Amendment
Bill No. 0398

Amendment No. 584845

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.  Subsection (3) of section 394.457, Florida
6	Statutes, is amended to read:
7	394.457  Operation and administration.--
8	(3)  POWER TO CONTRACT.--The department may contract to
9	provide, and be provided with, services and facilities in order
10	to carry out its responsibilities under this part with the
11	following agencies: public and private hospitals; receiving and
12	treatment facilities; clinics; laboratories; departments,
13	divisions, and other units of state government; the state
14	colleges and universities; the community colleges; private
15	colleges and universities; counties, municipalities, and any
16	other governmental unit, including facilities of the United
17	States Government; and any other public or private entity which
18	provides or needs facilities or services. Baker Act funds for
19	community inpatient, crisis stabilization, short-term
20	residential treatment, and screening services must be allocated
21	to each county pursuant to the department's funding allocation
22	methodology. Notwithstanding the provisions of s. 287.057(5)(f),
23	contracts for community-based Baker Act services for inpatient,
24	crisis stabilization, short-term residential treatment, and
25	screening provided under this part, other than those with other
26	units of government, to be provided for the department must be
27	awarded using competitive sealed bids when the county commission
28	of the county receiving the services makes a request to the
29	department's district office by January 15 of the contracting
30	year. The district shall not enter into a competitively bid
31	contract under this provision if such action will result in
32	increases of state or local expenditures for Baker Act services
33	within the district. Contracts for these Baker Act services
34	using competitive sealed bids will be effective for 3 years.
35	Services contracted for by the department may be reimbursed by
36	the state at a rate up to 100 percent. The department shall
37	adopt rules establishing minimum standards for such contracted
38	services and facilities and shall make periodic audits and
39	inspections to assure that the contracted services are provided
40	and meet the standards of the department.
41	Section 2.  Section 394.908, Florida Statutes, is amended
42	to read:
43	394.908  Substance abuse and mental health funding equity;
44	distribution of appropriations.--In recognition of the
45	historical inequity among service districts of the former
46	Department of Health and Rehabilitative Services in the funding
47	of substance abuse and mental health services for the
48	department's districts and regions, and in order to rectify this
49	inequity and provide for equitable funding in the future
50	throughout the state, the following funding process shall be
51	used adhered to:
52	(1)  Funding thresholds for substance abuse and mental
53	health services in each of the current districts, statewide,
54	shall be established based on the current number of persons in
55	need per district of substance abuse and mental health services,
56	respectively.
57	(2)  "Persons in need" means those persons who fit the
58	profile of the respective target populations and require mental
59	health or substance abuse services.
60	(3)  Seventy-five percent of Any additional funding beyond
61	the 2005-2006 1996-1997 fiscal year base appropriation for
62	alcohol, drug abuse, and mental health services shall be
63	allocated to districts for substance abuse and mental health
64	services based on:
65	(a)  Epidemiological estimates of disabilities that which
66	apply to the respective target populations.
67	(b)  A pro rata share distribution that ensures districts
68	below the statewide average funding level per person in each
69	target population of "persons in need" receive funding necessary
70	to achieve equity.
71	(4)  The remaining 25 percent shall be allocated based on
72	the number of persons in need of substance abuse and mental
73	health services per district without regard to current funding
74	levels.
75	(4)(5)  Target populations for persons in need shall be
76	displayed for each district and distributed concurrently with
77	the approved operating budget. The display by target population
78	shall show: The annual number of persons served based on prior
79	year actual numbers, the annual cost per person served, the
80	number of persons served by service cost center, and the
81	estimated number of the total target population for persons in
82	need.
83	(5)(6)  The annual cost per person served shall be defined
84	as the total actual funding for each target population divided
85	by the number of persons served in the target population for
86	that year.
87	(7)  Commencing on July 1, 1998, all additional funding
88	pursuant to this section shall be performance-based.
89	(8)  For fiscal year 2004-2005 only, and notwithstanding
90	the provisions of this section, all new funds received in excess
91	of fiscal year 2003-2004 recurring appropriations shall be
92	allocated in accordance with the provisions of the General
93	Appropriations Act; however, no district shall receive an
94	allocation of recurring funds less than its initial approved
95	operating budget, plus any distributions of lump sum
96	appropriations or reductions in unfunded budget, for fiscal year
97	2003-2004. This subsection expires July 1, 2005.
