within a timeframe that will not cause
  305  benefits to be withheld from an eligible enrollee.
  306         (11) The following individuals may be subject to
  307  prosecution in accordance with s. 414.39:
  308         (a) An applicant obtaining or attempting to obtain benefits
  309  for a potential enrollee under the Florida Kidcare program if
  310  when the applicant knows or should have known that the potential
  311  enrollee does not qualify for the Florida Kidcare program.
  312         (b) An individual who assists an applicant in obtaining or
  313  attempting to obtain benefits for a potential enrollee under the
  314  Florida Kidcare program if when the individual knows or should
  315  have known that the potential enrollee does not qualify for the
  316  Florida Kidcare program.
  317         Section 5. Section 409.902, Florida Statutes, is amended to
  318  read:
  319         409.902 Designated single state agency; eligibility
  320  determinations payment requirements; program title; release of
  321  medical records.—
  322         (1) The Agency for Health Care Administration is designated
  323  as the single state agency authorized to make payments for
  324  medical assistance and related services under Title XIX of the
  325  Social Security Act. These payments shall be made, subject to
  326  any limitations or directions provided for in the General
  327  Appropriations Act, only for services included in the program,
  328  shall be made only on behalf of eligible individuals, and shall
  329  be made only to qualified providers in accordance with federal
  330  requirements for Title XIX of the Social Security Act and the
  331  provisions of state law. This program of medical assistance is
  332  designated the “Medicaid program.”
  333         (2) The Department of Children and Family Services is
  334  responsible for determining Medicaid eligibility determinations,
  335  including, but not limited to, policy, rules, and the agreement
  336  with the Social Security Administration for Medicaid eligibility
  337  determinations for Supplemental Security Income recipients, as
  338  well as the actual determination of eligibility. As a condition
  339  of Medicaid eligibility, subject to federal approval, the agency
  340  for Health Care Administration and the department must of
  341  Children and Family Services shall ensure that each recipient of
  342  Medicaid consents to the release of her or his medical records
  343  to the agency for Health Care Administration and the Medicaid
  344  Fraud Control Unit of the Department of Legal Affairs.
  345         (3)(2) Eligibility is restricted to United States citizens
  346  and to lawfully admitted noncitizens who meet the criteria
  347  provided in s. 414.095(3).
  348         (a) Citizenship or immigration status must be verified. For
  349  noncitizens, this includes verification of the validity of
  350  documents with the United States Citizenship and Immigration
  351  Services using the federal SAVE verification process.
  352         (b) State funds may not be used to provide medical services
  353  to individuals who do not meet the requirements of this
  354  subsection unless the services are necessary to treat an
  355  emergency medical condition or are for pregnant women. Such
  356  services are authorized only to the extent provided under
  357  federal law and in accordance with federal regulations as
  358  provided in 42 C.F.R. s. 440.255.
  359         (4) To the extent funds are appropriated, the department
  360  shall collaborate with the agency to develop an Internet-based
  361  system for determining eligibility for the Medicaid and Kidcare
  362  programs which complies with all applicable federal and state
  363  laws and requirements.
  364         (a) The system must accomplish the following primary
  365  business objectives:
  366         1. Provide individuals and families with a single access
  367  point to information that explains benefits, premiums, and cost
  368  sharing available through Medicaid, Kidcare, or any other state
  369  or federal health insurance exchange.
  370         2. Enable timely, accurate, and efficient enrollment of
  371  eligible persons into available assistance programs.
  372         3. Prevent eligibility fraud.
  373         4. Allow for detailed financial analysis of eligibility
  374  based cost drivers.
  375         (b) The system must include, but need not be limited to,
  376  the following business and functional requirements:
  377         1. Allowing for the completion and submission of an online
  378  application for determining eligibility which accepts the use of
  379  electronic signatures.
  380         2.Including a process that enables automatic enrollment of
  381  qualified individuals into Medicaid, Kidcare, or any other state
  382  or federal exchange that offers cost-sharing benefits for the
  383  purchase of health insurance.
  384         3.Allowing for the determination of Medicaid eligibility
  385  based on modified adjusted gross income by using information
  386  submitted in the application and information accessed and
  387  verified through automated and secure interfaces with authorized
  388  databases.
  389         4.Including the ability to determine specific categories
  390  of Medicaid eligibility and interface with the Florida Medicaid
  391  Management Information System to support such determination,
  392  using federally approved assessment methodologies, of state and
  393  federal financial participation rates for persons in each
  394  eligibility category.
  395         5.Allowing for the accurate and timely processing of
  396  eligibility claims and adjudications.
  397         6.Aligning with and incorporating all applicable state and
  398  federal laws, requirements, and standards, including the
  399  information technology security requirements established under
  400  s. 282.318 and the accessibility standards established under
  401  part II of chapter 282.
  402         7.Producing transaction data, reports, and performance
  403  information that contributes to an evaluation of the program,
  404  continuous improvement in business operations, and increased
  405  transparency and accountability.
  406         (c)The department shall develop the system subject to
  407  approval by the Legislative Budget Commission and as required by
  408  the General Appropriations Act for the 2012-2013 fiscal year.
  409         (d)The system must be completed by October 1, 2013, and
  410  ready for implementation by January 1, 2014.
  411         (e)The department shall implement the following project
  412  governance structure until the system is implemented:
  413         1.The director of the department’s Economic Self
  414  Sufficiency Services Program Office shall have overall
  415  responsibility for the project.
  416         2.The project shall be governed by an executive steering
  417  committee composed of three department staff members appointed
  418  by the Secretary of Children and Family Services; three agency
  419  staff members, including at least two state Medicaid program
  420  staff members, appointed by the Secretary of Health Care
  421  Administration; and one staff member from Children’s Medical
  422  Services within the Department of Health appointed by the
  423  Surgeon General.
  424         3.The executive steering committee shall have overall
  425  responsibility for ensuring that the project meets its primary
  426  business objectives and shall:
  427         a.Provide management direction and support to the project
  428  management team.
  429         b.Review and approve any changes to the project’s scope,
  430  schedule, and budget.
  431         c.Review, approve, and determine whether to proceed with
  432  any major deliverable project.
  433         d.Recommend suspension or termination of the project to
  434  the Governor, the President of the Senate, and the Speaker of
  435  the House of Representatives if the committee determines that
  436  the primary business objectives cannot be achieved.
  437         4.A project management team shall be appointed by and work
  438  under the direction of the executive steering committee. The
  439  project management team shall:
  440         a.Provide planning, management, and oversight of the
  441  project.
  442         b.Submit an operational work plan and provide quarterly
  443  updates to the plan to the executive steering committee. The
  444  plan must specify project milestones, deliverables, and
  445  expenditures.
  446         c.Submit written monthly project status reports to the
  447  executive steering committee.
  448         Section 6. Subsection (5) of section 409.905, Florida
  449  Statutes, is amended to read:
  450         409.905 Mandatory Medicaid services.—The agency may make
  451  payments for the following services, which are required of the
  452  state by Title XIX of the Social Security Act, furnished by
  453  Medicaid providers to recipients who are determined to be
  454  eligible on the dates on which the services were provided. Any
  455  service under this section shall be provided only when medically
  456  necessary and in accordance with state and federal law.
  457  Mandatory services rendered by providers in mobile units to
  458  Medicaid recipients may be restricted by the agency. Nothing in
  459  this section shall be construed to prevent or limit the agency
  460  from adjusting fees, reimbursement rates, lengths of stay,
  461  number of visits, number of services, or any other adjustments
  462  necessary to comply with the availability of moneys and any
  463  limitations or directions provided for in the General
  464  Appropriations Act or chapter 216.
  465         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
  466  all covered services provided for the medical care and treatment
  467  of a Medicaid recipient who is admitted as an inpatient by a
  468  licensed physician or dentist to a hospital licensed under part
  469  I of chapter 395. However, the agency shall limit the payment
  470  for inpatient hospital services for a nonpregnant Medicaid
  471  recipient 21 years of age or older to 45 days per fiscal year or
  472  the number of days necessary to comply with the General
  473  Appropriations Act. Effective August 1, 2012, the agency shall
  474  limit payment for hospital emergency department visits for a
  475  nonpregnant recipient 21 years of age or older to six visits per
  476  fiscal year.
  477         (a) The agency may is authorized to implement reimbursement
  478  and utilization management reforms in order to comply with any
  479  limitations or directions in the General Appropriations Act,
  480  which may include, but are not limited to: prior authorization
  481  for inpatient psychiatric days; prior authorization for
  482  nonemergency hospital inpatient admissions for individuals 21
  483  years of age and older; authorization of emergency and urgent
  484  care admissions within 24 hours after admission; enhanced
  485  utilization and concurrent review programs for highly utilized
  486  services; reduction or elimination of covered days of service;
  487  adjusting reimbursement ceilings for variable costs; adjusting
  488  reimbursement ceilings for fixed and property costs; and
  489  implementing target rates of increase. The agency may limit
  490  prior authorization for hospital inpatient services to selected
  491  diagnosis-related groups, based on an analysis of the cost and
  492  potential for unnecessary hospitalizations represented by
  493  certain diagnoses. Admissions for normal delivery and newborns
  494  are exempt from requirements for prior authorization
  495  requirements. In implementing the provisions of this section
  496  related to prior authorization, the agency must shall ensure
  497  that the process for authorization is accessible 24 hours per
  498  day, 7 days per week and authorization is automatically granted
  499  if when not denied within 4 hours after the request.
  500  Authorization procedures must include steps for the review of
  501  denials. Upon implementing the prior authorization program for
  502  hospital inpatient services, the agency shall discontinue its
  503  hospital retrospective review program.
  504         (b) A licensed hospital maintained primarily for the care
  505  and treatment of patients having mental disorders or mental
  506  diseases is not eligible to participate in the hospital
  507  inpatient portion of the Medicaid program except as provided
  508  under in federal law. However, the department shall apply for a
  509  waiver, within 9 months after June 5, 1991, designed to provide
  510  hospitalization services for mental health reasons to children
  511  and adults in the most cost-effective and lowest cost setting
  512  possible. Such waiver must shall include a request for the
  513  opportunity to pay for care in hospitals known under federal law
  514  as “institutions for mental disease” or “IMD’s.” The waiver
  515  proposal may not shall propose no additional aggregate cost to
  516  the state or Federal Government, and shall be conducted in
  517  Hillsborough County, Highlands County, Hardee County, Manatee
  518  County, and Polk County. The waiver proposal may incorporate
  519  competitive bidding for hospital services, comprehensive
  520  brokering, prepaid capitated arrangements, or other mechanisms
  521  deemed by the department to show promise in reducing the cost of
  522  acute care and increasing the effectiveness of preventive care.
  523  When developing the waiver proposal, the department shall take
  524  into account price, quality, accessibility, linkages of the
  525  hospital to community services and family support programs,
  526  plans of the hospital to ensure the earliest discharge possible,
  527  and the comprehensiveness of the mental health and other health
  528  care services offered by participating providers.
