CS/HB 1429

1	A bill to be entitled
2	An act relating to mental health and substance abuse
3	services; amending s. 394.9082, F.S.; providing
4	legislative findings and intent; providing definitions;
5	providing service delivery strategies; providing for data
6	sharing agreements; establishing a process for the
7	Department of Children and Family Services to contract
8	with community-based managing entities; specifying
9	criteria for contracts between the department and managing
10	entities for the provision of behavioral health services;
11	establishing goals for service delivery ; creating
12	community-based systems of care; authorizing the
13	implementation of managing entities by the department;
14	specifying responsibilities of managing entities;
15	specifying roles and responsibilities of the department;
16	specifying management information system requirements;
17	providing for evaluations and reports; providing for a
18	monitoring process; providing rulemaking authority;
19	providing an effective date.
20
21	Be It Enacted by the Legislature of the State of Florida:
22
23	Section 1.  Section 394.9082, Florida Statutes, is amended
24	to read:
25	(Substantial rewording of section. See
26	s. 394.9082, F.S., for present text.)
27	394.9082  Behavioral health managing entities.--
28	(1)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature
29	finds that untreated behavioral health disorders constitute
30	major health problems for Floridians, are a major economic
31	burden to the citizens of this state, and substantially increase
32	demands on the state's criminal justice, juvenile justice, child
33	protection, and health care systems. The Legislature finds that
34	behavioral health disorders respond to appropriate treatment,
35	rehabilitation, and supportive intervention. The Legislature
36	finds that it has made a substantial long-term investment in the
37	funding of the community-based behavioral health treatment
38	service delivery systems and facilities in order to provide
39	critical emergency, acute care, residential, outpatient, and
40	rehabilitative services. The Legislature finds that local
41	communities have also made substantial investments in behavioral
42	health services by contracting with safety net providers that
43	provide specialized services to vulnerable and hard-to-serve
44	populations and have strong ties to local public health and
45	public safety agencies. The Legislature finds that a management
46	structure that places the responsibility for publicly financed
47	behavioral health treatment and prevention services within a
48	single private nonprofit entity at the local level promotes
49	improved access to care, promotes continuity of care, and
50	provides a more efficient and effective delivery of substance
51	abuse and mental health services. The Legislature finds that the
52	transformation of existing data systems into effective
53	decisionmaking models is required in order to provide the timely
54	and accurate information needed at the federal, state, and local
55	levels to support the integrated system of community-based care.
56	The Legislature further finds that streamlining administrative
57	processes creates cost efficiencies and provides the flexibility
58	to better match available services to the consumer's behavioral
59	health needs.
60	(2)  DEFINITIONS.--As used in this section, the term:
61	(a)  "Behavioral health services" means mental health
62	services and substance abuse prevention and treatment services
63	as defined in this chapter and chapter 397 that are provided
64	with state and federal funds.
65	(b)  "Decisionmaking model" means a comprehensive
66	management information system designed to determine, at the
67	federal, state, regional, and local level:
68	1.  The providers that will provide the services.
69	2.  The population that will receive the services.
70	3.  The cost of providing the services.
71	4.  The desired outcome.
72	(c)  "Geographic area" means a county, circuit, regional,
73	or multiregional area in the state.
74	(d)  "Managing entity" means a Florida corporation that is
75	exempt from taxation under s. 501(c)(3) of the Internal Revenue
76	Code and is under contract to the department to manage the day-
77	to-day operational delivery of behavioral health services
78	through the establishment of an organized system of care.
79	(e)  "Provider network" means the direct service delivery
80	agency under contract with a managing entity that together
81	provide emergency, acute care, residential, outpatient, recovery
82	support, and consumer support services.
83	(3)  SERVICE DELIVERY STRATEGIES.--The department may work
84	through a managing entity to develop service delivery strategies
85	to improve the coordination, integration, and management of the
86	delivery of behavioral health services to people with mental
87	health or substance abuse disorders. It is the intent of the
88	Legislature that a well-managed service delivery system will
89	increase access for those in need of care, improve the
90	coordination and continuity of care for vulnerable and high-risk
91	populations, and redirect service delivery dollars from
92	restrictive care settings to community-based recovery services.
93	(4)  DATA SHARING AGREEMENTS.--For the purpose of data
94	integration and cost-effectiveness, the department shall have
95	data sharing agreements with other state agencies to develop a
96	consumer-oriented reporting system with uniform definitions and
97	reporting categories to determine behavioral health care
98	services to be provided and the projected outcomes and costs of
99	these services.
