HB 3B

1	A bill to be entitled
2	An act relating to Medicaid; amending s. 641.2261, F.S.;
3	revising the applicability of solvency requirements to
4	include Medicaid provider service networks and updating a
5	reference; amending s. 409.911, F.S.; adding a duty to the
6	Medicaid Disproportionate Share Council; providing a
7	future repeal of the Disproportionate Share Council;
8	creating the Medicaid Low-Income Pool Council; providing
9	for membership and duties; amending s. 409.912, F.S.;
10	providing an exception from certain contract procurement
11	requirements for specified Medicaid managed care pilot
12	programs and Medicaid health maintenance organizations;
13	providing an exemption for federally qualified health
14	centers and entities owned by federally qualified health
15	centers from pts. I and III of ch. 641, F.S., under
16	certain circumstances; deleting the competitive
17	procurement requirement for provider service networks;
18	requiring provider service networks to comply with the
19	solvency requirements in s. 641.2261, F.S.; updating a
20	reference; including certain minority physician networks
21	and emergency room diversion programs in the description
22	of provider service networks; amending s. 409.91211, F.S.;
23	providing for distribution of upper payment limit,
24	hospital disproportionate share program, and low income
25	pool funds; providing legislative intent with respect to
26	distribution of said funds; providing for implementation
27	of the powers, duties, and responsibilities of the Agency
28	for Health Care Administration with respect to the pilot
29	program; including the Division of Children's Medical
30	Services Network within the Department of Health in a list
31	of state-authorized pilot programs; requiring the agency
32	to develop a data reporting system; requiring the agency
33	to implement procedures to minimize fraud and abuse;
34	providing that certain Medicaid and Supplemental Security
35	Income recipients are exempt from s. 409.9122, F.S.;
36	providing for Medicaid reimbursement of federally
37	qualified health centers that deliver certain school-based
38	services; authorizing the agency to assign certain
39	Medicaid recipients to reform plans; authorizing the
40	agency to implement the provisions of the waiver approved
41	by the Centers for Medicare and Medicaid Services and
42	requiring the agency to notify the Legislature prior to
43	seeking federal approval of modifications to said terms
44	and conditions; requiring the Secretary of Health Care
45	Administration to convene a technical advisory panel;
46	providing for membership and duties; limiting aggregate
47	risk score of certain managed care plans for payment
48	purposes for a specified period of time; providing for
49	phase in of capitation rates; providing applicability;
50	requiring rates to be certified and approved; defining the
51	term "capitated managed care plan"; providing for conflict
52	between specified provisions of ch. 409, F.S., and
53	requiring a report by the agency pertaining thereto;
54	creating s. 409.91212, F.S.; authorizing the agency to
55	expand the Medicaid reform demonstration program;
56	providing readiness criteria; providing for public
57	meetings; requiring notice of intent to expand the
58	demonstration program; requiring the agency to request a
59	hearing by the Joint Legislative Committee on Medicaid
60	Reform Implementation; authorizing the agency to request
61	certain budget transfers; amending s. 409.9122, F.S.;
62	revising provisions relating to assignment of certain
63	Medicaid recipients to managed care plans; creating s.
64	11.72, F.S.; creating the Joint Legislative Committee on
65	Medicaid Reform Implementation; providing for membership,
66	powers, and duties; amending s. 216.346, F.S.; revising
67	provisions relating to contracts between state agencies;
68	providing an effective date.
69
70	Be It Enacted by the Legislature of the State of Florida:
71
72	Section 1.  Section 641.2261, Florida Statutes, is amended
73	to read:
74	641.2261  Application of federal solvency requirements to
75	provider-sponsored organizations and Medicaid provider service
76	networks.--
77	(1)  The solvency requirements of ss. 1855 and 1856 of the
78	Balanced Budget Act of 1997 and 42 C.F.R. s. 422.350 subpart H
79	rules adopted by the Secretary of the United States Department
80	of Health and Human Services apply to a health maintenance
81	organization that is a provider-sponsored organization rather
82	than the solvency requirements of this part. However, if the
83	provider-sponsored organization does not meet the solvency
84	requirements of this part, the organization is limited to the
85	issuance of Medicare+Choice plans to eligible individuals. For
86	the purposes of this section, the terms "Medicare+Choice plans,"
87	"provider-sponsored organizations," and "solvency requirements"
88	have the same meaning as defined in the federal act and federal
89	rules and regulations.
90	(2)  The solvency requirements of 42 C.F.R. s. 422.350
91	subpart H and the solvency requirements established in the
92	approved federal waiver pursuant to chapter 409 apply to a
93	Medicaid provider service network rather than the solvency
94	requirements of this part.
95	Section 2.  Subsection (9) of section 409.911, Florida
96	Statutes, is amended, and subsection (10) is added to that
97	section, to read:
98	409.911  Disproportionate share program.--Subject to
99	specific allocations established within the General
100	Appropriations Act and any limitations established pursuant to
101	chapter 216, the agency shall distribute, pursuant to this
102	section, moneys to hospitals providing a disproportionate share
103	of Medicaid or charity care services by making quarterly
104	Medicaid payments as required. Notwithstanding the provisions of
105	s. 409.915, counties are exempt from contributing toward the
106	cost of this special reimbursement for hospitals serving a
107	disproportionate share of low-income patients.
108	(9)  The Agency for Health Care Administration shall create
109	a Medicaid Disproportionate Share Council.
110	(a)  The purpose of the council is to study and make
111	recommendations regarding:
112	1.  The formula for the regular disproportionate share
113	program and alternative financing options.
114	2.  Enhanced Medicaid funding through the Special Medicaid
115	Payment program.
116	3.  The federal status of the upper-payment-limit funding
117	option and how this option may be used to promote health care
118	initiatives determined by the council to be state health care
119	priorities.
120	4.  The development of the low-income pool plan as required
121	by the federal Centers for Medicare and Medicaid Services using
122	the objectives established in s. 409.91211(1)(c).
123	(b)  The council shall include representatives of the
124	Executive Office of the Governor and of the agency;
125	representatives from teaching, public, private nonprofit,
126	private for-profit, and family practice teaching hospitals; and
127	representatives from other groups as needed. The agency must
128	ensure that there is fair representation of each group specified
129	in this paragraph.
130	(c)  The council shall submit its findings and
131	recommendations to the Governor and the Legislature no later
132	than March February 1 of each year.
133	(d)  This subsection shall stand repealed June 30, 2006,
134	unless reviewed and saved from repeal through reenactment by the
135	Legislature.
136	(10)  The Agency for Health Care Administration shall
137	create a Medicaid Low-Income Pool Council by July 1, 2006. The
138	Low-Income Pool Council shall consist of 17 members, including
139	three representatives of statutory teaching hospitals, three
140	representatives of public hospitals, three representatives of
141	nonprofit hospitals, three representatives of for-profit
142	hospitals, two representatives of rural hospitals, two
143	representatives of units of local government which contribute
144	funding, and one representative of family practice teaching
145	hospitals. The council shall:
146	(a)  Make recommendations on the financing of the low-
147	income pool and the disproportionate share hospital program and
148	the distribution of their funds.
149	(b)  Advise the Agency for Health Care Administration on
150	the development of the low-income pool plan required by the
151	federal Centers for Medicare and Medicaid Services pursuant to
152	the Medicaid reform waiver.
153	(c)  Advise the Agency for Health Care Administration on
154	the distribution of hospital funds used to adjust inpatient
155	hospital rates, rebase rates, or otherwise exempt hospitals from
156	reimbursement limits as financed by intergovernmental transfers.
157	(d)  Submit its findings and recommendations to the
158	Governor and the Legislature no later than February 1 of each
159	year.
160	Section 3.  Paragraphs (b), (c), and (d) of subsection (4)
161	of section 409.912, Florida Statutes, are amended to read:
162	409.912  Cost-effective purchasing of health care.--The
163	agency shall purchase goods and services for Medicaid recipients
164	in the most cost-effective manner consistent with the delivery
165	of quality medical care. To ensure that medical services are
166	effectively utilized, the agency may, in any case, require a
167	confirmation or second physician's opinion of the correct
168	diagnosis for purposes of authorizing future services under the
169	Medicaid program. This section does not restrict access to
170	emergency services or poststabilization care services as defined
171	in 42 C.F.R. part 438.114. Such confirmation or second opinion
172	shall be rendered in a manner approved by the agency. The agency
173	shall maximize the use of prepaid per capita and prepaid
174	aggregate fixed-sum basis services when appropriate and other
175	alternative service delivery and reimbursement methodologies,
176	including competitive bidding pursuant to s. 287.057, designed
177	to facilitate the cost-effective purchase of a case-managed
178	continuum of care. The agency shall also require providers to
179	minimize the exposure of recipients to the need for acute
180	inpatient, custodial, and other institutional care and the
181	inappropriate or unnecessary use of high-cost services. The
182	agency shall contract with a vendor to monitor and evaluate the
183	clinical practice patterns of providers in order to identify
184	trends that are outside the normal practice patterns of a
185	provider's professional peers or the national guidelines of a
186	provider's professional association. The vendor must be able to
187	provide information and counseling to a provider whose practice
188	patterns are outside the norms, in consultation with the agency,
189	to improve patient care and reduce inappropriate utilization.
