Amendment

Bill No. 0700

Amendment No. 381609

CHAMBER ACTION
Senate		House
.
.
.

---

---

1	Representative Cantens offered the following:
2
3	Amendment (with directory and title amendments)
4	On page 44, between lines 29 and 30, insert:
5	Section 14.  Paragraph (b) of subsection (4) of section
6	409.912, Florida Statutes, is amended to read:
7	409.912  Cost-effective purchasing of health care.--The
8	agency shall purchase goods and services for Medicaid recipients
9	in the most cost-effective manner consistent with the delivery
10	of quality medical care. The agency shall maximize the use of
11	prepaid per capita and prepaid aggregate fixed-sum basis
12	services when appropriate and other alternative service delivery
13	and reimbursement methodologies, including competitive bidding
14	pursuant to s. 287.057, designed to facilitate the cost-
15	effective purchase of a case-managed continuum of care. The
16	agency shall also require providers to minimize the exposure of
17	recipients to the need for acute inpatient, custodial, and other
18	institutional care and the inappropriate or unnecessary use of
19	high-cost services. The agency may establish prior authorization
20	requirements for certain populations of Medicaid beneficiaries,
21	certain drug classes, or particular drugs to prevent fraud,
22	abuse, overuse, and possible dangerous drug interactions. The
23	Pharmaceutical and Therapeutics Committee shall make
24	recommendations to the agency on drugs for which prior
25	authorization is required. The agency shall inform the
26	Pharmaceutical and Therapeutics Committee of its decisions
27	regarding drugs subject to prior authorization.
28	(4)  The agency may contract with:
29	(b)  An entity that is providing comprehensive behavioral
30	health care services to certain Medicaid recipients through a
31	capitated, prepaid arrangement pursuant to the federal waiver
32	provided for by s. 409.905(5). Such an entity must be licensed
33	under chapter 624, chapter 636, or chapter 641 and must possess
34	the clinical systems and operational competence to manage risk
35	and provide comprehensive behavioral health care to Medicaid
36	recipients. As used in this paragraph, the term "comprehensive
37	behavioral health care services" means covered mental health and
38	substance abuse treatment services that are available to
39	Medicaid recipients. The secretary of the Department of Children
40	and Family Services shall approve provisions of procurements
41	related to children in the department's care or custody prior to
42	enrolling such children in a prepaid behavioral health plan. Any
43	contract awarded under this paragraph must be competitively
44	procured. In developing the behavioral health care prepaid plan
45	procurement document, the agency shall ensure that the
46	procurement document requires the contractor to develop and
47	implement a plan to ensure compliance with s. 394.4574 related
48	to services provided to residents of licensed assisted living
49	facilities that hold a limited mental health license. The agency
50	shall seek federal approval to contract with a single entity
51	meeting these requirements to provide comprehensive behavioral
52	health care services to all Medicaid recipients in an AHCA area.
53	Each entity must offer sufficient choice of providers in its
54	network to ensure recipient access to care and the opportunity
55	to select a provider with whom they are satisfied. The network
56	shall include all public mental health hospitals. To ensure
57	unimpaired access to behavioral health care services by Medicaid
58	recipients, all contracts issued pursuant to this paragraph
59	shall require 80 percent of the capitation paid to the managed
60	care plan, including health maintenance organizations, to be
61	expended for the provision of behavioral health care services.
62	In the event the managed care plan expends less than 80 percent
63	of the capitation paid pursuant to this paragraph for the
64	provision of behavioral health care services, the difference
65	shall be returned to the agency. The agency shall provide the
66	managed care plan with a certification letter indicating the
67	amount of capitation paid during each calendar year for the
68	provision of behavioral health care services pursuant to this
69	section. The agency may reimburse for substance abuse treatment
70	services on a fee-for-service basis until the agency finds that
71	adequate funds are available for capitated, prepaid
72	arrangements.
73	1.  By January 1, 2001, the agency shall modify the
74	contracts with the entities providing comprehensive inpatient
75	and outpatient mental health care services to Medicaid
76	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
77	Counties, to include substance abuse treatment services.
78	2.  By July 1, 2003, the agency and the Department of
79	Children and Family Services shall execute a written agreement
80	that requires collaboration and joint development of all policy,
81	budgets, procurement documents, contracts, and monitoring plans
82	that have an impact on the state and Medicaid community mental
83	health and targeted case management programs.
84	3.  By July 1, 2006, the agency and the Department of
85	Children and Family Services shall contract with managed care
