Florida Senate - 2025                        COMMITTEE AMENDMENT
       Bill No. SB 1490
       
       
       
       
       
       
                                Ì865162&Î865162                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/02/2025           .                                
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       The Committee on Health Policy (Harrell) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 102 - 691
    4  and insert:
    5         Section 2. Subsection (4) of section 409.974, Florida
    6  Statutes, is amended to read:
    7         409.974 Eligible plans.—
    8         (4) CHILDREN’S MEDICAL SERVICES NETWORK.—
    9         (a)The Department of Health’s Children’s Medical Services
   10  program shall do all of the following:
   11         1.Effective July 1, 2025, transfer to the agency the
   12  operation of managed care contracts procured by the department
   13  for Medicaid and Children’s Health Insurance Program services
   14  provided to children and youth with special health care needs
   15  who are enrolled in the Children’s Medical Services Managed Care
   16  Plan.
   17         2.Conduct clinical eligibility screening for children and
   18  youth with special health care needs who are eligible for or are
   19  enrolled in Medicaid or the Children’s Health Insurance Program.
   20         3.Provide ongoing consultation to the agency to ensure
   21  high-quality, family-centered, coordinated health services are
   22  provided within an effective system of care for children and
   23  youth with special health care needs.
   24         (b)The agency shall establish specific measures of access,
   25  quality, and costs of providing health care services to children
   26  and youth with special health care needs. The agency shall
   27  contract with an independent evaluator to conduct an evaluation
   28  of services provided. The evaluation must include, but need not
   29  be limited to, all of the following:
   30         1.A performance comparison of plans contracted to provide
   31  services to children and youth with special health care needs as
   32  well as plans contracted to serve a broader population of
   33  Managed Medical Assistance enrollees. The performance comparison
   34  must be based on the measures established by the agency and
   35  differentiated based on the age and medical condition or
   36  diagnosis of patients receiving services under each plan.
   37         2.For each plan, an assessment of cost savings, patient
   38  choice, access to services, coordination of care, person
   39  centered planning, health and quality-of-life outcomes, patient
   40  and provider satisfaction, and provider networks and quality of
   41  care.
   42  
   43  The agency shall submit the results of the evaluation to the
   44  Governor, the President of the Senate, and the Speaker of the
   45  House of Representatives by January 15, 2028 Participation by
   46  the Children’s Medical Services Network shall be pursuant to a
   47  single, statewide contract with the agency that is not subject
   48  to the procurement requirements or regional plan number limits
   49  of this section. The Children’s Medical Services Network must
   50  meet all other plan requirements for the managed medical
   51  assistance program.
   52         Section 3. Subsection (1) of section 391.016, Florida
   53  Statutes, is amended to read:
   54         391.016 Purposes and functions.—The Children’s Medical
   55  Services program is established for the following purposes and
   56  authorized to perform the following functions:
   57         (1) Provide to children and youth with special health care
   58  needs a family-centered, comprehensive, and coordinated
   59  statewide managed system of care that links community-based
   60  health care with multidisciplinary, regional, and tertiary
   61  pediatric specialty care. The program shall coordinate and
   62  maintain a consistent medical home for participating children.
   63         Section 4. Subsections (1), (2), and (4) of section
   64  391.021, Florida Statutes, are reordered and amended to read:
   65         391.021 Definitions.—When used in this act, the term:
   66         (2)(1) “Children’s Medical Services Managed Care Plan
   67  network” or “plan network” means a statewide managed care
   68  service system that includes health care providers, as defined
   69  in this section.
   70         (1)(2) “Children and youth with special health care needs”
   71  means those children and youth younger than 21 years of age who
   72  have chronic and serious physical, developmental, behavioral, or
   73  emotional conditions and who require health care and related
   74  services of a type or amount beyond that which is generally
   75  required by children and youth.
   76         (4) “Eligible individual” means a child or youth with a
   77  special health care need or a female with a high-risk pregnancy,
   78  who meets the financial and medical eligibility standards
   79  established in s. 391.029.