  529         (c) The agency shall implement a methodology for
  530  establishing base reimbursement rates for each hospital based on
  531  allowable costs, as defined by the agency. Rates shall be
  532  calculated annually and take effect July 1 of each year based on
  533  the most recent complete and accurate cost report submitted by
  534  each hospital. Adjustments may not be made to the rates after
  535  September 30 of the state fiscal year in which the rate takes
  536  effect, except that the agency may request that adjustments be
  537  approved by the Legislative Budget Commission when needed due to
  538  insufficient commitments or collections of intergovernmental
  539  transfers under s. 409.908(1) or s. 409.908(4). Errors in cost
  540  reporting or calculation of rates discovered after September 30
  541  must be reconciled in a subsequent rate period. The agency may
  542  not make any adjustment to a hospital’s reimbursement rate more
  543  than 5 years after a hospital is notified of an audited rate
  544  established by the agency. The prohibition against requirement
  545  that the agency making may not make any adjustment to a
  546  hospital’s reimbursement rate more than 5 years after a hospital
  547  is notified of an audited rate established by the agency is
  548  remedial and applies shall apply to actions by providers
  549  involving Medicaid claims for hospital services. Hospital rates
  550  shall be subject to such limits or ceilings as may be
  551  established in law or described in the agency’s hospital
  552  reimbursement plan. Specific exemptions to the limits or
  553  ceilings may be provided in the General Appropriations Act.
  554         (d) The agency shall implement a comprehensive utilization
  555  management program for hospital neonatal intensive care stays in
  556  certain high-volume participating hospitals, select counties, or
  557  statewide, and replace existing hospital inpatient utilization
  558  management programs for neonatal intensive care admissions. The
  559  program shall be designed to manage the lengths of stay for
  560  children being treated in neonatal intensive care units and must
  561  seek the earliest medically appropriate discharge to the child’s
  562  home or other less costly treatment setting. The agency may
  563  competitively bid a contract for the selection of a qualified
  564  organization to provide neonatal intensive care utilization
  565  management services. The agency may seek federal waivers to
  566  implement this initiative.
  567         (e) The agency may develop and implement a program to
  568  reduce the number of hospital readmissions among the non
  569  Medicare population eligible in areas 9, 10, and 11.
  570         (f) The agency shall develop a plan to convert Medicaid
  571  inpatient hospital rates to a prospective payment system that
  572  categorizes each case into diagnosis-related groups (DRG) and
  573  assigns a payment weight based on the average resources used to
  574  treat Medicaid patients in that DRG. To the extent possible, the
  575  agency shall propose an adaptation of an existing prospective
  576  payment system, such as the one used by Medicare, and shall
  577  propose such adjustments as are necessary for the Medicaid
  578  population and to maintain budget neutrality for inpatient
  579  hospital expenditures.
  580         1. The plan must:
  581         a. Define and describe DRGs for inpatient hospital care
  582  specific to Medicaid in this state;
  583         b. Develop the use of resources needed for each DRG;
  584         c. Apply current statewide levels of funding to DRGs based
  585  on the associated resource value of DRGs. Current statewide
  586  funding levels shall be calculated both with and without the use
  587  of intergovernmental transfers;
  588         d. Calculate the current number of services provided in the
  589  Medicaid program based on DRGs defined under this subparagraph;
  590         e. Estimate the number of cases in each DRG for future
  591  years based on agency data and the official workload estimates
  592  of the Social Services Estimating Conference;
  593         f. Estimate potential funding for each hospital with a
  594  Medicaid provider agreement, based on the DRGs and estimated
  595  workload;
  596         g. Propose supplemental DRG payments to augment hospital
  597  reimbursements based on patient acuity and individual hospital
  598  characteristics, including classification as a children’s
  599  hospital, rural hospital, trauma center, burn unit, and other
  600  characteristics that could warrant higher reimbursements; and
  601         h. Estimate potential funding for each hospital with a
  602  Medicaid provider agreement for DRGs defined pursuant to this
  603  subparagraph and supplemental DRG payments using current funding
  604  levels, calculated both with and without the use of
  605  intergovernmental transfers.
  606         2. The agency, through a competitive procurement pursuant
  607  to chapter 287, shall engage a consultant with expertise and
  608  experience in the implementation of DRG systems for hospital
  609  reimbursement to develop the DRG plan under subparagraph 1.
  610         3. The agency shall submit the Medicaid DRG plan,
  611  identifying all steps necessary for the transition and any costs
  612  associated with plan implementation, to the Governor, the
  613  President of the Senate, and the Speaker of the House of
  614  Representatives no later than December 1, 2012 January 1, 2013.
  615  Upon receiving legislative authorization, the agency shall begin
  616  making the necessary changes to fiscal agent coding by June 1,
  617  2013, with a target date of November 1, 2013, for full
  618  implementation of the DRG system of hospital reimbursement. If,
  619  during implementation of this paragraph, the agency determines
  620  that these timeframes might not be achievable, the agency shall
  621  report to the Legislative Budget Commission the status of its
  622  implementation efforts, the reasons the timeframes might not be
  623  achievable, and proposals for new timeframes.
  624         Section 7. Paragraph (c) of subsection (1) of section
  625  409.908, Florida Statutes, is amended, paragraph (e) is added to
  626  that subsection, and subsections (4) and (21) of that section
  627  are amended, to read:
  628         409.908 Reimbursement of Medicaid providers.—Subject to
  629  specific appropriations, the agency shall reimburse Medicaid
  630  providers, in accordance with state and federal law, according
  631  to methodologies set forth in the rules of the agency and in
  632  policy manuals and handbooks incorporated by reference therein.
  633  These methodologies may include fee schedules, reimbursement
  634  methods based on cost reporting, negotiated fees, competitive
  635  bidding pursuant to s. 287.057, and other mechanisms the agency
  636  considers efficient and effective for purchasing services or
  637  goods on behalf of recipients. If a provider is reimbursed based
  638  on cost reporting and submits a cost report late and that cost
  639  report would have been used to set a lower reimbursement rate
  640  for a rate semester, then the provider’s rate for that semester
  641  shall be retroactively calculated using the new cost report, and
  642  full payment at the recalculated rate shall be effected
  643  retroactively. Medicare-granted extensions for filing cost
  644  reports, if applicable, shall also apply to Medicaid cost
  645  reports. Payment for Medicaid compensable services made on
  646  behalf of Medicaid eligible persons is subject to the
  647  availability of moneys and any limitations or directions
  648  provided for in the General Appropriations Act or chapter 216.
  649  Further, nothing in this section shall be construed to prevent
  650  or limit the agency from adjusting fees, reimbursement rates,
  651  lengths of stay, number of visits, or number of services, or
  652  making any other adjustments necessary to comply with the
  653  availability of moneys and any limitations or directions
  654  provided for in the General Appropriations Act, provided the
  655  adjustment is consistent with legislative intent.
  656         (1) Reimbursement to hospitals licensed under part I of
  657  chapter 395 must be made prospectively or on the basis of
  658  negotiation.
  659         (c) Hospitals that provide services to a disproportionate
  660  share of low-income Medicaid recipients, or that participate in
  661  the regional perinatal intensive care center program under
  662  chapter 383, or that participate in the statutory teaching
  663  hospital disproportionate share program may receive additional
  664  reimbursement. The total amount of payment for disproportionate
  665  share hospitals shall be fixed by the General Appropriations
  666  Act. The computation of these payments must be made in
  667  compliance with all federal regulations and the methodologies
  668  described in ss. 409.911, 409.9112, and 409.9113.
  669         (e) The agency may accept voluntary intergovernmental
  670  transfers of local taxes and other qualified revenue from
  671  counties, municipalities, or special taxing districts under
  672  paragraphs (a) and (b) or the General Appropriations Act for the
  673  purpose of funding the costs of special Medicaid payments to
  674  hospitals, the costs of exempting hospitals from reimbursement
  675  ceilings, or the costs of buying back hospital Medicaid trend
  676  adjustments authorized under the General Appropriations Act,
  677  except that the use of these intergovernmental transfers for
  678  fee-for-service payments to hospitals is limited to the
  679  proportionate use of such funds accepted by the agency under
  680  subsection (4). As used in this paragraph, the term
  681  “proportionate use” means that the use of intergovernmental
  682  transfer funds under this subsection must be in the same
  683  proportion to the use of such funds under subsection (4)
  684  relative to the need for funding hospital costs under each
  685  subsection.
  686         (4) Subject to any limitations or directions provided for
  687  in the General Appropriations Act, alternative health plans,
  688  health maintenance organizations, and prepaid health plans,
  689  including health maintenance organizations, prepaid provider
  690  service networks, and other capitated managed care plans, shall
  691  be reimbursed a fixed, prepaid amount negotiated, or
  692  competitively bid pursuant to s. 287.057, by the agency and
  693  prospectively paid to the provider monthly for each Medicaid
  694  recipient enrolled. The amount may not exceed the average amount
  695  the agency determines it would have paid, based on claims
  696  experience, for recipients in the same or similar category of
  697  eligibility. The agency shall calculate capitation rates on a
  698  regional basis and, beginning September 1, 1995, shall include
  699  age-band differentials in such calculations.
  700         (a) Effective September 1, 2012:
  701         1. The costs of special Medicaid payments to hospitals, the
  702  costs of exempting hospitals from reimbursement ceilings, and
  703  the costs of buying back hospital Medicaid trend adjustments
  704  authorized under the General Appropriations Act, which are
  705  funded through intergovernmental transfers, may not be included
  706  as inpatient or outpatient costs in the calculation of prepaid
  707  health plan capitations under this part. This provision must be
  708  construed so that inpatient hospital costs included in the
  709  calculation of prepaid health plan capitations are identical to
  710  those represented by county billing rates under s. 409.915.
  711         2. Prepaid health plans may not reimburse hospitals for the
  712  costs described in subparagraph 1., except that plans may
  713  contract with hospitals to pay inpatient per diems that are
  714  between 95 percent and 105 percent of the county billing rate.
  715  Hospitals and prepaid health plans may negotiate mutually
  716  acceptable higher rates for medically complex care.
  717         (b)Notwithstanding paragraph (a):
  718         1. In order to fund the inclusion of costs described in
  719  paragraph (a) in the calculation of capitations paid to prepaid
  720  health plans, the agency may accept voluntary intergovernmental
  721  transfers of local taxes and other qualified revenue from
  722  counties, municipalities, or special taxing districts. After
  723  securing commitments from counties, municipalities, or special
  724  taxing districts to contribute intergovernmental transfers for
  725  that purpose, the agency shall develop capitation payments for
  726  prepaid health plans which include the costs described in
  727  paragraph (a) if those components of the capitation are funded
  728  through intergovernmental transfers and not with general
  729  revenue. The rate-setting methodology must preserve federal
  730  matching funds for the intergovernmental transfers collected
  731  under this paragraph and result in actuarially sound rates. The
  732  agency has the discretion to perform this function using
  733  supplemental capitation payments.
