HB 5007

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

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