   80         Section 5. Subsection (1) of section 391.025, Florida
   81  Statutes, is amended to read:
   82         391.025 Applicability and scope.—
   83         (1) The Children’s Medical Services program consists of the
   84  following components:
   85         (a) The newborn screening program established in s. 383.14
   86  and the newborn, infant, and toddler hearing screening program
   87  established in s. 383.145.
   88         (b) The regional perinatal intensive care centers program
   89  established in ss. 383.15-383.19.
   90         (c) The developmental evaluation and intervention program,
   91  including the Early Steps Program established in ss. 391.301
   92  391.308.
   93         (d) The Children’s Medical Services Managed Care Plan
   94  through the end of June 30, 2025 network.
   95         (e)The Children’s Multidisciplinary Assessment Team.
   96         (f)The Medical Foster Care Program.
   97         (g)The Title V Children and Youth with Special Health Care
   98  Needs program.
   99         (h)The Safety Net Program.
  100         (i)Child Protection Teams and sexual abuse treatment
  101  programs established under s. 39.303.
  102         (j)The State Child Abuse Death Review Committee and local
  103  child abuse death review committees established in s. 383.402.
  104         Section 6. Section 391.026, Florida Statutes, is amended to
  105  read:
  106         391.026 Powers and duties of the department.—The department
  107  shall have the following powers, duties, and responsibilities:
  108         (1) To provide or contract for the provision of health
  109  services to eligible individuals.
  110         (2) To provide services to abused and neglected children
  111  through Child Protection Teams pursuant to s. 39.303.
  112         (3) To determine the medical and financial eligibility of
  113  individuals seeking health services from the program.
  114         (4) To coordinate a comprehensive delivery system for
  115  eligible individuals to take maximum advantage of all available
  116  funds.
  117         (5) To coordinate with programs relating to children’s
  118  medical services in cooperation with other public and private
  119  agencies.
  120         (6) To initiate and coordinate applications to federal
  121  agencies and private organizations for funds, services, or
  122  commodities relating to children’s medical programs.
  123         (7) To sponsor or promote grants for projects, programs,
  124  education, or research in the field of children and youth with
  125  special health care needs, with an emphasis on early diagnosis
  126  and treatment.
  127         (8) To oversee and operate the Children’s Medical Services
  128  Managed Care Plan through the end of June 30, 2025 network.
  129         (9) To establish reimbursement mechanisms for the
  130  Children’s Medical Services network.
  131         (10)To establish Children’s Medical Services network
  132  standards and credentialing requirements for health care
  133  providers and health care services.
  134         (11)To serve as a provider and principal case manager for
  135  children with special health care needs under Titles XIX and XXI
  136  of the Social Security Act.
  137         (12) To monitor the provision of health services in the
  138  program, including the utilization and quality of health
  139  services.
  140         (10)(13) To administer the Children and Youth with Special
  141  Health Care Needs program in accordance with Title V of the
  142  Social Security Act.
  143         (14)To establish and operate a grievance resolution
  144  process for participants and health care providers.
  145         (15)To maintain program integrity in the Children’s
  146  Medical Services program.
  147         (11)(16) To receive and manage health care premiums,
  148  capitation payments, and funds from federal, state, local, and
  149  private entities for the program. The department may contract
  150  with a third-party administrator for processing claims,
  151  monitoring medical expenses, and other related services
  152  necessary to the efficient and cost-effective operation of the
  153  Children’s Medical Services Managed Care Plan through the end of
  154  June 30, 2025 network. The department is authorized to maintain
  155  a minimum reserve for the Children’s Medical Services network in
  156  an amount that is the greater of:
  157         (a)Ten percent of total projected expenditures for Title
  158  XIX-funded and Title XXI-funded children; or
  159         (b)Two percent of total annualized payments from the
  160  Agency for Health Care Administration for Title XIX and Title
  161  XXI of the Social Security Act.
  162         (12)(17) To provide or contract for peer review and other
  163  quality-improvement activities.
  164         (13)(18) To adopt rules pursuant to ss. 120.536(1) and
  165  120.54 to administer the Children’s Medical Services Act.