190	The agency may mandate prior authorization, drug therapy
191	management, or disease management participation for certain
192	populations of Medicaid beneficiaries, certain drug classes, or
193	particular drugs to prevent fraud, abuse, overuse, and possible
194	dangerous drug interactions. The Pharmaceutical and Therapeutics
195	Committee shall make recommendations to the agency on drugs for
196	which prior authorization is required. The agency shall inform
197	the Pharmaceutical and Therapeutics Committee of its decisions
198	regarding drugs subject to prior authorization. The agency is
199	authorized to limit the entities it contracts with or enrolls as
200	Medicaid providers by developing a provider network through
201	provider credentialing. The agency may competitively bid single-
202	source-provider contracts if procurement of goods or services
203	results in demonstrated cost savings to the state without
204	limiting access to care. The agency may limit its network based
205	on the assessment of beneficiary access to care, provider
206	availability, provider quality standards, time and distance
207	standards for access to care, the cultural competence of the
208	provider network, demographic characteristics of Medicaid
209	beneficiaries, practice and provider-to-beneficiary standards,
210	appointment wait times, beneficiary use of services, provider
211	turnover, provider profiling, provider licensure history,
212	previous program integrity investigations and findings, peer
213	review, provider Medicaid policy and billing compliance records,
214	clinical and medical record audits, and other factors. Providers
215	shall not be entitled to enrollment in the Medicaid provider
216	network. The agency shall determine instances in which allowing
217	Medicaid beneficiaries to purchase durable medical equipment and
218	other goods is less expensive to the Medicaid program than long-
219	term rental of the equipment or goods. The agency may establish
220	rules to facilitate purchases in lieu of long-term rentals in
221	order to protect against fraud and abuse in the Medicaid program
222	as defined in s. 409.913. The agency may seek federal waivers
223	necessary to administer these policies.
224	(4)  The agency may contract with:
225	(b)  An entity that is providing comprehensive behavioral
226	health care services to certain Medicaid recipients through a
227	capitated, prepaid arrangement pursuant to the federal waiver
228	provided for by s. 409.905(5). Such an entity must be licensed
229	under chapter 624, chapter 636, or chapter 641 and must possess
230	the clinical systems and operational competence to manage risk
231	and provide comprehensive behavioral health care to Medicaid
232	recipients. As used in this paragraph, the term "comprehensive
233	behavioral health care services" means covered mental health and
234	substance abuse treatment services that are available to
235	Medicaid recipients. The secretary of the Department of Children
236	and Family Services shall approve provisions of procurements
237	related to children in the department's care or custody prior to
238	enrolling such children in a prepaid behavioral health plan. Any
239	contract awarded under this paragraph must be competitively
240	procured. In developing the behavioral health care prepaid plan
241	procurement document, the agency shall ensure that the
242	procurement document requires the contractor to develop and
243	implement a plan to ensure compliance with s. 394.4574 related
244	to services provided to residents of licensed assisted living
245	facilities that hold a limited mental health license. Except as
246	provided in subparagraph 8. and except in counties where the
247	Medicaid managed care pilot program is authorized under s.
248	409.91211, the agency shall seek federal approval to contract
249	with a single entity meeting these requirements to provide
250	comprehensive behavioral health care services to all Medicaid
251	recipients not enrolled in a Medicaid capitated managed care
252	plan authorized under s. 409.91211 or a Medicaid health
253	maintenance organization in an AHCA area. In an AHCA area where
254	the Medicaid managed care pilot program is authorized under s.
255	409.91211 in one or more counties, the agency may procure a
256	contract with a single entity to serve the remaining counties as
257	an AHCA area or the remaining counties may be included with an
258	adjacent AHCA area and shall be subject to this paragraph. Each
259	entity must offer sufficient choice of providers in its network
260	to ensure recipient access to care and the opportunity to select
261	a provider with whom they are satisfied. The network shall
262	include all public mental health hospitals. To ensure unimpaired
263	access to behavioral health care services by Medicaid
264	recipients, all contracts issued pursuant to this paragraph
265	shall require 80 percent of the capitation paid to the managed
266	care plan, including health maintenance organizations, to be
267	expended for the provision of behavioral health care services.
268	In the event the managed care plan expends less than 80 percent
269	of the capitation paid pursuant to this paragraph for the
270	provision of behavioral health care services, the difference
271	shall be returned to the agency. The agency shall provide the
272	managed care plan with a certification letter indicating the
273	amount of capitation paid during each calendar year for the
274	provision of behavioral health care services pursuant to this
275	section. The agency may reimburse for substance abuse treatment
276	services on a fee-for-service basis until the agency finds that
277	adequate funds are available for capitated, prepaid
278	arrangements.
279	1.  By January 1, 2001, the agency shall modify the
280	contracts with the entities providing comprehensive inpatient
281	and outpatient mental health care services to Medicaid
282	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
283	Counties, to include substance abuse treatment services.
284	2.  By July 1, 2003, the agency and the Department of
285	Children and Family Services shall execute a written agreement
286	that requires collaboration and joint development of all policy,
287	budgets, procurement documents, contracts, and monitoring plans
288	that have an impact on the state and Medicaid community mental
289	health and targeted case management programs.
290	3.  Except as provided in subparagraph 8., by July 1, 2006,
291	the agency and the Department of Children and Family Services
292	shall contract with managed care entities in each AHCA area
293	except area 6 or arrange to provide comprehensive inpatient and
294	outpatient mental health and substance abuse services through
295	capitated prepaid arrangements to all Medicaid recipients who
296	are eligible to participate in such plans under federal law and
297	regulation. In AHCA areas where eligible individuals number less
298	than 150,000, the agency shall contract with a single managed
299	care plan to provide comprehensive behavioral health services to
300	all recipients who are not enrolled in a Medicaid health
301	maintenance organization or a Medicaid capitated managed care
302	plan authorized under s. 409.91211. The agency may contract with
303	more than one comprehensive behavioral health provider to
304	provide care to recipients who are not enrolled in a Medicaid
305	health maintenance organization or a Medicaid capitated managed
306	care plan authorized under s. 409.91211 in AHCA areas where the
307	eligible population exceeds 150,000. In an AHCA area where the
308	Medicaid managed care pilot program is authorized under s.
309	409.91211 in one or more counties, the agency may procure a
310	contract with a single entity to serve the remaining counties as
311	an AHCA area or the remaining counties may be included with an
312	adjacent AHCA area and shall be subject to this paragraph.
313	Contracts for comprehensive behavioral health providers awarded
314	pursuant to this section shall be competitively procured. Both
315	for-profit and not-for-profit corporations shall be eligible to
316	compete. Managed care plans contracting with the agency under
317	subsection (3) shall provide and receive payment for the same
318	comprehensive behavioral health benefits as provided in AHCA
319	rules, including handbooks incorporated by reference. In AHCA
320	area 11, the agency shall contract with at least two
321	comprehensive behavioral health care providers to provide
322	behavioral health care to recipients in that area who are
323	enrolled in, or assigned to, the MediPass program. One of the
324	behavioral health care contracts shall be with the existing
325	provider service network pilot project, as described in
326	paragraph (d), for the purpose of demonstrating the cost-
327	effectiveness of the provision of quality mental health services
328	through a public hospital-operated managed care model. Payment
329	shall be at an agreed-upon capitated rate to ensure cost
330	savings. Of the recipients in area 11 who are assigned to
331	MediPass under the provisions of s. 409.9122(2)(k), A minimum of
332	50,000 of those MediPass-enrolled recipients shall be assigned
333	to the existing provider service network in area 11 for their
334	behavioral care.
335	4.  By October 1, 2003, the agency and the department shall
336	submit a plan to the Governor, the President of the Senate, and
337	the Speaker of the House of Representatives which provides for
338	the full implementation of capitated prepaid behavioral health
339	care in all areas of the state.
340	a.  Implementation shall begin in 2003 in those AHCA areas
341	of the state where the agency is able to establish sufficient
342	capitation rates.
343	b.  If the agency determines that the proposed capitation
344	rate in any area is insufficient to provide appropriate
345	services, the agency may adjust the capitation rate to ensure
346	that care will be available. The agency and the department may
347	use existing general revenue to address any additional required
348	match but may not over-obligate existing funds on an annualized
349	basis.
350	c.  Subject to any limitations provided for in the General
351	Appropriations Act, the agency, in compliance with appropriate
352	federal authorization, shall develop policies and procedures
353	that allow for certification of local and state funds.
354	5.  Children residing in a statewide inpatient psychiatric
355	program, or in a Department of Juvenile Justice or a Department
356	of Children and Family Services residential program approved as
357	a Medicaid behavioral health overlay services provider shall not
358	be included in a behavioral health care prepaid health plan or
359	any other Medicaid managed care plan pursuant to this paragraph.
360	6.  In converting to a prepaid system of delivery, the
361	agency shall in its procurement document require an entity
362	providing only comprehensive behavioral health care services to
363	prevent the displacement of indigent care patients by enrollees
364	in the Medicaid prepaid health plan providing behavioral health
365	care services from facilities receiving state funding to provide
366	indigent behavioral health care, to facilities licensed under
367	chapter 395 which do not receive state funding for indigent
368	behavioral health care, or reimburse the unsubsidized facility
369	for the cost of behavioral health care provided to the displaced
370	indigent care patient.
371	7.  Traditional community mental health providers under
372	contract with the Department of Children and Family Services
373	pursuant to part IV of chapter 394, child welfare providers
374	under contract with the Department of Children and Family
375	Services in areas 1 and 6, and inpatient mental health providers
376	licensed pursuant to chapter 395 must be offered an opportunity
377	to accept or decline a contract to participate in any provider
378	network for prepaid behavioral health services.
379	8.  For fiscal year 2004-2005, all Medicaid eligible
380	children, except children in areas 1 and 6, whose cases are open
381	for child welfare services in the HomeSafeNet system, shall be
382	enrolled in MediPass or in Medicaid fee-for-service and all
383	their behavioral health care services including inpatient,
384	outpatient psychiatric, community mental health, and case
385	management shall be reimbursed on a fee-for-service basis.
