Amendment
Bill No. 0390

Amendment No. 313937

CHAMBER ACTION
Senate		House
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1	Representative(s) Bean offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Paragraph (a) of subsection (3) of section
6	400.23, Florida Statutes, is amended to read:
7	400.23  Rules; evaluation and deficiencies; licensure
8	status.--
9	(3)(a)  The agency shall adopt rules providing minimum
10	staffing requirements for nursing homes. These requirements
11	shall include, for each nursing home facility, a minimum
12	certified nursing assistant staffing of 2.3 hours of direct care
13	per resident per day beginning January 1, 2002, increasing to
14	2.6 hours of direct care per resident per day beginning January
15	1, 2003, and increasing to 2.9 hours of direct care per resident
16	per day beginning July 1, 2006. Beginning January 1, 2002, no
17	facility shall staff below one certified nursing assistant per
18	20 residents, and a minimum licensed nursing staffing of 1.0
19	hour of direct resident care per resident per day but never
20	below one licensed nurse per 40 residents. Nursing assistants
21	employed under s. 400.211(2) may be included in computing the
22	staffing ratio for certified nursing assistants only if they
23	provide nursing assistance services to residents on a full-time
24	basis. Each nursing home must document compliance with staffing
25	standards as required under this paragraph and post daily the
26	names of staff on duty for the benefit of facility residents and
27	the public. The agency shall recognize the use of licensed
28	nurses for compliance with minimum staffing requirements for
29	certified nursing assistants, provided that the facility
30	otherwise meets the minimum staffing requirements for licensed
31	nurses and that the licensed nurses are performing the duties of
32	a certified nursing assistant. Unless otherwise approved by the
33	agency, licensed nurses counted toward the minimum staffing
34	requirements for certified nursing assistants must exclusively
35	perform the duties of a certified nursing assistant for the
36	entire shift and not also be counted toward the minimum staffing
37	requirements for licensed nurses. If the agency approved a
38	facility's request to use a licensed nurse to perform both
39	licensed nursing and certified nursing assistant duties, the
40	facility must allocate the amount of staff time specifically
41	spent on certified nursing assistant duties for the purpose of
42	documenting compliance with minimum staffing requirements for
43	certified and licensed nursing staff. In no event may the hours
44	of a licensed nurse with dual job responsibilities be counted
45	twice.
46	Section 2.  Subsection (5) of section 409.904, Florida
47	Statutes, is amended to read:
48	409.904  Optional payments for eligible persons.--The
49	agency may make payments for medical assistance and related
50	services on behalf of the following persons who are determined
51	to be eligible subject to the income, assets, and categorical
52	eligibility tests set forth in federal and state law. Payment on
53	behalf of these Medicaid eligible persons is subject to the
54	availability of moneys and any limitations established by the
55	General Appropriations Act or chapter 216.
56	(5)  Subject to specific federal authorization, a
57	postpartum woman living in a family that has an income that is
58	at or below 185 percent of the most current federal poverty
59	level is eligible for family planning services as specified in
60	s. 409.905(3) for a period of up to 24 months following a loss
61	of Medicaid benefits pregnancy for which Medicaid paid for
62	pregnancy-related services.
63	Section 3.  Paragraph (d) of subsection (5) of section
64	409.905, Florida Statutes, is amended to read:
65	409.905  Mandatory Medicaid services.--The agency may make
66	payments for the following services, which are required of the
67	state by Title XIX of the Social Security Act, furnished by
68	Medicaid providers to recipients who are determined to be
69	eligible on the dates on which the services were provided. Any
70	service under this section shall be provided only when medically
71	necessary and in accordance with state and federal law.
72	Mandatory services rendered by providers in mobile units to
73	Medicaid recipients may be restricted by the agency. Nothing in
74	this section shall be construed to prevent or limit the agency
75	from adjusting fees, reimbursement rates, lengths of stay,
76	number of visits, number of services, or any other adjustments
77	necessary to comply with the availability of moneys and any
78	limitations or directions provided for in the General
79	Appropriations Act or chapter 216.
80	(5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay for
81	all covered services provided for the medical care and treatment
82	of a recipient who is admitted as an inpatient by a licensed
83	physician or dentist to a hospital licensed under part I of
84	chapter 395. However, the agency shall limit the payment for
85	inpatient hospital services for a Medicaid recipient 21 years of
86	age or older to 45 days or the number of days necessary to
87	comply with the General Appropriations Act.
88	(d)  The agency shall implement a hospitalist program in
89	certain high-volume participating hospitals, select counties, or
90	statewide. The program shall require hospitalists to authorize
91	and manage Medicaid recipients' hospital admissions and lengths
92	of stay. Individuals who are dually eligible for Medicare and
93	Medicaid are exempted from this requirement. Medicaid
94	participating physicians and other practitioners with hospital
95	admitting privileges shall coordinate and review admissions of
96	Medicaid recipients with the hospitalist. The agency may
97	competitively bid a contract for selection of a qualified
98	organization to provide hospitalist services. The qualified
99	organization shall employ board certified physicians who are
100	full-time dedicated employees of the contractor and have no
101	outside practice. Where used, the hospitalist program shall
102	replace the existing hospital utilization review program. The
103	agency is authorized to seek federal waivers to implement this
104	program.
105	Section 4.  Paragraph (b) of subsection (1) and subsection
106	(23) of section 409.906, Florida Statutes, are amended to read:
107	409.906  Optional Medicaid services.--Subject to specific
108	appropriations, the agency may make payments for services which
109	are optional to the state under Title XIX of the Social Security
110	Act and are furnished by Medicaid providers to recipients who
111	are determined to be eligible on the dates on which the services
112	were provided. Any optional service that is provided shall be
113	provided only when medically necessary and in accordance with
114	state and federal law. Optional services rendered by providers
115	in mobile units to Medicaid recipients may be restricted or
116	prohibited by the agency. Nothing in this section shall be
117	construed to prevent or limit the agency from adjusting fees,
118	reimbursement rates, lengths of stay, number of visits, or
119	number of services, or making any other adjustments necessary to
120	comply with the availability of moneys and any limitations or
121	directions provided for in the General Appropriations Act or
122	chapter 216. If necessary to safeguard the state's systems of
123	providing services to elderly and disabled persons and subject
124	to the notice and review provisions of s. 216.177, the Governor
125	may direct the Agency for Health Care Administration to amend
126	the Medicaid state plan to delete the optional Medicaid service
127	known as "Intermediate Care Facilities for the Developmentally
128	Disabled." Optional services may include:
129	(1)  ADULT DENTAL SERVICES.--
130	(b)  Beginning January 1, 2005, the agency may pay for
131	partial dentures and full dentures, the procedures required to
132	seat dentures, and the repair and reline of dentures, provided
133	by or under the direction of a licensed dentist, for a recipient
134	who is 21 years of age or older.
