HB 5085

1	A bill to be entitled
2	An act relating to health care; transferring and
3	reassigning certain functions and responsibilities,
4	including records, personnel, property, and unexpended
5	balances of appropriations and other resources, from the
6	Department of Health to the Department of Business and
7	Professional Regulation by a type two transfer; providing
8	for the continued validity of pending judicial or
9	administrative actions to which the Department of Health
10	is a party; providing for the continued validity of lawful
11	orders issued by the Department of Health; transferring
12	rules created by the Department of Health to the
13	Department of Business and Professional Regulation;
14	providing for the continued validity of permits and
15	certifications issued by the Department of Health;
16	amending s. 400.179, F.S.; authorizing the Agency for
17	Health Care Administration to transfer funds to the Grants
18	and Donations Trust Fund for certain repayments; amending
19	s. 409.905, F.S.; prohibiting payment for certain hospital
20	inpatient per diem rate adjustment for 2 fiscal years;
21	amending s. 409.906, F.S.; prohibiting payment for
22	Medicaid chiropractic services, hospice care services, and
23	podiatric services for 2 fiscal years; authorizing payment
24	of a specified amount for Medicaid services provided by an
25	anesthesiologist assistant; amending s. 409.908, F.S.;
26	deleting a provision prohibiting Medicaid from making any
27	payment toward deductibles and coinsurance for services
28	not covered by Medicaid; providing limitations on Medicaid
29	payments for coinsurance; revising reimbursement rates for
30	providers of Medicaid prescribed drugs; requiring the
31	agency to revise reimbursement rates for hospitals,
32	nursing homes, county health departments, and community
33	intermediate care facilities for the developmentally
34	disabled for 2 fiscal years; requiring the agency to apply
35	the effect of the revised reimbursement rates to set
36	payment rates for managed care plans and nursing home
37	diversion programs; requiring the agency to establish
38	workgroups to evaluate alternative reimbursement and
39	payment methodologies for hospitals, nursing facilities,
40	and managed care plans; requiring a report; providing for
41	future repeal of the suspension of the use of cost data to
42	set certain rates; amending s. 409.911, F.S.; revising the
43	share data used to calculate disproportionate share
44	payments to hospitals; amending s. 409.9112, F.S.;
45	revising the time period during which the agency is
46	prohibited from distributing disproportionate share
47	payments to regional perinatal intensive care centers;
48	amending s. 409.9113, F.S.; requiring the agency to
49	distribute moneys provided in the General Appropriations
50	Act to statutorily defined teaching hospitals and family
51	practice teaching hospitals under the teaching hospital
52	disproportionate share program for the 2008-2009 fiscal
53	year; amending s. 409.9117, F.S.; prohibiting the agency
54	from distributing moneys under the primary care
55	disproportionate share program for the 2008-2009 fiscal
56	year; amending s. 409.912, F.S.; adding a county for
57	participation in the Medicaid behavioral health care
58	services specialty prepaid plan; revising reimbursement
59	rates to pharmacies for Medicaid prescribed drugs;
60	requiring the agency to notify the Legislature before
61	seeking an amendment to the state plan in order to
62	implement programs authorized by the Deficit Reduction Act
63	of 2005; creating s. 409.91206, F.S.; providing for
64	proposed alternatives for health and long-term care
65	reforms; amending s. 409.91211, F.S.; providing for
66	expansion of the Medicaid managed care pilot program to
67	Hardee, Highlands, Hillsborough, Manatee, Miami-Dade,
68	Monroe, Pasco, Pinellas, and Polk Counties; permitting
69	fee-for-service provider service networks to be reimbursed
70	on a risk-adjusted capitated basis for certain services;
71	requiring the agency to encourage cost-effective
72	administration by provider service networks; requiring
73	quarterly monitoring and annual evaluation of plan network
74	adequacy; requiring that Medicaid recipients receive
75	prescription drug coverage information for each plan;
76	requiring the agency to set standards for prompt claims
77	payment; revising assignment processes for certain
78	recipients; amending s. 409.9124, F.S.; removing the
79	limitation on the application of certain rates and rate