98	Section 3.  Subsection (10) of section 402.33, Florida
99	Statutes, is amended to read:
100	402.33  Department authority to charge fees for services
101	provided.--
102	(10)(a)  Unless otherwise specified by the Legislature, fee
103	collections, including third-party reimbursements, in excess of
104	fee-supported appropriations may be used in conformance with the
105	provisions of chapter 216 to fund nonrecurring expenditures for
106	direct client services and to fund administrative costs of
107	improving the fee collection program of the department. No more
108	than one-sixth of the amount of collections in excess of the
109	amount of appropriations may be used to fund such improvements
110	to the program. Priority consideration for the expenditure of
111	excess collections shall be given to those districts and
112	programs most responsible for the excess. A plan for the use of
113	excess collections not spent in the fiscal year in which
114	collected shall be subject to approval by the Executive Office
115	of the Governor within 90 days from the end of the state fiscal
116	year in which the excess occurs.
117	(b)  For the 2005-2006 fiscal year only, the provisions of
118	paragraph (a) shall not apply. This paragraph expires July 1,
119	2006.
120	Section 4.  Subsection (7) of section 409.1671, Florida
121	Statutes, is amended to read:
122	409.1671  Foster care and related services; outsourcing.--
123	(7)  The Florida Coalition for Children, Inc., in
124	consultation with the department, shall develop a plan, in
125	consultation with the Florida Coalition for Children, Inc.,
126	based on an independent actuarial study regarding the long-term
127	use and structure of a statewide community-based care risk pool
128	for the protection of eligible lead community-based providers,
129	their subcontractors, and providers of other social services who
130	contract directly with the department. The plan must also
131	outline strategies to maximize federal earnings as they relate
132	to the community-based care risk pool. At a minimum, the plan
133	must allow for the use of federal earnings received from child
134	welfare programs to be allocated to the community-based care
135	risk pool by the department, which earnings are determined by
136	the department to be in excess of the amount appropriated in the
137	General Appropriations Act. The plan must specify the necessary
138	steps to ensure the financial integrity and industry-standard
139	risk management practices of the community-based care risk pool
140	and the continued availability of funding from federal, state,
141	and local sources. The plan must also include recommendations
142	that permit the program to be available to entities of the
143	department providing child welfare services until full
144	conversion to community-based care takes place. The final plan
145	shall be submitted to the department and then to the Executive
146	Office of the Governor and the Legislative Budget Commission for
147	formal adoption before January 1, 2005. Upon approval of the
148	plan by all parties, the department is authorized to expend
149	funds from the community-based care risk pool pursuant to the
150	provisions of the plan shall issue an interest-free loan that is
151	secured by the cumulative contractual revenue of the community-
152	based care risk pool membership, and the amount of the loan
153	shall equal the amount appropriated by the Legislature for this
154	purpose. The plan shall provide for a governance structure that
155	assures the department the ability to oversee the operation of
156	the community-based care risk pool at least until this loan is
157	repaid in full.
158	(a)  The purposes for which the community-based care risk
159	pool shall be used include, but are not limited to:
160	1.  Significant changes in the number or composition of
161	clients eligible to receive services.
162	2.  Significant changes in the services that are eligible
163	for reimbursement.
164	3.  Scheduled or unanticipated, but necessary, advances to
165	providers or other cash-flow issues.
166	4.  Proposals to participate in optional Medicaid services
167	or other federal grant opportunities.
168	5.  Appropriate incentive structures.
169	6.  Continuity of care in the event of failure,
170	discontinuance of service, or financial misconduct by a lead
171	agency.
172	7.  Payment for time-limited technical assistance and
173	consultation to lead agencies in the event of serious
174	performance or management problems.
175	8.  Payment for meeting all traditional and nontraditional
176	insurance needs of eligible members.
177	9.  Significant changes in the mix of available funds.
178	(b)  After approval of the plan in the 2004-2005 fiscal
179	year and annually thereafter, the department may also request in
180	its annual legislative budget request, and the Governor may
181	recommend, that the funding necessary to carry out paragraph (a)
