Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. SB 1828
Barcode 210298
CHAMBER ACTION
Senate House
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04/24/2007 02:15 PM .
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11 The Committee on Health and Human Services Appropriations
12 (Saunders) recommended the following amendment:
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14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Subsections (8) and (9) of section
19 409.91211, Florida Statutes, are amended to read:
20 409.91211 Medicaid managed care pilot program.--
21 (8)(a) The agency shall develop a methodology for
22 calculating risk-adjusted capitation rates using comprehensive
23 encounter data pursuant to subparagraph (3)(p)4. for all
24 Medicaid services specified under this section. The agency
25 shall concentrate on the managed care pilot areas in its
26 efforts to gather comprehensive encounter data. Prior to the
27 implementation of a risk-adjusted capitation rate methodology
28 that uses a comprehensive encounter data system, the agency
29 shall ensure that all of the following criteria are met:
30 1. The agency has confirmed that the encounter data
31 are accurate and have been screened for completeness, logic,
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. SB 1828
Barcode 210298
1 and consistency.
2 2. The agency has compiled no less than 1 year's worth
3 of complete encounter data to permit the adjustment of
4 capitation rates for health risk differences and has ensured
5 that the data are of sufficient integrity to be used for
6 risk-adjustment purposes in accordance with actuarial
7 standards of practice which are generally recognized as sound
8 and appropriate.
9 3. The agency has consulted with and sought input from
10 the technical advisory panel regarding the development and
11 implementation of the comprehensive encounter data system as
12 the system is developed.
13 (b) The agency may implement an interim risk-adjusted
14 capitation rate methodology to be used before a fully
15 functional encounter data system has been in operation for 12
16 months, pursuant to paragraph (a).
17 The agency must ensure, in the first two state fiscal
18 years in which a risk-adjusted methodology is a component of
19 rate setting, that no managed care plan providing
20 comprehensive benefits to TANF and SSI recipients has an
21 aggregate risk score that varies by more than 10 percent from
22 the aggregate weighted mean of all managed care plans
23 providing comprehensive benefits to TANF and SSI recipients in
24 a reform area. The agency's payment to a managed care plan
25 shall be based on such revised aggregate risk score.
26 (9) Risk-adjusted After any calculations of aggregate
27 risk scores or revised aggregate risk scores in subsection
28 (8), the capitation rates for plans participating under this
29 section shall be phased in as follows:
30 (a) In the first year of the pilot program, the
31 capitation rates shall be weighted so that 75 percent of each
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. SB 1828
Barcode 210298
1 capitation rate is based on the current methodology developed
2 under s. 409.9124 and 25 percent is based on a new
3 risk-adjusted capitation rate methodology developed under
4 subsection (8). During the first year of the pilot program, no
5 managed care plan's aggregate risk score shall vary by more
6 than 10 percent from the aggregate weighted mean of all
7 managed care plans providing comprehensive benefits to TANF or
8 SSI recipients in a reform area.
9 (b) In the second year of the pilot program, the
10 capitation rates shall be weighted so that 67 50 percent of
11 each capitation rate is based on the current methodology
12 developed under s. 409.9124 and 33 50 percent is based on a
13 new risk-adjusted capitation rate methodology developed under
14 subsection (8). During the second year of the pilot program,
15 no managed care plan's aggregate risk score shall vary by more
16 than 10 percent from the aggregate weighted mean of all
17 managed care plans providing comprehensive benefits to TANF or
18 SSI recipients in a reform area.
19 (c) In the third year of the pilot program, the
20 capitation rates shall be weighted so that 67 percent of each
21 capitation rate is based on the methodology developed under s.
22 409.9124 and 33 percent is based on a risk-adjusted capitation
23 rate methodology developed under subsection (8). During the
24 third year of the pilot program, no managed care plan's
25 aggregate risk score shall vary by more than 12.5 percent from
26 the aggregate weighted mean of all managed care plans
27 providing comprehensive benefits to TANF or SSI recipients in
28 a reform area. In the following fiscal year, the risk-adjusted
29 capitation methodology may be fully implemented.
30 (d) In the fourth year of the pilot program, the
31 agency shall seek to implement a risk-adjusted capitation rate
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. SB 1828
Barcode 210298
1 methodology using comprehensive encounter data pursuant to
2 paragraph (8)(a). Capitation rates in the fourth year shall be
3 weighted so that 50 percent of each capitation rate is based
4 on the methodology developed under s. 409.9124 and 50 percent
5 is based on a risk-adjusted capitation rate methodology which
6 uses a comprehensive encounter data system, and no managed
7 care plan's aggregate risk score shall vary by more than 15
8 percent from the aggregate weighted mean of all managed care
9 plans providing comprehensive benefits to TANF or SSI
10 recipients in a reform area.
11 (e) In the years following the first use of a
12 risk-adjusted capitation rate methodology using comprehensive
13 encounter data pursuant to paragraph (8)(a), such methodology
14 shall be fully implemented and shall account for 100 percent
15 of managed care plan capitation rates.
16 Section 2. This act shall take effect July 1, 2007.
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19 ================ T I T L E A M E N D M E N T ===============
20 And the title is amended as follows:
21 Delete everything before the enacting clause
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23 and insert:
24 A bill to be entitled
25 An act relating to the Medicaid managed care
26 pilot program; amending s. 409.91211, F.S.;
27 requiring the Agency for Health Care
28 Administration to develop a methodology for
29 calculating risk-adjusted capitation rates
30 based on comprehensive encounter data;
31 requiring that specified criteria be met prior
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Florida Senate - 2007 COMMITTEE AMENDMENT
Bill No. SB 1828
Barcode 210298
1 to implementation of the methodology; providing
2 for use of an interim risk-adjusted
3 methodology; providing a phase-in schedule for
4 the risk-adjusted methodology for participating
5 managed care plans; providing an effective
6 date.
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