386	Beginning July 1, 2005, such children, who are open for child
387	welfare services in the HomeSafeNet system, shall receive their
388	behavioral health care services through a specialty prepaid plan
389	operated by community-based lead agencies either through a
390	single agency or formal agreements among several agencies. The
391	specialty prepaid plan must result in savings to the state
392	comparable to savings achieved in other Medicaid managed care
393	and prepaid programs. Such plan must provide mechanisms to
394	maximize state and local revenues. The specialty prepaid plan
395	shall be developed by the agency and the Department of Children
396	and Family Services. The agency is authorized to seek any
397	federal waivers to implement this initiative.
398	(c)  A federally qualified health center or an entity owned
399	by one or more federally qualified health centers or an entity
400	owned by other migrant and community health centers receiving
401	non-Medicaid financial support from the Federal Government to
402	provide health care services on a prepaid or fixed-sum basis to
403	recipients. A federally qualified health center or an entity
404	owned by one or more federally qualified health centers that is
405	reimbursed by the agency on a prepaid basis is exempt from parts
406	I and III of chapter 641 but must comply with the solvency
407	requirements in s. 641.2261(2) and meet the appropriate
408	requirements governing financial reserve, quality assurance, and
409	patients' rights established by the agency. Such prepaid health
410	care services entity must be licensed under parts I and III of
411	chapter 641, but shall be prohibited from serving Medicaid
412	recipients on a prepaid basis, until such licensure has been
413	obtained. However, such an entity is exempt from s. 641.225 if
414	the entity meets the requirements specified in subsections (17)
415	and (18).
416	(d)  A provider service network which may be reimbursed on
417	a fee-for-service or prepaid basis. A provider service network
418	which is reimbursed by the agency on a prepaid basis shall be
419	exempt from parts I and III of chapter 641, but must comply with
420	the solvency requirements in s. 641.2261(2) and meet appropriate
421	financial reserve, quality assurance, and patient rights
422	requirements as established by the agency. The agency shall
423	award contracts on a competitive bid basis and shall select
424	bidders based upon price and quality of care. Medicaid
425	recipients assigned to a provider service network demonstration
426	project shall be chosen equally from those who would otherwise
427	have been assigned to prepaid plans and MediPass. The agency is
428	authorized to seek federal Medicaid waivers as necessary to
429	implement the provisions of this section. Any contract
430	previously awarded to a provider service network operated by a
431	hospital pursuant to this subsection shall remain in effect for
432	a period of 3 years following the current contract expiration
433	date, regardless of any contractual provisions to the contrary.
434	A provider service network is a network established or organized
435	and operated by a health care provider, or group of affiliated
436	health care providers, including minority physician networks and
437	emergency room diversion programs that meet the requirements of
438	s. 409.91211, which provides a substantial proportion of the
439	health care items and services under a contract directly through
440	the provider or affiliated group of providers and may make
441	arrangements with physicians or other health care professionals,
442	health care institutions, or any combination of such individuals
443	or institutions to assume all or part of the financial risk on a
444	prospective basis for the provision of basic health services by
445	the physicians, by other health professionals, or through the
446	institutions. The health care providers must have a controlling
447	interest in the governing body of the provider service network
448	organization.
449	Section 4.  Section 409.91211, Florida Statutes, is amended
450	to read:
451	409.91211  Medicaid managed care pilot program.--
452	(1)(a)  The agency is authorized to seek experimental,
453	pilot, or demonstration project waivers, pursuant to s. 1115 of
454	the Social Security Act, to create a statewide initiative to
455	provide for a more efficient and effective service delivery
456	system that enhances quality of care and client outcomes in the
457	Florida Medicaid program pursuant to this section. Phase one of
458	the demonstration shall be implemented in two geographic areas.
459	One demonstration site shall include only Broward County. A
460	second demonstration site shall initially include Duval County
461	and shall be expanded to include Baker, Clay, and Nassau
462	Counties within 1 year after the Duval County program becomes
463	operational. This waiver authority is contingent upon federal
464	approval to preserve the upper-payment-limit funding mechanism
465	for hospitals, including a guarantee of a reasonable growth
466	factor, a methodology to allow the use of a portion of these
467	funds to serve as a risk pool for demonstration sites,
468	provisions to preserve the state's ability to use
469	intergovernmental transfers, and provisions to protect the
470	disproportionate share program authorized pursuant to this
471	chapter. Under the upper payment limit program, the hospital
472	disproportionate share program, or the low income pool as
473	implemented by the agency pursuant to federal waiver, the state
474	matching funds required for the program shall be provided by the
475	state and by local governmental entities through
476	intergovernmental transfers in accordance with published federal
477	statutes and regulations. The agency shall distribute funds from
478	the upper payment limit program, the hospital disproportionate
479	share program, and the low income pool in accordance with
480	published federal statutes, regulations, and waivers and the low
481	income pool methodology approved by the Centers for Medicare and
482	Medicaid Services. Upon completion of the evaluation conducted
483	under s. 3, ch. 2005-133, Laws of Florida, the agency may
484	request statewide expansion of the demonstration projects.
485	Statewide phase-in to additional counties shall be contingent
486	upon review and approval by the Legislature.
487	(b)  It is the intent of the Legislature that the low
488	income pool plan required by the terms and conditions of the
489	Medicaid reform waiver and submitted to the Centers for Medicare
490	and Medicaid Services propose the distribution of the program
491	funds in paragraph (a) based on the following objectives:
492	1.  Ensure a broad and fair distribution of available funds
493	based on the access provided by Medicaid participating
494	hospitals, regardless of their ownership status, through their
495	delivery of inpatient or outpatient care for Medicaid
496	beneficiaries and uninsured and underinsured individuals.
497	2.  Ensure accessible emergency inpatient and outpatient
498	care for Medicaid beneficiaries and uninsured and underinsured
499	individuals.
500	3.  Enhance primary, preventive, and other ambulatory care
501	coverages for uninsured individuals.
502	4.  Promote teaching and specialty hospital programs.
503	5.  Promote the stability and viability of statutorily
504	defined rural hospitals and hospitals that serve as sole
505	community hospitals.
506	6.  Recognize the extent of hospital uncompensated care
507	costs.
508	7.  Maintain and enhance essential community hospital care.
509	8.  Maintain incentives for local governmental entities to
510	contribute to the cost of uncompensated care.
511	9.  Promote measures to avoid preventable hospitalizations.
512	10.  Account for hospital efficiency.
513	11.  Contribute to a community's overall health system.
514	(2)  The Legislature intends for the capitated managed care
515	pilot program to:
516	(a)  Provide recipients in Medicaid fee-for-service or the
517	MediPass program a comprehensive and coordinated capitated
518	managed care system for all health care services specified in
519	ss. 409.905 and 409.906.
520	(b)  Stabilize Medicaid expenditures under the pilot
521	program compared to Medicaid expenditures in the pilot area for
522	the 3 years before implementation of the pilot program, while
523	ensuring:
524	1.  Consumer education and choice.
525	2.  Access to medically necessary services.
526	3.  Coordination of preventative, acute, and long-term
527	care.
528	4.  Reductions in unnecessary service utilization.
529	(c)  Provide an opportunity to evaluate the feasibility of
530	statewide implementation of capitated managed care networks as a
531	replacement for the current Medicaid fee-for-service and
532	MediPass systems.
533	(3)  The agency shall have the following powers, duties,
534	and responsibilities with respect to the development of a pilot
535	program:
536	(a)  To implement develop and recommend a system to deliver
537	all mandatory services specified in s. 409.905 and optional
538	services specified in s. 409.906, as approved by the Centers for
539	Medicare and Medicaid Services and the Legislature in the waiver
540	pursuant to this section. Services to recipients under plan
541	benefits shall include emergency services provided under s.
542	409.9128.
543	(b)  To implement a pilot program that includes recommend
544	Medicaid eligibility categories, from those specified in ss.
545	409.903 and 409.904 as authorized in an approved federal waiver,
546	which shall be included in the pilot program.
547	(c)  To implement determine and recommend how to design the
548	managed care pilot program that maximizes in order to take
549	maximum advantage of all available state and federal funds,
550	including those obtained through intergovernmental transfers,
551	the low income pool, supplemental Medicaid payments upper-
552	payment-level funding systems, and the disproportionate share
553	program. Within the parameters allowed by federal statute and
554	rule, the agency is authorized to seek options for making direct
555	payments to hospitals and physicians employed by or under
556	contract with the state's medical schools for the costs
557	associated with graduate medical education under Medicaid
558	reform.
559	(d)  To implement determine and recommend actuarially
560	sound, risk-adjusted capitation rates for Medicaid recipients in
561	the pilot program which can be separated to cover comprehensive
562	care, enhanced services, and catastrophic care.
563	(e)  To implement determine and recommend policies and
564	guidelines for phasing in financial risk for approved provider
565	service networks over a 3-year period. These policies and
566	guidelines shall include an option for a provider service
567	network to be paid to pay fee-for-service rates. For any
568	provider service network established in a managed care pilot
569	area, the option to be paid fee-for-service rates shall include
570	a savings-settlement mechanism that is consistent with s.
571	409.912(44) that may include a savings-settlement option for at
572	least 2 years. This model shall may be converted to a risk-
573	adjusted capitated rate no later than the beginning of the
574	fourth in the third year of operation and may be converted
575	earlier at the option of the provider service network. Federally
576	qualified health centers may be offered an opportunity to accept
577	or decline a contract to participate in any provider network for
578	prepaid primary care services.
