| 1 | Representative Detert offered the following: |
| 2 |
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| 3 | Amendment |
| 4 | Remove lines 1038-1174 and insert: |
| 5 | (5) This section does not authorize the agency to |
| 6 | implement any provision of s. 1115 of the Social Security Act |
| 7 | experimental, pilot, or demonstration project waiver to reform |
| 8 | the state Medicaid program in any part of the state other than |
| 9 | the two geographic areas specified in this section unless |
| 10 | approved by the Legislature. |
| 11 | (6) The agency shall develop and submit for approval |
| 12 | applications for waivers of applicable federal laws and |
| 13 | regulations as necessary to implement the managed care pilot |
| 14 | project as defined in this section. The agency shall post all |
| 15 | waiver applications under this section on its Internet website |
| 16 | 30 days before submitting the applications to the United States |
| 17 | Centers for Medicare and Medicaid Services. All waiver |
| 18 | applications shall be provided for review and comment to the |
| 19 | appropriate committees of the Senate and House of |
| 20 | Representatives for at least 10 working days prior to |
| 21 | submission. All waivers submitted to and approved by the United |
| 22 | States Centers for Medicare and Medicaid Services under this |
| 23 | section must be approved by the Legislature. Federally approved |
| 24 | waivers must be submitted to the President of the Senate and the |
| 25 | Speaker of the House of Representatives for referral to the |
| 26 | appropriate legislative committees. The appropriate committees |
| 27 | shall recommend whether to approve the implementation of any |
| 28 | waivers to the Legislature as a whole. The agency shall submit a |
| 29 | plan containing a recommended timeline for implementation of any |
| 30 | waivers and budgetary projections of the effect of the pilot |
| 31 | program under this section on the total Medicaid budget for the |
| 32 | 2006-2007 through 2009-2010 state fiscal years. This |
| 33 | implementation plan shall be submitted to the President of the |
| 34 | Senate and the Speaker of the House of Representatives at the |
| 35 | same time any waivers are submitted for consideration by the |
| 36 | Legislature. The agency is authorized to implement the waiver |
| 37 | and Centers for Medicare and Medicaid Services Special Terms and |
| 38 | Conditions number 11-W-00206/4. If the agency seeks approval by |
| 39 | the Federal Government of any modifications to these special |
| 40 | terms and conditions, the agency shall provide written |
| 41 | notification of its intent to modify these terms and conditions |
| 42 | to the President of the Senate and Speaker of the House of |
| 43 | Representatives at least 15 days prior to submitting the |
| 44 | modifications to the Federal Government for consideration. The |
| 45 | notification shall identify all modifications being pursued and |
| 46 | the reason they are needed. Upon receiving federal approval of |
| 47 | any modifications to the special terms and conditions, the |
| 48 | agency shall report to the Legislature describing the federally |
| 49 | approved modifications to the special terms and conditions |
| 50 | within 7 days after their approval by the Federal Government. |
| 51 | (7) Upon review and approval of the applications for |
| 52 | waivers of applicable federal laws and regulations to implement |
| 53 | the managed care pilot program by the Legislature, the agency |
| 54 | may initiate adoption of rules pursuant to ss. 120.536(1) and |
| 55 | 120.54 to implement and administer the managed care pilot |
| 56 | program as provided in this section. |
| 57 | (8)(a) The Secretary of Health Care Administration shall |
| 58 | convene a technical advisory panel to advise the agency in the |
| 59 | following areas: risk-adjusted rate setting, benefit design, |
| 60 | and choice counseling. The panel shall include representatives |
| 61 | from the Florida Association of Health Plans, representatives |
| 62 | from provider-sponsored networks, and a representative from the |
| 63 | Office of Insurance Regulation. |
| 64 | (b) The technical advisory panel shall advise the agency |
| 65 | on the following: |
| 66 | 1. The risk-adjusted rate methodology to be used by the |
| 67 | agency including recommendations on mechanisms to recognize the |
| 68 | risk of all Medicaid enrollees and transitioning to a risk- |
| 69 | adjustment system, including recommendations for phasing in risk |
| 70 | adjustment and the uses of risk corridors. |
