CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 2360
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Kirkpatrick moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 41, between lines 8 and 9,
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16 insert:
17 Section 14. Paragraph (b) of subsection (3) of section
18 409.912, 1998 Supplement, is amended to read:
19 409.912 Cost-effective purchasing of health care.--The
20 agency shall purchase goods and services for Medicaid
21 recipients in the most cost-effective manner consistent with
22 the delivery of quality medical care. The agency shall
23 maximize the use of prepaid per capita and prepaid aggregate
24 fixed-sum basis services when appropriate and other
25 alternative service delivery and reimbursement methodologies,
26 including competitive bidding pursuant to s. 287.057, designed
27 to facilitate the cost-effective purchase of a case-managed
28 continuum of care. The agency shall also require providers to
29 minimize the exposure of recipients to the need for acute
30 inpatient, custodial, and other institutional care and the
31 inappropriate or unnecessary use of high-cost services.
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SENATE AMENDMENT
Bill No. CS for SB 2360
Amendment No.
1 (3) The agency may contract with:
2 (b) An entity that is providing comprehensive
3 inpatient and outpatient behavioral mental health care
4 services plan licensed under chapter 624, chapter 636, or
5 chapter 641. Unless otherwise authorized by law, the agency
6 shall limit such contract to services provided to certain
7 Medicaid recipients in Hillsborough, Highlands, Hardee,
8 Manatee, and Polk, Escambia, Santa Rosa, Okaloosa, Walton, and
9 Dade Counties, through a capitated, prepaid arrangement
10 pursuant to the federal waiver provided for by s. 409.905(5).
11 Such an entity must become licensed under chapter 624, chapter
12 636, or chapter 641 by December 31, 1998, and is exempt from
13 the provisions of part I of chapter 641 until then. However,
14 if the entity assumes risk, the Department of Insurance shall
15 develop appropriate regulatory requirements by rule under the
16 insurance code before the entity becomes operational.
17 1. A county in which the agency seeks to implement its
18 authority to award contracts as provided in this subparagraph
19 that has a Medicaid population in excess of 300,000, the
20 agency shall award one contract for every 100,000 Medicaid
21 recipients.
22 2. The agency shall set as part of the competitive
23 procurement an allowable medical/loss ratio to limit
24 administrative costs and shall use industry standards, which
25 shall be adjusted based upon size of the plan.
26 3. In developing the behavioral health care prepaid
27 plan procurement document, the agency shall consult and
28 coordinate with the Department of Children and Family Services
29 and the Department of Juvenile Justice. The Department of
30 Children and Family Services shall approve the sections of the
31 behavioral health care prepaid plan procurement document that
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SENATE AMENDMENT
Bill No. CS for SB 2360
Amendment No.
1 relates to children in the care and custody of Department of
2 Children and Family Services and their families. The
3 Department of Juvenile Justice shall approve the sections of
4 the behavioral health care prepaid plan procurement document
5 that relates to children in the care and custody of Department
6 of Juvenile Justice and their families.
7 4. A county that has a provider service network as
8 authorized in this section, which provides behavioral health
9 care services and is in operation as of October 1, 1999, the
10 agency shall not include those recipients served by the
11 provider service network in the behavioral health prepaid
12 plan, pursuant to this subsection.
13 5. As used in this paragraph:
14 a. "Behavioral health care" includes mental health
15 and substance abuse services.
16 b "District" means any district of the Department of
17 Children and Family Services.
18 c. "Therapeutic or Supportive Foster Care Homes"
19 means any foster care program operated by a Medicaid Community
20 Mental Health provider which is a licensed residential child
21 caring or child placing agency as defined in section 409.175.
22 d. "Specialized Therapeutic Foster Care" means any
23 foster care program provided under the Medicaid Community
24 Mental Health Program service entitled specialized therapeutic
25 foster care.
26 6. Children residing in a Department of Juvenile
27 Justice residential program approved as a Medicaid Behavioral
28 Health Overlay Services provider shall not be included in
29 behavioral health care prepaid plan pursuant to this
30 subparagraph.