  166         (14)(19) To serve as the lead agency in administering the
  167  Early Steps Program pursuant to part C of the federal
  168  Individuals with Disabilities Education Act and part III of this
  169  chapter.
  170         (15)To administer the Medical Foster Care Program,
  171  including all of the following:
  172         (a)Recruitment, training, assessment, and monitoring for
  173  the Medical Foster Care Program.
  174         (b)Monitoring access and facilitating admissions of
  175  eligible children and youth to the program and designated
  176  medical foster care homes.
  177         (c)Coordination with the Department of Children and
  178  Families and the Agency for Health Care Administration or their
  179  designees.
  180         Section 7. Effective July 1, 2025, subsections (8) through
  181  (11) of section 391.026, Florida Statutes, as amended by this
  182  act, are repealed.
  183         Section 8. Effective July 1, 2025, section 391.028, Florida
  184  Statutes, is repealed.
  185         Section 9. Subsections (2) and (3) of section 391.029,
  186  Florida Statutes, are amended to read:
  187         391.029 Program eligibility.—
  188         (2) The following individuals are eligible to receive
  189  services through the program:
  190         (a) Related to the regional perinatal intensive care
  191  centers, a high-risk pregnant female who is enrolled in
  192  Medicaid.
  193         (b) Children and youth with serious special health care
  194  needs from birth to 21 years of age who are enrolled in
  195  Medicaid.
  196         (c) Children and youth with serious special health care
  197  needs from birth to 19 years of age who are enrolled in a
  198  program under Title XXI of the Social Security Act.
  199         (3) Subject to the availability of funds, the following
  200  individuals may receive services through the Children’s Medical
  201  Services Safety Net program:
  202         (a) Children and youth with serious special health care
  203  needs from birth to 21 years of age who do not qualify for
  204  Medicaid or Title XXI of the Social Security Act but who are
  205  unable to access, due to lack of providers or lack of financial
  206  resources, specialized services that are medically necessary or
  207  essential family support services. Families shall participate
  208  financially in the cost of care based on a sliding fee scale
  209  established by the department.
  210         (b) Children and youth with special health care needs from
  211  birth to 21 years of age, as provided in Title V of the Social
  212  Security Act.
  213         (c) An infant who receives an award of compensation under
  214  s. 766.31(1). The Florida Birth-Related Neurological Injury
  215  Compensation Association shall reimburse the Children’s Medical
  216  Services Network the state’s share of funding, which must
  217  thereafter be used to obtain matching federal funds under Title
  218  XXI of the Social Security Act.
  219         Section 10. Section 391.0315, Florida Statutes, is amended
  220  to read:
  221         391.0315 Benefits.—Benefits provided under the Children’s
  222  Medical Services Managed Care Plan program for children with
  223  special health care needs shall be equivalent to benefits
  224  provided to children as specified in ss. 409.905 and 409.906.
  225  The department may offer additional benefits through Children’s
  226  Medical Services programs for early intervention services,
  227  respite services, genetic testing, genetic and nutritional
  228  counseling, and parent support services, if such services are
  229  determined to be medically necessary. This section is repealed
  230  on January 1, 2026.
  231         Section 11. Section 391.035, Florida Statutes, is repealed.
  232         Section 12. Effective January 1, 2026, section 391.037,
  233  Florida Statutes, is repealed.
  234         Section 13. Section 391.045, Florida Statutes, is repealed.
  235         Section 14. Effective January 1, 2026, section 391.047,
  236  Florida Statutes, is repealed.
  237         Section 15. Effective January 1, 2026, section 391.055,
  238  Florida Statutes, is repealed.
  239         Section 16. Effective January 1, 2026, section 391.071,
  240  Florida Statutes, is repealed.
  241         Section 17. Section 391.097, Florida Statutes, is amended
  242  to read:
  243         391.097 Research and evaluation.—
  244         (1) The department may initiate, fund, and conduct research
  245  and evaluation projects to improve the delivery of children’s
  246  medical services. The department may cooperate with public and
  247  private agencies engaged in work of a similar nature.
