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; establishing goals;
5	specifying roles and responsibilities of the Department of
6	Children and Family Services; creating community-based
7	systems of care; authorizing the implementation of
8	managing entities by the Department of Children and Family
9	Services; establishing a process for contracting with
10	managing entities; specifying qualifying criteria for
11	managing entities; specifying responsibilities of managing
12	entities; specifying responsibilities of the department;
13	providing for evaluations and reports; providing for a
14	monitoring process; providing an effective date.
15
16	Be It Enacted by the Legislature of the State of Florida:
17
18	Section 1.  Section 394.9082, Florida Statutes, is amended
19	to read:
20	(Substantial rewording of section. See
21	s. 394.9082, F.S., for present text.)
22	394.9082  Behavioral health managing entities.--
23	(1)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature
24	finds that untreated behavioral health disorders constitute
25	major health problems for residents of this state, are a major
26	economic burden to the citizens of this state, and substantially
27	increase demands on the state's juvenile and adult criminal
28	justice systems, the child welfare system, and health care
29	systems. The Legislature finds that behavioral health disorders
30	respond to appropriate treatment, rehabilitation, and supportive
31	intervention. The Legislature finds that it has made a
32	substantial long-term investment in the funding of the
33	community-based behavioral health prevention and treatment
34	service systems and facilities in order to provide critical
35	emergency, acute care, residential, outpatient, and
36	rehabilitative and recovery-based services. The Legislature
37	finds that local communities have also made substantial
38	investments in behavioral health services, contracting with
39	safety net providers who by mandate and mission provide
40	specialized services to vulnerable and hard-to-serve populations
41	and have strong ties to local public health and public safety
42	agencies. The Legislature finds that a management structure that
43	places the responsibility for publicly financed behavioral
44	health treatment and prevention services within a single
45	private, nonprofit entity at the local level will promote
46	improved access to care, promote service continuity, and provide
47	for more efficient and effective delivery of substance abuse and
48	mental health services. The Legislature finds that streamlining
49	administrative processes will create cost efficiencies and
50	provide flexibility to better match available services to
51	consumers' identified needs.
52	(2)  DEFINITIONS.--As used in this section, the term:
53	(a)  "Behavioral health services" means mental health
54	services and substance abuse prevention and treatment services
55	as defined in this chapter and chapter 397 which are provided
56	using state and federal funds.
57	(b)  "Decisionmaking model" means a comprehensive
58	management information system needed to answer the following
59	management questions at the federal, state, regional, circuit,
60	and local provider levels: who receives what services from which
61	providers with what outcomes and at what costs?
62	(c)  "Geographic area" means a county, circuit, regional,
63	or multiregional area in this state.
64	(d)  "Managing entity" means a corporation that is
65	organized in this state, is designated or filed as a nonprofit
66	organization under s. 501(c)3) of the Internal Revenue Service,
67	and is under contract to the department to manage the day-to-day
68	operational delivery of behavioral health services through an
69	organized system of care.
70	(e)  "Provider networks" mean the direct service agencies
71	that are under contract with a managing entity and that together
72	constitute a comprehensive array of emergency, acute care,
73	residential, outpatient, recovery support, and consumer support
74	services.
75	(3)  SERVICE DELIVERY STRATEGIES.--The department may work
76	through managing entities to develop service delivery strategies
77	that will improve the coordination, integration, and management
78	of the delivery of behavioral health services to people who have
79	mental or substance use disorders. It is the intent of the
80	Legislature that a well-managed service delivery system will
81	increase access for those in need of care, improve the
82	coordination and continuity of care for vulnerable and high-risk
83	populations, and redirect service dollars from restrictive care
84	settings to community-based recovery services.
85	(4)  CONTRACT FOR SERVICES.--
86	(a)  The department may contract for the purchase and
87	management of behavioral health services with community-based
88	managing entities. The department may require a managing entity
89	to contract for specialized services that are not currently part
90	of the managing entity's network if the department determines
91	that to do so is in the best interests of consumers of services.
