HB 0003B

CS

CHAMBER ACTION

1	The Health Care Regulation Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to Medicaid; amending s. 641.2261, F.S.;
7	revising the applicability of solvency requirements to
8	include Medicaid provider service networks and updating a
9	reference; amending s. 409.911, F.S.; renaming the
10	Medicaid Disproportionate Share Council; providing for
11	appointment of council members; providing responsibilities
12	of the council; amending s. 409.912, F.S.; providing an
13	exception from certain contract procurement requirements
14	for specified Medicaid managed care pilot programs and
15	Medicaid health maintenance organizations; deleting the
16	competitive procurement requirement for provider service
17	networks; requiring provider service networks to comply
18	with the solvency requirements in s. 641.2261, F.S.;
19	updating a reference; amending s. 409.91211, F.S.;
20	providing for distribution of upper payment limit,
21	hospital disproportionate share program, and low income
22	pool funds; providing legislative intent with respect to
23	distribution of said funds; providing for implementation
24	of the powers, duties, and responsibilities of the Agency
25	for Health Care Administration with respect to the pilot
26	program; including the Division of Children's Medical
27	Services Network within the Department of Health in a list
28	of state-authorized pilot programs; requiring the agency
29	to develop a data reporting system; requiring the agency
30	to implement procedures to minimize fraud and abuse;
31	providing that certain Medicaid and Supplemental Security
32	Income recipients are exempt from s. 409.9122, F.S.;
33	authorizing the agency to assign certain Medicaid
34	recipients to reform plans; authorizing the agency to
35	implement the provisions of the waiver approved by Centers
36	for Medicare and Medicaid Services and requiring the
37	agency to notify the Legislature prior to seeking federal
38	approval of modifications to said terms and conditions;
39	requiring the agency to adopt certain rules for the
40	managed care pilot program; requiring the Office of
41	Insurance Regulation to provide advisory recommendations
42	regarding the agency's rate setting methodology;
43	authorizing the office to enter into certain contracts;
44	requiring the agency to solicit input from certain
45	stakeholders regarding the agency's rate setting
46	methodology; requiring a report to the Governor and
47	Legislature; providing for implementation of adjustments
48	to risk-adjusted capitation rates by agency rule;
49	providing a schedule for the phasing in of capitation
50	rates; providing requirements for adjustments to
51	capitation rates; requiring certification of capitation
52	rates; defining the term "capitated managed care plan";
53	creating s. 409.91212, F.S.; authorizing the agency to
54	expand the Medicaid reform demonstration program;
55	providing readiness criteria; providing for public
56	meetings; requiring notice of intent to expand the
57	demonstration program; requiring the agency to request a
58	hearing by the Joint Legislative Committee on Medicaid
59	Reform Implementation; authorizing the agency to request
60	certain budget transfers; amending s. 409.9122, F.S.;
61	revising provisions relating to assignment of certain
62	Medicaid recipients to managed care plans; requiring the
63	agency to submit reports to the Legislature; specifying
64	content of reports; creating s. 11.72, F.S.; creating the
65	Joint Legislative Committee on Medicaid Reform
66	Implementation; providing for membership, powers, and
67	duties; providing for conflict between specified
68	provisions of ch. 409, F.S., and requiring a report by the
69	agency pertaining thereto; amending s. 216.346, F.S.;
70	revising provisions relating to contracts between state
71	agencies; providing an appropriation; providing an
72	effective date.
73
74	Be It Enacted by the Legislature of the State of Florida:
75
76	Section 1.  Section 641.2261, Florida Statutes, is amended
77	to read:
78	641.2261  Application of federal solvency requirements to
79	provider-sponsored organizations and Medicaid provider service
80	networks.--
81	(1)  The solvency requirements of ss. 1855 and 1856 of the
82	Balanced Budget Act of 1997 and 42 C.F.R. s. 422.350, subpart H,
83	rules adopted by the Secretary of the United States Department
84	of Health and Human Services apply to a health maintenance
85	organization that is a provider-sponsored organization rather
86	than the solvency requirements of this part. However, if the
87	provider-sponsored organization does not meet the solvency
88	requirements of this part, the organization is limited to the
89	issuance of Medicare+Choice plans to eligible individuals. For
90	the purposes of this section, the terms "Medicare+Choice plans,"
91	"provider-sponsored organizations," and "solvency requirements"
92	have the same meaning as defined in the federal act and federal
93	rules and regulations.
94	(2)  The solvency requirements of 42 C.F.R. s. 422.350,
95	subpart H, and the solvency requirements established in the
96	approved federal waiver pursuant to chapter 409 apply to a
97	Medicaid provider service network rather than the solvency
98	requirements of this part.
99	Section 2.  Subsection (9) of section 409.911, Florida
100	Statutes, is amended to read:
101	409.911  Disproportionate share program.--Subject to
102	specific allocations established within the General
103	Appropriations Act and any limitations established pursuant to
104	chapter 216, the agency shall distribute, pursuant to this
105	section, moneys to hospitals providing a disproportionate share
106	of Medicaid or charity care services by making quarterly
107	Medicaid payments as required. Notwithstanding the provisions of
108	s. 409.915, counties are exempt from contributing toward the
109	cost of this special reimbursement for hospitals serving a
110	disproportionate share of low-income patients.
111	(9)  The Agency for Health Care Administration shall create
112	a Medicaid Low Income Pool Disproportionate Share Council. The
113	Low Income Pool Council shall consist of 17 members, including
114	three representatives of statutory teaching hospitals, three
115	representatives of public hospitals, three representatives of
116	nonprofit hospitals, three representatives of for-profit
117	hospitals, two representatives of rural hospitals, two
118	representatives of units of local government which contribute
119	funding, and one representative from the Department of Health.
120	The council shall have the following responsibilities:
121	(a)  Make recommendations on the financing of the upper
122	payment limit program, the hospital disproportionate share
123	program, or the low income pool as implemented by the agency
124	pursuant to federal waiver and on the distribution of funds.
125	(b)  Advise the agency on the development of the low income
126	pool plan required by the Centers for Medicare and Medicaid
127	Services pursuant to the Medicaid reform waiver.
128	(c)  Advise the agency on the distribution of hospital
129	funds used to adjust inpatient hospital rates and rebase rates
130	or otherwise exempt hospitals from reimbursement limits as
131	financed by intergovernmental transfers.
132	(a)  The purpose of the council is to study and make
133	recommendations regarding:
134	1.  The formula for the regular disproportionate share
135	program and alternative financing options.
136	2.  Enhanced Medicaid funding through the Special Medicaid
137	Payment program.
138	3.  The federal status of the upper-payment-limit funding
139	option and how this option may be used to promote health care
140	initiatives determined by the council to be state health care
141	priorities.
142	(b)  The council shall include representatives of the
143	Executive Office of the Governor and of the agency;
144	representatives from teaching, public, private nonprofit,
145	private for-profit, and family practice teaching hospitals; and
146	representatives from other groups as needed.
147	(d)(c)  The council shall submit its findings and
148	recommendations to the Governor and the Legislature no later
149	than February 1 of each year.
150	Section 3.  Paragraphs (b) and (d) of subsection (4) of
151	section 409.912, Florida Statutes, are amended to read:
152	409.912  Cost-effective purchasing of health care.--The
153	agency shall purchase goods and services for Medicaid recipients
154	in the most cost-effective manner consistent with the delivery
155	of quality medical care. To ensure that medical services are
156	effectively utilized, the agency may, in any case, require a
157	confirmation or second physician's opinion of the correct
158	diagnosis for purposes of authorizing future services under the
159	Medicaid program. This section does not restrict access to
160	emergency services or poststabilization care services as defined
161	in 42 C.F.R. part 438.114. Such confirmation or second opinion
162	shall be rendered in a manner approved by the agency. The agency
163	shall maximize the use of prepaid per capita and prepaid
164	aggregate fixed-sum basis services when appropriate and other
165	alternative service delivery and reimbursement methodologies,
166	including competitive bidding pursuant to s. 287.057, designed
167	to facilitate the cost-effective purchase of a case-managed
168	continuum of care. The agency shall also require providers to
169	minimize the exposure of recipients to the need for acute
170	inpatient, custodial, and other institutional care and the
171	inappropriate or unnecessary use of high-cost services. The
172	agency shall contract with a vendor to monitor and evaluate the
173	clinical practice patterns of providers in order to identify
174	trends that are outside the normal practice patterns of a
175	provider's professional peers or the national guidelines of a
176	provider's professional association. The vendor must be able to
177	provide information and counseling to a provider whose practice
178	patterns are outside the norms, in consultation with the agency,
179	to improve patient care and reduce inappropriate utilization.
180	The agency may mandate prior authorization, drug therapy
181	management, or disease management participation for certain
182	populations of Medicaid beneficiaries, certain drug classes, or
183	particular drugs to prevent fraud, abuse, overuse, and possible
184	dangerous drug interactions. The Pharmaceutical and Therapeutics
185	Committee shall make recommendations to the agency on drugs for
186	which prior authorization is required. The agency shall inform
187	the Pharmaceutical and Therapeutics Committee of its decisions
188	regarding drugs subject to prior authorization. The agency is
189	authorized to limit the entities it contracts with or enrolls as
190	Medicaid providers by developing a provider network through
191	provider credentialing. The agency may competitively bid single-
192	source-provider contracts if procurement of goods or services
193	results in demonstrated cost savings to the state without
194	limiting access to care. The agency may limit its network based
195	on the assessment of beneficiary access to care, provider
196	availability, provider quality standards, time and distance
197	standards for access to care, the cultural competence of the
198	provider network, demographic characteristics of Medicaid
199	beneficiaries, practice and provider-to-beneficiary standards,
200	appointment wait times, beneficiary use of services, provider
201	turnover, provider profiling, provider licensure history,
202	previous program integrity investigations and findings, peer
203	review, provider Medicaid policy and billing compliance records,
204	clinical and medical record audits, and other factors. Providers
205	shall not be entitled to enrollment in the Medicaid provider
206	network. The agency shall determine instances in which allowing
207	Medicaid beneficiaries to purchase durable medical equipment and
208	other goods is less expensive to the Medicaid program than long-
209	term rental of the equipment or goods. The agency may establish
210	rules to facilitate purchases in lieu of long-term rentals in
211	order to protect against fraud and abuse in the Medicaid program
212	as defined in s. 409.913. The agency may seek federal waivers
213	necessary to administer these policies.