80	reductions used by the agency to reimburse managed care
81	plans; amending s. 409.913, F.S.; prohibiting mailing of
82	the explanation of benefits for certain Medicaid services;
83	repealing s. 381.0271, F.S., relating to the Florida
84	Patient Safety Corporation; repealing s. 381.0273, F.S.,
85	relating to public records exemption for patient safety
86	data; repealing s. 394.4595, F.S., relating to access to
87	patient records by the Florida statewide and local
88	advocacy councils; repealing s. 402.164, F.S., relating to
89	the Florida Statewide Advocacy Council and the Florida
90	local advocacy councils; repealing s. 402.165, F.S.,
91	relating to the Florida Statewide Advocacy Council;
92	repealing s. 402.166, F.S., relating to Florida local
93	advocacy councils; repealing s. 402.167, F.S., relating to
94	duties of state agencies that provide client services
95	relating to the Florida Statewide Advocacy Council and the
96	Florida local advocacy councils; repealing s. 409.9061,
97	F.S., relating to authority for a statewide laboratory
98	services contract; repealing s. 430.80, F.S., relating to
99	implementation of a teaching nursing home pilot project;
100	repealing s. 430.83, F.S., relating to the Sunshine for
101	Seniors Program; repealing ss. 464.0195, 464.0196, and
102	464.0197, F.S., relating to the Florida Center for
103	Nursing; repealing s. 464.0198, F.S., relating to the
104	Florida Center for Nursing Trust Fund; amending ss.
105	39.001, 39.0011, 39.202, 39.302, 215.22, 394.459,
106	394.4597, 394.4598, 394.4599, 394.4615, 400.0065, 400.118,
107	400.141, 415.1034, 415.104, 415.1055, 415.106, 415.107,
108	429.19, 429.28, 429.34, and 430.04, F.S.; conforming
109	provisions and correcting cross-references; providing an
110	effective date.
111
112	Be It Enacted by the Legislature of the State of Florida:
113
114	Section 1.  (1)  Effective April 1, 2009, all of the
115	statutory powers, duties and functions, records, personnel,
116	property, and unexpended balances of appropriations,
117	allocations, or other funds for the administration of part I of
118	chapter 499, Florida Statutes, relating to drugs, devices,
119	cosmetics, and household products shall be transferred by a type
120	two transfer, as defined in s. 20.06(2), Florida Statutes, from
121	the Department of Health to the Department of Business and
122	Professional Regulation.
123	(2)  The transfer of regulatory authority under part I of
124	chapter 499, Florida Statutes, provided by this act shall not
125	affect the validity of any judicial or administrative action
126	pending as of 11:59 p.m. on the day before the effective date of
127	this act to which the Department of Health is at that time a
128	party, and the Department of Business and Professional
129	Regulation shall be substituted as a party in interest in any
130	such action.
131	(3)  All lawful orders issued by the Department of Health
132	implementing or enforcing or otherwise in regard to any
133	provision of part I of chapter 499, Florida Statutes, issued
134	prior to the effective date of this act shall remain in effect
135	and be enforceable after the effective date of this act unless
136	thereafter modified in accordance with law.
137	(4)  The rules of the Department of Health relating to the
138	implementation of part I of chapter 499, Florida Statutes, that
139	were in effect at 11:59 p.m. on the day prior to this act taking
140	effect shall become the rules of the Department of Business and
141	Professional Regulation and shall remain in effect until amended
142	or repealed in the manner provided by law.
143	(5)  Notwithstanding the transfer of regulatory authority
144	under part I of chapter 499, Florida Statutes, provided by this
145	act, persons and entities holding in good standing any permit
146	under part I of chapter 499, Florida Statutes, as of 11:59 p.m.
147	on the day prior to the effective date of this act shall, as of
148	the effective date of this act, be deemed to hold in good
149	standing a permit in the same capacity as that for which the
150	permit was formerly issued.
151	(6)  Notwithstanding the transfer of regulatory authority
152	under part I of chapter 499, Florida Statutes, provided by this
153	act, persons holding in good standing any certification under
154	part I of chapter 499, Florida Statutes, as of 11:59 p.m. on the
155	day prior to the effective date of this act shall, as of the
156	effective date of this act, be deemed to be certified in the
157	same capacity in which they were formerly certified.