  734         2. The amounts included in a prepaid health plan’s
  735  capitations or supplemental capitations under this paragraph for
  736  funding the costs described in paragraph (a) must be used
  737  exclusively by the prepaid health plan to enhance hospital
  738  payments and be calculated by the agency as accurately as
  739  possible to equal the costs described in paragraph (a) which the
  740  prepaid health plan actually incurs and for which
  741  intergovernmental transfers have been secured.
  742         (21) The agency shall reimburse school districts that which
  743  certify the state match pursuant to ss. 409.9071 and 1011.70 for
  744  the federal portion of the school district’s allowable costs to
  745  deliver the services, based on the reimbursement schedule. The
  746  school district shall determine the costs for delivering
  747  services as authorized in ss. 409.9071 and 1011.70 for which the
  748  state match will be certified.
  749         (a) School districts participating in the certified school
  750  match program pursuant to this subsection and s. 1011.70 shall
  751  be reimbursed by Medicaid, subject to the limitations of s.
  752  1011.70(1), for a Medicaid-eligible child participating in the
  753  services, as authorized under s. 1011.70 and as provided in s.
  754  409.9071, regardless of whether the child is enrolled in
  755  MediPass or a managed care plan. Managed care plans and school
  756  districts shall make good faith efforts to execute agreements
  757  regarding the coordinated provision of services authorized under
  758  s. 1011.70. County health departments delivering school-based
  759  services pursuant to ss. 381.0056 and 381.0057 shall be
  760  reimbursed by Medicaid for the federal share for a Medicaid
  761  eligible child who receives Medicaid-covered services in a
  762  school setting, regardless of whether the child is enrolled in
  763  MediPass or a managed care plan. Managed care plans and county
  764  health departments shall make good faith efforts to execute
  765  agreements regarding the coordinated provision of services to a
  766  Medicaid-eligible child. To ensure continuity of care for
  767  Medicaid patients, the agency, the Department of Health, and the
  768  Department of Education shall develop procedures for ensuring
  769  that a student’s managed care plan or MediPass primary care
  770  provider receives information relating to services provided in
  771  accordance with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
  772         (b) Reimbursement of school-based providers is contingent
  773  on such providers being enrolled as Medicaid providers and
  774  meeting the qualifications contained in 42 C.F.R. s. 440.110,
  775  unless otherwise waived by the federal Centers for Medicare and
  776  Medicaid Services Health Care Financing Administration. Speech
  777  therapy providers who are certified through the Department of
  778  Education pursuant to rule 6A-4.0176, Florida Administrative
  779  Code, are eligible for reimbursement for services that are
  780  provided on school premises. An Any employee of the school
  781  district who has been fingerprinted and has received a criminal
  782  background check in accordance with Department of Education
  783  rules and guidelines is shall be exempt from any agency
  784  requirements relating to criminal background checks.
  785         Section 8. Subsection (1), paragraphs (a) and (b) of
  786  subsection (2), and paragraph (d) of subsection (4) of section
  787  409.911, Florida Statutes, are amended to read:
  788         409.911 Disproportionate share program.—Subject to specific
  789  allocations established within the General Appropriations Act
  790  and any limitations established pursuant to chapter 216, the
  791  agency shall distribute, pursuant to this section, moneys to
  792  hospitals providing a disproportionate share of Medicaid or
  793  charity care services by making quarterly Medicaid payments as
  794  required. Notwithstanding the provisions of s. 409.915, counties
  795  are exempt from contributing toward the cost of this special
  796  reimbursement for hospitals serving a disproportionate share of
  797  low-income patients.
  798         (1) DEFINITIONS.—As used in this section, s. 409.9112, and
  799  the Florida Hospital Uniform Reporting System manual:
  800         (a) “Adjusted patient days” means the sum of acute care
  801  patient days and intensive care patient days as reported to the
  802  agency for Health Care Administration, divided by the ratio of
  803  inpatient revenues generated from acute, intensive, ambulatory,
  804  and ancillary patient services to gross revenues.
  805         (b) “Actual audited data” or “actual audited experience”
  806  means data reported to the agency for Health Care Administration
  807  which has been audited in accordance with generally accepted
  808  auditing standards by the agency or representatives under
  809  contract with the agency.
  810         (c) “Charity care” or “uncompensated charity care” means
  811  that portion of hospital charges reported to the agency for
  812  Health Care Administration for which there is no compensation,
  813  other than restricted or unrestricted revenues provided to a
  814  hospital by local governments or tax districts, regardless of
  815  the method of payment, for care provided to a patient whose
  816  family income for the 12 months preceding the determination is
  817  less than or equal to 200 percent of the federal poverty level,
  818  unless the amount of hospital charges due from the patient
  819  exceeds 25 percent of the annual family income. However, in no
  820  case shall the hospital charges for a patient whose family
  821  income exceeds four times the federal poverty level for a family
  822  of four may not be considered charity.
  823         (d) “Charity care days” means the sum of the deductions
  824  from revenues for charity care minus 50 percent of restricted
  825  and unrestricted revenues provided to a hospital by local
  826  governments or tax districts, divided by gross revenues per
  827  adjusted patient day.
  828         (e) “Hospital” means a health care institution licensed as
  829  a hospital pursuant to chapter 395, but does not include
  830  ambulatory surgical centers.
  831         (f) “Medicaid days” means the number of actual days
  832  attributable to Medicaid recipients patients as determined by
  833  the agency for Health Care Administration.
  834         (2) The agency for Health Care Administration shall use the
  835  following actual audited data to determine the Medicaid days and
  836  charity care to be used in calculating the disproportionate
  837  share payment:
  838         (a) The average of the 2004, 2005, and 2006 audited
  839  disproportionate share data to determine each hospital’s
  840  Medicaid days and charity care for the 2012-2013 2011-2012 state
  841  fiscal year.
  842         (b) If the agency for Health Care Administration does not
  843  have the prescribed 3 years of audited disproportionate share
  844  data as noted in paragraph (a) for a hospital, the agency shall
  845  use the average of the years of the audited disproportionate
  846  share data as noted in paragraph (a) which is available.
  847         (4) The following formulas shall be used to pay
  848  disproportionate share dollars to public hospitals:
  849         (d) Any nonstate government owned or operated hospital
  850  eligible for payments under this section on July 1, 2011,
  851  remains eligible for payments during the 2012-2013 2011-2012
  852  state fiscal year.
  853         Section 9. Section 409.9112, Florida Statutes, is repealed.
  854         Section 10. Section 409.9113, Florida Statutes, is amended
  855  to read:
  856         409.9113 Disproportionate share program for teaching
  857  hospitals.—In addition to the payments made under s. ss. 409.911
  858  and 409.9112, the agency shall make disproportionate share
  859  payments to teaching hospitals, as defined in s. 408.07, for
  860  their increased costs associated with medical education programs
  861  and for tertiary health care services provided to the indigent.
  862  This system of payments must conform to federal requirements and
  863  distribute funds in each fiscal year for which an appropriation
  864  is made by making quarterly Medicaid payments. Notwithstanding
  865  s. 409.915, counties are exempt from contributing toward the
  866  cost of this special reimbursement for hospitals serving a
  867  disproportionate share of low-income patients. For the 2011-2012
  868  state fiscal year, The agency shall distribute the moneys
  869  provided in the General Appropriations Act to statutorily
  870  defined teaching hospitals and family practice teaching
  871  hospitals, as defined in s. 395.805, pursuant to this section.
  872  The funds provided for statutorily defined teaching hospitals
  873  shall be distributed as provided in the General Appropriations
  874  Act. The funds provided for family practice teaching hospitals
  875  shall be distributed equally among family practice teaching
  876  hospitals.
  877         (1) On or before September 15 of each year, the agency
  878  shall calculate an allocation fraction to be used for
  879  distributing funds to statutory teaching hospitals. Subsequent
  880  to the end of each quarter of the state fiscal year, the agency
  881  shall distribute to each statutory teaching hospital an amount
  882  determined by multiplying one-fourth of the funds appropriated
  883  for this purpose by the Legislature times such hospital’s
  884  allocation fraction. The allocation fraction for each such
  885  hospital shall be determined by the sum of the following three
  886  primary factors, divided by three:
  887         (a) The number of nationally accredited graduate medical
  888  education programs offered by the hospital, including programs
  889  accredited by the Accreditation Council for Graduate Medical
  890  Education and the combined Internal Medicine and Pediatrics
  891  programs acceptable to both the American Board of Internal
  892  Medicine and the American Board of Pediatrics at the beginning
  893  of the state fiscal year preceding the date on which the
  894  allocation fraction is calculated. The numerical value of this
  895  factor is the fraction that the hospital represents of the total
  896  number of programs, where the total is computed for all
  897  statutory teaching hospitals.
  898         (b) The number of full-time equivalent trainees in the
  899  hospital, which comprises two components:
  900         1. The number of trainees enrolled in nationally accredited
  901  graduate medical education programs, as defined in paragraph
  902  (a). Full-time equivalents are computed using the fraction of
  903  the year during which each trainee is primarily assigned to the
  904  given institution, over the state fiscal year preceding the date
  905  on which the allocation fraction is calculated. The numerical
  906  value of this factor is the fraction that the hospital
  907  represents of the total number of full-time equivalent trainees
  908  enrolled in accredited graduate programs, where the total is
  909  computed for all statutory teaching hospitals.
  910         2. The number of medical students enrolled in accredited
  911  colleges of medicine and engaged in clinical activities,
  912  including required clinical clerkships and clinical electives.
  913  Full-time equivalents are computed using the fraction of the
  914  year during which each trainee is primarily assigned to the
  915  given institution, over the course of the state fiscal year
  916  preceding the date on which the allocation fraction is
  917  calculated. The numerical value of this factor is the fraction
  918  that the given hospital represents of the total number of full
  919  time equivalent students enrolled in accredited colleges of
  920  medicine, where the total is computed for all statutory teaching
  921  hospitals.
  922  
  923  The primary factor for full-time equivalent trainees is computed
  924  as the sum of these two components, divided by two.
  925         (c) A service index that comprises three components:
  926         1. The Agency for Health Care Administration Service Index,
  927  computed by applying the standard Service Inventory Scores
  928  established by the agency to services offered by the given
  929  hospital, as reported on Worksheet A-2 for the last fiscal year
  930  reported to the agency before the date on which the allocation
  931  fraction is calculated. The numerical value of this factor is
  932  the fraction that the given hospital represents of the total
  933  index values, where the total is computed for all statutory
  934  teaching hospitals.
  935         2. A volume-weighted service index, computed by applying
  936  the standard Service Inventory Scores established by the agency
  937  to the volume of each service, expressed in terms of the
  938  standard units of measure reported on Worksheet A-2 for the last
  939  fiscal year reported to the agency before the date on which the
  940  allocation factor is calculated. The numerical value of this
  941  factor is the fraction that the given hospital represents of the
  942  total volume-weighted service index values, where the total is
  943  computed for all statutory teaching hospitals.