214	(4)  The agency may contract with:
215	(b)  An entity that is providing comprehensive behavioral
216	health care services to certain Medicaid recipients through a
217	capitated, prepaid arrangement pursuant to the federal waiver
218	provided for by s. 409.905(5). Such an entity must be licensed
219	under chapter 624, chapter 636, or chapter 641 and must possess
220	the clinical systems and operational competence to manage risk
221	and provide comprehensive behavioral health care to Medicaid
222	recipients. As used in this paragraph, the term "comprehensive
223	behavioral health care services" means covered mental health and
224	substance abuse treatment services that are available to
225	Medicaid recipients. The secretary of the Department of Children
226	and Family Services shall approve provisions of procurements
227	related to children in the department's care or custody prior to
228	enrolling such children in a prepaid behavioral health plan. Any
229	contract awarded under this paragraph must be competitively
230	procured. In developing the behavioral health care prepaid plan
231	procurement document, the agency shall ensure that the
232	procurement document requires the contractor to develop and
233	implement a plan to ensure compliance with s. 394.4574 related
234	to services provided to residents of licensed assisted living
235	facilities that hold a limited mental health license. Except as
236	provided in subparagraph 8. and except in counties where the
237	Medicaid managed care pilot program is authorized under s.
238	409.91211, the agency shall seek federal approval to contract
239	with a single entity meeting these requirements to provide
240	comprehensive behavioral health care services to all Medicaid
241	recipients not enrolled in a Medicaid capitated managed care
242	plan authorized under s. 409.91211 or a Medicaid health
243	maintenance organization in an AHCA area. In an AHCA area where
244	the Medicaid managed care pilot program is authorized under s.
245	409.91211 in one or more counties, the agency may procure a
246	contract with a single entity to serve the remaining counties as
247	an AHCA area or the remaining counties may be included with an
248	adjacent AHCA area and shall be subject to this paragraph. Each
249	entity must offer sufficient choice of providers in its network
250	to ensure recipient access to care and the opportunity to select
251	a provider with whom they are satisfied. The network shall
252	include all public mental health hospitals. To ensure unimpaired
253	access to behavioral health care services by Medicaid
254	recipients, all contracts issued pursuant to this paragraph
255	shall require 80 percent of the capitation paid to the managed
256	care plan, including health maintenance organizations, to be
257	expended for the provision of behavioral health care services.
258	In the event the managed care plan expends less than 80 percent
259	of the capitation paid pursuant to this paragraph for the
260	provision of behavioral health care services, the difference
261	shall be returned to the agency. The agency shall provide the
262	managed care plan with a certification letter indicating the
263	amount of capitation paid during each calendar year for the
264	provision of behavioral health care services pursuant to this
265	section. The agency may reimburse for substance abuse treatment
266	services on a fee-for-service basis until the agency finds that
267	adequate funds are available for capitated, prepaid
268	arrangements.
269	1.  By January 1, 2001, the agency shall modify the
270	contracts with the entities providing comprehensive inpatient
271	and outpatient mental health care services to Medicaid
272	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
273	Counties, to include substance abuse treatment services.
274	2.  By July 1, 2003, the agency and the Department of
275	Children and Family Services shall execute a written agreement
276	that requires collaboration and joint development of all policy,
277	budgets, procurement documents, contracts, and monitoring plans
278	that have an impact on the state and Medicaid community mental
279	health and targeted case management programs.
280	3.  Except as provided in subparagraph 8., by July 1, 2006,
281	the agency and the Department of Children and Family Services
282	shall contract with managed care entities in each AHCA area
283	except area 6 or arrange to provide comprehensive inpatient and
284	outpatient mental health and substance abuse services through
285	capitated prepaid arrangements to all Medicaid recipients who
286	are eligible to participate in such plans under federal law and
287	regulation. In AHCA areas where eligible individuals number less
288	than 150,000, the agency shall contract with a single managed
289	care plan to provide comprehensive behavioral health services to
290	all recipients who are not enrolled in a Medicaid health
291	maintenance organization or a Medicaid capitated managed care
292	plan authorized under s. 409.91211. The agency may contract with
293	more than one comprehensive behavioral health provider to
294	provide care to recipients who are not enrolled in a Medicaid
295	health maintenance organization or a Medicaid capitated managed
296	care plan authorized under s. 409.91211 in AHCA areas where the
297	eligible population exceeds 150,000. In an AHCA area where the
298	Medicaid managed care pilot program is authorized under s.
299	409.91211 in one or more counties, the agency may procure a
300	contract with a single entity to serve the remaining counties as
301	an AHCA area or the remaining counties may be included with an
302	adjacent AHCA area and shall be subject to this paragraph.
303	Contracts for comprehensive behavioral health providers awarded
304	pursuant to this section shall be competitively procured. Both
305	for-profit and not-for-profit corporations shall be eligible to
306	compete. Managed care plans contracting with the agency under
307	subsection (3) shall provide and receive payment for the same
308	comprehensive behavioral health benefits as provided in AHCA
309	rules, including handbooks incorporated by reference. In AHCA
310	area 11, the agency shall contract with at least two
311	comprehensive behavioral health care providers to provide
312	behavioral health care to recipients in that area who are
313	enrolled in, or assigned to, the MediPass program. One of the
314	behavioral health care contracts shall be with the existing
315	provider service network pilot project, as described in
316	paragraph (d), for the purpose of demonstrating the cost-
317	effectiveness of the provision of quality mental health services
318	through a public hospital-operated managed care model. Payment
319	shall be at an agreed-upon capitated rate to ensure cost
320	savings. Of the recipients in area 11 who are assigned to
321	MediPass under the provisions of s. 409.9122(2)(k), A minimum of
322	50,000 of those MediPass-enrolled recipients shall be assigned
323	to the existing provider service network in area 11 for their
324	behavioral care.
325	4.  By October 1, 2003, the agency and the department shall
326	submit a plan to the Governor, the President of the Senate, and
327	the Speaker of the House of Representatives which provides for
328	the full implementation of capitated prepaid behavioral health
329	care in all areas of the state.
330	a.  Implementation shall begin in 2003 in those AHCA areas
331	of the state where the agency is able to establish sufficient
332	capitation rates.
333	b.  If the agency determines that the proposed capitation
334	rate in any area is insufficient to provide appropriate
335	services, the agency may adjust the capitation rate to ensure
336	that care will be available. The agency and the department may
337	use existing general revenue to address any additional required
338	match but may not over-obligate existing funds on an annualized
339	basis.
340	c.  Subject to any limitations provided for in the General
341	Appropriations Act, the agency, in compliance with appropriate
342	federal authorization, shall develop policies and procedures
343	that allow for certification of local and state funds.
344	5.  Children residing in a statewide inpatient psychiatric
345	program, or in a Department of Juvenile Justice or a Department
346	of Children and Family Services residential program approved as
347	a Medicaid behavioral health overlay services provider shall not
348	be included in a behavioral health care prepaid health plan or
349	any other Medicaid managed care plan pursuant to this paragraph.
350	6.  In converting to a prepaid system of delivery, the
351	agency shall in its procurement document require an entity
352	providing only comprehensive behavioral health care services to
353	prevent the displacement of indigent care patients by enrollees
354	in the Medicaid prepaid health plan providing behavioral health
355	care services from facilities receiving state funding to provide
356	indigent behavioral health care, to facilities licensed under
357	chapter 395 which do not receive state funding for indigent
358	behavioral health care, or reimburse the unsubsidized facility
359	for the cost of behavioral health care provided to the displaced
360	indigent care patient.
361	7.  Traditional community mental health providers under
362	contract with the Department of Children and Family Services
363	pursuant to part IV of chapter 394, child welfare providers
364	under contract with the Department of Children and Family
365	Services in areas 1 and 6, and inpatient mental health providers
366	licensed pursuant to chapter 395 must be offered an opportunity
367	to accept or decline a contract to participate in any provider
368	network for prepaid behavioral health services.
369	8.  For fiscal year 2004-2005, all Medicaid eligible
370	children, except children in areas 1 and 6, whose cases are open
371	for child welfare services in the HomeSafeNet system, shall be
372	enrolled in MediPass or in Medicaid fee-for-service and all
373	their behavioral health care services including inpatient,
374	outpatient psychiatric, community mental health, and case
375	management shall be reimbursed on a fee-for-service basis.
376	Beginning July 1, 2005, such children, who are open for child
377	welfare services in the HomeSafeNet system, shall receive their
378	behavioral health care services through a specialty prepaid plan
379	operated by community-based lead agencies either through a
380	single agency or formal agreements among several agencies. The
381	specialty prepaid plan must result in savings to the state
382	comparable to savings achieved in other Medicaid managed care
383	and prepaid programs. Such plan must provide mechanisms to
384	maximize state and local revenues. The specialty prepaid plan
385	shall be developed by the agency and the Department of Children
386	and Family Services. The agency is authorized to seek any
387	federal waivers to implement this initiative.