135	(23)  CHILDREN'S VISUAL SERVICES.--The agency may pay for
136	visual examinations, eyeglasses, and eyeglass repairs for a
137	recipient younger than 21 years of age, if they are prescribed
138	by a licensed physician specializing in diseases of the eye or
139	by a licensed optometrist. Eyeglasses for adult recipients shall
140	be limited to two pairs per year per recipient, except a third
141	pair may be provided after prior authorization.
142	Section 5.  Paragraph (a) of subsection (9) of section
143	409.907, Florida Statutes, is amended to read:
144	409.907  Medicaid provider agreements.--The agency may make
145	payments for medical assistance and related services rendered to
146	Medicaid recipients only to an individual or entity who has a
147	provider agreement in effect with the agency, who is performing
148	services or supplying goods in accordance with federal, state,
149	and local law, and who agrees that no person shall, on the
150	grounds of handicap, race, color, or national origin, or for any
151	other reason, be subjected to discrimination under any program
152	or activity for which the provider receives payment from the
153	agency.
154	(9)  Upon receipt of a completed, signed, and dated
155	application, and completion of any necessary background
156	investigation and criminal history record check, the agency must
157	either:
158	(a)  Enroll the applicant as a Medicaid provider no earlier
159	than the effective date of the approval of the provider
160	application. With respect to providers who were recently granted
161	a change of ownership and those who primarily provide emergency
162	medical services transportation or emergency services and care
163	pursuant to s. 395.1041 or s. 401.45, or services provided by
164	entities under s. 409.91255, and out-of-state providers, upon
165	approval of the provider application., The enrollment effective
166	date shall be of approval is considered to be the date the
167	agency receives the provider application. Payment for any claims
168	for services provided to Medicaid recipients between the date of
169	receipt of the application and the date of approval is
170	contingent on applying any and all applicable audits and edits
171	contained in the agency's claims adjudication and payment
172	processing systems; or
173	Section 6.  Paragraph (c) of subsection (1) of section
174	409.9081, Florida Statutes, is amended to read:
175	409.9081  Copayments.--
176	(1)  The agency shall require, subject to federal
177	regulations and limitations, each Medicaid recipient to pay at
178	the time of service a nominal copayment for the following
179	Medicaid services:
180	(c)  Hospital emergency department visits for nonemergency
181	care: 5 percent of up to the first $300 of the Medicaid payment
182	for emergency room services, not to exceed $15 for each
183	emergency department visit.
184	Section 7.  Subsections (2), (3), and (4) of section
185	409.911, Florida Statutes, are amended to read:
186	409.911  Disproportionate share program.--Subject to
187	specific allocations established within the General
188	Appropriations Act and any limitations established pursuant to
189	chapter 216, the agency shall distribute, pursuant to this
190	section, moneys to hospitals providing a disproportionate share
191	of Medicaid or charity care services by making quarterly
192	Medicaid payments as required. Notwithstanding the provisions of
193	s. 409.915, counties are exempt from contributing toward the
194	cost of this special reimbursement for hospitals serving a
195	disproportionate share of low-income patients.
196	(2)  The Agency for Health Care Administration shall use
197	the following actual audited data to determine the Medicaid days
198	and charity care to be used in calculating the disproportionate
199	share payment:
200	(a)  The average of the 1998, 1999, and 2000, 2001, and
201	2002 audited disproportionate share data to determine each
202	hospital's Medicaid days and charity care for the 2006-2007
203	2004-2005 state fiscal year and the average of the 1999, 2000,
204	and 2001 audited disproportionate share data to determine the
205	Medicaid days and charity care for the 2005-2006 state fiscal
206	year.
207	(b)  If the Agency for Health Care Administration does not
208	have the prescribed 3 years of audited disproportionate share
209	data as noted in paragraph (a) for a hospital, the agency shall
210	use the average of the years of the audited disproportionate
211	share data as noted in paragraph (a) which is available.
212	(c)  In accordance with s. 1923(b) of the Social Security
213	Act, a hospital with a Medicaid inpatient utilization rate
214	greater than one standard deviation above the statewide mean or
215	a hospital with a low-income utilization rate of 25 percent or
216	greater shall qualify for reimbursement.
217	(3)  Hospitals that qualify for a disproportionate share
218	payment solely under paragraph (2)(c) shall have their payment
219	calculated in accordance with the following formulas:
220
221	DSHP = (HMD/TMSD) x $1 million
222
223	Where:
224	DSHP = disproportionate share hospital payment.
225	HMD = hospital Medicaid days.
226	TSD = total state Medicaid days.
227
228	Any funds not allocated to hospitals qualifying under this
229	section shall be redistributed to the non-state government owned
230	or operated hospitals with greater than 3,100 3,300 Medicaid
231	days.
232	(4)  The following formulas shall be used to pay
233	disproportionate share dollars to public hospitals:
234	(a)  For state mental health hospitals:
235
236	DSHP = (HMD/TMDMH) x TAAMH
237
238	shall be the difference between the federal cap for Institutions
239	for Mental Diseases and the amounts paid under the mental health
240	disproportionate share program.
241
242	Where:
243	DSHP = disproportionate share hospital payment.
244	HMD = hospital Medicaid days.
245	TMDHH = total Medicaid days for state mental health
246	hospitals.
247	TAAMH = total amount available for mental health hospitals.
248	(b)  For non-state government owned or operated hospitals
249	with 3,100 3,300 or more Medicaid days:
250
251	DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)]
252	x TAAPH
253	TAAPH = TAA - TAAMH
254
255	Where:
256	TAA = total available appropriation.
257	TAAPH = total amount available for public hospitals.
258	DSHP = disproportionate share hospital payments.
259	HMD = hospital Medicaid days.
260	TMD = total state Medicaid days for public hospitals.
261	HCCD = hospital charity care dollars.
262	TCCD = total state charity care dollars for public non-
263	state hospitals.