158	Section 2.  Paragraph (d) of subsection (2) of section
159	400.179, Florida Statutes, is amended to read:
160	400.179  Liability for Medicaid underpayments and
161	overpayments.--
162	(2)  Because any transfer of a nursing facility may expose
163	the fact that Medicaid may have underpaid or overpaid the
164	transferor, and because in most instances, any such underpayment
165	or overpayment can only be determined following a formal field
166	audit, the liabilities for any such underpayments or
167	overpayments shall be as follows:
168	(d)  Where the transfer involves a facility that has been
169	leased by the transferor:
170	1.  The transferee shall, as a condition to being issued a
171	license by the agency, acquire, maintain, and provide proof to
172	the agency of a bond with a term of 30 months, renewable
173	annually, in an amount not less than the total of 3 months'
174	Medicaid payments to the facility computed on the basis of the
175	preceding 12-month average Medicaid payments to the facility.
176	2.  A leasehold licensee may meet the requirements of
177	subparagraph 1. by payment of a nonrefundable fee, paid at
178	initial licensure, paid at the time of any subsequent change of
179	ownership, and paid annually thereafter, in the amount of 1
180	percent of the total of 3 months' Medicaid payments to the
181	facility computed on the basis of the preceding 12-month average
182	Medicaid payments to the facility. If a preceding 12-month
183	average is not available, projected Medicaid payments may be
184	used. The fee shall be deposited into the Health Care Trust Fund
185	and shall be accounted for separately as a Medicaid nursing home
186	overpayment account. These fees shall be used at the sole
187	discretion of the agency to repay nursing home Medicaid
188	overpayments. The agency is authorized to transfer funds to the
189	Grants and Donations Trust Fund for such repayments. Payment of
190	this fee shall not release the licensee from any liability for
191	any Medicaid overpayments, nor shall payment bar the agency from
192	seeking to recoup overpayments from the licensee and any other
193	liable party. As a condition of exercising this lease bond
194	alternative, licensees paying this fee must maintain an existing
195	lease bond through the end of the 30-month term period of that
196	bond. The agency is herein granted specific authority to
197	promulgate all rules pertaining to the administration and
198	management of this account, including withdrawals from the
199	account, subject to federal review and approval. This provision
200	shall take effect upon becoming law and shall apply to any
201	leasehold license application. The financial viability of the
202	Medicaid nursing home overpayment account shall be determined by
203	the agency through annual review of the account balance and the
204	amount of total outstanding, unpaid Medicaid overpayments owing
205	from leasehold licensees to the agency as determined by final
206	agency audits.
207	3.  The leasehold licensee may meet the bond requirement
208	through other arrangements acceptable to the agency. The agency
209	is herein granted specific authority to promulgate rules
210	pertaining to lease bond arrangements.
211	4.  All existing nursing facility licensees, operating the
212	facility as a leasehold, shall acquire, maintain, and provide
213	proof to the agency of the 30-month bond required in
214	subparagraph 1., above, on and after July 1, 1993, for each
215	license renewal.
216	5.  It shall be the responsibility of all nursing facility
217	operators, operating the facility as a leasehold, to renew the
218	30-month bond and to provide proof of such renewal to the agency
219	annually.
220	6.  Any failure of the nursing facility operator to
221	acquire, maintain, renew annually, or provide proof to the
222	agency shall be grounds for the agency to deny, revoke, and
223	suspend the facility license to operate such facility and to
224	take any further action, including, but not limited to,
225	enjoining the facility, asserting a moratorium pursuant to part
226	II of chapter 408, or applying for a receiver, deemed necessary
227	to ensure compliance with this section and to safeguard and
228	protect the health, safety, and welfare of the facility's
229	residents. A lease agreement required as a condition of bond
230	financing or refinancing under s. 154.213 by a health facilities
231	authority or required under s. 159.30 by a county or
232	municipality is not a leasehold for purposes of this paragraph
233	and is not subject to the bond requirement of this paragraph.
234	Section 3.  Paragraph (c) of subsection (5) of section
235	409.905, Florida Statutes, is amended to read:
236	409.905  Mandatory Medicaid services.--The agency may make
237	payments for the following services, which are required of the
238	state by Title XIX of the Social Security Act, furnished by
239	Medicaid providers to recipients who are determined to be
240	eligible on the dates on which the services were provided. Any
241	service under this section shall be provided only when medically
242	necessary and in accordance with state and federal law.