  248         (2)The Children’s Medical Services network shall be
  249  included in any evaluation conducted in accordance with the
  250  provisions of Title XXI of the Social Security Act as enacted by
  251  the Legislature.
  252         Section 18. Part II of chapter 391, Florida Statutes,
  253  consisting of ss. 391.221 and 391.223, Florida Statutes, is
  254  repealed, and part III of that chapter is redesignated as part
  255  II.
  256         Section 19. Effective July 1, 2025, paragraph (b) of
  257  subsection (5) of section 409.166, Florida Statutes, is amended
  258  to read:
  259         409.166 Children within the child welfare system; adoption
  260  assistance program.—
  261         (5) ELIGIBILITY FOR SERVICES.—
  262         (b) A child who is handicapped at the time of adoption is
  263  shall be eligible for services through a plan under contract
  264  with the agency to serve children and youth with special heath
  265  care needs the Children’s Medical Services network established
  266  under part I of chapter 391 if the child was eligible for such
  267  services before prior to the adoption.
  268         Section 20. Effective July 1, 2025, subsection (7) of
  269  section 409.811, Florida Statutes, is amended to read:
  270         409.811 Definitions relating to Florida Kidcare Act.—As
  271  used in ss. 409.810-409.821, the term:
  272         (7)“Children’s Medical Services Network” or “network”
  273  means a statewide managed care service system as defined in s.
  274  391.021(1).
  275         Section 21. Effective July 1, 2025, subsection (1) of
  276  section 409.813, Florida Statutes, is amended to read:
  277         409.813 Health benefits coverage; program components;
  278  entitlement and nonentitlement.—
  279         (1) The Florida Kidcare program includes health benefits
  280  coverage provided to children through the following program
  281  components, which shall be marketed as the Florida Kidcare
  282  program:
  283         (a) Medicaid;
  284         (b) Medikids as created in s. 409.8132;
  285         (c) The Florida Healthy Kids Corporation as created in s.
  286  624.91;
  287         (d) Employer-sponsored group health insurance plans
  288  approved under ss. 409.810-409.821; and
  289         (e) Plans under contract with the agency to serve children
  290  and youth with special health care needs The Children’s Medical
  291  Services network established in chapter 391.
  292         Section 22. Effective July 1, 2025, subsection (3) of
  293  section 409.8134, Florida Statutes, is amended to read:
  294         409.8134 Program expenditure ceiling; enrollment.—
  295         (3) Upon determination by the Social Services Estimating
  296  Conference that there are insufficient funds to finance the
  297  current enrollment in the Florida Kidcare program within current
  298  appropriations, the program shall initiate disenrollment
  299  procedures to remove enrollees, except those children enrolled
  300  in a plan under contract with the agency to serve children with
  301  special health care needs the Children’s Medical Services
  302  Network, on a last-in, first-out basis until the expenditure and
  303  appropriation levels are balanced.
  304         Section 23. Subsection (3) and paragraph (c) of subsection
  305  (10) of section 409.814, Florida Statutes, are amended to read:
  306         409.814 Eligibility.—A child who has not reached 19 years
  307  of age whose family income is equal to or below 300 percent of
  308  the federal poverty level is eligible for the Florida Kidcare
  309  program as provided in this section. If an enrolled individual
  310  is determined to be ineligible for coverage, he or she must be
  311  immediately disenrolled from the respective Florida Kidcare
  312  program component.
  313         (3) A Title XXI-funded child who is eligible for the
  314  Florida Kidcare program who is a child with special health care
  315  needs, as determined through a medical or behavioral screening
  316  instrument, is eligible for health benefits coverage from and
  317  shall be assigned to and may opt out of a plan under contract
  318  with the agency to serve children with special health care needs
  319  the Children’s Medical Services Network.