264
265	1.  For the 2005-2006 state fiscal year only, the DSHP for
266	the public nonstate hospitals shall be computed using a weighted
267	average of the disproportionate share payments for the 2004-2005
268	state fiscal year which uses an average of the 1998, 1999, and
269	2000 audited disproportionate share data and the
270	disproportionate share payments for the 2005-2006 state fiscal
271	year as computed using the formula above and using the average
272	of the 1999, 2000, and 2001 audited disproportionate share data.
273	The final DSHP for the public nonstate hospitals shall be
274	computed as an average using the calculated payments for the
275	2005-2006 state fiscal year weighted at 65 percent and the
276	disproportionate share payments for the 2004-2005 state fiscal
277	year weighted at 35 percent.
278	2.  The TAAPH shall be reduced by $6,365,257 before
279	computing the DSHP for each public hospital. The $6,365,257
280	shall be distributed equally between the public hospitals that
281	are also designated statutory teaching hospitals.
282	(c)  For non-state government owned or operated hospitals
283	with less than 3,100 3,300 Medicaid days, a total of $750,000
284	shall be distributed equally among these hospitals.
285	Section 8.  Section 409.9113, Florida Statutes, is amended
286	to read:
287	409.9113  Disproportionate share program for teaching
288	hospitals.--In addition to the payments made under ss. 409.911
289	and 409.9112, the Agency for Health Care Administration shall
290	make disproportionate share payments to statutorily defined
291	teaching hospitals for their increased costs associated with
292	medical education programs and for tertiary health care services
293	provided to the indigent. This system of payments shall conform
294	with federal requirements and shall distribute funds in each
295	fiscal year for which an appropriation is made by making
296	quarterly Medicaid payments. Notwithstanding s. 409.915,
297	counties are exempt from contributing toward the cost of this
298	special reimbursement for hospitals serving a disproportionate
299	share of low-income patients. For the state fiscal year 2006-
300	2007 2005-2006, the agency shall not distribute the moneys
301	provided in the General Appropriations Act to statutorily
302	defined teaching hospitals and family practice teaching
303	hospitals under the teaching hospital disproportionate share
304	program. The funds provided for statutorily defined teaching
305	hospitals shall be distributed in the same proportion as the
306	state fiscal year 2003-2004 teaching hospital disproportionate
307	share funds were distributed. The funds provided for family
308	practice teaching hospitals shall be distributed equally among
309	family practice teaching hospitals.
310	(1)  On or before September 15 of each year, the Agency for
311	Health Care Administration shall calculate an allocation
312	fraction to be used for distributing funds to state statutory
313	teaching hospitals. Subsequent to the end of each quarter of the
314	state fiscal year, the agency shall distribute to each statutory
315	teaching hospital, as defined in s. 408.07, an amount determined
316	by multiplying one-fourth of the funds appropriated for this
317	purpose by the Legislature times such hospital's allocation
318	fraction. The allocation fraction for each such hospital shall
319	be determined by the sum of three primary factors, divided by
320	three. The primary factors are:
321	(a)  The number of nationally accredited graduate medical
322	education programs offered by the hospital, including programs
323	accredited by the Accreditation Council for Graduate Medical
324	Education and the combined Internal Medicine and Pediatrics
325	programs acceptable to both the American Board of Internal
326	Medicine and the American Board of Pediatrics at the beginning
327	of the state fiscal year preceding the date on which the
328	allocation fraction is calculated. The numerical value of this
329	factor is the fraction that the hospital represents of the total
330	number of programs, where the total is computed for all state
331	statutory teaching hospitals.
332	(b)  The number of full-time equivalent trainees in the
333	hospital, which comprises two components:
334	1.  The number of trainees enrolled in nationally
335	accredited graduate medical education programs, as defined in
336	paragraph (a). Full-time equivalents are computed using the
337	fraction of the year during which each trainee is primarily
338	assigned to the given institution, over the state fiscal year
339	preceding the date on which the allocation fraction is
340	calculated. The numerical value of this factor is the fraction
341	that the hospital represents of the total number of full-time
342	equivalent trainees enrolled in accredited graduate programs,
343	where the total is computed for all state statutory teaching
344	hospitals.
345	2.  The number of medical students enrolled in accredited
346	colleges of medicine and engaged in clinical activities,
347	including required clinical clerkships and clinical electives.
348	Full-time equivalents are computed using the fraction of the
349	year during which each trainee is primarily assigned to the
350	given institution, over the course of the state fiscal year
351	preceding the date on which the allocation fraction is
352	calculated. The numerical value of this factor is the fraction
353	that the given hospital represents of the total number of full-
354	time equivalent students enrolled in accredited colleges of
355	medicine, where the total is computed for all state statutory
356	teaching hospitals.
357
358	The primary factor for full-time equivalent trainees is computed
359	as the sum of these two components, divided by two.
360	(c)  A service index that comprises three components:
361	1.  The Agency for Health Care Administration Service
362	Index, computed by applying the standard Service Inventory
363	Scores established by the Agency for Health Care Administration
364	to services offered by the given hospital, as reported on
365	Worksheet A-2 for the last fiscal year reported to the agency
366	before the date on which the allocation fraction is calculated.
367	The numerical value of this factor is the fraction that the
368	given hospital represents of the total Agency for Health Care
369	Administration Service Index values, where the total is computed
370	for all state statutory teaching hospitals.
371	2.  A volume-weighted service index, computed by applying
372	the standard Service Inventory Scores established by the Agency
373	for Health Care Administration to the volume of each service,
374	expressed in terms of the standard units of measure reported on
375	Worksheet A-2 for the last fiscal year reported to the agency
376	before the date on which the allocation factor is calculated.
377	The numerical value of this factor is the fraction that the
378	given hospital represents of the total volume-weighted service
379	index values, where the total is computed for all state
380	statutory teaching hospitals.
381	3.  Total Medicaid payments to each hospital for direct
382	inpatient and outpatient services during the fiscal year
383	preceding the date on which the allocation factor is calculated.
384	This includes payments made to each hospital for such services
385	by Medicaid prepaid health plans, whether the plan was
386	administered by the hospital or not. The numerical value of this
387	factor is the fraction that each hospital represents of the
388	total of such Medicaid payments, where the total is computed for
389	all state statutory teaching hospitals.
390
391	The primary factor for the service index is computed as the sum
392	of these three components, divided by three.
