(LATE FILED)	Amendment
Bill No. 0003B

Amendment No. 587531

CHAMBER ACTION
Senate		House
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1	Representative(s) Benson offered the following:
2
3	Substitute Amendment for Amendment ( 563285 ) (with title
4	amendment)
5	Remove line(s) 1228-1378 and insert:
6	Section 6.  Paragraphs (f), (k), and (l) of subsection (2)
7	of section 409.9122, Florida Statutes, are amended to read:
8	409.9122  Mandatory Medicaid managed care enrollment;
9	programs and procedures.--
10	(2)
11	(f)  When an eligible a Medicaid recipient does not choose
12	a managed care plan or MediPass provider, the agency shall
13	assign the Medicaid recipient to a managed care plan or MediPass
14	provider according to the following provisions:
15	1.  Effective January 1, 2006, Medicaid recipients who are
16	subject to mandatory Medicaid managed care enrollment but who
17	fail to make a choice shall be assigned to Medicaid managed care
18	plans until not less than 75 percent of all Medicaid recipients
19	eligible to choose managed care are enrolled in managed care
20	plans. When that percentage is achieved, assignment of Medicaid
21	recipients who fail to make a choice shall be based
22	proportionally each period on the preferences of recipients who
23	made a choice in the previous period. Such proportions shall be
24	revised at least quarterly to reflect an update of the
25	preferences of Medicaid recipients. Members of managed care
26	plans operating under the provisions of s. 409.91211 shall not
27	be included in the percentage calculation.
28	2.  Effective July 1, 2007, Medicaid recipients who are
29	subject to mandatory Medicaid managed care enrollment but who
30	fail to make a choice shall be assigned to managed care plans.
31	3.  For purposes of this paragraph, when referring to
32	assignment, the term "managed care plans" includes health
33	maintenance organizations, exclusive provider organizations,
34	provider service networks, minority physician networks, the
35	Children's Medical Services Network, and pediatric emergency
36	department diversion programs authorized by this chapter or the
37	General Appropriations Act.
38	4.  In counties in which there are no managed care plans
39	that accept Medicaid enrollees, assignment shall be to a
40	MediPass provider.
41	5.  When assigning Medicaid recipients who fail to make a
42	choice, the agency shall take into account the following
43	criteria:
44	a.  Network capacity is sufficient to meet the needs of
45	members.
46	b.  The recipient has an enrollment history with a managed
47	care plan or a treatment history with one of the primary care
48	providers within a managed care plan.
49	c.  The agency has knowledge that the member has previously
50	expressed a preference for a particular managed care plan but
51	has failed to make a choice.
52	d.  Primary care providers and specialists are
53	geographically accessible to the recipient's residence. Medicaid
54	recipients who are subject to mandatory assignment but who fail
55	to make a choice shall be assigned to managed care plans until
56	an enrollment of 40 percent in MediPass and 60 percent in
57	managed care plans is achieved. Once this enrollment is
58	achieved, the assignments shall be divided in order to maintain
59	an enrollment in MediPass and managed care plans which is in a
60	40 percent and 60 percent proportion, respectively. Thereafter,
61	assignment of Medicaid recipients who fail to make a choice
62	shall be based proportionally on the preferences of recipients
63	who have made a choice in the previous period. Such proportions
64	shall be revised at least quarterly to reflect an update of the
65	preferences of Medicaid recipients. The agency shall
66	disproportionately assign Medicaid-eligible recipients who are
67	required to but have failed to make a choice of managed care
68	plan or MediPass, including children, and who are to be assigned
69	to the MediPass program to children's networks as described in
70	s. 409.912(4)(g), Children's Medical Services Network as defined
71	in s. 391.021, exclusive provider organizations, provider
72	service networks, minority physician networks, and pediatric
73	emergency department diversion programs authorized by this
74	chapter or the General Appropriations Act, in such manner as the
75	agency deems appropriate, until the agency has determined that
76	the networks and programs have sufficient numbers to be
77	economically operated. For purposes of this paragraph, when
78	referring to assignment, the term "managed care plans" includes
79	health maintenance organizations, exclusive provider
80	organizations, provider service networks, minority physician
81	networks, Children's Medical Services Network, and pediatric
82	emergency department diversion programs authorized by this
83	chapter or the General Appropriations Act. When making
84	assignments, the agency shall take into account the following
85	criteria:
86	1.  A managed care plan has sufficient network capacity to
87	meet the need of members.
88	2.  The managed care plan or MediPass has previously
89	enrolled the recipient as a member, or one of the managed care
90	plan's primary care providers or MediPass providers has
91	previously provided health care to the recipient.
92	3.  The agency has knowledge that the member has previously
93	expressed a preference for a particular managed care plan or
94	MediPass provider as indicated by Medicaid fee-for-service
95	claims data, but has failed to make a choice.
96	4.  The managed care plan's or MediPass primary care
97	providers are geographically accessible to the recipient's
98	residence.
99	(k)  When a Medicaid recipient does not choose a managed
100	care plan or MediPass provider, the agency shall assign the
101	Medicaid recipient to a managed care plan, except in those
102	counties in which there are fewer than two managed care plans
103	accepting Medicaid enrollees, in which case assignment shall be
104	to a managed care plan or a MediPass provider. Medicaid
105	recipients in counties with fewer than two managed care plans
106	accepting Medicaid enrollees who are subject to mandatory
107	assignment but who fail to make a choice shall be assigned to
108	managed care plans until an enrollment of 40 percent in MediPass
109	and 60 percent in managed care plans is achieved. Once that
110	enrollment is achieved, the assignments shall be divided in
111	order to maintain an enrollment in MediPass and managed care
112	plans which is in a 40 percent and 60 percent proportion,
113	respectively. In service areas 1 and 6 of the Agency for Health
114	Care Administration where the agency is contracting for the
115	provision of comprehensive behavioral health services through a
116	capitated prepaid arrangement, recipients who fail to make a
117	choice shall be assigned equally to MediPass or a managed care
118	plan. For purposes of this paragraph, when referring to
119	assignment, the term "managed care plans" includes exclusive
120	provider organizations, provider service networks, Children's
121	Medical Services Network, minority physician networks, and
122	pediatric emergency department diversion programs authorized by
123	this chapter or the General Appropriations Act. When making
124	assignments, the agency shall take into account the following
125	criteria:
126	1.  A managed care plan has sufficient network capacity to
127	meet the need of members.
128	2.  The managed care plan or MediPass has previously
129	enrolled the recipient as a member, or one of the managed care
130	plan's primary care providers or MediPass providers has
131	previously provided health care to the recipient.
132	3.  The agency has knowledge that the member has previously
133	expressed a preference for a particular managed care plan or
134	MediPass provider as indicated by Medicaid fee-for-service
135	claims data, but has failed to make a choice.
136	4.  The managed care plan's or MediPass primary care
137	providers are geographically accessible to the recipient's
138	residence.
139	5.  The agency has authority to make mandatory assignments
140	based on quality of service and performance of managed care
141	plans.
142	(k)(l)  Notwithstanding the provisions of chapter 287, the
143	agency may, at its discretion, renew cost-effective contracts
144	for choice counseling services once or more for such periods as
145	the agency may decide. However, all such renewals may not
146	combine to exceed a total period longer than the term of the
147	original contract.
148
149	======= T I T L E  A M E N D M E N T =======
150	Remove lines 67-69 and insert:
151	Medicaid recipients to managed care plans; creating s. 11.72,
152	F.S.; creating the

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