  944         3. Total Medicaid payments to each hospital for direct
  945  inpatient and outpatient services during the fiscal year
  946  preceding the date on which the allocation factor is calculated.
  947  This includes payments made to each hospital for such services
  948  by Medicaid prepaid health plans, whether the plan was
  949  administered by the hospital or not. The numerical value of this
  950  factor is the fraction that each hospital represents of the
  951  total of such Medicaid payments, where the total is computed for
  952  all statutory teaching hospitals.
  953  
  954  The primary factor for the service index is computed as the sum
  955  of these three components, divided by three.
  956         (2) By October 1 of each year, the agency shall use the
  957  following formula to calculate the maximum additional
  958  disproportionate share payment for statutory teaching hospitals:
  959  
  960                           TAP = THAF x A                          
  961  
  962  Where:
  963         TAP = total additional payment.
  964         THAF = teaching hospital allocation factor.
  965         A = amount appropriated for a teaching hospital
  966  disproportionate share program.
  967         Section 11. Section 409.9117, Florida Statutes, is
  968  repealed.
  969         Section 12. Paragraphs (b) and (d) of subsection (4) of
  970  section 409.912, Florida Statutes, are amended to read:
  971         409.912 Cost-effective purchasing of health care.—The
  972  agency shall purchase goods and services for Medicaid recipients
  973  in the most cost-effective manner consistent with the delivery
  974  of quality medical care. To ensure that medical services are
  975  effectively utilized, the agency may, in any case, require a
  976  confirmation or second physician’s opinion of the correct
  977  diagnosis for purposes of authorizing future services under the
  978  Medicaid program. This section does not restrict access to
  979  emergency services or poststabilization care services as defined
  980  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  981  shall be rendered in a manner approved by the agency. The agency
  982  shall maximize the use of prepaid per capita and prepaid
  983  aggregate fixed-sum basis services when appropriate and other
  984  alternative service delivery and reimbursement methodologies,
  985  including competitive bidding pursuant to s. 287.057, designed
  986  to facilitate the cost-effective purchase of a case-managed
  987  continuum of care. The agency shall also require providers to
  988  minimize the exposure of recipients to the need for acute
  989  inpatient, custodial, and other institutional care and the
  990  inappropriate or unnecessary use of high-cost services. The
  991  agency shall contract with a vendor to monitor and evaluate the
  992  clinical practice patterns of providers in order to identify
  993  trends that are outside the normal practice patterns of a
  994  provider’s professional peers or the national guidelines of a
  995  provider’s professional association. The vendor must be able to
  996  provide information and counseling to a provider whose practice
  997  patterns are outside the norms, in consultation with the agency,
  998  to improve patient care and reduce inappropriate utilization.
  999  The agency may mandate prior authorization, drug therapy
 1000  management, or disease management participation for certain
 1001  populations of Medicaid beneficiaries, certain drug classes, or
 1002  particular drugs to prevent fraud, abuse, overuse, and possible
 1003  dangerous drug interactions. The Pharmaceutical and Therapeutics
 1004  Committee shall make recommendations to the agency on drugs for
 1005  which prior authorization is required. The agency shall inform
 1006  the Pharmaceutical and Therapeutics Committee of its decisions
 1007  regarding drugs subject to prior authorization. The agency is
 1008  authorized to limit the entities it contracts with or enrolls as
 1009  Medicaid providers by developing a provider network through
 1010  provider credentialing. The agency may competitively bid single
 1011  source-provider contracts if procurement of goods or services
 1012  results in demonstrated cost savings to the state without
 1013  limiting access to care. The agency may limit its network based
 1014  on the assessment of beneficiary access to care, provider
 1015  availability, provider quality standards, time and distance
 1016  standards for access to care, the cultural competence of the
 1017  provider network, demographic characteristics of Medicaid
 1018  beneficiaries, practice and provider-to-beneficiary standards,
 1019  appointment wait times, beneficiary use of services, provider
 1020  turnover, provider profiling, provider licensure history,
 1021  previous program integrity investigations and findings, peer
 1022  review, provider Medicaid policy and billing compliance records,
 1023  clinical and medical record audits, and other factors. Providers
 1024  are not entitled to enrollment in the Medicaid provider network.
 1025  The agency shall determine instances in which allowing Medicaid
 1026  beneficiaries to purchase durable medical equipment and other
 1027  goods is less expensive to the Medicaid program than long-term
 1028  rental of the equipment or goods. The agency may establish rules
 1029  to facilitate purchases in lieu of long-term rentals in order to
 1030  protect against fraud and abuse in the Medicaid program as
 1031  defined in s. 409.913. The agency may seek federal waivers
 1032  necessary to administer these policies.
 1033         (4) The agency may contract with:
 1034         (b) An entity that is providing comprehensive behavioral
 1035  health care services to certain Medicaid recipients through a
 1036  capitated, prepaid arrangement pursuant to the federal waiver
 1037  provided for by s. 409.905(5). Such entity must be licensed
 1038  under chapter 624, chapter 636, or chapter 641, or authorized
 1039  under paragraph (c) or paragraph (d), and must possess the
 1040  clinical systems and operational competence to manage risk and
 1041  provide comprehensive behavioral health care to Medicaid
 1042  recipients. As used in this paragraph, the term “comprehensive
 1043  behavioral health care services” means covered mental health and
 1044  substance abuse treatment services that are available to
 1045  Medicaid recipients. The secretary of the Department of Children
 1046  and Family Services shall approve provisions of procurements
 1047  related to children in the department’s care or custody before
 1048  enrolling such children in a prepaid behavioral health plan. Any
 1049  contract awarded under this paragraph must be competitively
 1050  procured. In developing the behavioral health care prepaid plan
 1051  procurement document, the agency must shall ensure that the
 1052  procurement document requires the contractor to develop and
 1053  implement a plan that ensures to ensure compliance with s.
 1054  394.4574 related to services provided to residents of licensed
 1055  assisted living facilities that hold a limited mental health
 1056  license. Except as provided in subparagraph 5., and except in
 1057  counties where the Medicaid managed care pilot program is
 1058  authorized pursuant to s. 409.91211, the agency shall seek
 1059  federal approval to contract with a single entity meeting these
 1060  requirements to provide comprehensive behavioral health care
 1061  services to all Medicaid recipients not enrolled in a Medicaid
 1062  managed care plan authorized under s. 409.91211, a provider
 1063  service network authorized under paragraph (d), or a Medicaid
 1064  health maintenance organization in an AHCA area. In an AHCA area
 1065  where the Medicaid managed care pilot program is authorized
 1066  pursuant to s. 409.91211 in one or more counties, the agency may
 1067  procure a contract with a single entity to serve the remaining
 1068  counties as an AHCA area or the remaining counties may be
 1069  included with an adjacent AHCA area and are subject to this
 1070  paragraph. Each entity must offer a sufficient choice of
 1071  providers in its network to ensure recipient access to care and
 1072  the opportunity to select a provider with whom they are
 1073  satisfied. The network must shall include all public mental
 1074  health hospitals. To ensure unimpaired access to behavioral
 1075  health care services by Medicaid recipients, all contracts
 1076  issued pursuant to this paragraph must require 80 percent of the
 1077  capitation paid to the managed care plan, including health
 1078  maintenance organizations and capitated provider service
 1079  networks, to be expended for the provision of behavioral health
 1080  care services. If the managed care plan expends less than 80
 1081  percent of the capitation paid for the provision of behavioral
 1082  health care services, the difference shall be returned to the
 1083  agency. The agency shall provide the plan with a certification
 1084  letter indicating the amount of capitation paid during each
 1085  calendar year for behavioral health care services pursuant to
 1086  this section. The agency may reimburse for substance abuse
 1087  treatment services on a fee-for-service basis until the agency
 1088  finds that adequate funds are available for capitated, prepaid
 1089  arrangements.
 1090         1. The agency shall modify the contracts with the entities
 1091  providing comprehensive inpatient and outpatient mental health
 1092  care services to Medicaid recipients in Hillsborough, Highlands,
 1093  Hardee, Manatee, and Polk Counties, to include substance abuse
 1094  treatment services.
 1095         2. Except as provided in subparagraph 5., the agency and
 1096  the Department of Children and Family Services shall contract
 1097  with managed care entities in each AHCA area except area 6 or
 1098  arrange to provide comprehensive inpatient and outpatient mental
 1099  health and substance abuse services through capitated prepaid
 1100  arrangements to all Medicaid recipients who are eligible to
 1101  participate in such plans under federal law and regulation. In
 1102  AHCA areas where eligible individuals number less than 150,000,
 1103  the agency shall contract with a single managed care plan to
 1104  provide comprehensive behavioral health services to all
 1105  recipients who are not enrolled in a Medicaid health maintenance
 1106  organization, a provider service network authorized under
 1107  paragraph (d), or a Medicaid capitated managed care plan
 1108  authorized under s. 409.91211. The agency may contract with more
 1109  than one comprehensive behavioral health provider to provide
 1110  care to recipients who are not enrolled in a Medicaid capitated
 1111  managed care plan authorized under s. 409.91211, a provider
 1112  service network authorized under paragraph (d), or a Medicaid
 1113  health maintenance organization in AHCA areas where the eligible
 1114  population exceeds 150,000. In an AHCA area where the Medicaid
 1115  managed care pilot program is authorized pursuant to s.
 1116  409.91211 in one or more counties, the agency may procure a
 1117  contract with a single entity to serve the remaining counties as
 1118  an AHCA area or the remaining counties may be included with an
 1119  adjacent AHCA area and shall be subject to this paragraph.
 1120  Contracts for comprehensive behavioral health providers awarded
 1121  pursuant to this section shall be competitively procured. Both
 1122  for-profit and not-for-profit corporations are eligible to
 1123  compete. Managed care plans contracting with the agency under
 1124  subsection (3) or paragraph (d) shall provide and receive
 1125  payment for the same comprehensive behavioral health benefits as
 1126  provided in AHCA rules, including handbooks incorporated by
 1127  reference. In AHCA area 11, prior to any fiscal year for which
 1128  the agency expects the number of MediPass enrollees in that area
 1129  to exceed 150,000, the agency shall seek to contract with at
 1130  least two comprehensive behavioral health care providers to
 1131  provide behavioral health care to recipients in that area who
 1132  are enrolled in, or assigned to, the MediPass program, and the
 1133  agency must offer one. One of the behavioral health care
 1134  contracts to must be with the existing public hospital-operated
 1135  provider service network pilot project, as described in
 1136  paragraph (d), for the purpose of demonstrating the cost
 1137  effectiveness of the provision of quality mental health services
 1138  through a public hospital-operated managed care model. Payment
 1139  shall be at an agreed-upon capitated rate to ensure cost
 1140  savings. Of the recipients in area 11 who are assigned to
 1141  MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those
 1142  MediPass-enrolled recipients shall be assigned to the existing
 1143  provider service network in area 11 for their behavioral care.