393	(2)  By October 1 of each year, the agency shall use the
394	following formula to calculate the maximum additional
395	disproportionate share payment for statutorily defined teaching
396	hospitals:
397
398	TAP = THAF x A
399
400	Where:
401	TAP = total additional payment.
402	THAF = teaching hospital allocation factor.
403	A = amount appropriated for a teaching hospital
404	disproportionate share program.
405	Section 9.  Section 409.9117, Florida Statutes, is amended
406	to read:
407	409.9117  Primary care disproportionate share program.--For
408	the state fiscal year 2006-2007 2005-2006, the agency shall not
409	distribute moneys under the primary care disproportionate share
410	program.
411	(1)  If federal funds are available for disproportionate
412	share programs in addition to those otherwise provided by law,
413	there shall be created a primary care disproportionate share
414	program.
415	(2)  The following formula shall be used by the agency to
416	calculate the total amount earned for hospitals that participate
417	in the primary care disproportionate share program:
418
419	TAE = HDSP/THDSP
420
421	Where:
422	TAE = total amount earned by a hospital participating in
423	the primary care disproportionate share program.
424	HDSP = the prior state fiscal year primary care
425	disproportionate share payment to the individual hospital.
426	THDSP = the prior state fiscal year total primary care
427	disproportionate share payments to all hospitals.
428	(3)  The total additional payment for hospitals that
429	participate in the primary care disproportionate share program
430	shall be calculated by the agency as follows:
431
432	TAP = TAE x TA
433
434	Where:
435	TAP = total additional payment for a primary care hospital.
436	TAE = total amount earned by a primary care hospital.
437	TA = total appropriation for the primary care
438	disproportionate share program.
439	(4)  In the establishment and funding of this program, the
440	agency shall use the following criteria in addition to those
441	specified in s. 409.911, payments may not be made to a hospital
442	unless the hospital agrees to:
443	(a)  Cooperate with a Medicaid prepaid health plan, if one
444	exists in the community.
445	(b)  Ensure the availability of primary and specialty care
446	physicians to Medicaid recipients who are not enrolled in a
447	prepaid capitated arrangement and who are in need of access to
448	such physicians.
449	(c)  Coordinate and provide primary care services free of
450	charge, except copayments, to all persons with incomes up to 100
451	percent of the federal poverty level who are not otherwise
452	covered by Medicaid or another program administered by a
453	governmental entity, and to provide such services based on a
454	sliding fee scale to all persons with incomes up to 200 percent
455	of the federal poverty level who are not otherwise covered by
456	Medicaid or another program administered by a governmental
457	entity, except that eligibility may be limited to persons who
458	reside within a more limited area, as agreed to by the agency
459	and the hospital.
460	(d)  Contract with any federally qualified health center,
461	if one exists within the agreed geopolitical boundaries,
462	concerning the provision of primary care services, in order to
463	guarantee delivery of services in a nonduplicative fashion, and
464	to provide for referral arrangements, privileges, and
465	admissions, as appropriate. The hospital shall agree to provide
466	at an onsite or offsite facility primary care services within 24
467	hours to which all Medicaid recipients and persons eligible
468	under this paragraph who do not require emergency room services
469	are referred during normal daylight hours.
470	(e)  Cooperate with the agency, the county, and other
471	entities to ensure the provision of certain public health
472	services, case management, referral and acceptance of patients,
473	and sharing of epidemiological data, as the agency and the
474	hospital find mutually necessary and desirable to promote and
475	protect the public health within the agreed geopolitical
476	boundaries.
477	(f)  In cooperation with the county in which the hospital
478	resides, develop a low-cost, outpatient, prepaid health care
479	program to persons who are not eligible for the Medicaid
480	program, and who reside within the area.
481	(g)  Provide inpatient services to residents within the
482	area who are not eligible for Medicaid or Medicare, and who do
483	not have private health insurance, regardless of ability to pay,
484	on the basis of available space, except that nothing shall
485	prevent the hospital from establishing bill collection programs
486	based on ability to pay.
487	(h)  Work with the Florida Healthy Kids Corporation, the
488	Florida Health Care Purchasing Cooperative, and business health
489	coalitions, as appropriate, to develop a feasibility study and
490	plan to provide a low-cost comprehensive health insurance plan
491	to persons who reside within the area and who do not have access
492	to such a plan.
493	(i)  Work with public health officials and other experts to
494	provide community health education and prevention activities
495	designed to promote healthy lifestyles and appropriate use of
496	health services.
497	(j)  Work with the local health council to develop a plan
498	for promoting access to affordable health care services for all
499	persons who reside within the area, including, but not limited
500	to, public health services, primary care services, inpatient
501	services, and affordable health insurance generally.
502
503	Any hospital that fails to comply with any of the provisions of
504	this subsection, or any other contractual condition, may not
505	receive payments under this section until full compliance is
506	achieved.
507	Section 10.  Paragraph (b) of subsection (4) and subsection
508	(44) of section 409.912, Florida Statutes, are amended, and
509	subsection (53) is added to that section, to read:
510	409.912  Cost-effective purchasing of health care.--The
511	agency shall purchase goods and services for Medicaid recipients
512	in the most cost-effective manner consistent with the delivery
513	of quality medical care. To ensure that medical services are
514	effectively utilized, the agency may, in any case, require a
515	confirmation or second physician's opinion of the correct
516	diagnosis for purposes of authorizing future services under the
517	Medicaid program. This section does not restrict access to
518	emergency services or poststabilization care services as defined
519	in 42 C.F.R. part 438.114. Such confirmation or second opinion
520	shall be rendered in a manner approved by the agency. The agency
521	shall maximize the use of prepaid per capita and prepaid
522	aggregate fixed-sum basis services when appropriate and other
523	alternative service delivery and reimbursement methodologies,
524	including competitive bidding pursuant to s. 287.057, designed
525	to facilitate the cost-effective purchase of a case-managed
526	continuum of care. The agency shall also require providers to
527	minimize the exposure of recipients to the need for acute
528	inpatient, custodial, and other institutional care and the
529	inappropriate or unnecessary use of high-cost services. The
530	agency shall contract with a vendor to monitor and evaluate the
531	clinical practice patterns of providers in order to identify
532	trends that are outside the normal practice patterns of a
533	provider's professional peers or the national guidelines of a
534	provider's professional association. The vendor must be able to
535	provide information and counseling to a provider whose practice
536	patterns are outside the norms, in consultation with the agency,
537	to improve patient care and reduce inappropriate utilization.