182	be appropriated to the department. Subsequent funding of the
183	community-based care risk pool shall be supported by premiums
184	assessed to members of the community-based care risk pool on a
185	recurring basis. The community-based care risk pool may invest
186	and retain interest earned on these funds. In addition, the
187	department may transfer funds to the community-based care risk
188	pool as available in order to ensure an adequate funding level
189	if the fund is declared to be insolvent and approval is granted
190	by the Legislative Budget Commission. Such payments for
191	insolvency shall be made only after a determination is made by
192	the department or its actuary that all participants in the
193	community-based care risk pool are current in their payments of
194	premiums and that assessments have been made at an actuarially
195	sound level. Such payments by participants in the community-
196	based care risk pool may not exceed reasonable industry
197	standards, as determined by the actuary. Money from this fund
198	may be used to match available federal dollars. Dividends or
199	other payments, with the exception of legitimate claims, may not
200	be paid to members of the community-based care risk pool until
201	the loan issued by the department is repaid in full. Dividends
202	or other payments, with the exception of legitimate claims and
203	other purposes contained in the approved plan, may not be paid
204	to members of the community-based care risk pool unless, at the
205	time of distribution, the community-based care risk pool is
206	deemed actuarially sound and solvent. Solvency shall be
207	determined by an independent actuary contracted by the
208	department. The plan shall be developed in consultation with the
209	Office of Insurance Regulation.
210	1.  Such funds shall constitute partial security for
211	contract performance by lead agencies and shall be used to
212	offset the need for a performance bond. Subject to the approval
213	of the plan, the community-based care risk pool shall be managed
214	by the Florida Coalition for Children, Inc., or the designated
215	contractors of the Florida Coalition for Children, Inc.
216	Nonmembers of the community-based care risk pool may continue to
217	contract with the department but must provide a letter of credit
218	equal to one-twelfth of the annual contract amount in lieu of
219	membership in the community-based care risk pool.
220	2.  The department may separately require a bond to
221	mitigate the financial consequences of potential acts of
222	malfeasance, misfeasance, or criminal violations by the
223	provider.
224	(c)  The department may issue an interest-free loan to the
225	Florida Coalition for Children, Inc., for the purpose of
226	creating a self-insurance program. The loan shall be secured by
227	the cumulative contractual revenue of the community-based care
228	lead agencies participating in the self-insurance program. The
229	amount of the loan shall be in an amount equal to the amount
230	appropriated by the Legislature for this purpose.
231	Section 5.  Effective upon this act becoming a law:
232	(1)  A 3-year pilot program is established for the
233	community-based care lead agencies serving Miami-Dade, Monroe,
234	and Broward Counties. This pilot program shall allow for the
235	transfer of the current lead agency oversight responsibilities
236	of the Department of Children and Family Services to independent
237	agents and for funding the program through a grant that enhances
238	funding flexibility. The pilot program shall expand the
239	responsibilities and services provided by these lead agencies.
240	(2)  The Department of Children and Family Services shall
241	enter into a 3-year contract with the designated community-based
242	care lead agency serving Miami-Dade and Monroe Counties and with
243	the designated community-based care lead agency serving Broward
244	County, which have been established in accordance with s.
245	409.1671, Florida Statutes. The contracts must be fixed-payment
246	contracts funded in 36 equal monthly installments. The first 2
247	months shall be paid in advance, and the contract must contain
248	the elements outlined in this section. The initial 2-month
249	advance payment is due July 10, 2006. The contracts shall be
250	funded by general revenue through a grant and by federal Title
251	IV-E funding and other federal funding sources. The amount of
252	federal Title IV-E funding allocated in each year of the 3-year
253	pilot program shall be equal to the amount earned by each of the
254	lead agencies during the 2005-2006 fiscal year. The state shall
255	be held harmless for any shortfall caused by the lead agencies'
256	inability to earn the allocated Title IV-E funding, and each
257	lead agency's contract shall be increased in accordance with any
258	federal overearnings. Funding in excess of the contracted
259	amounts for the lead agencies shall be available only in the
260	event of additional specific legislative appropriations for
261	services provided under s. 409.1671, Florida Statutes; an
262	increase in the population of children served that exceeds 3
263	percent of the population of children served on June 15, 2005,
264	by either lead agency; or unforeseen catastrophic events as
265	determined by the Governor and funded by the Legislature. The
266	lead agencies shall annually provide certified audited financial
267	statements to the Governor, the Department of Children and
268	Family Services, and the appropriations committees of the
269	Legislature. All other required fiscal reporting shall be
270	determined by the independent fiscal monitors selected by the
271	parties. For purposes of this section, the term "parties" means
272	the two lead agencies implementing this pilot program and the
273	Department of Children and Family Services. In order to
274	facilitate and expedite the execution of this section, the
275	parties shall engage an independent arbitrator for purposes of
276	dispute resolution, including any disputes related to the form
277	and substance of the contract to execute the pilot program, with
278	an award of fees and costs to the prevailing party. The
279	arbitrator's role shall be limited to selecting which party's
280	position is more reasonable.