388	(d)  A provider service network which may be reimbursed on
389	a fee-for-service or prepaid basis. A provider service network
390	which is reimbursed by the agency on a prepaid basis shall be
391	exempt from parts I and III of chapter 641, but must comply with
392	the solvency requirements in s. 641.2261(2) and meet appropriate
393	financial reserve, quality assurance, and patient rights
394	requirements as established by the agency. The agency shall
395	award contracts on a competitive bid basis and shall select
396	bidders based upon price and quality of care. Medicaid
397	recipients assigned to a provider service network demonstration
398	project shall be chosen equally from those who would otherwise
399	have been assigned to prepaid plans and MediPass. The agency is
400	authorized to seek federal Medicaid waivers as necessary to
401	implement the provisions of this section. Any contract
402	previously awarded to a provider service network operated by a
403	hospital pursuant to this subsection shall remain in effect for
404	a period of 3 years following the current contract expiration
405	date, regardless of any contractual provisions to the contrary.
406	A provider service network is a network established or organized
407	and operated by a health care provider, or group of affiliated
408	health care providers, which provides a substantial proportion
409	of the health care items and services under a contract directly
410	through the provider or affiliated group of providers and may
411	make arrangements with physicians or other health care
412	professionals, health care institutions, or any combination of
413	such individuals or institutions to assume all or part of the
414	financial risk on a prospective basis for the provision of basic
415	health services by the physicians, by other health
416	professionals, or through the institutions. The health care
417	providers must have a controlling interest in the governing body
418	of the provider service network organization.
419	Section 4.  Section 409.91211, Florida Statutes, is amended
420	to read:
421	409.91211  Medicaid managed care pilot program.--
422	(1)(a)  The agency is authorized to seek experimental,
423	pilot, or demonstration project waivers, pursuant to s. 1115 of
424	the Social Security Act, to create a statewide initiative to
425	provide for a more efficient and effective service delivery
426	system that enhances quality of care and client outcomes in the
427	Florida Medicaid program pursuant to this section. Phase one of
428	the demonstration shall be implemented in two geographic areas.
429	One demonstration site shall include only Broward County. A
430	second demonstration site shall initially include Duval County
431	and shall be expanded to include Baker, Clay, and Nassau
432	Counties within 1 year after the Duval County program becomes
433	operational. This waiver authority is contingent upon federal
434	approval to preserve the upper-payment-limit funding mechanism
435	for hospitals, including a guarantee of a reasonable growth
436	factor, a methodology to allow the use of a portion of these
437	funds to serve as a risk pool for demonstration sites,
438	provisions to preserve the state's ability to use
439	intergovernmental transfers, and provisions to protect the
440	disproportionate share program authorized pursuant to this
441	chapter. Under the upper payment limit program, the hospital
442	disproportionate share program, or the low income pool as
443	implemented by the agency pursuant to federal waiver, the state
444	matching funds required for the program shall be provided by the
445	state and by local governmental entities through
446	intergovernmental transfers. The agency shall distribute funds
447	from the upper payment limit program, the hospital
448	disproportionate share program, and the low income pool
449	according to federal regulations and waivers and the low income
450	pool methodology approved by the Centers for Medicare and
451	Medicaid Services. Upon completion of the evaluation conducted
452	under s. 3, ch. 2005-133, Laws of Florida, the agency may
453	request statewide expansion of the demonstration projects.
454	Statewide phase-in to additional counties shall be contingent
455	upon review and approval by the Legislature.
456	(b)  It is the intent of the Legislature that the low
457	income pool plan required by the terms and conditions of the
458	Medicaid reform waiver and submitted to the Centers for Medicare
459	and Medicaid Services propose the distribution of the program
460	funds in paragraph (a) based on the following objectives:
461	1.  Ensure a broad and fair distribution of available funds
462	based on the access provided by Medicaid participating
463	hospitals, regardless of their ownership status, through their
464	delivery of inpatient or outpatient care for Medicaid
465	beneficiaries and uninsured and underinsured individuals.
466	2.  Ensure accessible emergency inpatient and outpatient
467	care for Medicaid beneficiaries and uninsured and underinsured
468	individuals.
469	3.  Enhance primary, preventive, and other ambulatory care
470	coverages for uninsured individuals.
471	4.  Promote teaching and specialty hospital programs.
472	5.  Promote the stability and viability of statutorily
473	defined rural hospitals and hospitals that serve as sole
474	community hospitals.
475	6.  Recognize the extent of hospital uncompensated care
476	costs.
477	7.  Maintain and enhance essential community hospital care.
478	8.  Maintain incentives for local governmental entities to
479	contribute to the cost of uncompensated care.
480	9.  Promote measures to avoid preventable hospitalizations.
481	10.  Account for hospital efficiency.
482	11.  Contribute to a community's overall health system.
483	(2)  The Legislature intends for the capitated managed care
484	pilot program to:
485	(a)  Provide recipients in Medicaid fee-for-service or the
486	MediPass program a comprehensive and coordinated capitated
487	managed care system for all health care services specified in
488	ss. 409.905 and 409.906.
489	(b)  Stabilize Medicaid expenditures under the pilot
490	program compared to Medicaid expenditures in the pilot area for
491	the 3 years before implementation of the pilot program, while
492	ensuring:
493	1.  Consumer education and choice.
494	2.  Access to medically necessary services.
495	3.  Coordination of preventative, acute, and long-term
496	care.
497	4.  Reductions in unnecessary service utilization.
498	(c)  Provide an opportunity to evaluate the feasibility of
499	statewide implementation of capitated managed care networks as a
500	replacement for the current Medicaid fee-for-service and
501	MediPass systems.
502	(3)  The agency shall have the following powers, duties,
503	and responsibilities with respect to the development of a pilot
504	program:
505	(a)  To implement develop and recommend a system to deliver
506	all mandatory services specified in s. 409.905 and optional
507	services specified in s. 409.906, as approved by the Centers for
508	Medicare and Medicaid Services and the Legislature in the waiver
509	pursuant to this section. Services to recipients under plan
510	benefits shall include emergency services provided under s.
511	409.9128.
512	(b)  To implement a pilot program that includes recommend
513	Medicaid eligibility categories, from those specified in ss.
514	409.903 and 409.904 as authorized in an approved federal waiver,
515	which shall be included in the pilot program.
516	(c)  To implement determine and recommend how to design the
517	managed care pilot program that maximizes in order to take
518	maximum advantage of all available state and federal funds,
519	including those obtained through intergovernmental transfers,
520	the low income pool, supplemental Medicaid payments upper-
521	payment-level funding systems, and the disproportionate share
522	program. Within the parameters allowed by federal statute and
523	rule, the agency is authorized to seek options for making direct
524	payments to hospitals and physicians employed by or under
525	contract with the state's medical schools for the costs
526	associated with graduate medical education under Medicaid
527	reform.
528	(d)  To implement determine and recommend actuarially
529	sound, risk-adjusted capitation rates for Medicaid recipients in
530	the pilot program which can be separated to cover comprehensive
531	care, enhanced services, and catastrophic care.
532	(e)  To implement determine and recommend policies and
533	guidelines for phasing in financial risk for approved provider
534	service networks over a 3-year period. These policies and
535	guidelines shall include an option for a provider service
536	network to be paid to pay fee-for-service rates. For any
537	provider service network established in a managed care pilot
538	area, the option to be paid fee-for-service rates shall include
539	a savings-settlement mechanism that is consistent with s.
540	409.912(44) that may include a savings-settlement option for at
541	least 2 years. This model shall may be converted to a risk-
542	adjusted capitated rate no later than the beginning of the
543	fourth in the third year of operation and may be converted
544	earlier at the option of the provider service network. Federally
545	qualified health centers may be offered an opportunity to accept
546	or decline a contract to participate in any provider network for
547	prepaid primary care services.
548	(f)  To implement determine and recommend provisions
549	related to stop-loss requirements and the transfer of excess
550	cost to catastrophic coverage that accommodates the risks
551	associated with the development of the pilot program.
552	(g)  To determine and recommend a process to be used by the
553	Social Services Estimating Conference to determine and validate
554	the rate of growth of the per-member costs of providing Medicaid
555	services under the managed care pilot program.
556	(h)  To implement determine and recommend program standards
557	and credentialing requirements for capitated managed care
558	networks to participate in the pilot program, including those
559	related to fiscal solvency, quality of care, and adequacy of
560	access to health care providers. It is the intent of the
561	Legislature that, to the extent possible, any pilot program
562	authorized by the state under this section include any federally
563	qualified health center, any federally qualified rural health
564	clinic, county health department, the Division of Children's
565	Medical Services Network within the Department of Health, or any
566	other federally, state, or locally funded entity that serves the
567	geographic areas within the boundaries of the pilot program that
568	requests to participate. This paragraph does not relieve an
569	entity that qualifies as a capitated managed care network under
570	this section from any other licensure or regulatory requirements
571	contained in state or federal law which would otherwise apply to
572	the entity. The standards and credentialing requirements shall
573	be based upon, but are not limited to:
574	1.  Compliance with the accreditation requirements as
575	provided in s. 641.512.
576	2.  Compliance with early and periodic screening,
577	diagnosis, and treatment screening requirements under federal
578	law.
579	3.  The percentage of voluntary disenrollments.
580	4.  Immunization rates.
581	5.  Standards of the National Committee for Quality
582	Assurance and other approved accrediting bodies.
583	6.  Recommendations of other authoritative bodies.
584	7.  Specific requirements of the Medicaid program, or
585	standards designed to specifically meet the unique needs of
586	Medicaid recipients.
587	8.  Compliance with the health quality improvement system
588	as established by the agency, which incorporates standards and
589	guidelines developed by the Centers for Medicare and Medicaid
590	Services as part of the quality assurance reform initiative.
591	9.  The network's infrastructure capacity to manage
592	financial transactions, recordkeeping, data collection, and
593	other administrative functions.