100	(5)  CONTRACT FOR SERVICES.--
101	(a)  The department may contract for the purchase and
102	management of behavioral health services with a community-based
103	managing entity. The department may require a managing entity to
104	contract for specialized services not currently part of the
105	managing entity's network if the department determines that it
106	is in the best interest of the consumer of the services. The
107	secretary shall determine the schedule for phasing in a contract
108	with a managing entity. The managing entity shall be
109	accountable, at a minimum, for the operational oversight of the
110	delivery of behavioral health services funded by the department
111	and for the collection and submission of the required data
112	pertaining to these contracted services. A managing entity shall
113	serve a geographic area designated by the department. The
114	geographic area must have a population of sufficient size and
115	have enough public funds allocated for behavioral health
116	services to allow for flexibility and maximum efficiency.
117	(b)  The operating costs of the managing entity contract
118	shall be funded through the department and any savings and
119	efficiencies achieved through the implementation of managing
120	entities when realized by their participating provider network
121	agencies. The department recognizes that managing entities will
122	have infrastructure development costs during start up;
123	therefore, any efficiencies to be realized by providers from
124	consolidation of management functions and the resulting savings
125	will not be achieved during the early years of operation. The
126	department shall negotiate a reasonable and appropriate
127	administrative cost rate with the managing entity. The
128	Legislature intends that reduced local and state contract
129	management and other administrative duties passed on to the
130	managing entity allow funds previously allocated for these
131	purposes to be proportionately reduced and the savings used to
132	fund the administrative functions of the managing entity.
133	Department policies and procedures for monitoring contracts with
134	managing entities shall include provisions for eliminating
135	duplication of the department's and the managing entities'
136	contract management and other administrative duties to achieve
137	the goals of cost effectiveness and regulatory relief. To the
138	maximum extent possible, provider monitoring activities shall be
139	assigned to the managing entity.
140	(c)  Contracting and payment mechanisms for services shall
141	promote clinical and financial flexibility and responsiveness
142	and allow different categorical funds to be integrated at the
143	point of service. The contracted delivery options shall be
144	determined by using needs assessment and evidence-based, best
145	practice, and promising practice models and soliciting public
146	input. The department is authorized to employ prepaid case rate,
147	prepaid capitation, or other care-management methodologies to
148	purchase services that promote flexibility, efficiency, and
149	accountability.
150	(6)  GOALS.--The goal of the service delivery strategies is
151	to provide a design for an effective coordination, integration,
152	and management approach for delivering effective behavioral
153	health services to persons who are experiencing a mental health
154	or substance abuse crisis; who have a disabling mental illness
155	or substance abuse disorder or co-occurring mental health and
156	substance abuse disorders and require extended services in order
157	to recover from the disorder; or who need brief treatment or
158	long-term supportive interventions to avoid a crisis or
159	disability. Other goals include the following:
160	(a)  Improve accountability for a local system of
161	behavioral health care services to meet performance outcomes and
162	standards through the use of reliable and timely data.
163	(b)  Enhance continuity of care for all children,
164	adolescents, and adults who enter the publicly funded behavioral
165	health service system.
166	(c)  Preserve the safety net of publicly funded behavioral
167	health services and providers and recognize and ensure continued
168	local contributions to these services by establishing locally
169	designed and community-based systems of care.
170	(d)  Provide early diagnosis and treatment interventions to
171	enhance recovery and prevent hospitalization.
172	(e)  Improve assessment of local needs for behavioral
173	health services.
174	(f)  Improve the overall quality of behavioral health
175	services through the use of evidence-based, best practice, and
176	promising practice models.
177	(g)  Demonstrate improved service integration between
178	behavioral health programs and other programs, such as
179	vocational rehabilitation, education, child welfare, primary
180	health care, emergency services, juvenile justice, and criminal
181	justice.
182	(h)  Provide for additional testing of creative and
183	flexible strategies for financing behavioral health services to
184	enhance individualized treatment and support services.
185	(i)  Promote cost-effective quality care.
186	(j)  Work with the state to coordinate the admissions and
187	discharges from state civil and forensic hospitals and
188	coordinate admissions and discharges from residential treatment
189	centers.
190	(k)  Improve the integration, accessibility, and
191	dissemination of behavioral health data for planning and
192	monitoring purposes.
193	(l)  Promote specialized behavioral health services to
194	residents of assisted living facilities.
195	(m)  Work with the state and other stakeholders to reduce
196	the number of admissions and the length of stay for dependent
197	children in residential treatment centers.
198	(n)  Provide services to adults and children with co-
199	occurring mental health and substance abuse disorders.
200	(o)  Provide services to elders in crisis or at-risk for
201	placement in a more restrictive setting due to a serious mental
202	health or substance abuse disorder.
203	(7)  ESSENTIAL ELEMENTS.--It is the intent of the
204	Legislature that the department is authorized to plan for and
205	enter into contracts with managing entities to manage care in
206	geographical areas throughout the state. A managing entity shall
207	own and operate information systems with the capacity to
208	provide, at a minimum, information required for federal and
209	state reporting, monitoring care, assessing local needs, and
210	measuring outcomes.