579	(f)  To implement determine and recommend provisions
580	related to stop-loss requirements and the transfer of excess
581	cost to catastrophic coverage that accommodates the risks
582	associated with the development of the pilot program.
583	(g)  To determine and recommend a process to be used by the
584	Social Services Estimating Conference to determine and validate
585	the rate of growth of the per-member costs of providing Medicaid
586	services under the managed care pilot program.
587	(h)  To implement determine and recommend program standards
588	and credentialing requirements for capitated managed care
589	networks to participate in the pilot program, including those
590	related to fiscal solvency, quality of care, and adequacy of
591	access to health care providers. It is the intent of the
592	Legislature that, to the extent possible, any pilot program
593	authorized by the state under this section include any federally
594	qualified health center, any federally qualified rural health
595	clinic, county health department, the Division of Children's
596	Medical Services Network within the Department of Health, or any
597	other federally, state, or locally funded entity that serves the
598	geographic areas within the boundaries of the pilot program that
599	requests to participate. This paragraph does not relieve an
600	entity that qualifies as a capitated managed care network under
601	this section from any other licensure or regulatory requirements
602	contained in state or federal law which would otherwise apply to
603	the entity. The standards and credentialing requirements shall
604	be based upon, but are not limited to:
605	1.  Compliance with the accreditation requirements as
606	provided in s. 641.512.
607	2.  Compliance with early and periodic screening,
608	diagnosis, and treatment screening requirements under federal
609	law.
610	3.  The percentage of voluntary disenrollments.
611	4.  Immunization rates.
612	5.  Standards of the National Committee for Quality
613	Assurance and other approved accrediting bodies.
614	6.  Recommendations of other authoritative bodies.
615	7.  Specific requirements of the Medicaid program, or
616	standards designed to specifically meet the unique needs of
617	Medicaid recipients.
618	8.  Compliance with the health quality improvement system
619	as established by the agency, which incorporates standards and
620	guidelines developed by the Centers for Medicare and Medicaid
621	Services as part of the quality assurance reform initiative.
622	9.  The network's infrastructure capacity to manage
623	financial transactions, recordkeeping, data collection, and
624	other administrative functions.
625	10.  The network's ability to submit any financial,
626	programmatic, or patient-encounter data or other information
627	required by the agency to determine the actual services provided
628	and the cost of administering the plan.
629	(i)  To implement develop and recommend a mechanism for
630	providing information to Medicaid recipients for the purpose of
631	selecting a capitated managed care plan. For each plan available
632	to a recipient, the agency, at a minimum, shall ensure that the
633	recipient is provided with:
634	1.  A list and description of the benefits provided.
635	2.  Information about cost sharing.
636	3.  Plan performance data, if available.
637	4.  An explanation of benefit limitations.
638	5.  Contact information, including identification of
639	providers participating in the network, geographic locations,
640	and transportation limitations.
641	6.  Any other information the agency determines would
642	facilitate a recipient's understanding of the plan or insurance
643	that would best meet his or her needs.
644	(j)  To implement develop and recommend a system to ensure
645	that there is a record of recipient acknowledgment that choice
646	counseling has been provided.
647	(k)  To implement develop and recommend a choice counseling
648	system to ensure that the choice counseling process and related
649	material are designed to provide counseling through face-to-face
650	interaction, by telephone, and in writing and through other
651	forms of relevant media. Materials shall be written at the
652	fourth-grade reading level and available in a language other
653	than English when 5 percent of the county speaks a language
654	other than English. Choice counseling shall also use language
655	lines and other services for impaired recipients, such as
656	TTD/TTY.
657	(l)  To implement develop and recommend a system that
658	prohibits capitated managed care plans, their representatives,
659	and providers employed by or contracted with the capitated
660	managed care plans from recruiting persons eligible for or
661	enrolled in Medicaid, from providing inducements to Medicaid
662	recipients to select a particular capitated managed care plan,
663	and from prejudicing Medicaid recipients against other capitated
664	managed care plans. The system shall require the entity
665	performing choice counseling to determine if the recipient has
666	made a choice of a plan or has opted out because of duress,
667	threats, payment to the recipient, or incentives promised to the
668	recipient by a third party. If the choice counseling entity
669	determines that the decision to choose a plan was unlawfully
670	influenced or a plan violated any of the provisions of s.
671	409.912(21), the choice counseling entity shall immediately
672	report the violation to the agency's program integrity section
673	for investigation. Verification of choice counseling by the
674	recipient shall include a stipulation that the recipient
675	acknowledges the provisions of this subsection.
676	(m)  To implement develop and recommend a choice counseling
677	system that promotes health literacy and provides information
678	aimed to reduce minority health disparities through outreach
679	activities for Medicaid recipients.
680	(n)  To develop and recommend a system for the agency to
681	contract with entities to perform choice counseling. The agency
682	may establish standards and performance contracts, including
683	standards requiring the contractor to hire choice counselors who
684	are representative of the state's diverse population and to
685	train choice counselors in working with culturally diverse
686	populations.
687	(o)  To implement determine and recommend descriptions of
688	the eligibility assignment processes which will be used to
689	facilitate client choice while ensuring pilot programs of
690	adequate enrollment levels. These processes shall ensure that
691	pilot sites have sufficient levels of enrollment to conduct a
692	valid test of the managed care pilot program within a 2-year
693	timeframe.
694	(p)  To implement standards for plan compliance, including,
695	but not limited to, quality assurance and performance
696	improvement standards, peer or professional review standards,
697	grievance policies, and program integrity policies.
698	(q)  To develop a data reporting system, seek input from
699	managed care plans to establish patient-encounter reporting
700	requirements, and ensure that the data reported is accurate and
701	complete.
702	(r)  To work with managed care plans to establish a uniform
703	system to measure and monitor outcomes of a recipient of
704	Medicaid services which shall use financial, clinical, and other
705	criteria based on pharmacy services, medical services, and other
706	data related to the provision of Medicaid services, including,
707	but not limited to:
708	1.  Health Plan Employer Data and Information Set (HEDIS)
709	or HEDIS measures specific to Medicaid.
710	2.  Member satisfaction.
711	3.  Provider satisfaction.
712	4.  Report cards on plan performance and best practices.
713	5.  Compliance with the prompt payment of claims
714	requirements provided in ss. 627.613, 641.3155, and 641.513.
715	6.  Utilization and quality data for the purpose of
716	ensuring access to medically necessary services, including
717	underutilization or inappropriate denial of services.
718	(s)  To require managed care plans that have contracted
719	with the agency to establish a quality assurance system that
720	incorporates the provisions of s. 409.912(27) and any standards,
721	rules, and guidelines developed by the agency.
722	(t)  To establish a patient-encounter database to compile
723	data on health care services rendered by health care
724	practitioners that provide services to patients enrolled in
725	managed care plans in the demonstration sites. Health care
726	practitioners and facilities in the demonstration sites shall
727	submit, and managed care plans participating in the
728	demonstration sites shall receive, claims payment and any other
729	information reasonably related to the patient-encounter database
730	electronically in a standard format as required by the agency.
731	The agency shall establish reasonable deadlines for phasing in
732	the electronic transmittal of full-encounter data. The patient-
733	encounter database shall:
734	1.  Collect the following information, if applicable, for
735	each type of patient encounter with a health care practitioner
736	or facility, including:
737	a.  The demographic characteristics of the patient.
738	b.  The principal, secondary, and tertiary diagnosis.
739	c.  The procedure performed.
740	d.  The date when and the location where the procedure was
741	performed.
742	e.  The amount of the payment for the procedure.
743	f.  The health care practitioner's universal identification
744	number.
745	g.  If the health care practitioner rendering the service
746	is a dependent practitioner, the modifiers appropriate to
747	indicate that the service was delivered by the dependent
748	practitioner.
749	2.  Collect appropriate information relating to
750	prescription drugs for each type of patient encounter.
751	3.  Collect appropriate information related to health care
752	costs and utilization from managed care plans participating in
753	the demonstration sites. To the extent practicable, the agency
754	shall utilize a standardized claim form or electronic transfer
755	system that is used by health care practitioners, facilities,
756	and payors. To develop and recommend a system to monitor the
757	provision of health care services in the pilot program,
758	including utilization and quality of health care services for
759	the purpose of ensuring access to medically necessary services.
760	This system shall include an encounter data-information system
761	that collects and reports utilization information. The system
762	shall include a method for verifying data integrity within the
763	database and within the provider's medical records.
764	(u)(q)  To implement recommend a grievance resolution
765	process for Medicaid recipients enrolled in a capitated managed
766	care network under the pilot program modeled after the
767	subscriber assistance panel, as created in s. 408.7056. This
768	process shall include a mechanism for an expedited review of no
769	greater than 24 hours after notification of a grievance if the
770	life of a Medicaid recipient is in imminent and emergent
771	jeopardy.
772	(v)(r)  To implement recommend a grievance resolution
773	process for health care providers employed by or contracted with
774	a capitated managed care network under the pilot program in
775	order to settle disputes among the provider and the managed care
776	network or the provider and the agency.
777	(w)(s)  To implement develop and recommend criteria in an
778	approved federal waiver to designate health care providers as
779	eligible to participate in the pilot program. The agency and
780	capitated managed care networks must follow national guidelines
781	for selecting health care providers, whenever available. These
782	criteria must include at a minimum those criteria specified in
783	s. 409.907.
784	(x)(t)  To use develop and recommend health care provider
785	agreements for participation in the pilot program.