594	10.  The network's ability to submit any financial,
595	programmatic, or patient-encounter data or other information
596	required by the agency to determine the actual services provided
597	and the cost of administering the plan.
598	(i)  To implement develop and recommend a mechanism for
599	providing information to Medicaid recipients for the purpose of
600	selecting a capitated managed care plan. For each plan available
601	to a recipient, the agency, at a minimum, shall ensure that the
602	recipient is provided with:
603	1.  A list and description of the benefits provided.
604	2.  Information about cost sharing.
605	3.  Plan performance data, if available.
606	4.  An explanation of benefit limitations.
607	5.  Contact information, including identification of
608	providers participating in the network, geographic locations,
609	and transportation limitations.
610	6.  Any other information the agency determines would
611	facilitate a recipient's understanding of the plan or insurance
612	that would best meet his or her needs.
613	(j)  To implement develop and recommend a system to ensure
614	that there is a record of recipient acknowledgment that choice
615	counseling has been provided.
616	(k)  To implement develop and recommend a choice counseling
617	system to ensure that the choice counseling process and related
618	material are designed to provide counseling through face-to-face
619	interaction, by telephone, and in writing and through other
620	forms of relevant media. Materials shall be written at the
621	fourth-grade reading level and available in a language other
622	than English when 5 percent of the county speaks a language
623	other than English. Choice counseling shall also use language
624	lines and other services for impaired recipients, such as
625	TTD/TTY.
626	(l)  To implement develop and recommend a system that
627	prohibits capitated managed care plans, their representatives,
628	and providers employed by or contracted with the capitated
629	managed care plans from recruiting persons eligible for or
630	enrolled in Medicaid, from providing inducements to Medicaid
631	recipients to select a particular capitated managed care plan,
632	and from prejudicing Medicaid recipients against other capitated
633	managed care plans. The system shall require the entity
634	performing choice counseling to determine if the recipient has
635	made a choice of a plan or has opted out because of duress,
636	threats, payment to the recipient, or incentives promised to the
637	recipient by a third party. If the choice counseling entity
638	determines that the decision to choose a plan was unlawfully
639	influenced or a plan violated any of the provisions of s.
640	409.912(21), the choice counseling entity shall immediately
641	report the violation to the agency's program integrity section
642	for investigation. Verification of choice counseling by the
643	recipient shall include a stipulation that the recipient
644	acknowledges the provisions of this subsection.
645	(m)  To implement develop and recommend a choice counseling
646	system that promotes health literacy and provides information
647	aimed to reduce minority health disparities through outreach
648	activities for Medicaid recipients.
649	(n)  To develop and recommend a system for the agency to
650	contract with entities to perform choice counseling. The agency
651	may establish standards and performance contracts, including
652	standards requiring the contractor to hire choice counselors who
653	are representative of the state's diverse population and to
654	train choice counselors in working with culturally diverse
655	populations.
656	(o)  To implement determine and recommend descriptions of
657	the eligibility assignment processes which will be used to
658	facilitate client choice while ensuring pilot programs of
659	adequate enrollment levels. These processes shall ensure that
660	pilot sites have sufficient levels of enrollment to conduct a
661	valid test of the managed care pilot program within a 2-year
662	timeframe.
663	(p)  To implement standards for plan compliance, including,
664	but not limited to, quality assurance and performance
665	improvement standards, peer or professional review standards,
666	grievance policies, and program integrity policies.
667	(q)  To develop a data reporting system, seek input from
668	managed care plans to establish patient-encounter reporting
669	requirements, and ensure that the data reported is accurate and
670	complete.
671	(r)  To work with managed care plans to establish a uniform
672	system to measure and monitor outcomes of a recipient of
673	Medicaid services which shall use financial, clinical, and other
674	criteria based on pharmacy services, medical services, and other
675	data related to the provision of Medicaid services, including,
676	but not limited to:
677	1.  Health Plan Employer Data and Information Set (HEDIS)
678	or HEDIS measures specific to Medicaid.
679	2.  Member satisfaction.
680	3.  Provider satisfaction.
681	4.  Report cards on plan performance and best practices.
682	5.  Compliance with the prompt payment of claims
683	requirements provided in ss. 627.613, 641.3155, and 641.513.
684	(s)  To require managed care plans that have contracted
685	with the agency to establish a quality assurance system that
686	incorporates the provisions of s. 409.912(27) and any standards,
687	rules, and guidelines developed by the agency.
688	(t)  To establish a patient-encounter database to compile
689	data on health care services rendered by health care
690	practitioners that provide services to patients enrolled in
691	managed care plans in the demonstration sites. Health care
692	practitioners and facilities in the demonstration sites shall
693	submit, and managed care plans participating in the
694	demonstration sites shall receive, claims payment and any other
695	information reasonably related to the patient-encounter database
696	electronically in a standard format as required by the agency.
697	The agency shall establish reasonable deadlines for phasing in
698	the electronic transmittal of full-encounter data. The patient-
699	encounter database shall:
700	1.  Collect the following information, if applicable, for
701	each type of patient encounter with a health care practitioner
702	or facility, including:
703	a.  The demographic characteristics of the patient.
704	b.  The principal, secondary, and tertiary diagnosis.
705	c.  The procedure performed.
706	d.  The date when and the location where the procedure was
707	performed.
708	e.  The amount of the payment for the procedure.
709	f.  The health care practitioner's universal identification
710	number.
711	g.  If the health care practitioner rendering the service
712	is a dependent practitioner, the modifiers appropriate to
713	indicate that the service was delivered by the dependent
714	practitioner.
715	2.  Collect appropriate information relating to
716	prescription drugs for each type of patient encounter.
717	3.  Collect appropriate information related to health care
718	costs and utilization from managed care plans participating in
719	the demonstration sites. To the extent practicable, the agency
720	shall utilize a standardized claim form or electronic transfer
721	system that is used by health care practitioners, facilities,
722	and payors. To develop and recommend a system to monitor the
723	provision of health care services in the pilot program,
724	including utilization and quality of health care services for
725	the purpose of ensuring access to medically necessary services.
726	This system shall include an encounter data-information system
727	that collects and reports utilization information. The system
728	shall include a method for verifying data integrity within the
729	database and within the provider's medical records.
730	(u)(q)  To implement recommend a grievance resolution
731	process for Medicaid recipients enrolled in a capitated managed
732	care network under the pilot program modeled after the
733	subscriber assistance panel, as created in s. 408.7056. This
734	process shall include a mechanism for an expedited review of no
735	greater than 24 hours after notification of a grievance if the
736	life of a Medicaid recipient is in imminent and emergent
737	jeopardy.
738	(v)(r)  To implement recommend a grievance resolution
739	process for health care providers employed by or contracted with
740	a capitated managed care network under the pilot program in
741	order to settle disputes among the provider and the managed care
742	network or the provider and the agency.
743	(w)(s)  To implement develop and recommend criteria in an
744	approved federal waiver to designate health care providers as
745	eligible to participate in the pilot program. The agency and
746	capitated managed care networks must follow national guidelines
747	for selecting health care providers, whenever available. These
748	criteria must include at a minimum those criteria specified in
749	s. 409.907.
750	(x)(t)  To use develop and recommend health care provider
751	agreements for participation in the pilot program.
752	(y)(u)  To require that all health care providers under
753	contract with the pilot program be duly licensed in the state,
754	if such licensure is available, and meet other criteria as may
755	be established by the agency. These criteria shall include at a
756	minimum those criteria specified in s. 409.907.
757	(z)(v)  To ensure that managed care organizations work
758	collaboratively develop and recommend agreements with other
759	state or local governmental programs or institutions for the
760	coordination of health care to eligible individuals receiving
761	services from such programs or institutions.
762	(aa)(w)  To implement procedures to minimize the risk of
763	Medicaid fraud and abuse in all plans operating in the Medicaid
764	managed care pilot program authorized in this section:
765	1.  The agency shall ensure that applicable provisions of
766	chapters 409, 414, 626, 641, and 932, relating to Medicaid fraud
767	and abuse, are applied and enforced at the demonstration sites.
768	2.  Providers shall have the necessary certification,
769	license, and credentials required by law and federal waiver.
770	3.  The agency shall ensure that the plan is in compliance
771	with the provisions of s. 409.912(21) and (22).
772	4.  The agency shall require each plan to establish program
773	integrity functions and activities to reduce the incidence of
774	fraud and abuse. Plans must report instances of fraud and abuse
775	pursuant to chapter 641.
776	5.  The plan shall have written administrative and
777	management procedures, including a mandatory compliance plan,
778	that are designed to guard against fraud and abuse. The plan
779	shall designate a compliance officer with sufficient experience
780	in health care.
781	6.a.  The agency shall require all managed care plan
782	contractors in the pilot program to report all instances of
783	suspected fraud and abuse. A failure to report instances of
784	suspected fraud and abuse is a violation of law and subject to
785	the penalties provided by law.
786	b.  An instance of fraud and abuse in the managed care
787	plan, including, but not limited to, defrauding the state health
788	care benefit program by misrepresentation of fact in reports,
789	claims, certifications, enrollment claims, demographic
790	statistics, and patient-encounter data; misrepresentation of the
791	qualifications of persons rendering health care and ancillary
792	services; bribery and false statements relating to the delivery
793	of health care; unfair and deceptive marketing practices; and
794	managed care false claims actions, is a violation of law and
795	subject to the penalties provided by law.