 1144         3. Children residing in a statewide inpatient psychiatric
 1145  program, or in a Department of Juvenile Justice or a Department
 1146  of Children and Family Services residential program approved as
 1147  a Medicaid behavioral health overlay services provider may not
 1148  be included in a behavioral health care prepaid health plan or
 1149  any other Medicaid managed care plan pursuant to this paragraph.
 1150         4. Traditional community mental health providers under
 1151  contract with the Department of Children and Family Services
 1152  pursuant to part IV of chapter 394, child welfare providers
 1153  under contract with the Department of Children and Family
 1154  Services in areas 1 and 6, and inpatient mental health providers
 1155  licensed pursuant to chapter 395 must be offered an opportunity
 1156  to accept or decline a contract to participate in a any provider
 1157  network for prepaid behavioral health services.
 1158         5. All Medicaid-eligible children, except children in area
 1159  1 and children in Highlands County, Hardee County, Polk County,
 1160  or Manatee County of area 6, which that are open for child
 1161  welfare services in the statewide automated child welfare
 1162  information system, shall receive their behavioral health care
 1163  services through a specialty prepaid plan operated by community
 1164  based lead agencies through a single agency or formal agreements
 1165  among several agencies. The agency shall work with the specialty
 1166  plan to develop clinically effective, evidence-based
 1167  alternatives as a downward substitution for the statewide
 1168  inpatient psychiatric program and similar residential care and
 1169  institutional services. The specialty prepaid plan must result
 1170  in savings to the state comparable to savings achieved in other
 1171  Medicaid managed care and prepaid programs. Such plan must
 1172  provide mechanisms to maximize state and local revenues. The
 1173  specialty prepaid plan shall be developed by the agency and the
 1174  Department of Children and Family Services. The agency may seek
 1175  federal waivers to implement this initiative. Medicaid-eligible
 1176  children whose cases are open for child welfare services in the
 1177  statewide automated child welfare information system and who
 1178  reside in AHCA area 10 shall be enrolled in a capitated provider
 1179  service network or other capitated managed care plan, which, in
 1180  coordination with available community-based care providers
 1181  specified in s. 409.1671, must shall provide sufficient medical,
 1182  developmental, and behavioral health services to meet the needs
 1183  of these children.
 1184  
 1185  This paragraph expires October 1, 2014.
 1186         (d)1. A provider service network, which may be reimbursed
 1187  on a fee-for-service or prepaid basis. Prepaid provider service
 1188  networks shall receive per-member, per-month payments. A
 1189  provider service network that does not choose to be a prepaid
 1190  plan shall receive fee-for-service rates with a shared savings
 1191  settlement. The fee-for-service option shall be available to a
 1192  provider service network only for the first 2 years of the
 1193  plan’s operation or until the contract year beginning September
 1194  1, 2014, whichever is later. The agency shall annually conduct
 1195  cost reconciliations to determine the amount of cost savings
 1196  achieved by fee-for-service provider service networks for the
 1197  dates of service in the period being reconciled. Only payments
 1198  for covered services for dates of service within the
 1199  reconciliation period and paid within 6 months after the last
 1200  date of service in the reconciliation period shall be included.
 1201  The agency shall perform the necessary adjustments for the
 1202  inclusion of claims incurred but not reported within the
 1203  reconciliation for claims that could be received and paid by the
 1204  agency after the 6-month claims processing time lag. The agency
 1205  shall provide the results of the reconciliations to the fee-for
 1206  service provider service networks within 45 days after the end
 1207  of the reconciliation period. The fee-for-service provider
 1208  service networks shall review and provide written comments or a
 1209  letter of concurrence to the agency within 45 days after receipt
 1210  of the reconciliation results. This reconciliation shall be
 1211  considered final.
 1212         2. A provider service network that which is reimbursed by
 1213  the agency on a prepaid basis is shall be exempt from parts I
 1214  and III of chapter 641, but must comply with the solvency
 1215  requirements in s. 641.2261(2) and meet appropriate financial
 1216  reserve, quality assurance, and patient rights requirements as
 1217  established by the agency.
 1218         3. The agency shall assign Medicaid recipients assigned to
 1219  a provider service network in accordance with s. 409.9122 or s.
 1220  409.91211, as applicable shall be chosen equally from those who
 1221  would otherwise have been assigned to prepaid plans and
 1222  MediPass. The agency may is authorized to seek federal Medicaid
 1223  waivers as necessary to implement the provisions of this
 1224  section. This subparagraph expires October 1, 2014.
 1225         4. A provider service network is a network established or
 1226  organized and operated by a health care provider, or group of
 1227  affiliated health care providers, including minority physician
 1228  networks and emergency room diversion programs that meet the
 1229  requirements of s. 409.91211, which provides a substantial
 1230  proportion of the health care items and services under a
 1231  contract directly through the provider or affiliated group of
 1232  providers and may make arrangements with physicians or other
 1233  health care professionals, health care institutions, or any
 1234  combination of such individuals or institutions to assume all or
 1235  part of the financial risk on a prospective basis for the
 1236  provision of basic health services by the physicians, by other
 1237  health professionals, or through the institutions. The health
 1238  care providers must have a controlling interest in the governing
 1239  body of the provider service network organization.
 1240         Section 13. Section 409.9121, Florida Statutes, is amended
 1241  to read:
 1242         409.9121 Legislative findings and intent.—The Legislature
 1243  hereby finds that the Medicaid program has experienced an annual
 1244  growth rate of approximately 28 percent per year for the past 5
 1245  years, and is consuming more than half of all new general
 1246  revenue growth. The present Medicaid system must be reoriented
 1247  to emphasize, to the maximum extent possible, the delivery of
 1248  health care through entities and mechanisms that which are
 1249  designed to contain costs, to emphasize preventive and primary
 1250  care, and to promote access and continuity of care. The
 1251  Legislature further finds that the concept of “managed care”
 1252  best encompasses these multiple goals. The Legislature also
 1253  finds that, with the cooperation of the physician community,
 1254  MediPass, the Medicaid primary care case management program, is
 1255  responsible for ensuring that there is a sufficient supply of
 1256  primary care to provide access to preventive and primary care
 1257  services to Medicaid recipients. Therefore, the Legislature
 1258  declares its intent that the Medicaid program require, to the
 1259  maximum extent practicable and permitted by federal law, that
 1260  all Medicaid recipients be enrolled in a managed care program.
 1261         Section 14. Subsections (1), (2), (4), (5), and (12) of
 1262  section 409.9122, Florida Statutes, are amended to read:
 1263         409.9122 Mandatory Medicaid managed care enrollment;
 1264  programs and procedures.—
 1265         (1) It is the intent of the Legislature that Medicaid
 1266  managed care the MediPass program be cost-effective, provide
 1267  quality health care, and improve access to health services, and
 1268  that the program be implemented statewide. Medicaid managed care
 1269  shall consist of the enrollment of Medicaid recipients in the
 1270  MediPass program or managed care plans for comprehensive medical
 1271  services. This subsection expires October 1, 2014.
 1272         (2)(a) The agency shall enroll all Medicaid recipients in a
 1273  managed care plan or MediPass all Medicaid recipients, except
 1274  those Medicaid recipients who are: in an institution,; enrolled
 1275  in the Medicaid medically needy program,; or eligible for both
 1276  Medicaid and Medicare. Upon enrollment, recipients may
 1277  individuals will be able to change their managed care option
 1278  during the 90-day opt out period required by federal Medicaid
 1279  regulations. The agency may is authorized to seek the necessary
 1280  Medicaid state plan amendment to implement this policy. However,
 1281         (a) To the extent permitted by federal law, the agency may
 1282  enroll a recipient in a managed care plan or MediPass a Medicaid
 1283  recipient who is exempt from mandatory managed care enrollment
 1284  if, provided that:
 1285         1. The recipient’s decision to enroll in a managed care
 1286  plan or MediPass is voluntary;
 1287         2. If The recipient chooses to enroll in a managed care
 1288  plan and, the agency has determined that the managed care plan
 1289  provides specific programs and services that which address the
 1290  special health needs of the recipient; and
 1291         3. The agency receives any necessary waivers from the
 1292  federal Centers for Medicare and Medicaid Services.
 1293  
 1294  School districts participating in the certified school match
 1295  program pursuant to ss. 409.908(21) and 1011.70 shall be
 1296  reimbursed by Medicaid, subject to the limitations of s.
 1297  1011.70(1), for a Medicaid-eligible child participating in the
 1298  services as authorized in s. 1011.70, as provided for in s.
 1299  409.9071, regardless of whether the child is enrolled in
 1300  MediPass or a managed care plan. Managed care plans shall make a
 1301  good faith effort to execute agreements with school districts
 1302  regarding the coordinated provision of services authorized under
 1303  s. 1011.70. County health departments delivering school-based
 1304  services pursuant to ss. 381.0056 and 381.0057 shall be
 1305  reimbursed by Medicaid for the federal share for a Medicaid
 1306  eligible child who receives Medicaid-covered services in a
 1307  school setting, regardless of whether the child is enrolled in
 1308  MediPass or a managed care plan. Managed care plans shall make a
 1309  good faith effort to execute agreements with county health
 1310  departments regarding the coordinated provision of services to a
 1311  Medicaid-eligible child. To ensure continuity of care for
 1312  Medicaid patients, the agency, the Department of Health, and the
 1313  Department of Education shall develop procedures for ensuring
 1314  that a student’s managed care plan or MediPass provider receives
 1315  information relating to services provided in accordance with ss.
 1316  381.0056, 381.0057, 409.9071, and 1011.70.
 1317         (b) A Medicaid recipient may shall not be enrolled in or
 1318  assigned to a managed care plan or MediPass unless the managed
 1319  care plan or MediPass has complied with the quality-of-care
 1320  standards specified in paragraphs (3)(a) and (b), respectively.
 1321         (c) A Medicaid recipient eligible for managed care
 1322  enrollment recipients shall have a choice of managed care
 1323  options plans or MediPass. The Agency for Health Care
 1324  Administration, the Department of Health, the Department of
 1325  Children and Family Services, and the Department of Elderly
 1326  Affairs shall cooperate to ensure that each Medicaid recipient
 1327  receives clear and easily understandable information that meets
 1328  the following requirements:
 1329         1. Explains the concept of managed care, including
 1330  MediPass.
 1331         2. Provides information on the comparative performance of
 1332  managed care options available to the recipient plans and
 1333  MediPass in the areas of quality, credentialing, preventive
 1334  health programs, network size and availability, and patient
 1335  satisfaction.
 1336         3. Explains where additional information on each managed
 1337  care option plan and MediPass in the recipient’s area can be
 1338  obtained.
 1339         4. Explains that recipients have the right to choose their
 1340  managed care coverage at the time they first enroll in Medicaid
 1341  and again at regular intervals set by the agency. However, if a
 1342  recipient does not choose a managed care option plan or
 1343  MediPass, the agency shall will assign the recipient to a
 1344  managed care plan or MediPass according to the criteria
 1345  specified in this section.