211	(a)  The managing entity must demonstrate the ability of
212	its network of providers to comply with the applicable
213	provisions of this chapter and chapter 397 and to ensure the
214	provision of comprehensive behavioral health services. The
215	network of providers shall include, but is not limited to,
216	community mental health agencies, substance abuse treatment
217	providers, and best practice consumer services.
218	(b)  The department shall terminate its contracts for
219	mental health or substance abuse services provided by the
220	managing entity when the department enters into a contract with
221	the managing entity.
222	(c)  The managing entity shall ensure that its provider
223	network is broadly conceived. All mental health or substance
224	abuse providers currently under contract with the department
225	shall be offered a contract by the managing entity.
226	(d)  The department may contract with managing entities to
227	provide the following core functions:
228	1.  Financial accountability.
229	2.  Allocation of funds to network providers in a manner
230	that reflects the department's strategic direction and plans.
231	3.  Provider monitoring to ensure compliance with federal
232	and state laws and regulations.
233	4.  Data collection, reporting, and analysis.
234	5.  Operational plans to implement objectives of the
235	department's strategic plan.
236	6.  Contract compliance.
237	7.  Performance management.
238	8.  Collaboration with community stakeholders, including
239	local government.
240	9.  System of care through network development.
241	10.  Consumer care coordination.
242	11.  Continuous quality improvement.
243	12.  Timely access to appropriate services.
244	13.  Cost effectiveness and system improvements.
245	14.  Assistance in the development of the department's
246	strategic plan.
247	15.  Participation in community, circuit, regional, and
248	state planning.
249	16.  Resource management and maximization including pursuit
250	of third-party payments and grant applications.
251	17.  Incentives for providers to improve quality and
252	access.
253	18.  Liaison with consumers.
254	19.  Community needs assessment.
255	20.  Securing a local match.
256	(e)  The managing entity shall ensure that written
257	cooperative agreements are developed and implemented among the
258	criminal justice and juvenile justice systems, the local
259	community-based care network, and the local behavioral health
260	providers in the geographic area that define strategies and
261	alternatives for diverting people with mental health and
262	substance abuse disorders from the criminal justice system to
263	community-based services. These agreements must also address the
264	provision of appropriate services to persons with behavioral
265	health disorders who leave the criminal justice system.
266	(f)  Managing entities must collect and submit data to the
267	department regarding persons served, the outcomes of persons
268	served, and the costs of services provided through the
269	department's contract. The department shall evaluate managing
270	entity services based on consumer-centered outcome measures that
271	reflect national standards. The department shall work with
272	managing entities to establish performance standards related to:
273	1.  The extent to which individuals in the community
274	receive services.
275	2.  Improvement of quality of care for individuals served.
276	3.  The success of strategies to divert jail, prison, and
277	forensic facility admissions.
278	4.  Consumer and family satisfaction.
279	5.  Satisfaction of key community constituents such as law
280	enforcement agencies, juvenile justice agencies, the courts, the
281	schools, local government entities, hospitals, and others, as
282	appropriate for the geographical area of the managing entity.
283	(g)  The agency may establish a voluntary certified match
284	program. Under a certified match program, reimbursement is
285	limited to the federal Medicaid share to Medicaid-enrolled
286	strategy participants. The agency shall take no action to
287	implement a certified match program without ensuring that the
288	consultation provisions of chapter 216 have been met. The agency
289	may seek federal waivers that are necessary to implement the
290	behavioral health service delivery strategies.
291	(8)  MANAGING ENTITY REQUIREMENTS.--The department may
292	establish standards and a process for the qualification and
293	operation of managing entities that shall be based, in part, on
294	the following criteria:
295	(a)  The governing body of a managing entity shall, at a
296	minimum, include consumers and family members, community
297	stakeholders and organizations, and providers of substance abuse
298	and mental health services as defined in this chapter and
299	chapter 397. If there are one or more private receiving
300	facilities in the geographic coverage area of a managing entity,
301	the managing entity shall have one representative of private
302	receiving facilities as an ex officio member of its board of
303	directors.
304	(b)  A managing entity that was originally formed primarily
305	by substance abuse or mental health providers must present and
306	demonstrate a detailed, consensus approach to expanding its
307	provider network governance and organization to include both
308	substance abuse and mental health providers.
309	(c)  A managing entity shall submit a network management
310	plan and budget to the department. The plan must specify the
311	means for implementing the duties to be contracted to the
312	managing entity and the efficiencies to be anticipated by the
313	department as a result of executing the contract. The department
314	may require modifications to the plan and must approve the plan
315	before contracting with a managing entity. The department may
316	contract with a managing entity that demonstrates readiness to
317	assume core functions and may continue to add functions and
318	responsibilities to the managing entity contract over time as
319	additional standards are developed to measure the competencies
320	of the managing entity as provided in paragraph (9)(c).