796	c.  The agency shall require all contractors to make all
797	files and relevant billing and claims data accessible to state
798	regulators and investigators and all such data shall be linked
799	into a unified system for seamless reviews and investigations.
800	To develop and recommend a system to oversee the activities of
801	pilot program participants, health care providers, capitated
802	managed care networks, and their representatives in order to
803	prevent fraud or abuse, overutilization or duplicative
804	utilization, underutilization or inappropriate denial of
805	services, and neglect of participants and to recover
806	overpayments as appropriate. For the purposes of this paragraph,
807	the terms "abuse" and "fraud" have the meanings as provided in
808	s. 409.913. The agency must refer incidents of suspected fraud,
809	abuse, overutilization and duplicative utilization, and
810	underutilization or inappropriate denial of services to the
811	appropriate regulatory agency.
812	(bb)(x)  To develop and provide actuarial and benefit
813	design analyses that indicate the effect on capitation rates and
814	benefits offered in the pilot program over a prospective 5-year
815	period based on the following assumptions:
816	1.  Growth in capitation rates which is limited to the
817	estimated growth rate in general revenue.
818	2.  Growth in capitation rates which is limited to the
819	average growth rate over the last 3 years in per-recipient
820	Medicaid expenditures.
821	3.  Growth in capitation rates which is limited to the
822	growth rate of aggregate Medicaid expenditures between the 2003-
823	2004 fiscal year and the 2004-2005 fiscal year.
824	(cc)(y)  To develop a mechanism to require capitated
825	managed care plans to reimburse qualified emergency service
826	providers, including, but not limited to, ambulance services, in
827	accordance with ss. 409.908 and 409.9128. The pilot program must
828	include a provision for continuing fee-for-service payments for
829	emergency services, including, but not limited to, individuals
830	who access ambulance services or emergency departments and who
831	are subsequently determined to be eligible for Medicaid
832	services.
833	(dd)(z)  To ensure develop a system whereby school
834	districts participating in the certified school match program
835	pursuant to ss. 409.908(21) and 1011.70 shall be reimbursed by
836	Medicaid, subject to the limitations of s. 1011.70(1), for a
837	Medicaid-eligible child participating in the services as
838	authorized in s. 1011.70, as provided for in s. 409.9071,
839	regardless of whether the child is enrolled in a capitated
840	managed care network. Capitated managed care networks must make
841	a good faith effort to execute agreements with school districts
842	regarding the coordinated provision of services authorized under
843	s. 1011.70. County health departments delivering school-based
844	services pursuant to ss. 381.0056 and 381.0057 must be
845	reimbursed by Medicaid for the federal share for a Medicaid-
846	eligible child who receives Medicaid-covered services in a
847	school setting, regardless of whether the child is enrolled in a
848	capitated managed care network. Capitated managed care networks
849	must make a good faith effort to execute agreements with county
850	health departments regarding the coordinated provision of
851	services to a Medicaid-eligible child. To ensure continuity of
852	care for Medicaid patients, the agency, the Department of
853	Health, and the Department of Education shall develop procedures
854	for ensuring that a student's capitated managed care network
855	provider receives information relating to services provided in
856	accordance with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
857	(ee)(aa)  To implement develop and recommend a mechanism
858	whereby Medicaid recipients who are already enrolled in a
859	managed care plan or the MediPass program in the pilot areas
860	shall be offered the opportunity to change to capitated managed
861	care plans on a staggered basis, as defined by the agency. All
862	Medicaid recipients shall have 30 days in which to make a choice
863	of capitated managed care plans. Those Medicaid recipients who
864	do not make a choice shall be assigned to a capitated managed
865	care plan in accordance with paragraph (4)(a) and shall be
866	exempt from s. 409.9122. To facilitate continuity of care for a
867	Medicaid recipient who is also a recipient of Supplemental
868	Security Income (SSI), prior to assigning the SSI recipient to a
869	capitated managed care plan, the agency shall determine whether
870	the SSI recipient has an ongoing relationship with a provider or
871	capitated managed care plan, and, if so, the agency shall assign
872	the SSI recipient to that provider or capitated managed care
873	plan where feasible. Those SSI recipients who do not have such a
874	provider relationship shall be assigned to a capitated managed
875	care plan provider in accordance with paragraph (4)(a) and shall
876	be exempt from s. 409.9122.
877	(ff)(bb)  To develop and recommend a service delivery
878	alternative for children having chronic medical conditions which
879	establishes a medical home project to provide primary care
880	services to this population. The project shall provide
881	community-based primary care services that are integrated with
882	other subspecialties to meet the medical, developmental, and
883	emotional needs for children and their families. This project
884	shall include an evaluation component to determine impacts on
885	hospitalizations, length of stays, emergency room visits, costs,
886	and access to care, including specialty care and patient and
887	family satisfaction.
888	(gg)(cc)  To develop and recommend service delivery
889	mechanisms within capitated managed care plans to provide
890	Medicaid services as specified in ss. 409.905 and 409.906 to
891	persons with developmental disabilities sufficient to meet the
892	medical, developmental, and emotional needs of these persons.
893	(hh)(dd)  To develop and recommend service delivery
894	mechanisms within capitated managed care plans to provide
895	Medicaid services as specified in ss. 409.905 and 409.906 to
896	Medicaid-eligible children in foster care. These services must
897	be coordinated with community-based care providers as specified
898	in s. 409.1675, where available, and be sufficient to meet the
899	medical, developmental, and emotional needs of these children.
900	(4)(a)  A Medicaid recipient in the pilot area who is not
901	currently enrolled in a capitated managed care plan upon
902	implementation is not eligible for services as specified in ss.
903	409.905 and 409.906, for the amount of time that the recipient
904	does not enroll in a capitated managed care network. If a
905	Medicaid recipient has not enrolled in a capitated managed care
906	plan within 30 days after eligibility, the agency shall assign
907	the Medicaid recipient to a capitated managed care plan based on
908	the assessed needs of the recipient as determined by the agency
909	and shall be exempt from s. 409.9122. When making assignments,
910	the agency shall take into account the following criteria:
911	1.  A capitated managed care network has sufficient network
912	capacity to meet the needs of members.
913	2.  The capitated managed care network has previously
914	enrolled the recipient as a member, or one of the capitated
915	managed care network's primary care providers has previously
916	provided health care to the recipient.
917	3.  The agency has knowledge that the member has previously
918	expressed a preference for a particular capitated managed care
919	network as indicated by Medicaid fee-for-service claims data,
920	but has failed to make a choice.
921	4.  The capitated managed care network's primary care
922	providers are geographically accessible to the recipient's
923	residence.
924	(b)  When more than one capitated managed care network
925	provider meets the criteria specified in paragraph (3)(h), the
926	agency shall make recipient assignments consecutively by family
927	unit.
928	(c)  If a recipient is currently enrolled with a Medicaid
929	managed care organization that also operates an approved reform
930	plan within a pilot area and the recipient fails to choose a
931	plan during the reform enrollment process or during
932	redetermination of eligibility, the recipient shall be
933	automatically assigned by the agency into the most appropriate
934	reform plan operated by the recipient's current Medicaid managed
935	care organization. If the recipient's current managed care
936	organization does not operate a reform plan in the pilot area
937	that adequately meets the needs of the Medicaid recipient, the
938	agency shall use the auto assignment process as prescribed in
939	the Centers for Medicare and Medicaid Services Special Terms and
940	Conditions number 11-W-00206/4. All agency enrollment and choice
941	counseling materials shall communicate the provisions of this
942	paragraph to current managed care recipients.
943	(d)(c)  The agency may not engage in practices that are
944	designed to favor one capitated managed care plan over another
945	or that are designed to influence Medicaid recipients to enroll
946	in a particular capitated managed care network in order to
947	strengthen its particular fiscal viability.
948	(e)(d)  After a recipient has made a selection or has been
949	enrolled in a capitated managed care network, the recipient
950	shall have 90 days in which to voluntarily disenroll and select
951	another capitated managed care network. After 90 days, no
952	further changes may be made except for cause. Cause shall
953	include, but not be limited to, poor quality of care, lack of
954	access to necessary specialty services, an unreasonable delay or
955	denial of service, inordinate or inappropriate changes of
956	primary care providers, service access impairments due to
957	significant changes in the geographic location of services, or
958	fraudulent enrollment. The agency may require a recipient to use
959	the capitated managed care network's grievance process as
960	specified in paragraph (3)(g) prior to the agency's
961	determination of cause, except in cases in which immediate risk
962	of permanent damage to the recipient's health is alleged. The
963	grievance process, when used, must be completed in time to
964	permit the recipient to disenroll no later than the first day of
965	the second month after the month the disenrollment request was
966	made. If the capitated managed care network, as a result of the
967	grievance process, approves an enrollee's request to disenroll,
968	the agency is not required to make a determination in the case.
969	The agency must make a determination and take final action on a
970	recipient's request so that disenrollment occurs no later than
971	the first day of the second month after the month the request
972	was made. If the agency fails to act within the specified
973	timeframe, the recipient's request to disenroll is deemed to be
974	approved as of the date agency action was required. Recipients
975	who disagree with the agency's finding that cause does not exist
976	for disenrollment shall be advised of their right to pursue a
977	Medicaid fair hearing to dispute the agency's finding.
978	(f)(e)  The agency shall apply for federal waivers from the
979	Centers for Medicare and Medicaid Services to lock eligible
980	Medicaid recipients into a capitated managed care network for 12
981	months after an open enrollment period. After 12 months of
982	enrollment, a recipient may select another capitated managed
983	care network. However, nothing shall prevent a Medicaid
984	recipient from changing primary care providers within the
985	capitated managed care network during the 12-month period.