786	(y)(u)  To require that all health care providers under
787	contract with the pilot program be duly licensed in the state,
788	if such licensure is available, and meet other criteria as may
789	be established by the agency. These criteria shall include at a
790	minimum those criteria specified in s. 409.907.
791	(z)(v)  To ensure that managed care organizations work
792	collaboratively develop and recommend agreements with other
793	state or local governmental programs or institutions for the
794	coordination of health care to eligible individuals receiving
795	services from such programs or institutions.
796	(aa)(w)  To implement procedures to minimize the risk of
797	Medicaid fraud and abuse in all plans operating in the Medicaid
798	managed care pilot program authorized in this section:
799	1.  The agency shall ensure that applicable provisions of
800	chapters 409, 414, 626, 641, and 932, relating to Medicaid fraud
801	and abuse, are applied and enforced at the demonstration sites.
802	2.  Providers shall have the necessary certification,
803	license, and credentials required by law and federal waiver.
804	3.  The agency shall ensure that the plan is in compliance
805	with the provisions of s. 409.912(21) and (22).
806	4.  The agency shall require each plan to establish program
807	integrity functions and activities to reduce the incidence of
808	fraud and abuse. Plans must report instances of fraud and abuse
809	pursuant to chapter 641.
810	5.  The plan shall have written administrative and
811	management procedures, including a mandatory compliance plan,
812	that are designed to guard against fraud and abuse. The plan
813	shall designate a compliance officer with sufficient experience
814	in health care.
815	6.a.  The agency shall require all managed care plan
816	contractors in the pilot program to report all instances of
817	suspected fraud and abuse. A failure to report instances of
818	suspected fraud and abuse is a violation of law and subject to
819	the penalties provided by law.
820	b.  An instance of fraud and abuse in the managed care
821	plan, including, but not limited to, defrauding the state health
822	care benefit program by misrepresentation of fact in reports,
823	claims, certifications, enrollment claims, demographic
824	statistics, and patient-encounter data; misrepresentation of the
825	qualifications of persons rendering health care and ancillary
826	services; bribery and false statements relating to the delivery
827	of health care; unfair and deceptive marketing practices; and
828	managed care false claims actions, is a violation of law and
829	subject to the penalties provided by law.
830	c.  The agency shall require all contractors to make all
831	files and relevant billing and claims data accessible to state
832	regulators and investigators and all such data shall be linked
833	into a unified system for seamless reviews and investigations.
834	To develop and recommend a system to oversee the activities of
835	pilot program participants, health care providers, capitated
836	managed care networks, and their representatives in order to
837	prevent fraud or abuse, overutilization or duplicative
838	utilization, underutilization or inappropriate denial of
839	services, and neglect of participants and to recover
840	overpayments as appropriate. For the purposes of this paragraph,
841	the terms "abuse" and "fraud" have the meanings as provided in
842	s. 409.913. The agency must refer incidents of suspected fraud,
843	abuse, overutilization and duplicative utilization, and
844	underutilization or inappropriate denial of services to the
845	appropriate regulatory agency.
846	(bb)(x)  To develop and provide actuarial and benefit
847	design analyses that indicate the effect on capitation rates and
848	benefits offered in the pilot program over a prospective 5-year
849	period based on the following assumptions:
850	1.  Growth in capitation rates which is limited to the
851	estimated growth rate in general revenue.
852	2.  Growth in capitation rates which is limited to the
853	average growth rate over the last 3 years in per-recipient
854	Medicaid expenditures.
855	3.  Growth in capitation rates which is limited to the
856	growth rate of aggregate Medicaid expenditures between the 2003-
857	2004 fiscal year and the 2004-2005 fiscal year.
858	(cc)(y)  To develop a mechanism to require capitated
859	managed care plans to reimburse qualified emergency service
860	providers, including, but not limited to, ambulance services, in
861	accordance with ss. 409.908 and 409.9128. The pilot program must
862	include a provision for continuing fee-for-service payments for
863	emergency services, including, but not limited to, individuals
864	who access ambulance services or emergency departments and who
865	are subsequently determined to be eligible for Medicaid
866	services.
867	(dd)(z)  To ensure develop a system whereby school
868	districts participating in the certified school match program
869	pursuant to ss. 409.908(21) and 1011.70 shall be reimbursed by
870	Medicaid, subject to the limitations of s. 1011.70(1), for a
871	Medicaid-eligible child participating in the services as
872	authorized in s. 1011.70, as provided for in s. 409.9071,
873	regardless of whether the child is enrolled in a capitated
874	managed care network. Capitated managed care networks must make
875	a good faith effort to execute agreements with school districts
876	regarding the coordinated provision of services authorized under
877	s. 1011.70. County health departments and federally qualified
878	health centers delivering school-based services pursuant to ss.
879	381.0056 and 381.0057 must be reimbursed by Medicaid for the
880	federal share for a Medicaid-eligible child who receives
881	Medicaid-covered services in a school setting, regardless of
882	whether the child is enrolled in a capitated managed care
883	network. Capitated managed care networks must make a good faith
884	effort to execute agreements with county health departments
885	regarding the coordinated provision of services to a Medicaid-
886	eligible child. To ensure continuity of care for Medicaid
887	patients, the agency, the Department of Health, and the
888	Department of Education shall develop procedures for ensuring
889	that a student's capitated managed care network provider
890	receives information relating to services provided in accordance
891	with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
892	(ee)(aa)  To implement develop and recommend a mechanism
893	whereby Medicaid recipients who are already enrolled in a
894	managed care plan or the MediPass program in the pilot areas
895	shall be offered the opportunity to change to capitated managed
896	care plans on a staggered basis, as defined by the agency. All
897	Medicaid recipients shall have 30 days in which to make a choice
898	of capitated managed care plans. Those Medicaid recipients who
899	do not make a choice shall be assigned to a capitated managed
900	care plan in accordance with paragraph (4)(a) and shall be
901	exempt from s. 409.9122. To facilitate continuity of care for a
902	Medicaid recipient who is also a recipient of Supplemental
903	Security Income (SSI), prior to assigning the SSI recipient to a
904	capitated managed care plan, the agency shall determine whether
905	the SSI recipient has an ongoing relationship with a provider or
906	capitated managed care plan, and, if so, the agency shall assign
907	the SSI recipient to that provider or capitated managed care
908	plan where feasible. Those SSI recipients who do not have such a
909	provider relationship shall be assigned to a capitated managed
910	care plan provider in accordance with paragraph (4)(a) and shall
911	be exempt from s. 409.9122.
912	(ff)(bb)  To develop and recommend a service delivery
913	alternative for children having chronic medical conditions which
914	establishes a medical home project to provide primary care
915	services to this population. The project shall provide
916	community-based primary care services that are integrated with
917	other subspecialties to meet the medical, developmental, and
918	emotional needs for children and their families. This project
919	shall include an evaluation component to determine impacts on
920	hospitalizations, length of stays, emergency room visits, costs,
921	and access to care, including specialty care and patient and
922	family satisfaction.
923	(gg)(cc)  To develop and recommend service delivery
924	mechanisms within capitated managed care plans to provide
925	Medicaid services as specified in ss. 409.905 and 409.906 to
926	persons with developmental disabilities sufficient to meet the
927	medical, developmental, and emotional needs of these persons.
928	(hh)(dd)  To develop and recommend service delivery
929	mechanisms within capitated managed care plans to provide
930	Medicaid services as specified in ss. 409.905 and 409.906 to
931	Medicaid-eligible children in foster care. These services must
932	be coordinated with community-based care providers as specified
933	in s. 409.1675, where available, and be sufficient to meet the
934	medical, developmental, and emotional needs of these children.
935	(4)(a)  A Medicaid recipient in the pilot area who is not
936	currently enrolled in a capitated managed care plan upon
937	implementation is not eligible for services as specified in ss.
938	409.905 and 409.906, for the amount of time that the recipient
939	does not enroll in a capitated managed care network. If a
940	Medicaid recipient has not enrolled in a capitated managed care
941	plan within 30 days after eligibility, the agency shall assign
942	the Medicaid recipient to a capitated managed care plan based on
943	the assessed needs of the recipient as determined by the agency
944	and shall be exempt from s. 409.9122. When making assignments,
945	the agency shall take into account the following criteria:
946	1.  A capitated managed care network has sufficient network
947	capacity to meet the needs of members.
948	2.  The capitated managed care network has previously
949	enrolled the recipient as a member, or one of the capitated
950	managed care network's primary care providers has previously
951	provided health care to the recipient.
952	3.  The agency has knowledge that the member has previously
953	expressed a preference for a particular capitated managed care
954	network as indicated by Medicaid fee-for-service claims data,
955	but has failed to make a choice.
956	4.  The capitated managed care network's primary care
957	providers are geographically accessible to the recipient's
958	residence.
959	(b)  When more than one capitated managed care network
960	provider meets the criteria specified in paragraph (3)(h), the
961	agency shall make recipient assignments consecutively by family
962	unit.
963	(c)  If a recipient is currently enrolled with a Medicaid
964	managed care organization that also operates an approved reform
965	plan within a pilot area and the recipient fails to choose a
966	plan during the reform enrollment process or during
967	redetermination of eligibility, the recipient shall be
968	automatically assigned by the agency into the most appropriate
969	reform plan operated by the recipient's current Medicaid managed
970	care organization. If the recipient's current managed care
971	organization does not operate a reform plan in the pilot area
972	that adequately meets the needs of the Medicaid recipient, the
973	agency shall use the auto assignment process as prescribed in
974	the Centers for Medicare and Medicaid Services Special Terms and
975	Conditions number 11-W-00206/4. All agency enrollment and choice
976	counseling materials shall communicate the provisions of this
977	paragraph to current managed care recipients.