92	The secretary shall determine the schedule for phasing in
93	contracts with managing entities. The managing entities shall,
94	at a minimum, be accountable for the operational oversight of
95	the delivery of behavioral health services funded by the
96	department and for the collection and submission of the required
97	data pertaining to these contracted services. A managing entity
98	shall serve a geographic area designated by the department. The
99	geographic area must be of sufficient size in population and
100	have enough public funds for behavioral health services to allow
101	for flexibility and maximum efficiency.
102	(b)  The operating costs of the managing entity contract
103	shall be funded through funds from the department and any
104	savings and efficiencies achieved through the implementation of
105	managing entities when realized by their participating provider
106	network agencies. The department recognizes that managing
107	entities will have infrastructure development costs during
108	start-up so that any efficiencies to be realized by providers
109	from consolidation of management functions, and the resulting
110	savings, will not be achieved during the early years of
111	operation. The department shall negotiate a reasonable and
112	appropriate administrative cost rate with the managing entity.
113	The Legislature intends that reduced local and state contract
114	management and other administrative duties passed on to the
115	managing entity allows funds previously allocated for these
116	purposes to be proportionately reduced and the savings used to
117	purchase the administrative functions of the managing entity.
118	Policies and procedures of the department for monitoring
119	contracts with managing entities shall include provisions for
120	eliminating duplication of the department's and the managing
121	entities' contract management and other administrative
122	activities in order to achieve the goals of cost-effectiveness
123	and regulatory relief. To the maximum extent possible, provider-
124	monitoring activities shall be assigned to the managing entity.
125	(c)  Contracting and payment mechanisms for services must
126	promote clinical and financial flexibility and responsiveness
127	and must allow different categorical funds to be integrated at
128	the point of service. The contracted service array must be
129	determined by using public input, needs assessment, and
130	evidence-based and promising best-practice models. The
131	department may employ care-management methodologies, prepaid
132	capitation, and case rate or other methods of payment which
133	promote flexibility, efficiency, and accountability.
134	(5)  GOALS.--The goal of the service delivery strategies is
135	to provide a design for an effective coordination, integration,
136	and management approach for delivering effective behavioral
137	health services to persons who are experiencing a mental health
138	or substance abuse crisis, who have a disabling mental illness
139	or a substance use or co-occurring disorder, and require
140	extended services in order to recover from their illness, or who
141	need brief treatment or longer-term supportive interventions to
142	avoid a crisis or disability. Other goals include:
143	(a)  Improving accountability for a local system of
144	behavioral health care services to meet performance outcomes and
145	standards through the use of reliable and timely data.
146	(b)  Enhancing the continuity of care for all children,
147	adolescents, and adults who enter the publicly funded behavioral
148	health service system.
149	(c)  Preserving the "safety net" of publicly funded
150	behavioral health services and providers, and recognizing and
151	ensuring continued local contributions to these services, by
152	establishing locally designed and community-monitored systems of
153	care.
154	(d)  Providing early diagnosis and treatment interventions
155	to enhance recovery and prevent hospitalization.
156	(e)  Improving the assessment of local needs for behavioral
157	health services.
158	(f)  Improving the overall quality of behavioral health
159	services through the use of evidence-based, best-practice, and
160	promising-practice models.
161	(g)  Demonstrating improved service integration between
162	behavioral health programs and other programs, such as
163	vocational rehabilitation, education, child welfare, primary
164	health care, emergency services, juvenile justice, and criminal
165	justice.
166	(h)  Providing for additional testing of creative and
167	flexible strategies for financing behavioral health services to
168	enhance individualized treatment and support services.
169	(i)  Promoting cost-effective quality care.
170	(j)  Working with the state to coordinate admissions and
171	discharges from state civil and forensic hospitals and
172	coordinating admissions and discharges from residential
173	treatment centers.
174	(k)  Improving the integration, accessibility, and
175	dissemination of behavioral health data for planning and
176	monitoring purposes.
177	(l)  Promoting specialized behavioral health services to
178	residents of assisted living facilities.
179	(m)  Working with the state and other stakeholders to
180	reduce the admissions and the length of stay for dependent
181	children in residential treatment centers.
