Florida Senate - 2012 CS for SB 730
By the Committee on Health Regulation; and Senators Flores,
Negron, and Gaetz
588-02046A-12 2012730c1
1 A bill to be entitled
2 An act relating to Medicaid managed care plans;
3 amending s. 409.9122, F.S.; requiring the Agency for
4 Health Care Administration to establish per-member,
5 per-month payments; substituting the Medicare
6 Advantage Coordinated Care Plan for the Medicare
7 Advantage Special Needs Plan; amending s. 409.962,
8 F.S.; revising the definition of “eligible plan” to
9 include certain Medicare plans; amending s. 409.967,
10 F.S.; limiting the penalty that a plan must pay if it
11 leaves a region before the end of the contract term;
12 amending s. 409.974, F.S.; correcting a cross
13 reference; providing that certain Medicare plans are
14 not subject to procurement requirements or plan
15 limits; amending s. 409.977, F.S.; requiring dually
16 eligible Medicaid recipients to be enrolled in the
17 Medicare plan in which they are already enrolled;
18 amending s. 409.981, F.S.; revising the list of
19 Medicare plans that are not subject to procurement
20 requirements for long-term care plans; amending s.
21 409.984, F.S.; revising the list of Medicare plans in
22 which dually eligible Medicaid recipients are enrolled
23 in order to receive long-term care; providing an
24 effective date.
25
26 Be It Enacted by the Legislature of the State of Florida:
27
28 Section 1. Subsection (15) of section 409.9122, Florida
29 Statutes, is amended to read:
30 409.9122 Mandatory Medicaid managed care enrollment;
31 programs and procedures.—
32 (15) The agency shall may establish a per-member, per-month
33 payment for enrollees who are enrolled in a Medicare Advantage
34 Coordinated Care Plan and who Medicare Advantage Special Needs
35 members that are also eligible for Medicaid as a mechanism for
36 meeting the state’s cost-sharing obligation. The agency may also
37 develop a per-member, per-month payment only for Medicaid
38 covered services for which the state is responsible. The agency
39 shall develop a mechanism to ensure that such per-member, per
40 month payment enhances the value to the state and enrolled
41 members by limiting cost sharing, enhances the scope of Medicare
42 supplemental benefits that are equal to or greater than Medicaid
43 coverage for select services, and improves care coordination.
44 Section 2. Subsection (6) of section 409.962, Florida
45 Statutes, is amended to read:
46 409.962 Definitions.—As used in this part, except as
47 otherwise specifically provided, the term:
48 (6) “Eligible plan” means a health insurer authorized under
49 chapter 624, an exclusive provider organization authorized under
50 chapter 627, a health maintenance organization authorized under
51 chapter 641, or a provider service network authorized under s.
52 409.912(4)(d), or an accountable care organization authorized
53 under federal law. For purposes of the managed medical
54 assistance program, the term also includes the Children’s
55 Medical Services Network authorized under chapter 391. For
56 purposes of dually eligible Medicaid and Medicare recipients
57 enrolled in the managed medical assistance program and the long
58 term care managed care program, the term also includes entities
59 qualified under 42 C.F.R. part 422 as Medicare Advantage
60 Preferred Provider Organizations, Medicare Advantage Provider
61 sponsored Organizations, Medicare Advantage Health Maintenance
62 Organizations, Medicare Advantage Coordinated Care Plans, and
63 Medicare Advantage Special Needs Plans, and the Program of All
64 inclusive Care for the Elderly.
65 Section 3. Paragraph (h) of subsection (2) of section
66 409.967, Florida Statutes, is amended to read:
67 409.967 Managed care plan accountability.—
68 (2) The agency shall establish such contract requirements
69 as are necessary for the operation of the statewide managed care
70 program. In addition to any other provisions the agency may deem
71 necessary, the contract must require:
72 (h) Penalties.—
73 1. Withdrawal and enrollment reduction.—Managed care plans
74 that reduce enrollment levels or leave a region before the end
75 of the contract term must reimburse the agency for the cost of
76 enrollment changes and other transition activities. If more than
77 one plan leaves a region at the same time, costs must be shared
78 by the departing plans proportionate to their enrollments. In
79 addition to the payment of costs, departing provider services
80 networks must pay a per-enrollee per enrollee penalty of up to 3
81 months’ payment and continue to provide services to the enrollee
82 for 90 days or until the enrollee is enrolled in another plan,
83 whichever occurs first. In addition to payment of costs, all
84 other departing plans must pay a penalty of 25 percent of that
85 portion of the minimum surplus maintained requirement pursuant
86 to s. 641.225(1) which is attributable to the provision of
87 coverage to Medicaid enrollees. Plans shall provide at least 180
88 days’ notice to the agency before withdrawing from a region. If
89 a managed care plan leaves a region before the end of the
90 contract term, the agency shall terminate all contracts with
91 that plan in other regions, pursuant to the termination
92 procedures in subparagraph 3.
93 2. Encounter data.—If a plan fails to comply with the
94 encounter data reporting requirements of this section for 30
95 days, the agency must assess a fine of $5,000 per day for each
96 day of noncompliance beginning on the 31st day. On the 31st day,
97 the agency must notify the plan that the agency will initiate
98 contract termination procedures on the 90th day unless the plan
99 comes into compliance before that date.
100 3. Termination.—If the agency terminates more than one
101 regional contract with the same managed care plan due to
102 noncompliance with the requirements of this section, the agency
103 shall terminate all the regional contracts held by that plan.