978	(d)(c)  The agency may not engage in practices that are
979	designed to favor one capitated managed care plan over another
980	or that are designed to influence Medicaid recipients to enroll
981	in a particular capitated managed care network in order to
982	strengthen its particular fiscal viability.
983	(e)(d)  After a recipient has made a selection or has been
984	enrolled in a capitated managed care network, the recipient
985	shall have 90 days in which to voluntarily disenroll and select
986	another capitated managed care network. After 90 days, no
987	further changes may be made except for cause. Cause shall
988	include, but not be limited to, poor quality of care, lack of
989	access to necessary specialty services, an unreasonable delay or
990	denial of service, inordinate or inappropriate changes of
991	primary care providers, service access impairments due to
992	significant changes in the geographic location of services, or
993	fraudulent enrollment. The agency may require a recipient to use
994	the capitated managed care network's grievance process as
995	specified in paragraph (3)(g) prior to the agency's
996	determination of cause, except in cases in which immediate risk
997	of permanent damage to the recipient's health is alleged. The
998	grievance process, when used, must be completed in time to
999	permit the recipient to disenroll no later than the first day of
1000	the second month after the month the disenrollment request was
1001	made. If the capitated managed care network, as a result of the
1002	grievance process, approves an enrollee's request to disenroll,
1003	the agency is not required to make a determination in the case.
1004	The agency must make a determination and take final action on a
1005	recipient's request so that disenrollment occurs no later than
1006	the first day of the second month after the month the request
1007	was made. If the agency fails to act within the specified
1008	timeframe, the recipient's request to disenroll is deemed to be
1009	approved as of the date agency action was required. Recipients
1010	who disagree with the agency's finding that cause does not exist
1011	for disenrollment shall be advised of their right to pursue a
1012	Medicaid fair hearing to dispute the agency's finding.
1013	(f)(e)  The agency shall apply for federal waivers from the
1014	Centers for Medicare and Medicaid Services to lock eligible
1015	Medicaid recipients into a capitated managed care network for 12
1016	months after an open enrollment period. After 12 months of
1017	enrollment, a recipient may select another capitated managed
1018	care network. However, nothing shall prevent a Medicaid
1019	recipient from changing primary care providers within the
1020	capitated managed care network during the 12-month period.
1021	(g)(f)  The agency shall apply for federal waivers from the
1022	Centers for Medicare and Medicaid Services to allow recipients
1023	to purchase health care coverage through an employer-sponsored
1024	health insurance plan instead of through a Medicaid-certified
1025	plan. This provision shall be known as the opt-out option.
1026	1.  A recipient who chooses the Medicaid opt-out option
1027	shall have an opportunity for a specified period of time, as
1028	authorized under a waiver granted by the Centers for Medicare
1029	and Medicaid Services, to select and enroll in a Medicaid-
1030	certified plan. If the recipient remains in the employer-
1031	sponsored plan after the specified period, the recipient shall
1032	remain in the opt-out program for at least 1 year or until the
1033	recipient no longer has access to employer-sponsored coverage,
1034	until the employer's open enrollment period for a person who
1035	opts out in order to participate in employer-sponsored coverage,
1036	or until the person is no longer eligible for Medicaid,
1037	whichever time period is shorter.
1038	2.  Notwithstanding any other provision of this section,
1039	coverage, cost sharing, and any other component of employer-
1040	sponsored health insurance shall be governed by applicable state
1041	and federal laws.
1042	(5)  This section does not authorize the agency to
1043	implement any provision of s. 1115 of the Social Security Act
1044	experimental, pilot, or demonstration project waiver to reform
1045	the state Medicaid program in any part of the state other than
1046	the two geographic areas specified in this section unless
1047	approved by the Legislature.
1048	(5)(6)  The agency shall develop and submit for approval
1049	applications for waivers of applicable federal laws and
1050	regulations as necessary to implement the managed care pilot
1051	project as defined in this section. The agency shall post all
1052	waiver applications under this section on its Internet website
1053	30 days before submitting the applications to the United States
1054	Centers for Medicare and Medicaid Services. All waiver
1055	applications shall be provided for review and comment to the
1056	appropriate committees of the Senate and House of
1057	Representatives for at least 10 working days prior to
1058	submission. All waivers submitted to and approved by the United
1059	States Centers for Medicare and Medicaid Services under this
1060	section must be approved by the Legislature. Federally approved
1061	waivers must be submitted to the President of the Senate and the
1062	Speaker of the House of Representatives for referral to the
1063	appropriate legislative committees. The appropriate committees
1064	shall recommend whether to approve the implementation of any
1065	waivers to the Legislature as a whole. The agency shall submit a
1066	plan containing a recommended timeline for implementation of any
1067	waivers and budgetary projections of the effect of the pilot
1068	program under this section on the total Medicaid budget for the
1069	2006-2007 through 2009-2010 state fiscal years. This
1070	implementation plan shall be submitted to the President of the
1071	Senate and the Speaker of the House of Representatives at the
1072	same time any waivers are submitted for consideration by the
1073	Legislature. The agency is authorized to implement the waiver
1074	and Centers for Medicare and Medicaid Services Special Terms and
1075	Conditions number 11-W-00206/4. If the agency seeks approval by
1076	the Federal Government of any modifications to these special
1077	terms and conditions, the agency shall provide written
1078	notification of its intent to modify these terms and conditions
1079	to the President of the Senate and Speaker of the House of
1080	Representatives at least 15 days prior to submitting the
1081	modifications to the Federal Government for consideration. The
1082	notification shall identify all modifications being pursued and
1083	the reason they are needed. Upon receiving federal approval of
1084	any modifications to the special terms and conditions, the
1085	agency shall report to the Legislature describing the federally
1086	approved modifications to the special terms and conditions
1087	within 7 days after their approval by the Federal Government.
1088	(6)(7)  Upon review and approval of the applications for
1089	waivers of applicable federal laws and regulations to implement
1090	the managed care pilot program by the Legislature, the agency
1091	may initiate adoption of rules pursuant to ss. 120.536(1) and
1092	120.54 to implement and administer the managed care pilot
1093	program as provided in this section.
1094	(7)(a)  The Secretary of Health Care Administration shall
1095	convene a technical advisory panel to advise the agency in the
1096	following areas:  risk-adjusted rate setting, benefit design,
1097	and choice counseling. The panel shall include representatives
1098	from the Florida Association of Health Plans, representatives
1099	from provider-sponsored networks, and a representative from the
1100	Office of Insurance Regulation.
1101	(b)  The technical advisory panel shall advise the agency
1102	on the following:
1103	1.  The risk-adjusted rate methodology to be used by the
1104	agency including recommendations on mechanisms to recognize the
1105	risk of all Medicaid enrollees and transitioning to a risk-
1106	adjustment system, including recommendations for phasing in risk
1107	adjustment and the uses of risk corridors.
1108	2.  Implementation of an encounter data system to be used
1109	for risk-adjusted rates.
1110	3.  Administrative and implementation issues regarding the
1111	use of risk-adjusted rates, including, but not limited to, cost,
1112	simplicity, client privacy, data accuracy, and data exchange.
1113	4.  Benefit design issues, including the actuarial
1114	equivalence and sufficiency standards to be used.
1115	5.  The implementation plan for the proposed choice
1116	counseling system, including the information and materials to be
1117	provided to recipients, the methodologies by which recipients
1118	will be counseled regarding choices, criteria to be used to
1119	assess plan quality, the methodology to be used to assign
1120	recipients to plans if they fail to choose a managed care plan,
1121	and the standards to be used for responsiveness to recipient
1122	inquiries.
1123	(c)  The technical advisory panel shall continue in
1124	existence and advise the secretary on matters outlined in this
1125	subsection.
1126	(8)  The agency must ensure in the first 2 state fiscal
1127	years in which a risk-adjusted methodology is a component of
1128	rate setting that no managed care plan providing comprehensive
1129	benefits to TANF and SSI recipients has an aggregate risk score
1130	that varies by more than 10 percent from the aggregate weighted
1131	mean of all managed care plans providing comprehensive benefits
1132	to TANF and SSI recipients in a reform area. The agency's
1133	payment to a managed care plan shall be based on such revised
1134	aggregate risk score.
1135	(9)  After any calculations of aggregate risk scores or
1136	revised aggregate risk scores pursuant to subsection (8), the
1137	capitation rates for plans participating under 409.91211 shall
1138	be phased in as follows:
1139	(a)  In the first fiscal year, the capitation rates shall
1140	be weighted so that 75 percent of each capitation rate is based
1141	on the current methodology and 25 percent is based upon a new
1142	risk-adjusted capitation rate methodology.
1143	(b)  In the second fiscal year, the capitation rates shall
1144	be weighted so that 50 percent of each capitation rate is based
1145	on the current methodology and 50 percent is based on a new
1146	risk-adjusted rate methodology.
1147	(c)  In the following fiscal year, the risk-adjusted
1148	capitation methodology may be fully implemented.
1149	(10)  Subsections (8) and (9) shall not apply to managed
1150	care plans offering benefits exclusively to high-risk, specialty
1151	populations. The agency shall have the discretion to set risk-
1152	adjusted rates immediately for said plans.
1153	(11)  Prior to the implementation of risk-adjusted rates,
1154	rates shall be certified by an actuary and approved by the
1155	federal Centers for Medicare and Medicaid Services.