| 71 | 2. Implementation of an encounter data system to be used |
| 72 | for risk-adjusted rates. |
| 73 | 3. Administrative and implementation issues regarding the |
| 74 | use of risk-adjusted rates, including, but not limited to, cost, |
| 75 | simplicity, client privacy, data accuracy, and data exchange. |
| 76 | 4. Benefit design issues, including the actuarial |
| 77 | equivalence and sufficiency standards to be used. |
| 78 | 5. The implementation plan for the proposed choice |
| 79 | counseling system, including the information and materials to be |
| 80 | provided to recipients, the methodologies by which recipients |
| 81 | will be counseled regarding choices, criteria to be used to |
| 82 | assess plan quality, the methodology to be used to assign |
| 83 | recipients to plans if they fail to choose a managed care plan, |
| 84 | and the standards to be used for responsiveness to recipient |
| 85 | inquiries. |
| 86 | (c) The technical advisory panel shall continue in |
| 87 | existence and advise the secretary on matters outlined in this |
| 88 | subsection. |
| 89 | (9) The agency must ensure in the first 2 state fiscal |
| 90 | years in which a risk-adjusted methodology is a component of |
| 91 | rate setting that no managed care plan providing comprehensive |
| 92 | benefits to TANF and SSI recipients has an aggregate risk score |
| 93 | that varies by more than 10 percent from the aggregate weighted |
| 94 | mean of all managed care plans providing comprehensive benefits |
| 95 | to TANF and SSI recipients in a reform area. The agency's |
| 96 | payment to a managed care plan shall be based on such revised |
| 97 | aggregate risk score. |
| 98 | (10) After any calculations of aggregate risk scores or |
| 99 | revised aggregate risk scores pursuant to subsection (9), the |
| 100 | capitation rates for plans participating under 409.91211 shall |
| 101 | be phased in as follows: |
| 102 | (a) In the first fiscal year, the capitation rates shall |
| 103 | be weighted so that 75 percent of each capitation rate is based |
| 104 | on the current methodology and 25 percent is based upon a new |
| 105 | risk-adjusted capitation rate methodology. |
| 106 | (b) In the second fiscal year, the capitation rates shall |
| 107 | be weighted so that 50 percent of each capitation rate is based |
| 108 | on the current methodology and 50 percent is based on a new |
| 109 | risk-adjusted rate methodology. |
| 110 | (c) In the following fiscal year, the risk-adjusted |
| 111 | capitation methodology may be fully implemented. |
| 112 | (11) Subsections (9) and (10) shall not apply to managed |
| 113 | care plans offering benefits exclusively to high-risk, specialty |
| 114 | populations. The agency shall have the discretion to set risk- |
| 115 | adjusted rates immediately for said plans. |
| 116 | (12) Prior to the implementation of risk-adjusted rates, |
| 117 | rates shall be certified by an actuary and approved by the |
| 118 | federal Centers for Medicare and Medicaid Services. |
| 119 | (13) For purposes of this section, the term "capitated |
| 120 | managed care plan" includes health insurers authorized under |
| 121 | chapter 624, exclusive provider organizations authorized under |
| 122 | chapter 627, health maintenance organizations authorized under |
| 123 | chapter 641, the Children's Medical Services Network authorized |
| 124 | under chapter 391, and provider service networks that elect to |
| 125 | be paid fee-for-service for up to 3 years as authorized under |
| 126 | this section. |
| 127 | (14) It is the intent of the Legislature that if any |
| 128 | conflict exists between the provisions contained in this section |
| 129 | and other provisions of chapter 409, as they relate to |
| 130 | implementation of the Medicaid managed care pilot program, the |
| 131 | provisions contained in this section shall control. The agency |
| 132 | shall provide a written report to the President of the Senate |
| 133 | and the Speaker of the House of Representatives by April 1, |
| 134 | 2006, identifying any provisions of chapter 409 that conflict |
| 135 | with the implementation of the Medicaid managed care pilot |
| 136 | program as created in this section. After April 1, 2006, the |
| 137 | agency shall provide a written report to the President of the |
| 138 | Senate and the Speaker of the House of Representatives |
| 139 | immediately upon identifying any provisions of chapter 409 that |
| 140 | conflict with the implementation of the Medicaid managed care |
| 141 | pilot program as created in this section. |