  320         (10) In determining the eligibility of a child, an assets
  321  test is not required. If eligibility for the Florida Kidcare
  322  program cannot be verified using reliable data sources in
  323  accordance with federal requirements, each applicant shall
  324  provide documentation during the application process and the
  325  redetermination process, including, but not limited to, the
  326  following:
  327         (c) To enroll in a plan under contract with the agency to
  328  service children with special health care needs the Children’s
  329  Medical Services Network, a completed application, including a
  330  Children’s Medical Services clinical screening.
  331         Section 24. Effective July 1, 2025, paragraph (t) of
  332  subsection (2) of section 409.815, Florida Statutes, is amended
  333  to read:
  334         409.815 Health benefits coverage; limitations.—
  335         (2) BENCHMARK BENEFITS.—In order for health benefits
  336  coverage to qualify for premium assistance payments for an
  337  eligible child under ss. 409.810-409.821, the health benefits
  338  coverage, except for coverage under Medicaid and Medikids, must
  339  include the following minimum benefits, as medically necessary.
  340         (t) Enhancements to minimum requirements.—
  341         1. This section sets the minimum benefits that must be
  342  included in any health benefits coverage, other than Medicaid or
  343  Medikids coverage, offered under ss. 409.810-409.821. Health
  344  benefits coverage may include additional benefits not included
  345  under this subsection, but may not include benefits excluded
  346  under paragraph (r).
  347         2. Health benefits coverage may extend any limitations
  348  beyond the minimum benefits described in this section.
  349  
  350  Except for a plan under contract with the agency to serve
  351  children with special health care needs the Children’s Medical
  352  Services Network, the agency may not increase the premium
  353  assistance payment for either additional benefits provided
  354  beyond the minimum benefits described in this section or the
  355  imposition of less restrictive service limitations.
  356         Section 25. Effective July 1, 2025, paragraph (i) of
  357  subsection (1) of section 409.8177, Florida Statutes, is amended
  358  to read:
  359         409.8177 Program evaluation.—
  360         (1) The agency, in consultation with the Department of
  361  Health, the Department of Children and Families, and the Florida
  362  Healthy Kids Corporation, shall contract for an evaluation of
  363  the Florida Kidcare program and shall by January 1 of each year
  364  submit to the Governor, the President of the Senate, and the
  365  Speaker of the House of Representatives a report of the program.
  366  In addition to the items specified under s. 2108 of Title XXI of
  367  the Social Security Act, the report shall include an assessment
  368  of crowd-out and access to health care, as well as the
  369  following:
  370         (i) An assessment of the effectiveness of the Florida
  371  Kidcare program, including Medicaid, the Florida Healthy Kids
  372  program, Medikids, and the plans under contract with the agency
  373  to serve children with special health care needs Children’s
  374  Medical Services network, and other public and private programs
  375  in the state in increasing the availability of affordable
  376  quality health insurance and health care for children.
  377         Section 26. Effective July 1, 2025, subsection (4) of
  378  section 409.818, Florida Statutes, is amended to read:
  379         409.818 Administration.—In order to implement ss. 409.810
  380  409.821, the following agencies shall have the following duties:
  381         (4) The Office of Insurance Regulation shall certify that
  382  health benefits coverage plans that seek to provide services
  383  under the Florida Kidcare program, except those offered through
  384  the Florida Healthy Kids Corporation or the Children’s Medical
  385  Services Network, meet, exceed, or are actuarially equivalent to
  386  the benchmark benefit plan and that health insurance plans will
  387  be offered at an approved rate. In determining actuarial
  388  equivalence of benefits coverage, the Office of Insurance
  389  Regulation and health insurance plans must comply with the
  390  requirements of s. 2103 of Title XXI of the Social Security Act.
  391  The department shall adopt rules necessary for certifying health
  392  benefits coverage plans.