1156	(12)  For purposes of this section, the term "capitated
1157	managed care plan" includes health insurers authorized under
1158	chapter 624, exclusive provider organizations authorized under
1159	chapter 627, health maintenance organizations authorized under
1160	chapter 641, the Children's Medical Services Network authorized
1161	under chapter 391, and provider service networks that elect to
1162	be paid fee-for-service for up to 3 years as authorized under
1163	this section.
1164	(13)  It is the intent of the Legislature that if any
1165	conflict exists between the provisions contained in this section
1166	and other provisions of chapter 409, as they relate to
1167	implementation of the Medicaid managed care pilot program, the
1168	provisions contained in this section shall control. The agency
1169	shall provide a written report to the President of the Senate
1170	and the Speaker of the House of Representatives by April 1,
1171	2006, identifying any provisions of chapter 409 that conflict
1172	with the implementation of the Medicaid managed care pilot
1173	program as created in this section. After April 1, 2006, the
1174	agency shall provide a written report to the President of the
1175	Senate and the Speaker of the House of Representatives
1176	immediately upon identifying any provisions of chapter 409 that
1177	conflict with the implementation of the Medicaid managed care
1178	pilot program as created in this section.
1179	Section 5.  Section 409.91212, Florida Statutes, is created
1180	to read:
1181	409.91212  Medicaid reform demonstration program
1182	expansion.--
1183	(1)  The agency may expand the Medicaid reform
1184	demonstration program pursuant to s. 409.91211 into any county
1185	of the state beginning in year two of the demonstration program
1186	if readiness criteria are met, the Joint Legislative Committee
1187	on Medicaid Reform Implementation has submitted a recommendation
1188	pursuant to s. 11.72 regarding the extent to which the criteria
1189	have been met, and the agency has secured budget approval from
1190	the Legislative Budget Commission pursuant to s. 11.90. For the
1191	purpose of this section, the term "readiness" means there is
1192	evidence that at least two programs in a county meet the
1193	following criteria:
1194	(a)  Demonstrate knowledge and understanding of managed
1195	care under the framework of Medicaid reform.
1196	(b)  Demonstrate financial capability to meet solvency
1197	standards.
1198	(c)  Demonstrate adequate controls and process for
1199	financial management.
1200	(d)  Demonstrate the capability for clinical management of
1201	Medicaid recipients.
1202	(e)  Demonstrate the adequacy, capacity, and accessibility
1203	of the services network.
1204	(f)  Demonstrate the capability to operate a management
1205	information system and an encounter data system.
1206	(g)  Demonstrate capability to implement quality assurance
1207	and utilization management activities.
1208	(h)  Demonstrate capability to implement fraud control
1209	activities.
1210	(2)  The agency shall conduct meetings and public hearings
1211	in the targeted expansion county with the public and provider
1212	community. The agency shall provide notice regarding public
1213	hearings. The agency shall maintain records of the proceedings.
1214	(3)  The agency shall provide a 30-day notice of intent to
1215	expand the demonstration program with supporting documentation
1216	that the readiness criteria has been met to the President of the
1217	Senate, the Speaker of the House of Representatives, the
1218	Minority Leader of the Senate, the Minority Leader of the House
1219	of Representatives, and the Office of Program Policy Analysis
1220	and Government Accountability.
1221	(4)  The agency shall request a hearing and consideration
1222	by the Joint Legislative Committee on Medicaid Reform
1223	Implementation after the 30-day notice required in subsection
1224	(3) has expired in the form of a letter to the chair of the
1225	committee.
1226	(5)  Upon receiving a memorandum from the Joint Legislative
1227	Committee on Medicaid Reform Implementation regarding the extent
1228	to which the expansion criteria pursuant to subsection (1) have
1229	been met, the agency may submit a budget amendment, pursuant to
1230	chapter 216, to request the necessary budget transfers
1231	associated with the expansion of the demonstration program.
1232	Section 6.  Paragraphs (f), (k), and (l) of subsection (2)
1233	of section 409.9122, Florida Statutes, are amended to read:
1234	409.9122  Mandatory Medicaid managed care enrollment;
1235	programs and procedures.--
1236	(2)
1237	(f)  When an eligible a Medicaid recipient does not choose
1238	a managed care plan or MediPass provider, the agency shall
1239	assign the Medicaid recipient to a managed care plan or MediPass
1240	provider according to the following provisions:
1241	1.  Effective January 1, 2006, Medicaid recipients who are
1242	subject to mandatory Medicaid managed care enrollment but who
1243	fail to make a choice shall be assigned to Medicaid managed care
1244	plans until not less than 75 percent of all Medicaid recipients
1245	eligible to choose managed care are enrolled in managed care
1246	plans. When that percentage is achieved, assignment of Medicaid
1247	recipients who fail to make a choice shall be based
1248	proportionally each period on the preferences of recipients who
1249	made a choice in the previous period. Such proportions shall be
1250	revised at least quarterly to reflect an update of the
1251	preferences of Medicaid recipients. Members of managed care
1252	plans operating under the provisions of s. 409.91211 shall not
1253	be included in the percentage calculation.
1254	2.  Effective July 1, 2007, Medicaid recipients who are
1255	subject to mandatory Medicaid managed care enrollment but who
1256	fail to make a choice shall be assigned to managed care plans.
1257	3.  For purposes of this paragraph, when referring to
1258	assignment, the term "managed care plans" includes health
1259	maintenance organizations, exclusive provider organizations,
1260	provider service networks, minority physician networks, the
1261	Children's Medical Services Network, and pediatric emergency
1262	department diversion programs authorized by this chapter or the
1263	General Appropriations Act.
1264	4.  In counties in which there are no managed care plans
1265	that accept Medicaid enrollees, assignment shall be to a
1266	MediPass provider.
1267	5.  When assigning Medicaid recipients who fail to make a
1268	choice, the agency shall take into account the following
1269	criteria:
1270	a.  Network capacity is sufficient to meet the needs of
1271	members.
1272	b.  The recipient has an enrollment history with a managed
1273	care plan or a treatment history with one of the primary care
1274	providers within a managed care plan.
1275	c.  The agency has knowledge that the member has previously
1276	expressed a preference for a particular managed care plan but
1277	has failed to make a choice.
1278	d.  Primary care providers and specialists are
1279	geographically accessible to the recipient's residence. Medicaid
1280	recipients who are subject to mandatory assignment but who fail
1281	to make a choice shall be assigned to managed care plans until
1282	an enrollment of 40 percent in MediPass and 60 percent in
1283	managed care plans is achieved. Once this enrollment is
1284	achieved, the assignments shall be divided in order to maintain
1285	an enrollment in MediPass and managed care plans which is in a
1286	40 percent and 60 percent proportion, respectively. Thereafter,
1287	assignment of Medicaid recipients who fail to make a choice
1288	shall be based proportionally on the preferences of recipients
1289	who have made a choice in the previous period. Such proportions
1290	shall be revised at least quarterly to reflect an update of the
1291	preferences of Medicaid recipients. The agency shall
1292	disproportionately assign Medicaid-eligible recipients who are
1293	required to but have failed to make a choice of managed care
1294	plan or MediPass, including children, and who are to be assigned
1295	to the MediPass program to children's networks as described in
1296	s. 409.912(4)(g), Children's Medical Services Network as defined
1297	in s. 391.021, exclusive provider organizations, provider
1298	service networks, minority physician networks, and pediatric
1299	emergency department diversion programs authorized by this
1300	chapter or the General Appropriations Act, in such manner as the
1301	agency deems appropriate, until the agency has determined that
1302	the networks and programs have sufficient numbers to be
1303	economically operated. For purposes of this paragraph, when
1304	referring to assignment, the term "managed care plans" includes
1305	health maintenance organizations, exclusive provider
1306	organizations, provider service networks, minority physician
1307	networks, Children's Medical Services Network, and pediatric
1308	emergency department diversion programs authorized by this
1309	chapter or the General Appropriations Act. When making
1310	assignments, the agency shall take into account the following
1311	criteria:
1312	1.  A managed care plan has sufficient network capacity to
1313	meet the need of members.
1314	2.  The managed care plan or MediPass has previously
1315	enrolled the recipient as a member, or one of the managed care
1316	plan's primary care providers or MediPass providers has
1317	previously provided health care to the recipient.
1318	3.  The agency has knowledge that the member has previously
1319	expressed a preference for a particular managed care plan or
1320	MediPass provider as indicated by Medicaid fee-for-service
1321	claims data, but has failed to make a choice.
1322	4.  The managed care plan's or MediPass primary care
1323	providers are geographically accessible to the recipient's
1324	residence.
1325	(k)  When a Medicaid recipient does not choose a managed
1326	care plan or MediPass provider, the agency shall assign the
1327	Medicaid recipient to a managed care plan, except in those
1328	counties in which there are fewer than two managed care plans
1329	accepting Medicaid enrollees, in which case assignment shall be
1330	to a managed care plan or a MediPass provider. Medicaid
1331	recipients in counties with fewer than two managed care plans
1332	accepting Medicaid enrollees who are subject to mandatory
1333	assignment but who fail to make a choice shall be assigned to
1334	managed care plans until an enrollment of 40 percent in MediPass
1335	and 60 percent in managed care plans is achieved. Once that
1336	enrollment is achieved, the assignments shall be divided in
1337	order to maintain an enrollment in MediPass and managed care
1338	plans which is in a 40 percent and 60 percent proportion,
1339	respectively. In service areas 1 and 6 of the Agency for Health
1340	Care Administration where the agency is contracting for the
1341	provision of comprehensive behavioral health services through a
1342	capitated prepaid arrangement, recipients who fail to make a
1343	choice shall be assigned equally to MediPass or a managed care
1344	plan. For purposes of this paragraph, when referring to
1345	assignment, the term "managed care plans" includes exclusive
1346	provider organizations, provider service networks, Children's
1347	Medical Services Network, minority physician networks, and
1348	pediatric emergency department diversion programs authorized by
1349	this chapter or the General Appropriations Act. When making
1350	assignments, the agency shall take into account the following
1351	criteria:
1352	1.  A managed care plan has sufficient network capacity to
1353	meet the need of members.