281	(3)  Contract management, fiscal oversight, and
282	programmatic oversight shall be conducted by independent,
283	nongovernmental third-party entities under contract to the
284	department and shall be conducted in a manner jointly agreed to
285	by the lead agencies and the department. The cost of contracting
286	with these independent entities shall be funded by the
287	department. Notwithstanding any other provision to the contrary,
288	the pilot program may not be implemented until the parties have
289	agreed to the selection of these entities and the manner in
290	which they are to carry out their responsibilities. Such
291	agreement must be reached by the parties no later than July 1,
292	2006. The selection of the entities for purposes of compliance
293	with this subsection shall be exempt from the provisions of s.
294	287.057, Florida Statutes. Fiscal oversight shall be conducted
295	in a manner similar to the model used by the department during
296	the 2005-2006 fiscal year in Miami-Dade and Monroe Counties. In
297	order to be able to compare the performance of the pilot
298	program's lead agencies with that of other lead agencies, the
299	programmatic performance of the pilot program's lead agencies
300	shall be measured and monitored by outcome measures contained in
301	their contracts with the department that are in effect on the
302	effective date of this section. The independent entities shall
303	submit their reports directly to the Governor, the President of
304	the Senate, and the Speaker of the House of Representatives.
305	(4)  The department and the lead agencies implementing the
306	pilot program shall develop an implementation plan with the
307	Agency for Health Care Administration regarding the pending
308	Medicaid mental health reform for the purpose of implementing a
309	local reform model that allows for the integration of services
310	in the current systems of care.
311	(5)  The annual evaluation required by s. 409.1671(4)(a),
312	Florida Statutes, shall include an evaluation of the pilot
313	program described in this act that compares performance and
314	fiscal management of the community-based care lead agencies in
315	the pilot program to those that are not in the pilot program. In
316	addition, the Office of Program Policy Analysis and Government
317	Accountability and the Office of the Auditor General shall
318	jointly complete an evaluation of the pilot program and provide
319	an interim report to the President of the Senate and the Speaker
320	of the House of Representatives no later than February 1, 2008,
321	and a final report no later than February 1, 2009.
322	Section 6.  Except as otherwise expressly provided in this
323	act, this act shall take effect July 1, 2006.
324
325	======= T I T L E  A M E N D M E N T ==========
326	Remove the entire title and insert:
327	A bill to be entitled
328	An act relating to funding for social services; amending
329	s. 394.457, F.S.; deleting provisions authorizing a
330	reimbursement rate of 100 percent by the Department of
331	Children and Family Services for certain services provided
332	under the Baker Act; amending s. 394.908, F.S.; revising
333	the funding allocation methodology; amending s. 402.33,
334	F.S.; eliminating certain authority of the Department of
335	Children and Family Services and the Department of Health
336	to use fee collections in excess of fee-supported
337	appropriations for certain purposes; amending s. 409.1671,
338	F.S.; requiring the Department of Children and Family
339	Services to develop a statewide plan for outsourcing
340	foster care and related services; removing certain plan
341	requirements; removing an obsolete date; authorizing the
342	expenditure of certain funds; removing a requirement to
343	issue certain loans; removing certain provisions relative
344	to the sources of future funding; making conforming
345	changes; removing authority of the Florida Coalition for
346	Children, Inc., or its subcontractors to manage certain
347	risk pool funds; authorizing the department to issue an
348	interest-free loan to the Florida Coalition for Children,
349	Inc., to establish a self-insurance program based on
350	certain appropriations; establishing a 3-year pilot
351	program in Miami-Dade, Monroe, and Broward Counties;
352	providing for the transfer of certain responsibilities
353	from the Department of Children and Family Services to
354	specified community-based care lead agencies; providing
355	for funding the pilot program from grants and federal
356	funds; requiring that the department enter into fixed-
357	payment contracts; requiring that annual financial
358	statements regarding the pilot program be provided to the
359	Governor, the department, and the Legislature; requiring
360	that an independent arbitrator resolve certain disputes
361	related to contracts; requiring that contract management
362	and oversight be conducted by third-party entities;
363	providing an exemption from s. 287.057, F.S.; requiring
364	such entities to submit reports to the Governor and the
365	Legislature; requiring that the department, the lead
366	agencies implementing the pilot program, and the Agency
367	for Health Care Administration develop a plan for
368	integrating certain Medicaid mental health services;
369	specifying that the annual evaluation required in s.
370	409.1671, F.S., include an evaluation of the pilot
371	program; directing the Office of Program Policy Analysis
372	and Government Accountability and the Office of the
373	Auditor General to complete an evaluation of the pilot
374	program and to report to the Legislature; providing
375	effective dates.

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