 1346         5. Explains the recipient’s right to complain, file a
 1347  grievance, or change his or her managed care option as specified
 1348  in this section plans or MediPass providers if the recipient is
 1349  not satisfied with the managed care plan or MediPass.
 1350         (d) The agency shall develop a mechanism for providing
 1351  information to Medicaid recipients for the purpose of choosing
 1352  making a managed care option plan or MediPass selection.
 1353  Examples of such mechanisms may include, but are not be limited
 1354  to, interactive information systems, mailings, and mass
 1355  marketing materials. Managed care plans and MediPass providers
 1356  may not provide are prohibited from providing inducements to
 1357  Medicaid recipients to select their plans or prejudice from
 1358  prejudicing Medicaid recipients against other managed care plans
 1359  or MediPass providers.
 1360         (e) Medicaid recipients who are already enrolled in a
 1361  managed care plan or MediPass shall be offered the opportunity
 1362  to change managed care plans or MediPass providers, as
 1363  applicable, on a staggered basis, as defined by the agency. All
 1364  Medicaid recipients shall have 30 days in which to choose a
 1365  managed care option make a choice of managed care plans or
 1366  MediPass providers. Those Medicaid recipients who do not make a
 1367  choice shall be assigned in accordance with paragraph (f). To
 1368  facilitate continuity of care, for a Medicaid recipient who is
 1369  also a recipient of Supplemental Security Income (SSI), prior to
 1370  assigning the SSI recipient to a managed care plan or MediPass,
 1371  the agency shall determine whether the SSI recipient has an
 1372  ongoing relationship with a MediPass provider or managed care
 1373  plan, and if so, the agency shall assign the SSI recipient to
 1374  that MediPass provider or managed care plan. Those SSI
 1375  recipients who do not have such a provider relationship shall be
 1376  assigned to a managed care plan or MediPass provider in
 1377  accordance with paragraph (f).
 1378         1. During the 30-day choice period:
 1379         a. A recipient residing in a county in which two or more
 1380  managed care plans are eligible to accept Medicaid enrollees,
 1381  including a recipient who was enrolled in MediPass at the
 1382  commencement of his or her 30-day choice period, shall choose
 1383  from those managed care plans. A recipient may opt out of his or
 1384  her choice and choose a different managed care plan during the
 1385  90-day opt out period.
 1386         b. A recipient residing in a county in which only one
 1387  managed care plan is eligible to accept Medicaid enrollees shall
 1388  choose the managed care plan or a MediPass provider. A recipient
 1389  who chooses the managed care plan may opt out of the plan and
 1390  choose a MediPass provider during the 90-day opt out period.
 1391         c. A recipient residing in a county in which no managed
 1392  care plan is accepting Medicaid enrollees shall choose a
 1393  MediPass provider.
 1394         2. For the purposes of recipient choice, if a managed care
 1395  plan reaches its enrollment capacity, as determined by the
 1396  agency, the plan may not accept additional Medicaid enrollees
 1397  until the agency determines that the plan’s enrollment is
 1398  sufficiently less than its enrollment capacity, due to a decline
 1399  in enrollment or by an increase in enrollment capacity. If a
 1400  managed care plan notifies the agency of its intent to exit a
 1401  county, the plan may not accept additional Medicaid enrollees in
 1402  that county before the exit date.
 1403         3. As used in this paragraph, when referring to recipient
 1404  choice, the term “managed care plans” includes health
 1405  maintenance organizations, exclusive provider organizations,
 1406  provider service networks, minority physician networks,
 1407  Children’s Medical Services Networks, and pediatric emergency
 1408  department diversion programs authorized by this chapter or the
 1409  General Appropriations Act.
 1410         4. The agency shall seek federal waiver authority or a
 1411  state plan amendment consistent with 42 U.S.C. 1396u-2(a)(1), as
 1412  needed, to implement this paragraph.
 1413         (f) If a Medicaid recipient does not choose a managed care
 1414  option:
 1415         1. If the recipient resides in a county in which two or
 1416  more managed care plans are accepting Medicaid enrollees, the
 1417  agency shall assign the recipient, including a recipient who was
 1418  enrolled in MediPass at the commencement of his or her 30-day
 1419  choice period, to one of those managed care plans. A recipient
 1420  assigned to a managed care plan under this subparagraph may opt
 1421  out of the managed care plan and enroll in a different managed
 1422  care plan during the 90-day opt out period. The agency shall
 1423  seek to make assignments among the managed care plans on an even
 1424  basis under the criteria in subparagraph 6.
 1425         2. If the recipient resides in a county in which only one
 1426  managed care plan is accepting Medicaid enrollees, the agency
 1427  shall assign the recipient, including a recipient who was
 1428  enrolled in MediPass at the commencement of his or her 30-day
 1429  choice period, to the managed care plan. A recipient assigned to
 1430  a managed care plan under this subparagraph may opt out of the
 1431  managed care plan and choose a MediPass provider during the 90
 1432  day opt out period.
 1433         3. If the recipient resides in a county in which no managed
 1434  care plan is accepting Medicaid enrollees, the agency shall
 1435  assign the recipient to a MediPass provider.
 1436         4. For the purpose of assignment, if a managed care plan
 1437  reaches its enrollment capacity, as determined by the agency,
 1438  the plan may not accept additional Medicaid enrollees until the
 1439  agency determines that the plan’s enrollment is sufficiently
 1440  less than its enrollment capacity, due to a decline in
 1441  enrollment or by an increase in enrollment capacity. If a
 1442  managed care plan notifies the agency of its intent to exit a
 1443  county, the agency may not assign additional Medicaid enrollees
 1444  to the plan in that county before the exit date. plan or
 1445  MediPass provider, the agency shall assign the Medicaid
 1446  recipient to a managed care plan or MediPass provider. Medicaid
 1447  recipients eligible for managed care plan enrollment who are
 1448  subject to mandatory assignment but who fail to make a choice
 1449  shall be assigned to managed care plans until an enrollment of
 1450  35 percent in MediPass and 65 percent in managed care plans, of
 1451  all those eligible to choose managed care, is achieved. Once
 1452  this enrollment is achieved, the assignments shall be divided in
 1453  order to maintain an enrollment in MediPass and managed care
 1454  plans which is in a 35 percent and 65 percent proportion,
 1455  respectively. Thereafter, assignment of Medicaid recipients who
 1456  fail to make a choice shall be based proportionally on the
 1457  preferences of recipients who have made a choice in the previous
 1458  period. Such proportions shall be revised at least quarterly to
 1459  reflect an update of the preferences of Medicaid recipients. The
 1460  agency shall disproportionately assign Medicaid-eligible
 1461  recipients who are required to but have failed to make a choice
 1462  of managed care plan or MediPass to the Children’s Medical
 1463  Services Network as defined in s. 391.021, exclusive provider
 1464  organizations, provider service networks, minority physician
 1465  networks, and pediatric emergency department diversion programs
 1466  authorized by this chapter or the General Appropriations Act, in
 1467  such manner as the agency deems appropriate, until the agency
 1468  has determined that the networks and programs have sufficient
 1469  numbers to be operated economically.
 1470         5. As used in For purposes of this paragraph, when
 1471  referring to assignment, the term “managed care plans” includes
 1472  health maintenance organizations, exclusive provider
 1473  organizations, provider service networks, minority physician
 1474  networks, Children’s Medical Services Network, and pediatric
 1475  emergency department diversion programs authorized by this
 1476  chapter or the General Appropriations Act.
 1477         6. When making assignments, the agency shall consider take
 1478  into account the following criteria, as applicable:
 1479         a.1.Whether a managed care plan has sufficient network
 1480  capacity to meet the need of members.
 1481         b.2.Whether the managed care plan or MediPass has
 1482  previously enrolled the recipient as a member, or one of the
 1483  managed care plan’s primary care providers or a MediPass primary
 1484  care provider providers has previously provided health care to
 1485  the recipient.
 1486         c.3.Whether the agency has knowledge that the recipient
 1487  member has previously expressed a preference for a particular
 1488  managed care plan or MediPass primary care provider as indicated
 1489  by Medicaid fee-for-service claims data, but has failed to make
 1490  a choice.
 1491         d.4.Whether the managed care plan’s or MediPass primary
 1492  care providers are geographically accessible to the recipient’s
 1493  residence.
 1494         e. If the recipient was already enrolled in a managed care
 1495  plan at the commencement of his or her 30-day choice period and
 1496  fails to choose a different option, the recipient must remain
 1497  enrolled in that same managed care plan.
 1498         f. To facilitate continuity of care for a Medicaid
 1499  recipient who is also a recipient of Supplemental Security
 1500  Income (SSI), before assigning the SSI recipient, the agency
 1501  shall determine whether the SSI recipient has an ongoing
 1502  relationship with a managed care plan or a MediPass primary care
 1503  provider, and if so, the agency shall assign the SSI recipient
 1504  to that managed care plan or MediPass provider, as applicable.
 1505  However, if the recipient has an ongoing relationship with a
 1506  MediPass primary care provider who is included in the provider
 1507  network of one or more managed care plans, the agency shall
 1508  assign the recipient to one of those managed care plans.
 1509         g. If the recipient is diagnosed with HIV/AIDS and resides
 1510  in Broward County, Miami-Dade County, or Palm Beach County, the
 1511  agency shall assign the Medicaid recipient to a managed care
 1512  plan that is a health maintenance organization authorized under
 1513  chapter 641, that was under contract with the agency on July 1,
 1514  2011, and that offers a delivery system in partnership with a
 1515  university-based teaching and research-oriented organization
 1516  specializing in providing health care services and treatment for
 1517  individuals diagnosed with HIV/AIDS. Recipients not diagnosed
 1518  with HIV/AIDS may not be assigned under this paragraph to a
 1519  managed care plan that specializes in HIV/AIDS.
 1520         7. The agency shall seek federal waiver authority or a
 1521  state plan amendment consistent with 42 U.S.C. 1396u-2(a)(4)(D),
 1522  as needed, to implement this paragraph.
 1523         (g) When more than one managed care plan or MediPass
 1524  provider meets the criteria specified in paragraph (f), the
 1525  agency shall make recipient assignments consecutively by family
 1526  unit.
 1527         (h) The agency may not engage in practices that are
 1528  designed to favor one managed care plan over another or that are
 1529  designed to influence Medicaid recipients to enroll in MediPass
 1530  rather than in a managed care plan or to enroll in a managed
 1531  care plan rather than in MediPass, as applicable. This
 1532  subsection does not prohibit the agency from reporting on the
 1533  performance of MediPass or any managed care plan, as measured by
 1534  performance criteria developed by the agency.