182	(n)  Providing services to adults and children with co-
183	occurring disorders of mental illnesses and substance abuse
184	problems.
185	(o)  Providing services to elder adults in crisis or at-
186	risk for placement in a more restrictive setting due to a
187	serious mental illness or substance abuse.
188	(6)  ESSENTIAL ELEMENTS.--It is the intent of the
189	Legislature that the department may plan for and enter into
190	contracts with managing entities to manage care in geographical
191	areas throughout the state.
192	(a)  The managing entity must demonstrate the ability of
193	its network of providers to comply with the pertinent provisions
194	of this chapter and chapter 397 and to ensure the provision of
195	comprehensive behavioral health services. The network of
196	providers must include, but need not be limited to, community
197	mental health agencies, substance abuse treatment providers, and
198	best-practice consumer services providers.
199	(b)  The department shall terminate its mental health or
200	substance abuse provider contracts for services to be provided
201	by the managing entity at the same time it contracts with the
202	managing entity.
203	(c)  The managing entity shall ensure that its provider
204	network is broadly conceived. All mental health or substance
205	abuse treatment providers currently under contract with the
206	department shall be offered a contract by the managing entity.
207	(d)  The department may contract with managing entities to
208	provide the following core functions:
209	1.  Financial accountability.
210	2.  Allocation of funds to network providers in a manner
211	that reflects the department's strategic direction and plans.
212	3.  Provider monitoring to ensure compliance with federal
213	and state laws, rules, and regulations.
214	4.  Data collection, reporting, and analysis.
215	5.  Operational plans to implement objectives of the
216	department's strategic plan.
217	6.  Contract compliance.
218	7.  Performance management.
219	8.  Collaboration with community stakeholders, including
220	local government.
221	9.  System of care through network development.
222	10.  Consumer care coordination.
223	11.  Continuous quality improvement.
224	12.  Timely access to appropriate services.
225	13.  Cost-effectiveness and system improvements.
226	14.  Assistance in the development of the department's
227	strategic plan.
228	15.  Participation in community, circuit, regional, and
229	state planning.
230	16.  Resource management and maximization, including
231	pursuit of third-party payments and grant applications.
232	17.  Incentives for providers to improve quality and
233	access;
234	18.  Liaison with consumers.
235	19.  Community needs assessment.
236	20.  Securing local matching funds.
237	(e)  The managing entity shall ensure that written
238	cooperative agreements are developed and implemented among the
239	criminal and juvenile justice systems, the local community-based
240	care network, and the local behavioral health providers in the
241	geographic area which define strategies and alternatives for
242	diverting people who have mental illness and substance abuse
243	problems from the criminal justice system to the community.
244	These agreements must also address the provision of appropriate
245	services to persons who have behavioral health problems and
246	leave the criminal justice system.
247	(f)  Managing entities must collect and submit data to the
248	department regarding persons served, outcomes of persons served,
249	and the costs of services provided through the department's
250	contract. The department shall evaluate managing entity services
251	based on consumer-centered outcome measures that reflect
252	national standards that can dependably be measured. The
253	department shall work with managing entities to establish
254	performance standards related to:
255	1.  The extent to which individuals in the community
256	receive services.
257	2.  The improvement of quality of care for individuals
258	served.
259	3.  The success of strategies to divert jail, prison, and
260	forensic facility admissions.
261	4.  Consumer and family satisfaction.
262	5.  The satisfaction of key community constituents such as
263	law enforcement agencies, juvenile justice agencies, the courts,
264	the schools, local government entities, hospitals, and others as
265	appropriate for the geographical area of the managing entity.
266	(g)  The Agency for Health Care Administration may
267	establish a certified match program, which must be voluntary.
268	Under a certified match program, reimbursement is limited to the
269	federal Medicaid share to Medicaid-enrolled strategy
270	participants. The agency may take no action to implement a
271	certified match program unless the consultation provisions of
272	chapter 216 have been met. The agency may seek federal waivers
273	that are necessary to implement the behavioral health service
274	delivery strategies.
