HB 1871

1	A bill to be entitled
2	An act relating to Medicaid; providing waiver authority
3	for the Agency for Health Care Administration; providing
4	definitions; identifying categorical groups for
5	eligibility under the waiver; establishing the choice
6	counseling process; providing for managed care plans;
7	including behavioral health care benefits in the capitated
8	structure; providing for applicability and enforcement;
9	granting rulemaking authority to the agency; requiring
10	legislative authority to implement the waiver; providing
11	for future review and repeal of the act; providing an
12	effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1.  Medicaid reform; eligibility determination;
17	services.--
18	(1)  WAIVER AUTHORITY.--Notwithstanding any other law to
19	the contrary, the Agency for Health Care Administration is
20	authorized to seek an experimental, pilot, or demonstration
21	project waiver, pursuant to s. 1115 of the Social Security Act,
22	to reform Florida's Medicaid program pursuant to this section in
23	urban and rural demonstration sites contingent on federal
24	approval to preserve the upper-payment-limit funding method and
25	the disproportionate share program pursuant to chapter 409,
26	Florida Statutes.
27	(2)  DEFINITIONS.--As used in this section, the term:
28	(a)  "Agency" means the Agency for Health Care
29	Administration.
30	(b)  "Managed care plan" means a health maintenance
31	organization authorized under part I of chapter 641, Florida
32	Statutes; an entity under part II or part III of chapter 641,
33	chapter 627, chapter 636, or s. 409.912, Florida Statutes; the
34	Children's Medical Services network under chapter 391, Florida
35	Statutes; a licensed mental health provider under chapter 394,
36	Florida Statutes; a licensed substance abuse provider under
37	chapter 397, Florida Statutes; a certified administrator under
38	chapter 626, Florida Statutes; or a hospital under chapter 395,
39	Florida Statutes, certified by the agency to operate as a
40	managed care plan.
41	(c)  "Medicaid opt-out option" means a program that allows
42	recipients to purchase health care insurance through the private
43	insurance market instead of through a Medicaid-certified plan.
44	(d)  "Plan benefits" means the mandatory services specified
45	in s. 409.905, Florida Statutes, behavioral health services
46	specified in s. 409.906(8), Florida Statutes, and pharmacy
47	services specified in s. 409.906(20), Florida Statutes, and may
48	include any supplemental coverage offered to attract recipients
49	and provide needed care.
50	(3)  ELIGIBILITY.--The agency may pursue a waiver to reform
51	Medicaid for the following categorical groups:
52	(a)  Temporary assistance for needy families consistent
53	with ss. 402 and 1931 of the Social Security Act and chapter
54	409, chapter 414, or chapter 445, Florida Statutes.
55	(b)  Supplemental security income recipients as defined in
56	Title XVI of the Social Security Act, except for persons who are
57	dually eligible for Medicaid and Medicare.
58	(c)  All children covered pursuant to Title XIX and Title
59	XXI of the Social Security Act.
60	(4)  CHOICE COUNSELING.--
61	(a)  At the time of eligibility application, a recipient
62	shall be temporarily placed in a managed care plan. Within 30
63	days after initial placement in a plan, a recipient shall choose
64	either to remain in the plan to receive health care coverage
65	through Medicaid benefits or through the private insurance
66	market.
67	(b)  During the 30-day period between initial placement in
68	a plan and the recipient choosing a plan, the agency shall
69	provide the recipient with all the Medicaid health care options
70	available in that community and shall provide choice counseling
71	to assist the recipient in making an informed decision regarding
72	health coverage options.
73	(c)  The agency shall ensure that the recipient is provided
74	with:
75	1.  A list and description of the benefits provided.
76	2.  Cost data.
77	3.  Plan performance data, if available.
78	4.  Explanation of benefit limitations.
79	5.  Contact information, including geographic locations and
80	phone numbers of all plan providers and transportation
81	limitations.
82	6.  Any other information the agency determines would
83	facilitate a recipient's understanding of the plan or insurance
84	that would best meet his or her needs.
85	(d)  The agency shall ensure that there is a record of
86	recipient acknowledgment that choice counseling has been
87	provided.
88	(e)  The agency shall ensure that the choice counseling
89	process and material provided are designed to allow recipients
90	with limited education, mental impairment, physical impairment,
91	sensory impairment, cultural differences, and language barriers
92	to understand the choices they must make and the consequences of
93	their choices.
94	(f)  The agency shall require the entity performing choice
95	counseling to determine if the recipient has made a choice of a
96	plan or has opted out because of duress, threats, payment to the
97	recipient, or incentives promised to the recipient by a third
98	party. If the choice counseling entity determines that the
99	decision to choose a plan was unlawfully influenced or a plan
100	violated any of the provisions of s. 409.912(21), Florida
101	Statutes, the choice counseling entity shall immediately report
102	the violation to the agency's program integrity section for
103	investigation. Verification of choice counseling by the
104	recipient shall include a stipulation that the recipient
105	acknowledges the provisions of this subsection.
106	(g)  It is the intent of the Legislature, within the
107	authority of the waiver and within available resources, that the
108	agency promote health literacy through outreach activities for
109	Medicaid recipients.
110	(h)  The agency is authorized to contract with entities to
111	perform choice counseling and may establish standards and
112	performance contracts.
113	(5)  PLANS.--
114	(a)  The agency shall develop a capitated system of care
115	that promotes choice and competition.
116	(b)  Plan benefits shall include the mandatory services
117	specified in s. 409.905, Florida Statutes, behavioral health
118	services specified in s. 409.906(8), Florida Statutes, and
119	pharmacy services specified in s. 409.906(20), Florida Statutes,
120	and may include any supplemental coverage offered to attract
121	recipients and provide needed care.
122	(c)1.  The agency shall include behavioral health care
123	benefits as part of the capitation structure to enable a plan to
124	coordinate and fully manage all aspects of patient care.
125	2.  The agency may set standards for behavioral health care
126	benefits for managed care plans and health insurance plans
127	participating in the Medicaid opt-out option pursuant to this
128	section.
129	3.  The agency may set appropriate medication guidelines,
130	including copayments.
131	(6)  APPLICABILITY OF OTHER LAW.--The Legislature
132	authorizes the Agency for Health Care Administration to apply
133	and enforce any provision of law not referenced in this section
134	to ensure the safety, quality, and integrity of the waiver.
135	(7)  RULEMAKING.--The Agency for Health Care Administration
136	is authorized to adopt rules to implement the provisions of this
137	section.
138	(8)  IMPLEMENTATION.--Upon approval of a waiver by the
139	Centers for Medicare and Medicaid Services, the Agency for
140	Health Care Administration shall report the provisions and
141	structure of the approved waiver and any deviations from this
142	section to the Legislature. The agency shall implement the
143	waiver after authority to implement the waiver is granted by the
144	Legislature.
145	(9)  REVIEW AND REPEAL.--This section shall stand repealed
146	on July 1, 2010, unless reviewed and saved from repeal through
147	reenactment by the Legislature.
148	Section 2.  This act shall take effect July 1, 2005.

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