31 7. When implementing the Behavioral Health Care
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SENATE AMENDMENT
Bill No. CS for SB 2360
Amendment No.
1 prepaid program in Dade County, the agency shall not include
2 the following:
3 a. dependent children placed by the Department of
4 Children and Family Services or children placed by a licensed
5 child placing agency into a licensed residential group care
6 facility which is operated by a Medicaid Community Mental
7 Health provider.
8 b. dependent children of the department receiving
9 therapeutic or supportive foster home care.
10 c. services to children in the care or custody of the
11 department while they are in emergency shelter.
12 d. children served under the Community Mental Health
13 program specialized therapeutic foster care.
14 8. When implementing the Behavioral Health Care
15 prepaid program in Dade County, the agency shall require that
16 any existing licensed child caring or child placing agency
17 that is also a Medicaid Community Mental Health Program
18 provider will be part of the provider network.
19 9. The agency and the department shall approve
20 behavioral health care criteria and protocols for services
21 provided to children referred from the child protection team
22 for follow-up services.
23 10. In all the behavioral health care prepaid plans,
24 substance abuse services shall be reimbursed fee for service
25 from State Medicaid funds until such time as the agency
26 determines that adequate funds are available for prepaid
27 methods. The agency shall insure that any contractors for
28 pre-paid behavioral health services shall propose practical
29 methods of integrating mental health and substance abuse
30 services, including opportunities for community-based
31 substance abuse agencies to become partners in the provider
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SENATE AMENDMENT
Bill No. CS for SB 2360
Amendment No.
1 networks established at a district or area level, and to
2 participate in the development of protocols for substance
3 abuse services.
4 11. In developing the behavioral health care prepaid
5 plan procurement document, the agency must ensure that
6 conversion to a prepaid system of delivery shall not result in
7 the displacement of indigent care patients from facilities
8 receiving state funding to provide indigent behavioral health
9 care to facilities licensed under chapter 395 which do not
10 receive state subsidies unless the unsubsidized facilities are
11 reimbursed for the costs of all treatment, including medical
12 treatment which is a precondition to admission into a
13 subsidized facility. Traditional inpatient mental health
14 providers licensed pursuant to chapter 395 must be included in
15 any provider network for prepaid behavioral health services.
16 12. The agency shall notify the Legislature of the
17 status and plans to expand the behavioral managed care
18 projects to those counties designated in this paragraph by
19 October 1, 2000. With respect to any county or district in
20 which expansion of behavioral managed care projects cannot be
21 accomplished within the 3-year time frame, the plan must
22 clearly state the reasons the time frame cannot be met and the
23 efforts that should be made to address the obstacles, which
24 may include alternatives to behavioral managed care. The plan
25 must also address the status of services to children and their
26 families in the care and custody of the department and
27 Juvenile Justice. The plan must address how the services for
28 those children and families will be integrated into the
29 comprehensive behavioral health care program or how services
30 will be provided using alternative methods over the 3-year
31 phase in.
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SENATE AMENDMENT
Bill No. CS for SB 2360
Amendment No.
1 13. For counties not specifically designated in this
2 paragraph, a local planning process shall be completed prior
3 to the agency expanding behavioral managed care projects to
4 other areas. The planning process shall be completed with
5 local community participation including, but not limited to,
6 input from community-based mental health, substance abuse,
7 child welfare, and delinquency providers currently under
8 contract with the Department of Children and Family Services,
9 Department of Juvenile Justice or the agency. Facilities
10 licensed under chapter 395 will be included in the local
11 planning process.
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13 (Redesignate subsequent sections.)
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17 And the title is amended as follows:
18 On page 1, line 2, delete that line
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20 and insert:
21 An act relating to health care; amending s.
22 409.912, F.S.; authorizing the Agency for
23 Health Care Administration to contract with
24 entities providing behavioral health care
25 services to certain Medicaid recipients in
26 certain counties under certain circumstances;
27 providing requirements; providing limitations;
28 providing definitions;
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