Senate Bill sb2404c1
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Florida Senate - 2003 CS for SB 2404
By the Committee on Children and Families; and Senator Lynn
300-2153-03
1 A bill to be entitled
2 An act relating to substance abuse services;
3 amending s. 394.74, F.S.; authorizing the
4 Department of Children and Family Services to
5 adopt by rule new payment methodologies and to
6 eliminate unit-based methodologies for mental
7 health and substance abuse services;
8 authorizing the department to adopt rules for
9 local match based on new methodologies;
10 prohibiting changes to the ratio of state to
11 local matching resources or to the sources of
12 local match and prohibiting the increase in the
13 amount of local matching funds required;
14 amending s. 394.9082, F.S.; modifying the
15 services for which a managing entity is
16 accountable; establishing data system
17 requirements; providing for establishment of a
18 single managing entity for the delivery of
19 substance abuse services to child protective
20 services recipients in specified districts of
21 the department; providing for a contract;
22 requiring certain information to be kept;
23 requiring an evaluative study; providing for
24 reports to the Governor and Legislature;
25 providing an effective date.
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27 Be It Enacted by the Legislature of the State of Florida:
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29 Section 1. Paragraph (b) of subsection (2) of section
30 394.74, Florida Statutes, is amended to read:
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Florida Senate - 2003 CS for SB 2404
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1 394.74 Contracts for provision of local substance
2 abuse and mental health programs.--
3 (2)
4 (b) Notwithstanding s. 394.76(3)(a) and (c), the
5 department may use unit cost methods of payment in contracts
6 for purchasing mental health and substance abuse services. The
7 unit cost contracting system must account for those patient
8 fees that are paid on behalf of a specific client and those
9 that are earned and used by the provider for those services
10 funded in whole or in part by the department. The department
11 is authorized to implement through administrative rule
12 fee-for-service, prepaid case rate, and prepaid capitation
13 contract methodologies to purchase mental health and substance
14 abuse services. Fee-for-service, prepaid case rate, or
15 prepaid capitation mechanisms shall not be implemented
16 statewide without the elimination of the unit cost method of
17 payment. Notwithstanding the provisions of s. 394.76(3), the
18 department may adopt administrative rules that account for
19 local match in a manner that is consistent with
20 fee-for-service, prepaid case rate, and prepaid capitated
21 payment methodologies. Such provisions may not result in a
22 change of the ratio of state to local matching resources or in
23 the sources of local matching funds and may not increase the
24 amount of required local matching funds. It is the intent of
25 the Legislature that the provisions to account for local match
26 be consistent with the financial principles adopted for the
27 payment of state funds.
28 Section 2. Paragraphs (a) and (d) of subsection (4) of
29 section 394.9082, Florida Statutes, are amended, present
30 subsection (8) of that section is renumbered as subsection (9)
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Florida Senate - 2003 CS for SB 2404
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1 and amended, and a new subsection (8) is added to that
2 section, to read:
3 394.9082 Behavioral health service delivery
4 strategies.--
5 (4) CONTRACT FOR SERVICES.--
6 (a) The Department of Children and Family Services and
7 the Agency for Health Care Administration may contract for the
8 provision or management of behavioral health services with a
9 managing entity in at least two geographic areas. Both the
10 Department of Children and Family Services and the Agency for
11 Health Care Administration must contract with the same
12 managing entity in any distinct geographic area where the
13 strategy operates. This managing entity shall be accountable
14 at a minimum for the delivery of behavioral health services
15 specified and funded by the department and the agency for
16 children, adolescents, and adults. The geographic area must be
17 of sufficient size in population and have enough public funds
18 for behavioral health services to allow for flexibility and
19 maximum efficiency. Notwithstanding the provisions of s.
20 409.912(3)(b)1. and 2., at least one service delivery strategy
21 must be in one of the service districts in the catchment area
22 of G. Pierce Wood Memorial Hospital.
23 (d) Under both strategies, the Department of Children
24 and Family Services and the Agency for Health Care
25 Administration may:
26 1. Establish benefit packages based on the level of
27 severity of illness and level of client functioning;
28 2. Align and integrate procedure codes, standards, or
29 other requirements if it is jointly determined that these
30 actions will simplify or improve client services and
31 efficiencies in service delivery;
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Florida Senate - 2003 CS for SB 2404
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1 3. Use prepaid per capita and prepaid aggregate
2 fixed-sum payment methodologies; and
3 4. Modify their current procedure codes to increase
4 clinical flexibility, encourage the use of the most effective
5 interventions, and support rehabilitative activities; and.
6 5. Establish or develop data management and reporting
7 systems that promote efficient use of data by the service
8 delivery system. Data management and reporting systems must
9 address the management and clinical care needs of the service
10 providers and managing entities and provide information needed
11 by the department for required state and federal reporting. In
12 order to develop and test the application of new data systems,
13 a strategy implementation area is not required to provide
14 information that matches all current statewide reporting
15 requirements if the strategy's data systems include client
16 demographic, admission, discharge, enrollment, service events,
17 performance outcome information, and functional assessment.