 1535         (i) After a recipient has made his or her selection or has
 1536  been enrolled in a managed care plan or MediPass, the recipient
 1537  shall have 90 days to exercise the opportunity to voluntarily
 1538  disenroll and select another managed care option plan or
 1539  MediPass. After 90 days, no further changes may be made except
 1540  for good cause. Good cause includes, but is not limited to, poor
 1541  quality of care, lack of access to necessary specialty services,
 1542  an unreasonable delay or denial of service, or fraudulent
 1543  enrollment. The agency shall develop criteria for good cause
 1544  disenrollment for chronically ill and disabled populations who
 1545  are assigned to managed care plans if more appropriate care is
 1546  available through the MediPass program. The agency must make a
 1547  determination as to whether good cause exists. However, the
 1548  agency may require a recipient to use the managed care plan’s or
 1549  MediPass grievance process prior to the agency’s determination
 1550  of good cause, except in cases in which immediate risk of
 1551  permanent damage to the recipient’s health is alleged. The
 1552  grievance process, if used when utilized, must be completed in
 1553  time to permit the recipient to disenroll by the first day of
 1554  the second month after the month the disenrollment request was
 1555  made. If the managed care plan or MediPass, as a result of the
 1556  grievance process, approves an enrollee’s request to disenroll,
 1557  the agency is not required to make a determination in the case.
 1558  The agency must make a determination and take final action on a
 1559  recipient’s request so that disenrollment occurs by no later
 1560  than the first day of the second month after the month the
 1561  request was made. If the agency fails to act within the
 1562  specified timeframe, the recipient’s request to disenroll is
 1563  deemed to be approved as of the date agency action was required.
 1564  Recipients who disagree with the agency’s finding that good
 1565  cause does not exist for disenrollment shall be advised of their
 1566  right to pursue a Medicaid fair hearing to dispute the agency’s
 1567  finding.
 1568         (j) Consistent with 42 U.S.C. 1396u-2(a)(4)(A) or under
 1569  federal waiver authority, as needed, the agency shall apply for
 1570  a federal waiver from the Centers for Medicare and Medicaid
 1571  Services to lock eligible Medicaid recipients into a managed
 1572  care plan or MediPass for 12 months after an open enrollment
 1573  period, except for the 90-day opt out period and good cause
 1574  disenrollment. After 12 months’ enrollment, a recipient may
 1575  select another managed care plan or MediPass provider. However,
 1576  nothing shall prevent a Medicaid recipient may not be prevented
 1577  from changing primary care providers within the managed care
 1578  plan or MediPass program, as applicable, during the 12-month
 1579  period.
 1580         (k) The agency shall maintain MediPass provider networks in
 1581  all counties, including those counties in which two or more
 1582  managed care plans are accepting Medicaid enrollees. When a
 1583  Medicaid recipient does not choose a managed care plan or
 1584  MediPass provider, the agency shall assign the Medicaid
 1585  recipient to a managed care plan, except in those counties in
 1586  which there are fewer than two managed care plans accepting
 1587  Medicaid enrollees, in which case assignment shall be to a
 1588  managed care plan or a MediPass provider. Medicaid recipients in
 1589  counties with fewer than two managed care plans accepting
 1590  Medicaid enrollees who are subject to mandatory assignment but
 1591  who fail to make a choice shall be assigned to managed care
 1592  plans until an enrollment of 35 percent in MediPass and 65
 1593  percent in managed care plans, of all those eligible to choose
 1594  managed care, is achieved. Once that enrollment is achieved, the
 1595  assignments shall be divided in order to maintain an enrollment
 1596  in MediPass and managed care plans which is in a 35 percent and
 1597  65 percent proportion, respectively. For purposes of this
 1598  paragraph, when referring to assignment, the term “managed care
 1599  plans” includes exclusive provider organizations, provider
 1600  service networks, Children’s Medical Services Network, minority
 1601  physician networks, and pediatric emergency department diversion
 1602  programs authorized by this chapter or the General
 1603  Appropriations Act. When making assignments, the agency shall
 1604  take into account the following criteria:
 1605         1. A managed care plan has sufficient network capacity to
 1606  meet the need of members.
 1607         2. The managed care plan or MediPass has previously
 1608  enrolled the recipient as a member, or one of the managed care
 1609  plan’s primary care providers or MediPass providers has
 1610  previously provided health care to the recipient.
 1611         3. The agency has knowledge that the member has previously
 1612  expressed a preference for a particular managed care plan or
 1613  MediPass provider as indicated by Medicaid fee-for-service
 1614  claims data, but has failed to make a choice.
 1615         4. The managed care plan’s or MediPass primary care
 1616  providers are geographically accessible to the recipient’s
 1617  residence.
 1618         5. The agency has authority to make mandatory assignments
 1619  based on quality of service and performance of managed care
 1620  plans.
 1621         (l) If the Medicaid recipient is diagnosed with HIV/AIDS
 1622  and resides in Broward County, Miami-Dade County, or Palm Beach
 1623  County, the agency shall assign the Medicaid recipient to a
 1624  managed care plan that is a health maintenance organization
 1625  authorized under chapter 641, is under contract with the agency
 1626  on July 1, 2011, and which offers a delivery system through a
 1627  university-based teaching and research-oriented organization
 1628  that specializes in providing health care services and treatment
 1629  for individuals diagnosed with HIV/AIDS.
 1630         (l)(m) Notwithstanding the provisions of chapter 287, the
 1631  agency may, at its discretion, renew cost-effective contracts
 1632  for choice counseling services once or more for such periods as
 1633  the agency may decide. However, all such renewals may not
 1634  combine to exceed a total period longer than the term of the
 1635  original contract.
 1636  
 1637  This subsection expires October 1, 2014.
 1638         (4)(a) Each female recipient may select as her primary care
 1639  provider an obstetrician/gynecologist who has agreed to
 1640  participate within a managed care plan’s provider network or as
 1641  a MediPass primary care case manager, as applicable.
 1642         (b) The agency shall establish a complaints and grievance
 1643  process to assist Medicaid recipients enrolled in the MediPass
 1644  program to resolve complaints and grievances. The agency shall
 1645  investigate reports of quality-of-care grievances which remain
 1646  unresolved to the satisfaction of the enrollee.
 1647  
 1648  This subsection expires October 1, 2014.
 1649         (5)(a) The agency shall work cooperatively with the Social
 1650  Security Administration to identify recipients beneficiaries who
 1651  are jointly eligible for Medicare and Medicaid and shall develop
 1652  cooperative programs to encourage these recipients beneficiaries
 1653  to enroll in a Medicare participating health maintenance
 1654  organization or prepaid health plans.
 1655         (b) The agency shall work cooperatively with the Department
 1656  of Elderly Affairs to assess the potential cost-effectiveness of
 1657  providing managed care enrollment MediPass to recipients
 1658  beneficiaries who are jointly eligible for Medicare and Medicaid
 1659  on a voluntary choice basis. If the agency determines that
 1660  enrollment of these recipients beneficiaries in managed care
 1661  MediPass has the potential for being cost-effective for the
 1662  state, the agency shall offer managed care enrollment MediPass
 1663  to these recipients beneficiaries on a voluntary choice basis in
 1664  the counties where managed care is available MediPass operates.
 1665  
 1666  This subsection expires October 1, 2014.
 1667         (12) The agency shall include in its calculation of the
 1668  hospital inpatient component of a Medicaid health maintenance
 1669  organization’s capitation rate any special payments, including,
 1670  but not limited to, upper payment limit or disproportionate
 1671  share hospital payments, made to qualifying hospitals through
 1672  the fee-for-service program. The agency may seek federal waiver
 1673  approval or state plan amendment as needed to implement this
 1674  adjustment. This subsection expires September 1, 2012.
 1675         Section 15. Section 409.9123, Florida Statutes, is amended
 1676  to read:
 1677         409.9123 Quality-of-care reporting.—In order to promote
 1678  competition between Medicaid managed care plans and MediPass
 1679  based on quality-of-care indicators, The agency shall annually
 1680  develop and publish a set of measures of managed care plan
 1681  performance based on quality-of-care indicators. This
 1682  information shall be made available to each Medicaid recipient
 1683  who makes a choice of a managed care plan in her or his area.
 1684  This information must shall be easily understandable to the
 1685  Medicaid recipient and shall use nationally recognized standards
 1686  wherever possible. In formulating this information, the agency
 1687  shall, at a minimum, consider take into account at least the
 1688  following:
 1689         (1) The recommendations of the National Committee for
 1690  Quality Assurance Medicaid HEDIS Task Force.
 1691         (2) Requirements and recommendations of the Centers for
 1692  Medicare and Medicaid Services Health Care Financing
 1693  Administration.
 1694         (3) Recommendations of the managed care industry.
 1695         Section 16. For the purpose of incorporating the amendment
 1696  made by this act to section 409.9122, Florida Statutes, in a
 1697  reference thereto, subsection (1) of section 409.9126, Florida
 1698  Statutes, is reenacted to read:
 1699         409.9126 Children with special health care needs.—
 1700         (1) Except as provided in subsection (4), children eligible
 1701  for Children’s Medical Services who receive Medicaid benefits,
 1702  and other Medicaid-eligible children with special health care
 1703  needs, shall be exempt from the provisions of s. 409.9122 and
 1704  shall be served through the Children’s Medical Services network
 1705  established in chapter 391.
 1706         Section 17. Effective upon this act becoming a law,
 1707  subsections (4) through (6) of section 409.915, Florida
 1708  Statutes, are amended, and subsections (7) through (11) are
 1709  added to that section, to read:
 1710         409.915 County contributions to Medicaid.—Although the
 1711  state is responsible for the full portion of the state share of
 1712  the matching funds required for the Medicaid program, in order
 1713  to acquire a certain portion of these funds, the state shall
 1714  charge the counties for certain items of care and service as
 1715  provided in this section.
 1716         (4) Each county shall contribute pay into the General
 1717  Revenue Fund, unallocated, its pro rata share of the total
 1718  county participation based upon statements rendered by the
 1719  agency in consultation with the counties. The agency shall
 1720  render such statements monthly based on each county’s eligible
 1721  recipients. For purposes of this section, each county’s eligible
 1722  recipients shall be determined by the recipients’ address
 1723  information contained in the federally approved Medicaid
 1724  eligibility system within the Department of Children and Family
 1725  Services. The process developed under subsection (10) may be
 1726  used for cases in which the Medicaid eligibility system’s
 1727  address information may indicate a need for revision.
 1728         (5) The Department of Financial Services shall withhold
 1729  from the cigarette tax receipts or any other funds to be
 1730  distributed to the counties the individual county share that has
 1731  not been remitted within 60 days after billing.
 1732         (5)(6) In any county in which a special taxing district or
 1733  authority is located which will benefit from the medical
 1734  assistance programs covered by this section, the board of county
 1735  commissioners may divide the county’s financial responsibility
 1736  for this purpose proportionately, and each such district or
 1737  authority must furnish its share to the board of county
 1738  commissioners in time for the board to comply with the
 1739  provisions of subsection (3). Any appeal of the proration made
 1740  by the board of county commissioners must be made to the
 1741  Department of Financial Services, which shall then set the
 1742  proportionate share of each party.