538	The agency may mandate prior authorization, drug therapy
539	management, or disease management participation for certain
540	populations of Medicaid beneficiaries, certain drug classes, or
541	particular drugs to prevent fraud, abuse, overuse, and possible
542	dangerous drug interactions. The Pharmaceutical and Therapeutics
543	Committee shall make recommendations to the agency on drugs for
544	which prior authorization is required. The agency shall inform
545	the Pharmaceutical and Therapeutics Committee of its decisions
546	regarding drugs subject to prior authorization. The agency is
547	authorized to limit the entities it contracts with or enrolls as
548	Medicaid providers by developing a provider network through
549	provider credentialing. The agency may competitively bid single-
550	source-provider contracts if procurement of goods or services
551	results in demonstrated cost savings to the state without
552	limiting access to care. The agency may limit its network based
553	on the assessment of beneficiary access to care, provider
554	availability, provider quality standards, time and distance
555	standards for access to care, the cultural competence of the
556	provider network, demographic characteristics of Medicaid
557	beneficiaries, practice and provider-to-beneficiary standards,
558	appointment wait times, beneficiary use of services, provider
559	turnover, provider profiling, provider licensure history,
560	previous program integrity investigations and findings, peer
561	review, provider Medicaid policy and billing compliance records,
562	clinical and medical record audits, and other factors. Providers
563	shall not be entitled to enrollment in the Medicaid provider
564	network. The agency shall determine instances in which allowing
565	Medicaid beneficiaries to purchase durable medical equipment and
566	other goods is less expensive to the Medicaid program than long-
567	term rental of the equipment or goods. The agency may establish
568	rules to facilitate purchases in lieu of long-term rentals in
569	order to protect against fraud and abuse in the Medicaid program
570	as defined in s. 409.913. The agency may seek federal waivers
571	necessary to administer these policies.
572	(4)  The agency may contract with:
573	(b)  An entity that is providing comprehensive behavioral
574	health care services to certain Medicaid recipients through a
575	capitated, prepaid arrangement pursuant to the federal waiver
576	provided for by s. 409.905(5). Such an entity must be licensed
577	under chapter 624, chapter 636, or chapter 641 and must possess
578	the clinical systems and operational competence to manage risk
579	and provide comprehensive behavioral health care to Medicaid
580	recipients. As used in this paragraph, the term "comprehensive
581	behavioral health care services" means covered mental health and
582	substance abuse treatment services that are available to
583	Medicaid recipients. The secretary of the Department of Children
584	and Family Services shall approve provisions of procurements
585	related to children in the department's care or custody prior to
586	enrolling such children in a prepaid behavioral health plan. Any
587	contract awarded under this paragraph must be competitively
588	procured. In developing the behavioral health care prepaid plan
589	procurement document, the agency shall ensure that the
590	procurement document requires the contractor to develop and
591	implement a plan to ensure compliance with s. 394.4574 related
592	to services provided to residents of licensed assisted living
593	facilities that hold a limited mental health license. Except as
594	provided in subparagraph 8., and except in counties where the
595	Medicaid managed care pilot program is authorized pursuant to s.
596	409.91211, the agency shall seek federal approval to contract
597	with a single entity meeting these requirements to provide
598	comprehensive behavioral health care services to all Medicaid
599	recipients not enrolled in a Medicaid managed care plan
600	authorized under s. 409.91211 or a Medicaid health maintenance
601	organization in an AHCA area. In an AHCA area where the Medicaid
602	managed care pilot program is authorized pursuant to s.
603	409.91211 in one or more counties, the agency may procure a
604	contract with a single entity to serve the remaining counties as
605	an AHCA area or the remaining counties may be included with an
606	adjacent AHCA area and shall be subject to this paragraph. Each
607	entity must offer sufficient choice of providers in its network
608	to ensure recipient access to care and the opportunity to select
609	a provider with whom they are satisfied. The network shall
610	include all public mental health hospitals. To ensure unimpaired
611	access to behavioral health care services by Medicaid
612	recipients, all contracts issued pursuant to this paragraph
613	shall require 80 percent of the capitation paid to the managed
614	care plan, including health maintenance organizations, to be
615	expended for the provision of behavioral health care services.
616	In the event the managed care plan expends less than 80 percent
617	of the capitation paid pursuant to this paragraph for the
618	provision of behavioral health care services, the difference
619	shall be returned to the agency. The agency shall provide the
620	managed care plan with a certification letter indicating the
621	amount of capitation paid during each calendar year for the
622	provision of behavioral health care services pursuant to this
623	section. the agency may reimburse for substance abuse treatment
624	services on a fee-for-service basis until the agency finds that
625	adequate funds are available for capitated, prepaid
626	arrangements.
627	1.  By January 1, 2001, the agency shall modify the
628	contracts with the entities providing comprehensive inpatient
629	and outpatient mental health care services to Medicaid
630	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
631	Counties, to include substance abuse treatment services.
632	2.  By July 1, 2003, the agency and the Department of
633	Children and Family Services shall execute a written agreement
634	that requires collaboration and joint development of all policy,
635	budgets, procurement documents, contracts, and monitoring plans
636	that have an impact on the state and Medicaid community mental
637	health and targeted case management programs.
638	3.  Except as provided in subparagraph 8., by July 1, 2006,
639	the agency and the Department of Children and Family Services
640	shall contract with managed care entities in each AHCA area
641	except area 6 or arrange to provide comprehensive inpatient and
642	outpatient mental health and substance abuse services through
643	capitated prepaid arrangements to all Medicaid recipients who
644	are eligible to participate in such plans under federal law and
645	regulation. In AHCA areas where eligible individuals number less
646	than 150,000, the agency shall contract with a single managed
647	care plan to provide comprehensive behavioral health services to
648	all recipients who are not enrolled in a Medicaid health
649	maintenance organization or a Medicaid capitated managed care
650	plan authorized under s. 409.91211. The agency may contract with
651	more than one comprehensive behavioral health provider to
652	provide care to recipients who are not enrolled in a Medicaid
653	capitated managed care plan authorized under s. 409.91211 or a
654	Medicaid health maintenance organization in AHCA areas where the
655	eligible population exceeds 150,000. In an AHCA area where the
656	Medicaid managed care pilot program is authorized pursuant to s.
657	409.91211 in one or more counties, the agency may procure a
658	contract with a single entity to serve the remaining counties as
659	an AHCA area or the remaining counties may be included with an
660	adjacent AHCA area and shall be subject to this paragraph.