  393         Section 27. Effective July 1, 2025, subsection (11) of
  394  section 409.912, Florida Statutes, is amended to read:
  395         409.912 Cost-effective purchasing of health care.—The
  396  agency shall purchase goods and services for Medicaid recipients
  397  in the most cost-effective manner consistent with the delivery
  398  of quality medical care. To ensure that medical services are
  399  effectively utilized, the agency may, in any case, require a
  400  confirmation or second physician’s opinion of the correct
  401  diagnosis for purposes of authorizing future services under the
  402  Medicaid program. This section does not restrict access to
  403  emergency services or poststabilization care services as defined
  404  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
  405  shall be rendered in a manner approved by the agency. The agency
  406  shall maximize the use of prepaid per capita and prepaid
  407  aggregate fixed-sum basis services when appropriate and other
  408  alternative service delivery and reimbursement methodologies,
  409  including competitive bidding pursuant to s. 287.057, designed
  410  to facilitate the cost-effective purchase of a case-managed
  411  continuum of care. The agency shall also require providers to
  412  minimize the exposure of recipients to the need for acute
  413  inpatient, custodial, and other institutional care and the
  414  inappropriate or unnecessary use of high-cost services. The
  415  agency shall contract with a vendor to monitor and evaluate the
  416  clinical practice patterns of providers in order to identify
  417  trends that are outside the normal practice patterns of a
  418  provider’s professional peers or the national guidelines of a
  419  provider’s professional association. The vendor must be able to
  420  provide information and counseling to a provider whose practice
  421  patterns are outside the norms, in consultation with the agency,
  422  to improve patient care and reduce inappropriate utilization.
  423  The agency may mandate prior authorization, drug therapy
  424  management, or disease management participation for certain
  425  populations of Medicaid beneficiaries, certain drug classes, or
  426  particular drugs to prevent fraud, abuse, overuse, and possible
  427  dangerous drug interactions. The Pharmaceutical and Therapeutics
  428  Committee shall make recommendations to the agency on drugs for
  429  which prior authorization is required. The agency shall inform
  430  the Pharmaceutical and Therapeutics Committee of its decisions
  431  regarding drugs subject to prior authorization. The agency is
  432  authorized to limit the entities it contracts with or enrolls as
  433  Medicaid providers by developing a provider network through
  434  provider credentialing. The agency may competitively bid single
  435  source-provider contracts if procurement of goods or services
  436  results in demonstrated cost savings to the state without
  437  limiting access to care. The agency may limit its network based
  438  on the assessment of beneficiary access to care, provider
  439  availability, provider quality standards, time and distance
  440  standards for access to care, the cultural competence of the
  441  provider network, demographic characteristics of Medicaid
  442  beneficiaries, practice and provider-to-beneficiary standards,
  443  appointment wait times, beneficiary use of services, provider
  444  turnover, provider profiling, provider licensure history,
  445  previous program integrity investigations and findings, peer
  446  review, provider Medicaid policy and billing compliance records,
  447  clinical and medical record audits, and other factors. Providers
  448  are not entitled to enrollment in the Medicaid provider network.
  449  The agency shall determine instances in which allowing Medicaid
  450  beneficiaries to purchase durable medical equipment and other
  451  goods is less expensive to the Medicaid program than long-term
  452  rental of the equipment or goods. The agency may establish rules
  453  to facilitate purchases in lieu of long-term rentals in order to
  454  protect against fraud and abuse in the Medicaid program as
  455  defined in s. 409.913. The agency may seek federal waivers
  456  necessary to administer these policies.
  457         (11) The agency shall implement a program of all-inclusive
  458  care for children. The program of all-inclusive care for
  459  children shall be established to provide in-home hospice-like
  460  support services to children diagnosed with a life-threatening
  461  illness and enrolled in the Children’s Medical Services network
  462  to reduce hospitalizations as appropriate. The agency, in
  463  consultation with the Department of Health, may implement the
  464  program of all-inclusive care for children after obtaining
  465  approval from the Centers for Medicare and Medicaid Services.
  466         Section 28. Effective July 1, 2025, subsection (1) of
  467  section 409.9126, Florida Statutes, is amended to read:
  468         409.9126 Children with special health care needs.—
  469         (1) Except as provided in subsection (4), children eligible
  470  for the Children’s Medical Services program who receive Medicaid
  471  benefits, and other Medicaid-eligible children with special
  472  health care needs, are shall be exempt from the provisions of s.