275	(7)  MANAGING ENTITY REQUIREMENTS.--The department may
276	adopt rules and standards and a process for the qualification
277	and operation of managing entities which are based, in part, on
278	the following criteria:
279	(a)  A managing entity's governance structure shall be
280	representative and shall, at a minimum, include consumers and
281	family members, appropriate community stakeholders and
282	organizations, and providers of substance abuse and mental
283	health services as defined in this chapter and chapter 397. If
284	there are one or more private-receiving facilities in the
285	geographic coverage area of a managing entity, the managing
286	entity shall have one representative for the private-receiving
287	facilities as an ex officio member of its board of directors.
288	(b)  A managing entity that was originally formed primarily
289	by substance abuse or mental health providers must present and
290	demonstrate a detailed, consensus approach to expanding its
291	provider network and governance to include both substance abuse
292	and mental health providers.
293	(c)  A managing entity must submit a network management
294	plan and budget in a form and manner determined by the
295	department. The plan must detail the means for implementing the
296	duties to be contracted to the managing entity and the
297	efficiencies to be anticipated by the department as a result of
298	executing the contract. The department may require modifications
299	to the plan and must approve the plan before contracting with a
300	managing entity. The department may contract with a managing
301	entity that demonstrates readiness to assume core functions, and
302	may continue to add functions and responsibilities to the
303	managing entity's contract over time as additional competencies
304	are developed as identified in paragraph (g). Notwithstanding
305	other provisions of this section, the department may continue
306	and expand managing entity contracts if the department
307	determines that the managing entity meets the requirements
308	specified in this section.
309	(d)  Notwithstanding paragraphs (b) and (c), a managing
310	entity that is currently a fully integrated system providing
311	mental health and substance abuse services, Medicaid, and child
312	welfare services is permitted to continue operating under its
313	current governance structure as long as the managing entity can
314	demonstrate to the department that consumers, other
315	stakeholders, and network providers are included in the planning
316	process.
317	(e)  Managing entities shall operate in a transparent
318	manner, providing public access to information, notice of
319	meetings, and opportunities for broad public participation in
320	decisionmaking. The managing entity's network management plan
321	must detail policies and procedures that ensure transparency.
322	(f)  Before contracting with a managing entity, the
323	department must perform an on-site readiness review of a
324	managing entity to determine its operational capacity to
325	satisfactorily perform the duties to be contracted.
326	(g)  The department shall engage community stakeholders,
327	including providers and managing entities under contract with
328	the department, in the development of objective standards to
329	measure the competencies of managing entities and their
330	readiness to assume the responsibilities described in this
331	section, and the outcomes to hold them accountable.
332	(8)  DEPARTMENT RESPONSIBILITIES.--With the introduction of
333	managing entities to monitor department-contracted providers'
334	day-to-day operations, the department and its regional and
335	circuit offices will have increased ability to focus on broad
336	systemic substance abuse and mental health issues. After the
337	department enters into a managing entity contract in a
338	geographic area, the regional and circuit offices of the
339	department in that area shall direct their efforts primarily to
340	monitoring the managing entity contract, including negotiation
341	of system quality improvement goals each contract year, and
342	review of the managing entity's plans to execute department
343	strategic plans; carrying out statutorily mandated licensure
344	functions; conducting community and regional substance abuse and
345	mental health planning; communicating to the department the
346	local needs assessed by the managing entity; preparing
347	department strategic plans; coordinating with other state and
348	local agencies; assisting the department in assessing local
349	trends and issues and advising departmental headquarters on
350	local priorities; and providing leadership in disaster planning
351	and preparation.
352	(9)  REPORTING.--Reports of the department's activities,
353	progress, and needs in achieving the goal of contracting with
354	managing entities in each circuit and region statewide must be
355	submitted to the appropriate substantive and appropriations
356	committees in the Senate and the House of Representatives on
357	January 1 and July 1 of each year until the full transition to
358	managing entities has been accomplished statewide.
359	(10)  RULES.--The department shall adopt rules to
360	administer this section and, as necessary, to further specify
361	requirements of managing entities.
362	Section 2.  This act shall take effect July 1, 2008.

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