661	Contracts for comprehensive behavioral health providers awarded
662	pursuant to this section shall be competitively procured. Both
663	for-profit and not-for-profit corporations shall be eligible to
664	compete. Managed care plans contracting with the agency under
665	subsection (3) shall provide and receive payment for the same
666	comprehensive behavioral health benefits as provided in AHCA
667	rules, including handbooks incorporated by reference. In AHCA
668	area 11, the agency shall contract with at least two
669	comprehensive behavioral health care providers to provide
670	behavioral health care to recipients in that area who are
671	enrolled in, or assigned to, the MediPass program. One of the
672	behavioral health care contracts shall be with the existing
673	provider service network pilot project, as described in
674	paragraph (d), for the purpose of demonstrating the cost-
675	effectiveness of the provision of quality mental health services
676	through a public hospital-operated managed care model. Payment
677	shall be at an agreed-upon capitated rate to ensure cost
678	savings. Of the recipients in area 11 who are assigned to
679	MediPass under the provisions of s. 409.9122(2)(k), a minimum of
680	50,000 of those MediPass-enrolled recipients shall be assigned
681	to the existing provider service network in area 11 for their
682	behavioral care.
683	4.  By October 1, 2003, the agency and the department shall
684	submit a plan to the Governor, the President of the Senate, and
685	the Speaker of the House of Representatives which provides for
686	the full implementation of capitated prepaid behavioral health
687	care in all areas of the state.
688	a.  Implementation shall begin in 2003 in those AHCA areas
689	of the state where the agency is able to establish sufficient
690	capitation rates.
691	b.  If the agency determines that the proposed capitation
692	rate in any area is insufficient to provide appropriate
693	services, the agency may adjust the capitation rate to ensure
694	that care will be available. The agency and the department may
695	use existing general revenue to address any additional required
696	match but may not over-obligate existing funds on an annualized
697	basis.
698	c.  Subject to any limitations provided for in the General
699	Appropriations Act, the agency, in compliance with appropriate
700	federal authorization, shall develop policies and procedures
701	that allow for certification of local and state funds.
702	5.  Children residing in a statewide inpatient psychiatric
703	program, or in a Department of Juvenile Justice or a Department
704	of Children and Family Services residential program approved as
705	a Medicaid behavioral health overlay services provider shall not
706	be included in a behavioral health care prepaid health plan or
707	any other Medicaid managed care plan pursuant to this paragraph.
708	6.  In converting to a prepaid system of delivery, the
709	agency shall in its procurement document require an entity
710	providing only comprehensive behavioral health care services to
711	prevent the displacement of indigent care patients by enrollees
712	in the Medicaid prepaid health plan providing behavioral health
713	care services from facilities receiving state funding to provide
714	indigent behavioral health care, to facilities licensed under
715	chapter 395 which do not receive state funding for indigent
716	behavioral health care, or reimburse the unsubsidized facility
717	for the cost of behavioral health care provided to the displaced
718	indigent care patient.
719	7.  Traditional community mental health providers under
720	contract with the Department of Children and Family Services
721	pursuant to part IV of chapter 394, child welfare providers
722	under contract with the Department of Children and Family
723	Services in areas 1 and 6, and inpatient mental health providers
724	licensed pursuant to chapter 395 must be offered an opportunity
725	to accept or decline a contract to participate in any provider
726	network for prepaid behavioral health services.
727	8.  For fiscal year 2004-2005, all Medicaid eligible
728	children, except children in areas 1 and 6, whose cases are open
729	for child welfare services in the HomeSafeNet system, shall be
730	enrolled in MediPass or in Medicaid fee-for-service and all
731	their behavioral health care services including inpatient,
732	outpatient psychiatric, community mental health, and case
733	management shall be reimbursed on a fee-for-service basis.
734	Beginning July 1, 2005, such children, who are open for child
735	welfare services in the HomeSafeNet system, shall receive their
736	behavioral health care services through a specialty prepaid plan
737	operated by community-based lead agencies either through a
738	single agency or formal agreements among several agencies. The
739	specialty prepaid plan must result in savings to the state
740	comparable to savings achieved in other Medicaid managed care
741	and prepaid programs. Such plan must provide mechanisms to
742	maximize state and local revenues. The specialty prepaid plan
743	shall be developed by the agency and the Department of Children
744	and Family Services. The agency is authorized to seek any
745	federal waivers to implement this initiative.
746	(44)  The Agency for Health Care Administration shall
747	ensure that any Medicaid managed care plan as defined in s.
748	409.9122(2)(f)(h), whether paid on a capitated basis or a shared
749	savings basis, is cost-effective. For purposes of this
750	subsection, the term "cost-effective" means that a network's
751	per-member, per-month costs to the state, including, but not
752	limited to, fee-for-service costs, administrative costs, and
753	case-management fees, if any, must be no greater than the
754	state's costs associated with contracts for Medicaid services
755	established under subsection (3), which may shall be actuarially
756	adjusted for health status case mix, model, and service area.
757	The agency shall conduct actuarially sound adjustments for
758	health status audits adjusted for case mix and model in order to
759	ensure such cost-effectiveness and shall publish the audit
760	results on its Internet website and submit the audit results
761	annually to the Governor, the President of the Senate, and the
762	Speaker of the House of Representatives no later than December
763	31 of each year. Contracts established pursuant to this
764	subsection which are not cost-effective may not be renewed.
765	(53)  In accordance with s. 430.705 and 42 C.F.R. s. 438,
766	Medicaid capitation payments for managed long-term care programs
767	shall be risk adjusted by plan and reflect members' level of
768	chronic illness, functional limitations, and risk of
769	institutional placement, as determined by expenditures for a
770	comparable fee-for-service population. Payments for Medicaid
771	home and community-based services shall be actuarially
772	equivalent to plan experience.