986	(g)(f)  The agency shall apply for federal waivers from the
987	Centers for Medicare and Medicaid Services to allow recipients
988	to purchase health care coverage through an employer-sponsored
989	health insurance plan instead of through a Medicaid-certified
990	plan. This provision shall be known as the opt-out option.
991	1.  A recipient who chooses the Medicaid opt-out option
992	shall have an opportunity for a specified period of time, as
993	authorized under a waiver granted by the Centers for Medicare
994	and Medicaid Services, to select and enroll in a Medicaid-
995	certified plan. If the recipient remains in the employer-
996	sponsored plan after the specified period, the recipient shall
997	remain in the opt-out program for at least 1 year or until the
998	recipient no longer has access to employer-sponsored coverage,
999	until the employer's open enrollment period for a person who
1000	opts out in order to participate in employer-sponsored coverage,
1001	or until the person is no longer eligible for Medicaid,
1002	whichever time period is shorter.
1003	2.  Notwithstanding any other provision of this section,
1004	coverage, cost sharing, and any other component of employer-
1005	sponsored health insurance shall be governed by applicable state
1006	and federal laws.
1007	(5)  This section does not authorize the agency to
1008	implement any provision of s. 1115 of the Social Security Act
1009	experimental, pilot, or demonstration project waiver to reform
1010	the state Medicaid program in any part of the state other than
1011	the two geographic areas specified in this section unless
1012	approved by the Legislature.
1013	(5)(6)  The agency shall develop and submit for approval
1014	applications for waivers of applicable federal laws and
1015	regulations as necessary to implement the managed care pilot
1016	project as defined in this section. The agency shall post all
1017	waiver applications under this section on its Internet website
1018	30 days before submitting the applications to the United States
1019	Centers for Medicare and Medicaid Services. All waiver
1020	applications shall be provided for review and comment to the
1021	appropriate committees of the Senate and House of
1022	Representatives for at least 10 working days prior to
1023	submission. All waivers submitted to and approved by the United
1024	States Centers for Medicare and Medicaid Services under this
1025	section must be approved by the Legislature. Federally approved
1026	waivers must be submitted to the President of the Senate and the
1027	Speaker of the House of Representatives for referral to the
1028	appropriate legislative committees. The appropriate committees
1029	shall recommend whether to approve the implementation of any
1030	waivers to the Legislature as a whole. The agency shall submit a
1031	plan containing a recommended timeline for implementation of any
1032	waivers and budgetary projections of the effect of the pilot
1033	program under this section on the total Medicaid budget for the
1034	2006-2007 through 2009-2010 state fiscal years. This
1035	implementation plan shall be submitted to the President of the
1036	Senate and the Speaker of the House of Representatives at the
1037	same time any waivers are submitted for consideration by the
1038	Legislature. The agency is authorized to implement the waiver
1039	and Centers for Medicare and Medicaid Services Special Terms and
1040	Conditions number 11-W-00206/4. If the agency seeks approval by
1041	the Federal Government of any modifications to these special
1042	terms and conditions, the agency shall provide written
1043	notification of its intent to modify these terms and conditions
1044	to the President of the Senate and Speaker of the House of
1045	Representatives at least 15 days prior to submitting the
1046	modifications to the Federal Government for consideration. The
1047	notification shall identify all modifications being pursued and
1048	the reason they are needed. Upon receiving federal approval of
1049	any modifications to the special terms and conditions, the
1050	agency shall report to the Legislature describing the federally
1051	approved modifications to the special terms and conditions
1052	within 7 days after their approval by the Federal Government.
1053	(6)(7)  Upon review and approval of the applications for
1054	waivers of applicable federal laws and regulations to implement
1055	the managed care pilot program by the Legislature, the agency
1056	may initiate adoption of rules pursuant to ss. 120.536(1) and
1057	120.54 to implement and administer the managed care pilot
1058	program as provided in this section and the agency shall
1059	initiate adoption of rules pursuant to ss. 120.536(1) and 120.54
1060	to develop, implement, and administer the following provisions
1061	of the managed care pilot program:
1062	(a)  Risk-adjusted capitation rates pursuant to paragraph
1063	(3)(d).
1064	(b)  A mechanism for providing information to Medicaid
1065	recipients pursuant to paragraph (3)(i).
1066	(c)  A choice counseling system pursuant to paragraphs
1067	(3)(k), (l), and (m).
1068	(7)(a)  The Office of Insurance Regulation shall provide
1069	ongoing guidance to the agency in the implementation of risk-
1070	adjusted rates. Beginning on the effective date of this act, the
1071	Office of Insurance Regulation shall make advisory
1072	recommendations to the agency regarding the following items:
1073	1.  The methodology adopted by the agency for risk-adjusted
1074	rates, including any suggestions to improve the predictive value
1075	of the system.
1076	2.  Alternative options based on the agency's methodology.
1077	3.  The risk-adjusted rate for each Medicaid eligibility
1078	category in the demonstration program.
1079	4.  Administrative and implementation issues regarding the
1080	use of risk-adjusted rates, including, but not limited to, cost,
1081	simplicity, client privacy, data accuracy, and data exchange.
1082	5.  The appropriateness of phasing in risk-adjusted rates.
1083	(b)  As a part of this process, the Office of Insurance
1084	Regulation shall contract with an independent actuary firm to
1085	assist in the annual review and to provide technical expertise.
1086	(c)  As a part of this process, the agency shall solicit
1087	input concerning the agency's rate setting methodology from the
1088	Florida Association of Health Plans, the Florida Hospital
1089	Association, the Florida Medical Association, Medicaid recipient
1090	advocacy groups, and other stakeholder representatives as
1091	necessary to obtain a broad representation of perspectives on
1092	the effects of the agency's adopted rate setting methodology and
1093	recommendations on possible modifications to the methodology.
1094	(d)  The Office of Insurance Regulation shall submit a
1095	report of its findings and advisory recommendations to the
1096	Governor, the President of the Senate, and the Speaker of the
1097	House of Representatives prior to the implementation of risk-
1098	adjusted rates on July 1, 2006, and annually thereafter no later
1099	than February 1 of each year for consideration by the
1100	Legislature for inclusion in the General Appropriations Act.
1101	(8)  Any provision of law to the contrary notwithstanding,
1102	adjustments to risk-adjusted capitation rates shall be
1103	implemented through rules of the agency, as required by s.
1104	409.9124, based upon the recommendation of the committee.
1105	(9)  The capitation rates for plans participating under
1106	this section shall be phased in as follows:
1107	(a)  In the first fiscal year, the capitation rates shall
1108	be weighted so that 75 percent of each capitation rate is based
1109	upon the current methodology and 25 percent is based upon a new
1110	risk-adjusted capitation rate methodology.
1111	(b)  In the second fiscal year, the capitation rates shall
1112	be weighted so that 50 percent of each capitation rate is based
1113	upon the current methodology and 50 percent is based upon a new
1114	risk-adjusted rate methodology.
1115	(c)  In the third fiscal year, the capitation rates shall
1116	be weighted so that 25 percent of each capitation rate is based
1117	upon the current methodology and 75 percent is based upon a new
1118	risk-adjusted capitation rate methodology.
1119	(d)  In the following fiscal year, the risk-adjusted
1120	capitation rate methodology may be fully implemented.
1121	(10)  The agency must ensure the following when using a
1122	risk-adjustment rate methodology in whole or part:
1123	(a)  The agency's total annual payment shall be based on
1124	each managed care plan's own aggregate risk score, except that
1125	in no case shall the aggregate risk score of any managed care
1126	plan in an area vary by more than 10 percent from the aggregate
1127	weighted mean of all managed care plans providing comprehensive
1128	benefits to TANF and SSI recipients in that area. The agency's
1129	total annual payment to a managed care plan shall be based on
1130	such revised aggregate risk score.
1131	(b)  After any adjustments required pursuant to paragraph
1132	(a), the aggregate payments calculated to be made to managed
1133	care plans on behalf of enrollees in any pilot area must be no
1134	less than what the aggregate payments would have been using the
1135	current rate methodology under s. 409.9124. If the agency
1136	determines that such aggregate payments under the risk-adjusted
1137	methodology will be lower than the aggregate payments that the
1138	plans would have been paid using the current rate methodology
1139	under s. 409.9124, supplemental payments shall be made to
1140	managed care plans so that the proportion of overall revenue
1141	remains the same on an aggregate basis per plan. Such
1142	supplemental payments shall be made to bring total payments up
1143	to the amount that would have been paid under s. 409.9124.
1144	(11)  Prior to the implementation of risk-adjusted
1145	capitation rates, the rates shall be certified by an actuary and
1146	approved by the Centers for Medicare and Medicaid Services.
1147	(12)  For purposes of this section, the term "capitated
1148	managed care plan" includes health insurers authorized under
1149	chapter 624, exclusive provider organizations authorized under
1150	chapter 627, health maintenance organizations authorized under
1151	chapter 641, and provider service networks that elect to be paid
1152	fee-for-service for up to 3 years as authorized under this
1153	section.
1154	Section 5.  Section 409.91212, Florida Statutes, is created
1155	to read:
1156	409.91212  Medicaid reform demonstration program
1157	expansion.--
1158	(1)  The agency may expand the Medicaid reform
1159	demonstration program pursuant to s. 409.91211 into any county
1160	of the state beginning in year two of the demonstration program
1161	if readiness criteria are met, the Joint Legislative Committee
1162	on Medicaid Reform Implementation has submitted a recommendation
1163	pursuant to s. 11.72 regarding the extent to which the criteria
1164	have been met, and the agency has secured budget approval from
1165	the Legislative Budget Commission pursuant to s. 11.90. For the
1166	purpose of this section, the term "readiness" means there is
1167	evidence that at least two programs in a county meet the
1168	following criteria:
1169	(a)  Demonstrate knowledge and understanding of managed
1170	care under the framework of Medicaid reform.