  473  409.9122 and shall be served through the Children’s Medical
  474  Services network established in chapter 391.
  475         Section 29. Effective July 1, 2025, paragraph (a) of
  476  subsection (5) of section 409.9131, Florida Statutes, is amended
  477  to read:
  478         409.9131 Special provisions relating to integrity of the
  479  Medicaid program.—
  480         (5) DETERMINATIONS OF OVERPAYMENT.—In making a
  481  determination of overpayment to a physician, the agency must:
  482         (a) Use accepted and valid auditing, accounting,
  483  analytical, statistical, or peer-review methods, or combinations
  484  thereof. Appropriate statistical methods may include, but are
  485  not limited to, sampling and extension to the population,
  486  parametric and nonparametric statistics, tests of hypotheses,
  487  other generally accepted statistical methods, review of medical
  488  records, and a consideration of the physician’s client case mix.
  489  Before performing a review of the physician’s Medicaid records,
  490  however, the agency shall make every effort to consider the
  491  physician’s patient case mix, including, but not limited to,
  492  patient age and whether individual patients are clients of the
  493  Children’s Medical Services Network established in chapter 391.
  494  In meeting its burden of proof in any administrative or court
  495  proceeding, the agency may introduce the results of such
  496  statistical methods and its other audit findings as evidence of
  497  overpayment.
  498         Section 30. Effective July 1, 2025, paragraph (e) of
  499  subsection (1) of section 409.920, Florida Statutes, is amended
  500  to read:
  501         409.920 Medicaid provider fraud.—
  502         (1) For the purposes of this section, the term:
  503         (e) “Managed care plans” means a health insurer authorized
  504  under chapter 624, an exclusive provider organization authorized
  505  under chapter 627, a health maintenance organization authorized
  506  under chapter 641, the Children’s Medical Services Network
  507  authorized under chapter 391, a prepaid health plan authorized
  508  under this chapter, a provider service network authorized under
  509  this chapter, a minority physician network authorized under this
  510  chapter, and an emergency department diversion program
  511  authorized under this chapter or the General Appropriations Act,
  512  providing health care services pursuant to a contract with the
  513  Medicaid program.
  514         Section 31. Effective July 1, 2025, subsection (7) of
  515  section 409.962, Florida Statutes, is amended to read:
  516         409.962 Definitions.—As used in this part, except as
  517  otherwise specifically provided, the term:
  518         (7) “Eligible plan” means a health insurer authorized under
  519  chapter 624, an exclusive provider organization authorized under
  520  chapter 627, a health maintenance organization authorized under
  521  chapter 641, or a provider service network authorized under s.
  522  409.912(1) or an accountable care organization authorized under
  523  federal law. For purposes of the managed medical assistance
  524  program, the term also includes the Children’s Medical Services
  525  Network authorized under chapter 391 and entities qualified
  526  under 42 C.F.R. part 422 as Medicare Advantage Preferred
  527  Provider Organizations, Medicare Advantage Provider-sponsored
  528  Organizations, Medicare Advantage Health Maintenance
  529  Organizations, Medicare Advantage Coordinated Care Plans, and
  530  Medicare Advantage Special Needs Plans, and the Program of All
  531  inclusive Care for the Elderly.
  532         Section 32. The Agency for Health Care Administration shall
  533  develop a comprehensive plan to redesign the Florida Medicaid
  534  Model Waiver for home- and community-based services to include
  535  children who receive private duty nursing services. The plan
  536  must propose an array of tiered services with the goal of
  537  ensuring that institutional care is avoided so children can
  538  remain in the home or other community setting. The agency shall
  539  work with stakeholders in developing the plan, including, but
  540  not limited to, families of children who are in the model waiver
  541  or receiving private duty nursing, advocates for children,
  542  providers of services to children receiving private duty
  543  nursing, and Statewide Medicaid Managed Care plans. The agency
  544  is authorized to contract with necessary experts to assist in
  545  developing the plan. The agency shall submit a report to the
  546  Governor, the President of the Senate, and the Speaker of the
  547  House of Representatives by September 30, 2025, addressing, at a
  548  minimum, all of the following:
  549         (1)The purpose, rationale, and expected benefits of the
  550  redesigned waiver plan.