1354	2.  The managed care plan or MediPass has previously
1355	enrolled the recipient as a member, or one of the managed care
1356	plan's primary care providers or MediPass providers has
1357	previously provided health care to the recipient.
1358	3.  The agency has knowledge that the member has previously
1359	expressed a preference for a particular managed care plan or
1360	MediPass provider as indicated by Medicaid fee-for-service
1361	claims data, but has failed to make a choice.
1362	4.  The managed care plan's or MediPass primary care
1363	providers are geographically accessible to the recipient's
1364	residence.
1365	5.  The agency has authority to make mandatory assignments
1366	based on quality of service and performance of managed care
1367	plans.
1368	(k)(l)  Notwithstanding the provisions of chapter 287, the
1369	agency may, at its discretion, renew cost-effective contracts
1370	for choice counseling services once or more for such periods as
1371	the agency may decide. However, all such renewals may not
1372	combine to exceed a total period longer than the term of the
1373	original contract.
1374	Section 7.  The Agency for Health Care Administration shall
1375	report to the Legislature by April 1, 2006, the specific
1376	preimplementation milestones required by the Centers for
1377	Medicare and Medicaid Services Special Terms and Conditions
1378	related to the low income pool that have been approved by the
1379	Federal Government and the status of any remaining
1380	preimplementation milestones that have not been approved by the
1381	Federal Government.
1382	Section 8.  Quarterly progress and annual reports.--The
1383	Agency for Health Care Administration shall submit to the
1384	Governor, the President of the Senate, the Speaker of the House
1385	of Representatives, the Minority Leader of the Senate, the
1386	Minority Leader of the House of Representatives, and the Office
1387	of Program Policy Analysis and Government Accountability the
1388	following reports:
1389	(1)  Quarterly progress reports submitted to Centers for
1390	Medicare and Medicaid Services no later than 60 days following
1391	the end of each quarter. These reports shall present the
1392	agency's analysis and the status of various operational areas.
1393	The quarterly progress reports shall include, but are not
1394	limited to, the following:
1395	(a)  Documentation of events that occurred during the
1396	quarter or that are anticipated to occur in the near future that
1397	affect health care delivery, including, but not limited to, the
1398	approval of contracts with new managed care plans, the
1399	procedures for designating coverage areas, the process of
1400	phasing in managed care, a description of the populations served
1401	and the benefits provided, the number of recipients enrolled, a
1402	list of grievances submitted by enrollees, and other operational
1403	issues.
1404	(b)  Action plans for addressing policy and administrative
1405	issues.
1406	(c)  Documentation of agency efforts related to the
1407	collection and verification of encounter and utilization data.
1408	(d)  Enrollment data for each managed care plan according
1409	to the following specifications: total number of enrollees,
1410	eligibility category, number of enrollees receiving Temporary
1411	Assistance for Needy Families or Supplemental Security Income,
1412	market share, and percentage change in enrollment. In addition,
1413	the agency shall provide a summary of voluntary and mandatory
1414	selection rates and disenrollment data. Enrollment data, number
1415	of members by month, and expenditures shall be submitted in the
1416	format for monitoring budget neutrality provided by the Centers
1417	for Medicare and Medicaid Services.
1418	(e)  Documentation of low income pool activities and
1419	associated expenditures.
1420	(f)  Documentation of activities related to the
1421	implementation of choice counseling including efforts to improve
1422	health literacy and the methods used to obtain public input
1423	including recipient focus groups.
1424	(g)  Participation rates in the Enhanced Benefit Accounts
1425	Program, as established in the Centers for Medicare and Medicaid
1426	Services Special Terms and Conditions number 11-W-00206/4, which
1427	shall include: participation levels, summary of activities and
1428	associated expenditures, number of accounts established
1429	including active participants and individuals who continue to
1430	retain access to funds in an account but no longer actively
1431	participate, estimated quarterly deposits in accounts, and
1432	expenditures from the accounts.
1433	(h)  Enrollment data on employer-sponsored insurance that
1434	documents the number of individuals selecting to opt out when
1435	employer-sponsored insurance is available. The agency shall
1436	include data that identifies enrollee characteristics to include
1437	eligibility category, type of employer-sponsored insurance, and
1438	type of coverage based on whether the coverage is for the
1439	individual or the family. The agency shall develop and maintain
1440	disenrollment reports specifying the reason for disenrolling in
1441	an employer-sponsored insurance program. The agency shall also
1442	track and report on those enrollees who elect to reenroll in the
1443	Medicaid reform waiver demonstration program.
1444	(i)  Documentation of progress toward the demonstration
1445	program goals.
1446	(j)  Documentation of evaluation activities.
1447	(2)  The annual report shall document accomplishments,
1448	program status, quantitative and case study findings,
1449	utilization data, and policy and administrative difficulties in
1450	the operation of the Medicaid reform waiver demonstration
1451	program. The agency shall submit the draft annual report no
1452	later than October 1 after the end of each fiscal year.
1453	(a)  Beginning with the annual report for demonstration
1454	program year two, the agency shall include a section on the
1455	administration of enhanced benefit accounts, participation
1456	rates, an assessment of expenditures, and potential cost
1457	savings.
1458	(b)  Beginning with the annual report for demonstration
1459	program year four, the agency shall include a section that
1460	provides qualitative and quantitative data that describes the
1461	impact of the low income pool on the number of uninsured persons
1462	in the state from the start of the implementation of the
1463	demonstration program.
1464	Section 9.  Section 11.72, Florida Statutes, is created to
1465	read:
1466	11.72  Joint Legislative Committee on Medicaid Reform
1467	Implementation; creation; membership; powers; duties.--
1468	(1)  There is created a standing joint committee of the
1469	Legislature designated the Joint Legislative Committee on
1470	Medicaid Reform Implementation for the purpose of reviewing
1471	policy issues related to expansion of the Medicaid managed care
1472	pilot program pursuant to s. 409.91211.
1473	(2)  The Joint Legislative Committee on Medicaid Reform
1474	Implementation shall be composed of eight members appointed as
1475	follows: four members of the House of Representatives appointed
1476	by the Speaker of the House of Representatives, one of whom
1477	shall be a member of the minority party; and four members of the
1478	Senate appointed by the President of the Senate, one of whom
1479	shall be a member of the minority party. The President of the
1480	Senate shall appoint the chair in even-numbered years and the
1481	vice chair in odd-numbered years, and the Speaker of the House
1482	of Representatives shall appoint the chair in odd-numbered years
1483	and the vice chair in even-numbered years from among the
1484	committee membership. Vacancies shall be filled in the same
1485	manner as the original appointment. Members shall serve without
1486	compensation, except that members are entitled to reimbursement
1487	for per diem and travel expenses in accordance with s. 112.061.
1488	(3)  The committee shall be governed by joint rules of the
1489	Senate and the House of Representatives which shall remain in
1490	effect until repealed or amended by concurrent resolution.
1491	(4)  The committee shall meet at the call of the chair. The
1492	committee may hold hearings on matters within its purview which
1493	are in the public interest. A quorum shall consist of a majority
1494	of members from each house, plus one additional member from
1495	either house. Action by the committee requires a majority vote
1496	of the members present of each house.
1497	(5)  The committee shall be jointly staffed by the
1498	appropriations and substantive committees of the House of
1499	Representatives and the Senate. During even-numbered years the
1500	Senate shall serve as lead staff and during odd-numbered years
1501	the House of Representatives shall serve as lead staff.
1502	(6)  The committee shall:
1503	(a)  Review reports, public hearing proceedings, documents,
1504	and materials provided by the Agency for Health Care
1505	Administration relating to the expansion of the Medicaid managed
1506	care pilot program to other counties of the state pursuant to s.
1507	409.91212.
1508	(b)  Consult with the substantive and fiscal committees of
1509	the House of Representatives and the Senate which have
1510	jurisdiction over the Medicaid matters relating to agency action
1511	to expand the Medicaid managed care pilot program.
1512	(c)  Meet to consider and make a recommendation regarding
1513	the extent to which the expansion criteria pursuant to s.
1514	409.91212 have been met.
1515	(7)  Within 2 days after meeting, during which the
1516	committee reviewed documents, material, and testimony related to
1517	the expansion criteria, the committee shall submit a memorandum
1518	to the Speaker of the House of Representatives, the President of
1519	the Senate, the Legislative Budget Commission, and the agency
1520	delineating the extent to which the agency met the expansion
1521	criteria.
1522	Section 10.  Section 216.346, Florida Statutes, is amended
1523	to read:
1524	216.346  Contracts between state agencies; restriction on
1525	overhead or other indirect costs.--In any contract between state
1526	agencies, including any contract involving the State University
1527	System or the Florida Community College System, the agency
1528	receiving the contract or grant moneys shall charge no more than
1529	a reasonable percentage 5 percent of the total cost of the
1530	contract or grant for overhead or indirect costs or any other
1531	costs not required for the payment of direct costs. This
1532	provision is not intended to limit an agency's ability to
1533	certify matching funds or designate in-kind contributions which
1534	will allow the drawdown of federal Medicaid dollars that do not
1535	affect state budgeting.
1536	Section 11.  This act shall take effect upon becoming a
1537	law.

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