1171	(b)  Demonstrate financial capability to meet solvency
1172	standards.
1173	(c)  Demonstrate adequate controls and process for
1174	financial management.
1175	(d)  Demonstrate the capability for clinical management of
1176	Medicaid recipients.
1177	(e)  Demonstrate the adequacy, capacity, and accessibility
1178	of the services network.
1179	(f)  Demonstrate the capability to operate a management
1180	information system and an encounter data system.
1181	(g)  Demonstrate capability to implement quality assurance
1182	and utilization management activities.
1183	(h)  Demonstrate capability to implement fraud control
1184	activities.
1185	(2)  The agency shall conduct meetings and public hearings
1186	in the targeted expansion county with the public and provider
1187	community. The agency shall provide notice regarding public
1188	hearings. The agency shall maintain records of the proceedings.
1189	(3)  The agency shall provide a 30-day notice of intent to
1190	expand the demonstration program with supporting documentation
1191	that the readiness criteria has been met to the President of the
1192	Senate, the Speaker of the House of Representatives, the
1193	Minority Leader of the Senate, the Minority Leader of the House
1194	of Representatives, and the Office of Program Policy Analysis
1195	and Government Accountability.
1196	(4)  The agency shall request a hearing and consideration
1197	by the Joint Legislative Committee on Medicaid Reform
1198	Implementation after the 30-day notice required in subsection
1199	(3) has expired in the form of a letter to the chair of the
1200	committee.
1201	(5)  Upon receiving a memorandum from the Joint Legislative
1202	Committee on Medicaid Reform Implementation regarding the extent
1203	to which the expansion criteria pursuant to subsection (1) have
1204	been met, the agency may submit a budget amendment, pursuant to
1205	chapter 216, to request the necessary budget transfers
1206	associated with the expansion of the demonstration program.
1207	Section 6.  Subsections (8) through (14) of section
1208	409.9122, Florida Statutes, are renumbered as subsections (7)
1209	through (13), respectively, and paragraphs (e), (f), (g), (h),
1210	(k), and (l) of subsection (2) and present subsection (7) of
1211	that section are amended to read:
1212	409.9122  Mandatory Medicaid managed care enrollment;
1213	programs and procedures.--
1214	(2)
1215	(e)  Medicaid recipients who are already enrolled in a
1216	managed care plan or MediPass shall be offered the opportunity
1217	to change managed care plans or MediPass providers on a
1218	staggered basis, as defined by the agency. All Medicaid
1219	recipients shall have 30 days in which to make a choice of
1220	managed care plans or MediPass providers. Those Medicaid
1221	recipients who do not make a choice shall be assigned to a
1222	managed care plan or MediPass in accordance with paragraph (f).
1223	To facilitate continuity of care, for a Medicaid recipient who
1224	is also a recipient of Supplemental Security Income (SSI), prior
1225	to assigning the SSI recipient to a managed care plan or
1226	MediPass, the agency shall determine whether the SSI recipient
1227	has an ongoing relationship with a MediPass provider or managed
1228	care plan, and if so, the agency shall assign the SSI recipient
1229	to that MediPass provider or managed care plan. Those SSI
1230	recipients who do not have such a provider relationship shall be
1231	assigned to a managed care plan or MediPass provider in
1232	accordance with paragraph (f).
1233	(f)  When a Medicaid recipient does not choose a managed
1234	care plan or MediPass provider, the agency shall assign the
1235	Medicaid recipient to a managed care plan or MediPass provider.
1236	Medicaid recipients who are subject to mandatory assignment but
1237	who fail to make a choice shall be assigned to managed care
1238	plans until an enrollment of 40 percent in MediPass and 60
1239	percent in managed care plans is achieved. Once this enrollment
1240	is achieved, the assignments shall be divided in order to
1241	maintain an enrollment in MediPass and managed care plans which
1242	is in a 40 percent and 60 percent proportion, respectively.
1243	Thereafter, assignment of Medicaid recipients who fail to make a
1244	choice shall be based proportionally on the preferences of
1245	recipients who have made a choice in the previous period. Such
1246	proportions shall be revised at least quarterly to reflect an
1247	update of the preferences of Medicaid recipients. The agency
1248	shall disproportionately assign Medicaid-eligible recipients who
1249	are required to but have failed to make a choice of managed care
1250	plan or MediPass, including children, and who are to be assigned
1251	to the MediPass program to children's networks as described in
1252	s. 409.912(4)(g), Children's Medical Services Network as defined
1253	in s. 391.021, exclusive provider organizations, provider
1254	service networks, minority physician networks, and pediatric
1255	emergency department diversion programs authorized by this
1256	chapter or the General Appropriations Act, in such manner as the
1257	agency deems appropriate, until the agency has determined that
1258	the networks and programs have sufficient numbers to be
1259	economically operated. For purposes of this paragraph, when
1260	referring to assignment, the term "managed care plans" includes
1261	health maintenance organizations, exclusive provider
1262	organizations, provider service networks, minority physician
1263	networks, Children's Medical Services Network, and pediatric
1264	emergency department diversion programs authorized by this
1265	chapter or the General Appropriations Act. When making
1266	assignments, the agency shall take into account the following
1267	criteria:
1268	1.  A managed care plan has sufficient network capacity to
1269	meet the need of members.
1270	2.  The managed care plan or MediPass has previously
1271	enrolled the recipient as a member, or one of the managed care
1272	plan's primary care providers or MediPass providers has
1273	previously provided health care to the recipient.
1274	3.  The agency has knowledge that the member has previously
1275	expressed a preference for a particular managed care plan or
1276	MediPass provider as indicated by Medicaid fee-for-service
1277	claims data, but has failed to make a choice.
1278	4.  The managed care plan is plan's or MediPass primary
1279	care providers are geographically accessible to the recipient's
1280	residence.
1281	5.  The agency has authority to make mandatory assignments
1282	based on quality of service and performance of managed care
1283	plans.
1284	(g)  When more than one managed care plan or MediPass
1285	provider meets the criteria specified in paragraph (f), the
1286	agency shall make recipient assignments consecutively by family
1287	unit.
1288	(h)  The agency may not engage in practices that are
1289	designed to favor one managed care plan over another or that are
1290	designed to influence Medicaid recipients to enroll in MediPass
1291	rather than in a managed care plan or to enroll in a managed
1292	care plan rather than in MediPass. This subsection does not
1293	prohibit the agency from reporting on the performance of
1294	MediPass or any managed care plan, as measured by performance
1295	criteria developed by the agency.
1296	(k)  When a Medicaid recipient does not choose a managed
1297	care plan or MediPass provider, the agency shall assign the
1298	Medicaid recipient to a managed care plan, except in those
1299	counties in which there are fewer than two managed care plans
1300	accepting Medicaid enrollees, in which case assignment shall be
1301	to a managed care plan or a MediPass provider. Medicaid
1302	recipients in counties with fewer than two managed care plans
1303	accepting Medicaid enrollees who are subject to mandatory
1304	assignment but who fail to make a choice shall be assigned to
1305	managed care plans until an enrollment of 40 percent in MediPass
1306	and 60 percent in managed care plans is achieved. Once that
1307	enrollment is achieved, the assignments shall be divided in
1308	order to maintain an enrollment in MediPass and managed care
1309	plans which is in a 40 percent and 60 percent proportion,
1310	respectively. In service areas 1 and 6 of the Agency for Health
1311	Care Administration where the agency is contracting for the
1312	provision of comprehensive behavioral health services through a
1313	capitated prepaid arrangement, recipients who fail to make a
1314	choice shall be assigned equally to MediPass or a managed care
1315	plan. For purposes of this paragraph, when referring to
1316	assignment, the term "managed care plans" includes exclusive
1317	provider organizations, provider service networks, Children's
1318	Medical Services Network, minority physician networks, and
1319	pediatric emergency department diversion programs authorized by
1320	this chapter or the General Appropriations Act. When making
1321	assignments, the agency shall take into account the following
1322	criteria:
1323	1.  A managed care plan has sufficient network capacity to
1324	meet the need of members.
1325	2.  The managed care plan or MediPass has previously
1326	enrolled the recipient as a member, or one of the managed care
1327	plan's primary care providers or MediPass providers has
1328	previously provided health care to the recipient.
1329	3.  The agency has knowledge that the member has previously
1330	expressed a preference for a particular managed care plan or
1331	MediPass provider as indicated by Medicaid fee-for-service
1332	claims data, but has failed to make a choice.
1333	4.  The managed care plan's or MediPass primary care
1334	providers are geographically accessible to the recipient's
1335	residence.
1336	5.  The agency has authority to make mandatory assignments
1337	based on quality of service and performance of managed care
1338	plans.
1339	(k)(l)  Notwithstanding the provisions of chapter 287, the
1340	agency may, at its discretion, renew cost-effective contracts
1341	for choice counseling services once or more for such periods as
1342	the agency may decide. However, all such renewals may not
1343	combine to exceed a total period longer than the term of the
1344	original contract.
1345	(7)  The agency shall investigate the feasibility of
1346	developing managed care plan and MediPass options for the
1347	following groups of Medicaid recipients:
1348	(a)  Pregnant women and infants.
1349	(b)  Elderly and disabled recipients, especially those who
1350	are at risk of nursing home placement.
1351	(c)  Persons with developmental disabilities.
1352	(d)  Qualified Medicare beneficiaries.
1353	(e)  Adults who have chronic, high-cost medical conditions.
1354	(f)  Adults and children who have mental health problems.