  551         (2)The proposed eligibility criteria for clients and
  552  service benefit packages to be offered through the redesigned
  553  waiver plan. Managed care plans participating in the Statewide
  554  Medicaid Managed Care program must provide services under the
  555  redesigned waiver plan.
  556         (3)A proposed implementation plan and timeline, including,
  557  but not limited to, recommendations for the number of clients
  558  served by the redesigned waiver plan at initial implementation,
  559  changes over time, and any per-client benefit caps.
  560         (4)The fiscal impact for the implementation year and
  561  projections for the next 5 years determined on an actuarially
  562  sound basis.
  563         (5)An analysis of the availability of services and service
  564  providers that would be offered under the redesigned waiver plan
  565  and recommendations to increase availability of such services,
  566  as applicable.
  567         (6)A list of all stakeholders, public and private, who
  568  were consulted or contacted during the development of the plan.
  569  
  570  ================= T I T L E  A M E N D M E N T ================
  571  And the title is amended as follows:
  572         Delete lines 15 - 68
  573  and insert:
  574         specified purpose; amending s. 409.974, F.S.;
  575         requiring the CMS program to transfer operation of
  576         certain managed care contracts from the department to
  577         the agency effective on a specified date; requiring
  578         the CMS program to conduct clinical eligibility
  579         screening for certain children and youth with special
  580         health care needs; requiring the program to provide
  581         ongoing consultation to the agency for a specified
  582         purpose; requiring the agency to establish specific
  583         measures for evaluation of services provided to
  584         children and youth with special health care needs;
  585         requiring the agency to contract with an independent
  586         evaluator to conduct the evaluation of services
  587         provided; specifying requirements for the evaluation;
  588         requiring the agency to submit the results of the
  589         evaluation to the Governor and the Legislature by a
  590         specified date; amending s. 391.016, F.S.; revising
  591         the purposes and functions of the CMS program;
  592         amending s. 391.021, F.S.; revising definitions;
  593         amending s. 391.025, F.S.; revising the scope of the
  594         CMS program; amending s. 391.026, F.S.; revising the
  595         powers and duties of the department to conform to
  596         changes made by the act; providing for the future
  597         repeal of s. 391.026(8) through (11), F.S., relating
  598         to the department’s oversight and administration of
  599         the CMS program; repealing s. 391.028, F.S., relating
  600         to administration of the program; amending s. 391.029,
  601         F.S.; revising program eligibility requirements;
  602         conforming provisions to changes made by the act;
  603         amending s. 391.0315, F.S.; conforming provisions to
  604         changes made by the act; providing for future repeal
  605         of specified provisions; repealing ss. 391.035,
  606         391.037, 391.045, 391.047, 391.055, and 391.071, F.S.,
  607         relating to provider qualifications, physicians and
  608         private sector services, provider reimbursements,
  609         third-party payments, service delivery systems under
  610         the program, and quality of care requirements,
  611         respectively; amending s. 391.097, F.S.; conforming a
  612         provision to changes made by the act; repealing part
  613         II of ch. 391, F.S., consisting of ss. 391.221 and
  614         391.223, F.S., relating to Children’s Medical Services
  615         councils and panels; amending ss. 409.166, 409.811,
  616         409.813, 409.8134, 409.814, 409.815, 409.8177,
  617         409.818, 409.912, 409.9126, 409.9131, 409.920, and
  618         409.962, F.S.; conforming provisions to changes made
  619         by the act; requiring the agency to develop a
  620         comprehensive plan to redesign the Florida Medicaid
  621         Model Waiver for home and community-based services to
  622         include children who receive private duty nursing
  623         services; providing requirements for the redesign of
  624         the waiver plan; requiring the agency to submit a
  625         report to the Governor and the Legislature by a
  626         specified date; providing requirements for the report;
  627         providing