Amendment
Bill No. 0017
Amendment No. 627463
CHAMBER ACTION
Senate House
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1Representative(s) Sands offered the following:
2
3     Amendment (with directory and title amendments)
4     Between line(s) 61 and 62 insert:
5     (4)  The agency may contract with:
6     (b)  An entity that is providing comprehensive behavioral
7health care services to certain Medicaid recipients through a
8capitated, prepaid arrangement pursuant to the federal waiver
9provided for by s. 409.905(5). Such an entity must be licensed
10under chapter 624, chapter 636, or chapter 641 and must possess
11the clinical systems and operational competence to manage risk
12and provide comprehensive behavioral health care to Medicaid
13recipients. As used in this paragraph, the term "comprehensive
14behavioral health care services" means covered mental health and
15substance abuse treatment services that are available to
16Medicaid recipients. The secretary of the Department of Children
17and Family Services shall approve provisions of procurements
18related to children in the department's care or custody prior to
19enrolling such children in a prepaid behavioral health plan. Any
20contract awarded under this paragraph must be competitively
21procured. In developing the behavioral health care prepaid plan
22procurement document, the agency shall ensure that the
23procurement document requires the contractor to develop and
24implement a plan to ensure compliance with s. 394.4574 related
25to services provided to residents of licensed assisted living
26facilities that hold a limited mental health license. Except as
27provided in subparagraph 8., the agency shall seek federal
28approval to contract with a single entity meeting these
29requirements to provide comprehensive behavioral health care
30services to all Medicaid recipients not enrolled in a managed
31care plan in an AHCA area. Each entity must offer sufficient
32choice of providers in its network to ensure recipient access to
33care and the opportunity to select a provider with whom they are
34satisfied. The network shall include all public mental health
35hospitals. To ensure unimpaired access to behavioral health care
36services by Medicaid recipients, all contracts issued pursuant
37to this paragraph shall require 80 percent of the capitation
38paid to the managed care plan, including health maintenance
39organizations, to be expended for the provision of behavioral
40health care services. In the event the managed care plan expends
41less than 80 percent of the capitation paid pursuant to this
42paragraph for the provision of behavioral health care services,
43the difference shall be returned to the agency. The agency shall
44provide the managed care plan with a certification letter
45indicating the amount of capitation paid during each calendar
46year for the provision of behavioral health care services
47pursuant to this section. The agency may reimburse for substance
48abuse treatment services on a fee-for-service basis until the
49agency finds that adequate funds are available for capitated,
50prepaid arrangements.
51     1.  By January 1, 2001, the agency shall modify the
52contracts with the entities providing comprehensive inpatient
53and outpatient mental health care services to Medicaid
54recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
55Counties, to include substance abuse treatment services.
56     2.  By July 1, 2003, the agency and the Department of
57Children and Family Services shall execute a written agreement
58that requires collaboration and joint development of all policy,
59budgets, procurement documents, contracts, and monitoring plans
60that have an impact on the state and Medicaid community mental
61health and targeted case management programs.
62     3.  Except as provided in subparagraph 8., by July 1, 2006,
63the agency and the Department of Children and Family Services
64shall contract with managed care entities in each AHCA area
65except area 6 or arrange to provide comprehensive inpatient and
66outpatient mental health and substance abuse services through
67capitated prepaid arrangements to all Medicaid recipients who
68are eligible to participate in such plans under federal law and
69regulation. In AHCA areas where eligible individuals number less
70than 150,000, the agency shall contract with a single managed
71care plan to provide comprehensive behavioral health services to
72all recipients who are not enrolled in a Medicaid health
73maintenance organization. The agency may contract with more than
74one comprehensive behavioral health provider to provide care to
75recipients who are not enrolled in a Medicaid health maintenance
76organization in AHCA areas where the eligible population exceeds
77150,000. Contracts for comprehensive behavioral health providers
78awarded pursuant to this section shall be competitively
79procured. Both for-profit and not-for-profit corporations shall
80be eligible to compete. Managed care plans contracting with the
81agency under subsection (3) shall provide and receive payment
82for the same comprehensive behavioral health benefits as
83provided in AHCA rules, including handbooks incorporated by
84reference. Existing provider service networks shall be permitted
85to continue their programs for a period of no less than 3 years
86and shall include mental health care and substance abuse
87services as part of the services offered by the network.