1355	(g)  Other recipients for whom managed care plans and
1356	MediPass offer the opportunity of more cost-effective care and
1357	greater access to qualified providers.
1358	Section 7.  The Agency for Health Care Administration shall
1359	report to the Legislature by April 1, 2006, the specific
1360	preimplementation milestones required by the Centers for
1361	Medicare and Medicaid Services Special Terms and Conditions
1362	related to the low income pool that have been approved by the
1363	Federal Government and the status of any remaining
1364	preimplementation milestones that have not been approved by the
1365	Federal Government.
1366	Section 8.  Quarterly progress and annual reports.--The
1367	Agency for Health Care Administration shall submit to the
1368	Governor, the President of the Senate, the Speaker of the House
1369	of Representatives, the Minority Leader of the Senate, the
1370	Minority Leader of the House of Representatives, and the Office
1371	of Program Policy Analysis and Government Accountability the
1372	following reports:
1373	(1)  Quarterly progress reports submitted to Centers for
1374	Medicare and Medicaid Services no later than 60 days following
1375	the end of each quarter. These reports shall present the
1376	agency's analysis and the status of various operational areas.
1377	The quarterly progress reports shall include, but are not
1378	limited to, the following:
1379	(a)  Documentation of events that occurred during the
1380	quarter or that are anticipated to occur in the near future that
1381	affect health care delivery, including, but not limited to, the
1382	approval of contracts with new managed care plans, the
1383	procedures for designating coverage areas, the process of
1384	phasing in managed care, a description of the populations served
1385	and the benefits provided, the number of recipients enrolled, a
1386	list of grievances submitted by enrollees, and other operational
1387	issues.
1388	(b)  Action plans for addressing policy and administrative
1389	issues.
1390	(c)  Documentation of agency efforts related to the
1391	collection and verification of encounter and utilization data.
1392	(d)  Enrollment data for each managed care plan according
1393	to the following specifications: total number of enrollees,
1394	eligibility category, number of enrollees receiving Temporary
1395	Assistance for Needy Families or Supplemental Security Income,
1396	market share, and percentage change in enrollment. In addition,
1397	the agency shall provide a summary of voluntary and mandatory
1398	selection rates and disenrollment data. Enrollment data, number
1399	of members by month, and expenditures shall be submitted in the
1400	format for monitoring budget neutrality provided by the Centers
1401	for Medicare and Medicaid Services.
1402	(e)  Documentation of low income pool activities and
1403	associated expenditures.
1404	(f)  Documentation of activities related to the
1405	implementation of choice counseling including efforts to improve
1406	health literacy and the methods used to obtain public input
1407	including recipient focus groups.
1408	(g)  Participation rates in the Enhanced Benefit Accounts
1409	Program, as established in the Centers for Medicare and Medicaid
1410	Services Special Terms and Conditions number 11-W-00206/4, which
1411	shall include: participation levels, summary of activities and
1412	associated expenditures, number of accounts established
1413	including active participants and individuals who continue to
1414	retain access to funds in an account but no longer actively
1415	participate, estimated quarterly deposits in accounts, and
1416	expenditures from the accounts.
1417	(h)  Enrollment data on employer-sponsored insurance that
1418	documents the number of individuals selecting to opt out when
1419	employer-sponsored insurance is available. The agency shall
1420	include data that identifies enrollee characteristics to include
1421	eligibility category, type of employer-sponsored insurance, and
1422	type of coverage based on whether the coverage is for the
1423	individual or the family. The agency shall develop and maintain
1424	disenrollment reports specifying the reason for disenrolling in
1425	an employer-sponsored insurance program. The agency shall also
1426	track and report on those enrollees who elect to reenroll in the
1427	Medicaid reform waiver demonstration program.
1428	(i)  Documentation of progress toward the demonstration
1429	program goals.
1430	(j)  Documentation of evaluation activities.
1431	(2)  The annual report shall document accomplishments,
1432	program status, quantitative and case study findings,
1433	utilization data, and policy and administrative difficulties in
1434	the operation of the Medicaid reform waiver demonstration
1435	program. The agency shall submit the draft annual report no
1436	later than October 1 after the end of each fiscal year.
1437	(a)  Beginning with the annual report for demonstration
1438	program year two, the agency shall include a section on the
1439	administration of enhanced benefit accounts, participation
1440	rates, an assessment of expenditures, and potential cost
1441	savings.
1442	(b)  Beginning with the annual report for demonstration
1443	program year four, the agency shall include a section that
1444	provides qualitative and quantitative data that describes the
1445	impact of the low income pool on the number of uninsured persons
1446	in the state from the start of the implementation of the
1447	demonstration program.
1448	Section 9.  Section 11.72, Florida Statutes, is created to
1449	read:
1450	11.72  Joint Legislative Committee on Medicaid Reform
1451	Implementation; creation; membership; powers; duties.--
1452	(1)  There is created a standing joint committee of the
1453	Legislature designated the Joint Legislative Committee on
1454	Medicaid Reform Implementation for the purpose of reviewing
1455	policy issues related to expansion of the Medicaid managed care
1456	pilot program pursuant to s. 409.91211.
1457	(2)  The Joint Legislative Committee on Medicaid Reform
1458	Implementation shall be composed of eight members appointed as
1459	follows: four members of the House of Representatives appointed
1460	by the Speaker of the House of Representatives, one of whom
1461	shall be a member of the minority party; and four members of the
1462	Senate appointed by the President of the Senate, one of whom
1463	shall be a member of the minority party. The President of the
1464	Senate shall appoint the chair in even-numbered years and the
1465	vice chair in odd-numbered years, and the Speaker of the House
1466	of Representatives shall appoint the chair in odd-numbered years
1467	and the vice chair in even-numbered years from among the
1468	committee membership. Vacancies shall be filled in the same
1469	manner as the original appointment. Members shall serve without
1470	compensation, except that members are entitled to reimbursement
1471	for per diem and travel expenses in accordance with s. 112.061.
1472	(3)  The committee shall be governed by joint rules of the
1473	Senate and the House of Representatives which shall remain in
1474	effect until repealed or amended by concurrent resolution.
1475	(4)  The committee shall meet at the call of the chair. The
1476	committee may hold hearings on matters within its purview which
1477	are in the public interest. A quorum shall consist of a majority
1478	of members from each house, plus one additional member from
1479	either house. Action by the committee requires a majority vote
1480	of the members present of each house.
1481	(5)  The committee shall be jointly staffed by the
1482	appropriations and substantive committees of the House of
1483	Representatives and the Senate. During even-numbered years the
1484	Senate shall serve as lead staff and during odd-numbered years
1485	the House of Representatives shall serve as lead staff.
1486	(6)  The committee shall:
1487	(a)  Review reports, public hearing proceedings, documents,
1488	and materials provided by the Agency for Health Care
1489	Administration relating to the expansion of the Medicaid managed
1490	care pilot program to other counties of the state pursuant to s.
1491	409.91212.
1492	(b)  Consult with the substantive and fiscal committees of
1493	the House of Representatives and the Senate which have
1494	jurisdiction over the Medicaid matters relating to agency action
1495	to expand the Medicaid managed care pilot program.
1496	(c)  Meet to consider and make a recommendation regarding
1497	the extent to which the expansion criteria pursuant to s.
1498	409.91212 have been met.
1499	(7)  Within 2 days after meeting, during which the
1500	committee reviewed documents, material, and testimony related to
1501	the expansion criteria, the committee shall submit a memorandum
1502	to the Speaker of the House of Representatives, the President of
1503	the Senate, the Legislative Budget Commission, and the agency
1504	delineating the extent to which the agency met the expansion
1505	criteria.
1506	Section 10.  It is the intent of the Legislature that if
1507	any conflict exists between the provisions contained in s.
1508	409.91211, Florida Statutes, and other provisions of chapter
1509	409, Florida Statutes, as they relate to implementation of the
1510	Medicaid managed care pilot program, the provisions contained in
1511	s. 409.91211, Florida Statutes, shall control. The Agency for
1512	Health Care Administration shall provide a written report to the
1513	President of the Senate and the Speaker of the House of
1514	Representatives by April 1, 2006, identifying any provisions of
1515	chapter 409, Florida Statutes, that conflict with the
1516	implementation of the Medicaid managed care pilot program as
1517	created in s. 409.91211, Florida Statutes. After April 1, 2006,
1518	the agency shall provide a written report to the President of
1519	the Senate and the Speaker of the House of Representatives
1520	immediately upon identifying any provisions of chapter 409,
1521	Florida Statutes, that conflict with the implementation of the
1522	Medicaid managed care pilot program as created in s. 409.91211,
1523	Florida Statutes.
1524	Section 11.  Section 216.346, Florida Statutes, is amended
1525	to read:
1526	216.346  Contracts between state agencies; restriction on
1527	overhead or other indirect costs.--In any contract between state
1528	agencies, including any contract involving the State University
1529	System or the Florida Community College System, the agency
1530	receiving the contract or grant moneys shall charge no more than
1531	a reasonable percentage 5 percent of the total cost of the
1532	contract or grant for overhead or indirect costs or any other
1533	costs not required for the payment of direct costs. This
1534	provision is not intended to limit an agency's ability to
1535	certify matching funds or designate in-kind contributions which
1536	will allow the drawdown of federal Medicaid dollars that do not
1537	affect state budgeting.
1538	Section 12.  One full-time equivalent position is
1539	authorized and the sum of $250,000 is appropriated for fiscal
1540	year 2006-2007 from the General Revenue Fund to the Office of
1541	Insurance Regulation of the Financial Services Commission to
1542	fund the annual review of the Medicaid managed care pilot
1543	program's risk-adjusted rate setting methodology.
1544	Section 13.  This act shall take effect upon becoming a
1545	law.

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