773	Section 11.  Paragraphs (f) and (k) of subsection (2) of
774	section 409.9122, Florida Statutes, are amended to read:
775	409.9122  Mandatory Medicaid managed care enrollment;
776	programs and procedures.--
777	(2)
778	(f)  When a Medicaid recipient does not choose a managed
779	care plan or MediPass provider, the agency shall assign the
780	Medicaid recipient to a managed care plan or MediPass provider.
781	Medicaid recipients who are subject to mandatory assignment but
782	who fail to make a choice shall be assigned to managed care
783	plans until an enrollment of 35 40 percent in MediPass and 65 60
784	percent in managed care plans, of all those eligible to choose
785	managed care, is achieved. Once this enrollment is achieved, the
786	assignments shall be divided in order to maintain an enrollment
787	in MediPass and managed care plans which is in a 35 40 percent
788	and 65 60 percent proportion, respectively. Thereafter,
789	assignment of Medicaid recipients who fail to make a choice
790	shall be based proportionally on the preferences of recipients
791	who have made a choice in the previous period. Such proportions
792	shall be revised at least quarterly to reflect an update of the
793	preferences of Medicaid recipients. The agency shall
794	disproportionately assign Medicaid-eligible recipients who are
795	required to but have failed to make a choice of managed care
796	plan or MediPass, including children, and who are to be assigned
797	to the MediPass program to children's networks as described in
798	s. 409.912(4)(g), Children's Medical Services Network as defined
799	in s. 391.021, exclusive provider organizations, provider
800	service networks, minority physician networks, and pediatric
801	emergency department diversion programs authorized by this
802	chapter or the General Appropriations Act, in such manner as the
803	agency deems appropriate, until the agency has determined that
804	the networks and programs have sufficient numbers to be
805	economically operated. For purposes of this paragraph, when
806	referring to assignment, the term "managed care plans" includes
807	health maintenance organizations, exclusive provider
808	organizations, provider service networks, minority physician
809	networks, Children's Medical Services Network, and pediatric
810	emergency department diversion programs authorized by this
811	chapter or the General Appropriations Act. When making
812	assignments, the agency shall take into account the following
813	criteria:
814	1.  A managed care plan has sufficient network capacity to
815	meet the need of members.
816	2.  The managed care plan or MediPass has previously
817	enrolled the recipient as a member, or one of the managed care
818	plan's primary care providers or MediPass providers has
819	previously provided health care to the recipient.
820	3.  The agency has knowledge that the member has previously
821	expressed a preference for a particular managed care plan or
822	MediPass provider as indicated by Medicaid fee-for-service
823	claims data, but has failed to make a choice.
824	4.  The managed care plan's or MediPass primary care
825	providers are geographically accessible to the recipient's
826	residence.
827	(k)  When a Medicaid recipient does not choose a managed
828	care plan or MediPass provider, the agency shall assign the
829	Medicaid recipient to a managed care plan, except in those
830	counties in which there are fewer than two managed care plans
831	accepting Medicaid enrollees, in which case assignment shall be
832	to a managed care plan or a MediPass provider. Medicaid
833	recipients in counties with fewer than two managed care plans
834	accepting Medicaid enrollees who are subject to mandatory
835	assignment but who fail to make a choice shall be assigned to
836	managed care plans until an enrollment of 35 40 percent in
837	MediPass and 65 60 percent in managed care plans, of all those
838	eligible to choose managed care, is achieved. Once that
839	enrollment is achieved, the assignments shall be divided in
840	order to maintain an enrollment in MediPass and managed care
841	plans which is in a 35 40 percent and 65 60 percent proportion,
842	respectively. In service areas 1 and 6 of the Agency for Health
843	Care Administration where the agency is contracting for the
844	provision of comprehensive behavioral health services through a
845	capitated prepaid arrangement, recipients who fail to make a
846	choice shall be assigned equally to MediPass or a managed care
847	plan. For purposes of this paragraph, when referring to
848	assignment, the term "managed care plans" includes exclusive
849	provider organizations, provider service networks, Children's
850	Medical Services Network, minority physician networks, and
851	pediatric emergency department diversion programs authorized by
852	this chapter or the General Appropriations Act. When making
853	assignments, the agency shall take into account the following
854	criteria:
855	1.  A managed care plan has sufficient network capacity to
856	meet the need of members.
857	2.  The managed care plan or MediPass has previously
858	enrolled the recipient as a member, or one of the managed care
859	plan's primary care providers or MediPass providers has
860	previously provided health care to the recipient.
861	3.  The agency has knowledge that the member has previously
862	expressed a preference for a particular managed care plan or
863	MediPass provider as indicated by Medicaid fee-for-service
864	claims data, but has failed to make a choice.
865	4.  The managed care plan's or MediPass primary care
866	providers are geographically accessible to the recipient's
867	residence.
868	5.  The agency has authority to make mandatory assignments
869	based on quality of service and performance of managed care
870	plans.
871	Section 12.  Paragraph (b) of subsection (5) of section
872	624.91, Florida Statutes, is amended to read:
873	624.91  The Florida Healthy Kids Corporation Act.--
874	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
875	(b)  The Florida Healthy Kids Corporation shall:
876	1.  Arrange for the collection of any family, local
877	contributions, or employer payment or premium, in an amount to
878	be determined by the board of directors, to provide for payment
879	of premiums for comprehensive insurance coverage and for the
880	actual or estimated administrative expenses.
881	2.  Arrange for the collection of any voluntary
882	contributions to provide for payment of premiums for children
883	who are not eligible for medical assistance under Title XXI of
884	the Social Security Act. Each fiscal year, the corporation shall
885	establish a local match policy for the enrollment of non-Title-
886	XXI-eligible children in the Healthy Kids program. By May 1 of
887	each year, the corporation shall provide written notification of
888	the amount to be remitted to the corporation for the following
889	fiscal year under that policy. Local match sources may include,
890	but are not limited to, funds provided by municipalities,
891	counties, school boards, hospitals, health care providers,
892	charitable organizations, special taxing districts, and private
893	organizations. The minimum local match cash contributions
894	required each fiscal year and local match credits shall be
895	determined by the General Appropriations Act. The corporation
896	shall calculate a county's local match rate based upon that
897	county's percentage of the state's total non-Title-XXI
898	expenditures as reported in the corporation's most recently
899	audited financial statement. In awarding the local match
900	credits, the corporation may consider factors including, but not
901	limited to, population density, per capita income, and existing
902	child-health-related expenditures and services. If local match
903	amounts collected exceed expenditures during any fiscal year,
904	including the 2005-2006 fiscal year, the corporation shall
905	return unspent local funds collected based on a formula
906	developed by the corporation.
907	3.  Subject to the provisions of s. 409.8134, accept
908	voluntary supplemental local match contributions that comply
909	with the requirements of Title XXI of the Social Security Act
910	for the purpose of providing additional coverage in contributing
911	counties under Title XXI.
912	4.  Establish the administrative and accounting procedures
913	for the operation of the corporation.