86	entities in each AHCA area except area 6 or arrange to provide
87	comprehensive inpatient and outpatient mental health and
88	substance abuse services through capitated prepaid arrangements
89	to all Medicaid recipients who are eligible to participate in
90	such plans under federal law and regulation. In AHCA areas where
91	eligible individuals number less than 150,000, the agency shall
92	contract with a single managed care plan to provide
93	comprehensive behavioral health services to all recipients who
94	are not enrolled in a Medicaid health maintenance organization.
95	The agency may contract with more than one comprehensive
96	behavioral health provider to provide care to recipients who are
97	not enrolled in a Medicaid health maintenance organization plan
98	in AHCA areas where the eligible population exceeds 150,000. In
99	AHCA area 11, the agency shall award a pilot project to a
100	provider service network as described in paragraph (4)(d) with a
101	minimum of 150,000 lives for purposes of demonstrating the cost
102	effectiveness and improvements in the provision of quality
103	mental health services through a provider-based managed care
104	model. Contracts for comprehensive behavioral health providers
105	awarded pursuant to this section shall be competitively
106	procured. Both for-profit and not-for-profit corporations shall
107	be eligible to compete. Only single managed care plans which are
108	contracted to provide comprehensive behavioral health services
109	to Medicaid recipients not enrolled in an health maintenance
110	organization shall be capitated to provide and receive payment
111	for the comprehensive behavioral health benefits as provided in
112	agency rules, including handbooks incorporated by reference.
113	4.  By October 1, 2003, the agency and the department shall
114	submit a plan to the Governor, the President of the Senate, and
115	the Speaker of the House of Representatives which provides for
116	the full implementation of capitated prepaid behavioral health
117	care in all areas of the state. The plan shall include
118	provisions which ensure that children and families receiving
119	foster care and other related services are appropriately served
120	and that these services assist the community-based care lead
121	agencies in meeting the goals and outcomes of the child welfare
122	system. The plan will be developed with the participation of
123	community-based lead agencies, community alliances, sheriffs,
124	and community providers serving dependent children.
125	a.  Implementation shall begin in 2003 in those AHCA areas
126	of the state where the agency is able to establish sufficient
127	capitation rates.
128	b.  If the agency determines that the proposed capitation
129	rate in any area is insufficient to provide appropriate
130	services, the agency may adjust the capitation rate to ensure
131	that care will be available. The agency and the department may
132	use existing general revenue to address any additional required
133	match but may not over-obligate existing funds on an annualized
134	basis.
135	c.  Subject to any limitations provided for in the General
136	Appropriations Act, the agency, in compliance with appropriate
137	federal authorization, shall develop policies and procedures
138	that allow for certification of local and state funds.
139	5.  Children residing in a statewide inpatient psychiatric
140	program, or in a Department of Juvenile Justice or a Department
141	of Children and Family Services residential program approved as
142	a Medicaid behavioral health overlay services provider shall not
143	be included in a behavioral health care prepaid health plan
144	pursuant to this paragraph.
145	6.  In converting to a prepaid system of delivery, the
146	agency shall in its procurement document require an entity
147	providing comprehensive behavioral health care services to
148	prevent the displacement of indigent care patients by enrollees
149	in the Medicaid prepaid health plan providing behavioral health
150	care services from facilities receiving state funding to provide
151	indigent behavioral health care, to facilities licensed under
152	chapter 395 which do not receive state funding for indigent
153	behavioral health care, or reimburse the unsubsidized facility
154	for the cost of behavioral health care provided to the displaced
155	indigent care patient.
156	7.  Traditional community mental health providers under
157	contract with the Department of Children and Family Services
158	pursuant to part IV of chapter 394, child welfare providers
159	under contract with the Department of Children and Family
160	Services, and inpatient mental health providers licensed
161	pursuant to chapter 395 must be offered an opportunity to accept
162	or decline a contract to participate in any provider network for
163	prepaid behavioral health services.
164
165	================= T I T L E  A M E N D M E N T =================
166	On page 1, remove line 24, and insert:
167	severability; legislative intent; amending s. 409.912, F.S.;
168	authorizing the agency to contract for certain services;
169	providing for funding of trauma; providing effective dates.

CODING: Words stricken are deletions; words underlined are additions.