 1743         (6)(7) Counties are exempt from contributing toward the
 1744  cost of new exemptions on inpatient ceilings for statutory
 1745  teaching hospitals, specialty hospitals, and community hospital
 1746  education program hospitals that came into effect July 1, 2000,
 1747  and for special Medicaid payments that came into effect on or
 1748  after July 1, 2000.
 1749         (7) By September 1, 2012, the agency shall certify to the
 1750  Department of Revenue, for each county, an amount equal to 85
 1751  percent of each county’s billings through April 30, 2012, which
 1752  remain unpaid.
 1753         (8)(a)Beginning with the October 2012 distribution, the
 1754  Department of Revenue shall reduce each county’s distributions
 1755  pursuant to s. 218.26 by one thirty-sixth of the amount
 1756  certified by the agency under subsection (7) for that county.
 1757  However, the amount of the reduction may not exceed 50 percent
 1758  of each county’s distribution. If, after 36 months, the
 1759  reductions for each county do not equal the total amount
 1760  initially certified by the agency, the Department of Revenue
 1761  shall continue to reduce each distribution by up to 50 percent
 1762  until the total amount certified is reached. The amounts by
 1763  which the distributions are reduced shall be transferred to the
 1764  General Revenue Fund.
 1765         (b) As an assurance to holders of bonds issued before the
 1766  effective date of this act to which distributions made pursuant
 1767  to s. 218.26 are pledged, or bonds issued to refund such bonds
 1768  which mature no later than the bonds they refunded and which
 1769  result in a reduction of debt service payable in each fiscal
 1770  year, the amount available for distribution to a county shall
 1771  remain as provided by law and continue to be subject to any lien
 1772  or claim on behalf of the bondholders. The Department of Revenue
 1773  must ensure that any reduction in amounts distributed pursuant
 1774  to paragraph (a) does not reduce the amount of distribution to a
 1775  county below the amount necessary for the payment of principal
 1776  and interest on the bonds and the amount necessary to comply
 1777  with any covenant under the bond resolution or other documents
 1778  relating to the issuance of the bonds.
 1779         (9)(a)Beginning May 1, 2012, and each month thereafter,
 1780  the agency shall certify to the Department of Revenue the amount
 1781  of the monthly statement rendered to each county pursuant to
 1782  subsection (4). The department shall reduce each county’s
 1783  monthly distribution pursuant to s. 218.61 by the amount
 1784  certified. The amounts by which the distributions are reduced
 1785  shall be transferred to the General Revenue Fund.
 1786         (b) As an assurance to holders of bonds issued before the
 1787  effective date of this act to which distributions made pursuant
 1788  to s. 218.61 are pledged, or bonds issued to refund such bonds
 1789  which mature no later than the bonds they refunded and which
 1790  result in a reduction of debt service payable in each fiscal
 1791  year, the amount available for distribution to a county shall
 1792  remain as provided by law and continue to be subject to any lien
 1793  or claim on behalf of the bondholders. The Department of Revenue
 1794  must ensure that any reductions in amounts distributed pursuant
 1795  to paragraph (a) does not reduce the amount of distribution to a
 1796  county below the amount necessary for the payment of principal
 1797  and interest on the bonds and the amount necessary to comply
 1798  with any covenant under the bond resolution or other documents
 1799  relating to the issuance of the bonds.
 1800         (10)The Department of Revenue shall pay certified refund
 1801  requests in accordance with a process developed by the agency
 1802  and the department which:
 1803         (a)Allows counties to submit to the agency written
 1804  requests for refunds of any amounts by which the distributions
 1805  were reduced as provided in subsection (9) and which set forth
 1806  the reasons for the refund requests.
 1807         (b)Requires the agency to make a determination as to
 1808  whether a refund request is appropriate and should be approved,
 1809  in which case the agency shall certify the amount of the refund
 1810  to the department.
 1811         (c)Requires the department to issue the refund for the
 1812  certified amount to the county from the General Revenue Fund.
 1813         (11) Beginning in the 2013-2014 fiscal year and each year
 1814  thereafter until the 2020-2021 fiscal year, the Chief Financial
 1815  Officer shall transfer from the General Revenue Fund to the
 1816  Lawton Chiles Endowment Fund an amount equal to the amounts
 1817  transferred to the General Revenue Fund in the previous fiscal
 1818  year pursuant to subsections (8) and (9), reduced by the amount
 1819  of refunds paid pursuant to subsection (10), which are in excess
 1820  of the official estimate for medical hospital fees for such
 1821  previous fiscal year adopted by the Revenue Estimating
 1822  Conference on January 12, 2012, as reflected in the conference’s
 1823  workpapers. By July 20 of each year, the Office of Economic and
 1824  Demographic Research shall certify the amount to be transferred
 1825  to the Chief Financial Officer. Such transfers must be made
 1826  before July 31 of each year until the total transfers for all
 1827  years equal $265 million. The Office of Economic and Demographic
 1828  Research shall publish the official estimates reflected in the
 1829  conference’s workpapers on its website.
 1830         Section 18. Subsection (2) of section 409.979, Florida
 1831  Statutes, is amended to read:
 1832         409.979 Eligibility.—
 1833         (2) Medicaid recipients who, on the date long-term care
 1834  managed care plans become available in their region, reside in a
 1835  nursing home facility or are enrolled in one of the following
 1836  long-term care Medicaid waiver programs are eligible to
 1837  participate in the long-term care managed care program for up to
 1838  12 months without being reevaluated for their need for nursing
 1839  facility care as defined in s. 409.985(3):
 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 described
 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         Section 19. Subsection (15) of section 430.04, Florida
 1850  Statutes, is amended to read:
 1851         430.04 Duties and responsibilities of the Department of
 1852  Elderly Affairs.—The Department of Elderly Affairs shall:
 1853         (15) Administer all Medicaid waivers and programs relating
 1854  to elders and their appropriations. The waivers include, but are
 1855  not limited to:
 1856         (a) The Assisted Living for the Frail Elderly Waiver.
 1857         (b) The Aged and Disabled Adult Waiver.
 1858         (c) The Adult Day Health Care Waiver.
 1859         (c)(d) The Consumer-Directed Care Plus Program as defined
 1860  in s. 409.221.
 1861         (d)(e) The Program of All-inclusive Care for the Elderly.
 1862         (e)(f) The Long-Term Care Community-Based Diversion Pilot
 1863  Project as described in s. 430.705.
 1864         (f)(g) The Channeling Services Waiver for Frail Elders.
 1865  
 1866  The department shall develop a transition plan for recipients
 1867  receiving services in long-term care Medicaid waivers for elders
 1868  or disabled adults on the date eligible plans become available
 1869  in each recipient’s region defined in s. 409.981(2) to enroll
 1870  those recipients in eligible plans. This subsection expires
 1871  October 1, 2014.
 1872         Section 20. Section 31 of chapter 2009-223, Laws of
 1873  Florida, as amended by section 44 of chapter 2010-151, Laws of
 1874  Florida, is redesignated as section 409.9132, Florida Statutes,
 1875  and amended to read:
 1876         409.9132 Section 31. Pilot project to monitor home health
 1877  services.—The agency for Health Care Administration shall expand
 1878  the develop and implement a home health agency monitoring pilot
 1879  project in Miami-Dade County on a statewide basis effective July
 1880  1, 2012, except in counties in which the program will not be
 1881  cost-effective, as determined by the agency by January 1, 2010.
 1882  The agency shall contract with a vendor to verify the
 1883  utilization and delivery of home health services and provide an
 1884  electronic billing interface for home health services. The
 1885  contract must require the creation of a program to submit claims
 1886  electronically for the delivery of home health services. The
 1887  program must verify telephonically visits for the delivery of
 1888  home health services using voice biometrics. The agency may seek
 1889  amendments to the Medicaid state plan and waivers of federal
 1890  laws, as necessary, to implement or expand the pilot project.
 1891  Notwithstanding s. 287.057(3)(f), Florida Statutes, the agency
 1892  must award the contract through the competitive solicitation
 1893  process and may use the current contract to expand the home
 1894  health agency monitoring pilot project to include additional
 1895  counties as authorized under this section. The agency shall
 1896  submit a report to the Governor, the President of the Senate,
 1897  and the Speaker of the House of Representatives evaluating the
 1898  pilot project by February 1, 2011.
 1899         Section 21. Section 32 of chapter 2009-223, Laws of
 1900  Florida, is redesignated as section 409.9133, Florida Statutes,
 1901  and amended to read:
 1902         409.9133 Section 32. Pilot project for home health care
 1903  management.—The agency for Health Care Administration shall
 1904  expand the implement a comprehensive care management pilot
 1905  project for home health services statewide and include private
 1906  duty nursing and personal care services effective July 1, 2012,
 1907  except in counties in which the program will not be cost
 1908  effective, as determined by the agency by January 1, 2010. The
 1909  program must include, which includes face-to-face assessments by
 1910  a nurse licensed pursuant to chapter 464, Florida Statutes,
 1911  consultation with physicians ordering services to substantiate
 1912  the medical necessity for services, and on-site or desk reviews
 1913  of recipients’ medical records in Miami-Dade County. The agency
 1914  may enter into a contract with a qualified organization to
 1915  implement or expand the pilot project. The agency may use the
 1916  current contract to expand the comprehensive care management
 1917  pilot project to include the additional services and counties
 1918  authorized under this section. The agency may seek amendments to
 1919  the Medicaid state plan and waivers of federal laws, as
 1920  necessary, to implement or expand the pilot project.
 1921         Section 22. Notwithstanding s. 430.707, Florida Statutes,
 1922  and subject to federal approval of an additional site for the
 1923  Program of All-Inclusive Care for the Elderly (PACE), the Agency
 1924  for Health Care Administration shall contract with a current
 1925  PACE organization authorized to provide PACE services in
 1926  Southeast Florida to develop and operate a PACE program in
 1927  Broward County to serve frail elders who reside in Broward
 1928  County. The organization shall be exempt from chapter 641,
 1929  Florida Statutes. The agency, in consultation with the
 1930  Department of Elderly Affairs and subject to an appropriation,
 1931  shall approve up to 150 initial enrollee slots in the Broward
 1932  program established by the organization.
 1933         Section 23. Effective upon this act becoming a law and for
 1934  the 2011-2012 state fiscal year only, a public hospital located
 1935  in trauma service area 2 which has local funds available for
 1936  intergovernmental transfers that allow for exemptions from
 1937  inpatient and outpatient reimbursement limitations may,
 1938  notwithstanding s. 409.905(5)(c), Florida Statues, have its
 1939  reimbursement rates adjusted after September 30 of the state
 1940  fiscal year in which the rates take effect.
 1941         Section 24. Except as otherwise expressly provided in this
 1942  act and except for this section, which shall take effect upon
 1943  this act becoming a law, this act shall take effect July 1,
 1944  2012.