18 (8) EXPANSION IN DISTRICTS 4 AND 12.--The department
19 shall work with community agencies to establish a single
20 managing entity for districts 4 and 12 accountable for the
21 delivery of substance abuse services to child protective
22 services recipients in the two districts. The purpose of this
23 strategy is to enhance the coordination of substance abuse
24 services with community-based care agencies and the
25 department. The department shall work with affected
26 stakeholders to develop and implement a plan that allows the
27 phase-in of services beginning with the delivery of substance
28 abuse services, with phase-in of subsequent substance abuse
29 services agreed upon by the managing entity and authorized by
30 the department, providing the necessary technical assistance
31 to assure provider and district readiness for implementation.
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Florida Senate - 2003 CS for SB 2404
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1 When a single managing entity is established and meets
2 readiness requirements, the department may enter into a
3 noncompetitive contract with the entity. The department shall
4 maintain detailed information on the methodology used for
5 selection and a justification for the selection. Performance
6 objectives shall be developed which ensure that services that
7 are delivered directly affect and complement the child's
8 permanency plan. During the initial planning and
9 implementation phase of this project, the requirements in
10 subsections (6) and (7) are waived. Considering the critical
11 substance abuse problems experienced by many families in the
12 child protection system, the department shall initiate the
13 implementation of the substance abuse delivery component of
14 this program without delay and furnish status reports to the
15 appropriate substantive committees of the Senate and the House
16 of Representatives no later than February 29, 2004, and
17 February 28, 2005. The integration of all services agreed upon
18 by the managing entity and authorized by the department must
19 be completed within 2 years after project initiation. Ongoing
20 monitoring and evaluation of this strategy shall be conducted
21 in accordance with subsection (9).
22 (9)(8) MONITORING AND EVALUATION.--The Department of
23 Children and Family Services and the Agency for Health Care
24 Administration shall provide routine monitoring and oversight
25 of and technical assistance to the managing entities. The
26 Louis de la Parte Florida Mental Health Institute shall
27 conduct an ongoing formative evaluation of each strategy to
28 identify the most effective methods and techniques used to
29 manage, integrate, and deliver behavioral health services. The
30 entity conducting the evaluation shall report to the
31 Department of Children and Family Services, the Agency for
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1 Health Care Administration, the Executive Office of the
2 Governor, and the Legislature every 12 months regarding the
3 status of the implementation of the service delivery
4 strategies. The report must include a summary of activities
5 that have occurred during the past 12 months of implementation
6 and any problems or obstacles that prevented, or may prevent
7 in the future, the managing entity from achieving performance
8 goals and measures. The first status report is due January 1,
9 2002. After the service delivery strategies have been
10 operational for 1 year, the status report must include an
11 analysis of administrative costs and the status of the
12 achievement of performance outcomes. By December 31, 2006, the
13 Louis de la Parte Florida Mental Health Institute, as a part
14 of the ongoing formative evaluation of each strategy, must
15 conduct a study of the strategies established in Districts
16 1,8, 4, and 12 under this section, and must include an
17 assessment of best practice models in other states. The study
18 must address programmatic outcomes that include, but are not
19 limited to: timeliness of service delivery; effectiveness of
20 treatment services; cost effectiveness of selected models; and
21 customer satisfaction with services. Based upon the results of
22 this study, the department and the Agency for Health Care
23 Administration, in consultation with the managing entities,
24 must provide a report to the Executive Office of the Governor,
25 the President of the Senate, and the Speaker of the House of
26 Representatives. This report must contain recommendations for
27 the statewide implementation of successful strategies,
28 including any modifications to the strategies; the
29 identification and prioritization of strategies to be
30 implemented; and timeframes for statewide completion that
31 include target dates to complete milestones as well as a date
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Florida Senate - 2003 CS for SB 2404
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1 for full statewide implementation. Upon receiving the annual
2 report from the evaluator, the Department of Children and
3 Family Services and the Agency for Health Care Administration
4 shall jointly make any recommendations to the Executive Office
5 of the Governor regarding changes in the service delivery
6 strategies or in the implementation of the strategies,
7 including timeframes.
8 Section 3. This act shall take effect upon becoming a
9 law.
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11 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
12 Senate Bill 2404
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14 Authorizes the department to implement through administrative
rule fee-for-services, prepaid case rate, and prepaid
15 capitation contract methodologies to purchase mental health
and substance abuse services while maintaining the current
16 level of required local match.
17 Restricts the expansion of the program in Districts 4 and 12
to the provision of substance abuse services.
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Provides additional direction for the study to be conducted by
19 the Florida Mental Health Institute (FMHI), as a part of the
ongoing evaluation of the strategies, to address the
20 strategies implemented in Districts 1, 8, 4 and 12. This
report must contain recommendations for statewide
21 implementation of successful strategies, including any
modification to the strategies currently in use, and is to be
22 provided by December 31, 2006.
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