88Notwithstanding the provisions of this section, county
89governments may participate as provider service networks.
90     4.  By October 1, 2003, the agency and the department shall
91submit a plan to the Governor, the President of the Senate, and
92the Speaker of the House of Representatives which provides for
93the full implementation of capitated prepaid behavioral health
94care in all areas of the state.
95     a.  Implementation shall begin in 2003 in those AHCA areas
96of the state where the agency is able to establish sufficient
97capitation rates.
98     b.  If the agency determines that the proposed capitation
99rate in any area is insufficient to provide appropriate
100services, the agency may adjust the capitation rate to ensure
101that care will be available. The agency and the department may
102use existing general revenue to address any additional required
103match but may not over-obligate existing funds on an annualized
104basis.
105     c.  Subject to any limitations provided for in the General
106Appropriations Act, the agency, in compliance with appropriate
107federal authorization, shall develop policies and procedures
108that allow for certification of local and state funds.
109     5.  Children residing in a statewide inpatient psychiatric
110program, or in a Department of Juvenile Justice or a Department
111of Children and Family Services residential program approved as
112a Medicaid behavioral health overlay services provider shall not
113be included in a behavioral health care prepaid health plan or
114any other Medicaid managed care plan pursuant to this paragraph.
115     6.  In converting to a prepaid system of delivery, the
116agency shall in its procurement document require an entity
117providing only comprehensive behavioral health care services to
118prevent the displacement of indigent care patients by enrollees
119in the Medicaid prepaid health plan providing behavioral health
120care services from facilities receiving state funding to provide
121indigent behavioral health care, to facilities licensed under
122chapter 395 which do not receive state funding for indigent
123behavioral health care, or reimburse the unsubsidized facility
124for the cost of behavioral health care provided to the displaced
125indigent care patient.
126     7.  Traditional community mental health providers under
127contract with the Department of Children and Family Services
128pursuant to part IV of chapter 394, child welfare providers
129under contract with the Department of Children and Family
130Services in areas 1 and 6, and inpatient mental health providers
131licensed pursuant to chapter 395 must be offered an opportunity
132to accept or decline a contract to participate in any provider
133network for prepaid behavioral health services.
134     8.  For fiscal year 2004-2005, all Medicaid eligible
135children, except children in areas 1 and 6, whose cases are open
136for child welfare services in the HomeSafeNet system, shall be
137enrolled in MediPass or in Medicaid fee-for-service and all
138their behavioral health care services including inpatient,
139outpatient psychiatric, community mental health, and case
140management shall be reimbursed on a fee-for-service basis.
141Beginning July 1, 2005, such children, who are open for child
142welfare services in the HomeSafeNet system, shall receive their
143behavioral health care services through a specialty prepaid plan
144operated by community-based lead agencies either through a
145single agency or formal agreements among several agencies. The
146specialty prepaid plan must result in savings to the state
147comparable to savings achieved in other Medicaid managed care
148and prepaid programs. Such plan must provide mechanisms to
149maximize state and local revenues. The specialty prepaid plan
150shall be developed by the agency and the Department of Children
151and Family Services. The agency is authorized to seek any
152federal waivers to implement this initiative.
153
154=========== D I R E C T O R Y  A M E N D M E N T ==========
155Remove line(s) 15 and 16 and insert:
156     Section 1.  Paragraph (b) of subsection (4) of section
157409.912, Florida Statutes, is amended, and subsection (50) is
158added to said section, to read:
159
160================ T I T L E  A M E N D M E N T =============
161     Remove line(s) 3 and insert:
162
163409.912, F.S.; authorizing existing provider service networks to
164continue their programs for a specified period of time;
165including mental health and substance abuse services;
166authorizing county governments to participate as networks;
167requiring the Agency for Health Care


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