321	Notwithstanding the provisions of this section, nothing shall
322	prevent the department from continuing and expanding managing
323	entity contracts if the department determines that the managing
324	entity meets the requirements specified in this section.
325	(d)  Notwithstanding paragraphs (b) and (c), a managing
326	entity that is currently a fully integrated system providing
327	both mental health and substance abuse, Medicaid, and child
328	welfare services shall be permitted to continue operating under
329	its current governance structure as long as the managing entity
330	can demonstrate to the department that consumers, other
331	stakeholders, and network providers are included in the planning
332	process.
333	(e)  A managing entity shall provide public access to
334	information, notice of meetings, and opportunities for broad
335	public participation in decisionmaking. The managing entity's
336	network management plan must provide detailed policies and
337	procedures to the public.
338	(9)  DEPARTMENT RESPONSIBILITIES.--
339	(a)  When a managing entity begins to monitor the day-to-
340	day operations of a provider under contract with the department,
341	the department and its regional and circuit offices will have
342	increased ability to focus on broad systemic substance abuse and
343	mental health issues. After the department enters into a
344	contract with a managing entity in a geographic area, the
345	regional and circuit offices of the department in that area
346	shall direct their efforts primarily to monitoring that
347	contract, including negotiating a system to implement quality
348	improvement goals for each contract year and reviewing the
349	managing entity's plans to execute the department's strategic
350	plans; carrying out statutorily mandated licensure functions;
351	conducting community and regional substance abuse and mental
352	health planning activities; communicating the local needs
353	assessed by the managing entity to the department; preparing the
354	department's strategic plans; coordinating the provisions of
355	services with other state and local agencies; assisting the
356	department in assessing local trends and issues and advising
357	departmental headquarters on local priorities; and providing
358	leadership in disaster planning and preparation.
359	(b)  Before entering into a contract with a managing
360	entity, the department shall perform an onsite readiness review
361	of the managing entity to determine its capacity to
362	satisfactorily perform the duties to be contracted.
363	(c)  The department shall engage community stakeholders,
364	including providers and managing entities under contract with
365	the department, in the development of objective standards to
366	measure the competencies of managing entities and their
367	readiness to assume the responsibilities described in this
368	subsection and to hold them accountable for the outcomes.
369	(d)  Notwithstanding any other provision of law or
370	administrative rule to the contrary, the Department of Financial
371	Services and the Department of Management Services shall provide
372	the department with the flexibility needed to implement this
373	section.
374	(10)  MANAGEMENT INFORMATION SYSTEM REQUIREMENTS.--
375	(a)  The department, in collaboration with the managing
376	entities, shall design and implement a comprehensive behavioral
377	health management information system.
378	(b)  Each managing entity shall develop and maintain a data
379	system that includes data from agencies under contract with the
380	managing entity. At a minimum, the managing entity's data system
381	shall provide information needed by the managing entity to
382	address the management and clinical care needs of the local
383	provider networks and information needed by the department to
384	meet state and federal data reporting requirements and to
385	evaluate planning and system-of-care provisions.
386	(c)  The department shall collaborate with managing
387	entities to develop business requirements that managing entities
388	shall use to extract data required at the state and federal
389	level from their local database systems and to submit these data
390	electronically into the department's central data system. The
391	Legislature recognizes that the department is not in the
392	business of application software development and maintenance and
393	is not adequately staffed to do so. The initial development and
394	ongoing maintenance and operation of the department's central
395	data system may be outsourced through contract with an
396	established third-party information technology vendor to
397	increase system access to users and provide timely and accurate
398	information to stakeholders at all levels of management.
399	(d)  The department shall use the central data system to
400	provide nonconfidential data accessible to stakeholders for
401	planning, monitoring, evaluation, and research purposes.
402	(11)  REPORTING.--Reports of the department's activities,
403	progress, and needs in achieving the goal of contracting with
404	managing entities in each circuit and region statewide must be
405	submitted to the appropriate substantive and appropriations
406	committees in the House of Representatives and the Senate by
407	January 1 and July 1 annually until a full transition to
408	managing entities has been accomplished statewide. A section of
409	each report shall address accomplishments and barriers to
410	implementation of the management information system described in
411	this section as necessary to support the department's decision
412	to enter into a contract with a managing entity, including the
413	department's actions and support to assist managing entities
414	statewide to achieve the desired interoperability of their
415	information systems.
416	(12)  RULES.--The department shall adopt rules pursuant to
417	ss. 120.536(1) and 120.54 to administer the provisions of this
418	section and, as necessary, to further specify requirements of
419	managing entities.
420	Section 2.  This act shall take effect upon becoming a law.

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