914	5.  Establish, with consultation from appropriate
915	professional organizations, standards for preventive health
916	services and providers and comprehensive insurance benefits
917	appropriate to children, provided that such standards for rural
918	areas shall not limit primary care providers to board-certified
919	pediatricians.
920	6.  Determine eligibility for children seeking to
921	participate in the Title XXI-funded components of the Florida
922	KidCare program consistent with the requirements specified in s.
923	409.814, as well as the non-Title-XXI-eligible children as
924	provided in subsection (3).
925	7.  Establish procedures under which providers of local
926	match to, applicants to and participants in the program may have
927	grievances reviewed by an impartial body and reported to the
928	board of directors of the corporation.
929	8.  Establish participation criteria and, if appropriate,
930	contract with an authorized insurer, health maintenance
931	organization, or third-party administrator to provide
932	administrative services to the corporation.
933	9.  Establish enrollment criteria which shall include
934	penalties or waiting periods of not fewer than 60 days for
935	reinstatement of coverage upon voluntary cancellation for
936	nonpayment of family premiums.
937	10.  Contract with authorized insurers or any provider of
938	health care services, meeting standards established by the
939	corporation, for the provision of comprehensive insurance
940	coverage to participants. Such standards shall include criteria
941	under which the corporation may contract with more than one
942	provider of health care services in program sites. Health plans
943	shall be selected through a competitive bid process. The Florida
944	Healthy Kids Corporation shall purchase goods and services in
945	the most cost-effective manner consistent with the delivery of
946	quality medical care. The maximum administrative cost for a
947	Florida Healthy Kids Corporation contract shall be 15 percent.
948	For health care contracts, the minimum medical loss ratio for a
949	Florida Healthy Kids Corporation contract shall be 85 percent.
950	For dental contracts, the remaining compensation to be paid to
951	the authorized insurer or provider under a Florida Healthy Kids
952	Corporation contract shall be no less than an amount which is 85
953	percent of premium; to the extent any contract provision does
954	not provide for this minimum compensation, this section shall
955	prevail. The health plan selection criteria and scoring system,
956	and the scoring results, shall be available upon request for
957	inspection after the bids have been awarded.
958	11.  Establish disenrollment criteria in the event local
959	matching funds are insufficient to cover enrollments.
960	12.  Develop and implement a plan to publicize the Florida
961	Healthy Kids Corporation, the eligibility requirements of the
962	program, and the procedures for enrollment in the program and to
963	maintain public awareness of the corporation and the program.
964	13.  Secure staff necessary to properly administer the
965	corporation. Staff costs shall be funded from state and local
966	matching funds and such other private or public funds as become
967	available. The board of directors shall determine the number of
968	staff members necessary to administer the corporation.
969	14.  Provide a report annually to the Governor, Chief
970	Financial Officer, Commissioner of Education, Senate President,
971	Speaker of the House of Representatives, and Minority Leaders of
972	the Senate and the House of Representatives.
973	15.  Establish benefit packages which conform to the
974	provisions of the Florida KidCare program, as created in ss.
975	409.810-409.820.
976	Section 13.  Subsection (4) of section 430.705, Florida
977	Statutes, is amended to read:
978	430.705  Implementation of the long-term care community
979	diversion pilot projects.--
980	(4)  Pursuant to 42 C.F.R. s. 438.6(c), the agency, in
981	consultation with the department, shall annually reevaluate and
982	recertify the capitation rates for the diversion pilot projects.
983	The agency, in consultation with the department, shall secure
984	the utilization and cost data for Medicaid and Medicare
985	beneficiaries served by the program which shall be used in
986	developing rates for the diversion pilot projects. The
987	capitation rates shall be risk adjusted by plan and reflect
988	members' level of chronic illness, functional limitations, and
989	risk of institutional placement, as determined by expenditures
990	for a comparable fee-for-service population. Payments for
991	Medicaid home and community-based services shall be actuarially
992	equivalent to plan experience.
993	Section 14.  This act shall take effect July 1, 2006.
994
995	======= T I T L E  A M E N D M E N T ==========
996	Remove the entire title and insert:
997	A bill to be entitled
998	An act relating to health care; amending s. 400.23, F.S.;
999	revising minimum staffing requirements for nursing homes;
1000	amending s. 409.904, F.S.; revising requirements relating
1001	to eligibility of certain women for family planning
1002	services; amending s. 409.905, F.S.; revising requirements
1003	for the hospitalist program; removing a provision
1004	authorizing the Agency for Health Care Administration to
1005	seek certain waivers to implement the program; amending s.
1006	409.906, F.S.; revising provisions relating to optional
1007	adult dental and visual services covered by Medicaid;
1008	amending s. 409.907, F.S.; revising the enrollment
1009	effective date for Medicaid providers; providing
1010	procedures for payment for certain claims for services;
1011	amending s. 409.9081, F.S.; revising the limitation on
1012	Medicaid recipient copayments for emergency room services;
1013	amending s. 409.911, F.S., relating to the hospital
1014	disproportionate share program; revising the method for
1015	calculating disproportionate share payments to hospitals;
1016	deleting obsolete provisions; amending s. 409.9113, F.S.;
1017	providing guidelines for distribution of disproportionate
1018	share funds to certain teaching hospitals; amending s.
1019	409.9117, F.S., relating to the primary care
1020	disproportionate share program; revising the time period
1021	during which the agency shall not distribute certain
1022	moneys; amending s. 409.912, F.S., relating to cost-
1023	effective purchasing of health care; deleting an obsolete
1024	provision requiring a certain percentage of capitation
1025	paid to managed care plans to be expended for behavioral
1026	health services; providing that adjustments for health
1027	status be considered in agency evaluations of the cost-
1028	effectiveness of Medicaid managed care plans; providing
1029	requirements for Medicaid capitation payments for managed
1030	long-term care programs and payments for Medicaid home and
1031	community-based services; amending s. 409.9122, F.S.;
1032	revising enrollment limits for Medicaid recipients who are
1033	subject to mandatory assignment to managed care plans and
1034	MediPass; amending s. 624.91, F.S.; requiring the Florida
1035	Healthy Kids Corporation to return certain unspent funds
1036	based on a formula developed by the corporation; amending
1037	s. 430.705, F.S., relating to implementation of the long-
1038	term care community diversion pilot projects; providing
1039	requirements for Medicaid capitation payments for managed
1040	long-term care programs and payments for Medicaid home and
1041	community-based services; providing an effective date.

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