104 When terminating multiple contracts, the agency must develop a
105 plan to provide for the transition of enrollees to other plans,
106 and phase in phase-in the terminations over a time period
107 sufficient to ensure a smooth transition.
108 Section 4. Subsection (2) of section 409.974, Florida
109 Statutes, is amended, and subsection (5) is added to that
110 section, to read:
111 409.974 Eligible plans.—
112 (2) QUALITY SELECTION CRITERIA.—In addition to the criteria
113 established in s. 409.966, the agency shall consider evidence
114 that an eligible plan has written agreements or signed contracts
115 or has made substantial progress in establishing relationships
116 with providers before the plan submitted submitting a response.
117 The agency shall evaluate and give special weight to evidence of
118 signed contracts with essential providers as determined defined
119 by the agency pursuant to s. 409.975(1) 409.975(2). The agency
120 shall exercise a preference for plans with a provider network in
121 which more than over 10 percent of the providers use electronic
122 health records, as defined in s. 408.051. When all other factors
123 are equal, the agency shall consider whether the organization
124 has a contract to provide managed long-term care services in the
125 same region and shall exercise a preference for such plans.
126 (5) MEDICARE PLANS.—Participation by an entity qualified
127 under 42 C.F.R. PART 422 as a Medicare Advantage Preferred
128 Provider Organization, Medicare Advantage Provider-sponsored
129 Organization, Medicare Advantage Health Maintenance
130 Organization, Medicare Advantage Coordinated Care Plan, or
131 Medicare Advantage Special Needs Plan shall be pursuant to a
132 contract with the agency and is not subject to the procurement
133 requirements or regional plan limits of this section if the
134 plan’s Medicaid enrollees in the region consist exclusively of
135 its current Medicare enrollees who are dually eligible for
136 Medicaid and Medicare services. Otherwise, such organizations
137 and plans are subject to all procurement requirements.
138 Section 5. Subsection (1) of section 409.977, Florida
139 Statutes, is amended to read:
140 409.977 Enrollment.—
141 (1) The agency shall automatically enroll into a managed
142 care plan those Medicaid recipients who do not voluntarily
143 choose a plan pursuant to s. 409.969. The agency shall
144 automatically enroll recipients in plans that meet or exceed the
145 performance or quality standards established pursuant to s.
146 409.967 and may not automatically enroll recipients in a plan
147 that is deficient in those performance or quality standards. If
148 When a specialty plan is available to accommodate a specific
149 condition or diagnosis of a recipient, the agency shall assign
150 the recipient to that plan. In the first year of the first
151 contract term only, if a recipient was previously enrolled in a
152 plan that is still available in the region, the agency shall
153 automatically enroll the recipient in that plan unless an
154 applicable specialty plan is available. If a recipient is dually
155 eligible for Medicaid and Medicare services and is currently
156 receiving Medicare services from an entity listed in s.
157 409.974(5), the agency shall automatically enroll the recipient
158 in that plan for Medicaid services if the plan is currently
159 under contract with the agency pursuant to s. 409.974(5). Except
160 as otherwise provided in this part, the agency may not engage in
161 practices that are designed to favor one managed care plan over
162 another.
163 Section 6. Subsection (5) of section 409.981, Florida
164 Statutes, is amended to read:
165 409.981 Eligible long-term care plans.—
166 (5) MEDICARE PLANS.—Participation by a Medicare Advantage
167 Preferred Provider Organization, Medicare Advantage Provider
168 sponsored Organization, Medicare Advantage Health Maintenance
169 Organization, Medicare Advantage Coordinated Care Plan, or
170 Medicare Advantage Special Needs Plan shall be pursuant to a
171 contract with the agency and is not subject to the procurement
172 requirements if the plan’s Medicaid enrollees consist
173 exclusively of its current Medicare enrollees recipients who are
174 deemed dually eligible for Medicaid and Medicare services.
175 Otherwise, such organizations and plans Medicare Advantage
176 Preferred Provider Organizations, Medicare Advantage Provider
177 sponsored Organizations, and Medicare Advantage Special Needs
178 Plans are subject to all procurement requirements.
179 Section 7. Subsection (1) of section 409.984, Florida
180 Statutes, is amended to read:
181 409.984 Enrollment in a long-term care managed care plan.—
182 (1) The agency shall automatically enroll into a long-term
183 care managed care plan those Medicaid recipients who do not
184 voluntarily choose a plan pursuant to s. 409.969. The agency
185 shall automatically enroll recipients in plans that meet or
186 exceed the performance or quality standards established pursuant
187 to s. 409.967 and may not automatically enroll recipients in a
188 plan that is deficient in those performance or quality
189 standards. If a recipient is deemed dually eligible for Medicaid
190 and Medicare services and is currently receiving Medicare
191 services from an entity qualified under 42 C.F.R. part 422 as a
192 Medicare Advantage Preferred Provider Organization, Medicare
193 Advantage Provider-sponsored Organization, Medicare Advantage
194 Health Maintenance Organization, Medicare Advantage Coordinated
195 Care Plan, or Medicare Advantage Special Needs Plan, the agency
196 shall automatically enroll the recipient in such plan for
197 Medicaid services if the plan is under contract with the agency
198 currently participating in the long-term care managed care
199 program. Except as otherwise provided in this part, the agency
200 may not engage in practices that are designed to favor one
201 managed care plan over another.
202 Section 8. This act shall take effect July 1, 2012.