243	Mandatory services rendered by providers in mobile units to
244	Medicaid recipients may be restricted by the agency. Nothing in
245	this section shall be construed to prevent or limit the agency
246	from adjusting fees, reimbursement rates, lengths of stay,
247	number of visits, number of services, or any other adjustments
248	necessary to comply with the availability of moneys and any
249	limitations or directions provided for in the General
250	Appropriations Act or chapter 216.
251	(5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay for
252	all covered services provided for the medical care and treatment
253	of a recipient who is admitted as an inpatient by a licensed
254	physician or dentist to a hospital licensed under part I of
255	chapter 395. However, the agency shall limit the payment for
256	inpatient hospital services for a Medicaid recipient 21 years of
257	age or older to 45 days or the number of days necessary to
258	comply with the General Appropriations Act.
259	(c)  For 2 fiscal years beginning July 1, 2008, and ending
260	June 30, 2010, the Agency for Health Care Administration may not
261	shall adjust a hospital's current inpatient per diem rate to
262	reflect the cost of serving the Medicaid population at that
263	institution if:
264	1.  The hospital experiences an increase in Medicaid
265	caseload by more than 25 percent in any year, primarily
266	resulting from the closure of a hospital in the same service
267	area occurring after July 1, 1995;
268	2.  The hospital's Medicaid per diem rate is at least 25
269	percent below the Medicaid per patient cost for that year; or
270	3.  The hospital is located in a county that has five or
271	fewer hospitals, began offering obstetrical services on or after
272	September 1999, and has submitted a request in writing to the
273	agency for a rate adjustment after July 1, 2000, but before
274	September 30, 2000, in which case such hospital's Medicaid
275	inpatient per diem rate shall be adjusted to cost, effective
276	July 1, 2002.
277
278	No later than October 1 of each year, the agency must provide
279	estimated costs for any adjustment in a hospital inpatient per
280	diem pursuant to this paragraph to the Executive Office of the
281	Governor, the House of Representatives General Appropriations
282	Committee, and the Senate Appropriations Committee. Before the
283	agency implements a change in a hospital's inpatient per diem
284	rate pursuant to this paragraph, the Legislature must have
285	specifically appropriated sufficient funds in the General
286	Appropriations Act to support the increase in cost as estimated
287	by the agency.
288	Section 4.  Subsections (7), (14), and (19) of section
289	409.906, Florida Statutes, are amended, and subsection (26) is
290	added to that section, to read:
291	409.906  Optional Medicaid services.--Subject to specific
292	appropriations, the agency may make payments for services which
293	are optional to the state under Title XIX of the Social Security
294	Act and are furnished by Medicaid providers to recipients who
295	are determined to be eligible on the dates on which the services
296	were provided. Any optional service that is provided shall be
297	provided only when medically necessary and in accordance with
298	state and federal law. Optional services rendered by providers
299	in mobile units to Medicaid recipients may be restricted or
300	prohibited by the agency. Nothing in this section shall be
301	construed to prevent or limit the agency from adjusting fees,
302	reimbursement rates, lengths of stay, number of visits, or
303	number of services, or making any other adjustments necessary to
304	comply with the availability of moneys and any limitations or
305	directions provided for in the General Appropriations Act or
306	chapter 216. If necessary to safeguard the state's systems of
307	providing services to elderly and disabled persons and subject
308	to the notice and review provisions of s. 216.177, the Governor
309	may direct the Agency for Health Care Administration to amend
310	the Medicaid state plan to delete the optional Medicaid service
311	known as "Intermediate Care Facilities for the Developmentally
312	Disabled." Optional services may include:
313	(7)  CHIROPRACTIC SERVICES.--For 2 fiscal years beginning
314	July 1, 2008, and ending June 30, 2010, the agency may not pay
315	for chiropractic services. The agency may pay for manual
316	manipulation of the spine and initial services, screening, and X
317	rays provided to a recipient by a licensed chiropractic
318	physician.
319	(14)  HOSPICE CARE SERVICES.--For 2 fiscal years beginning
320	July 1, 2008, and ending June 30, 2010, the agency may not pay
321	for hospice care services. The agency may pay for all reasonable
322	and necessary services for the palliation or management of a
323	recipient's terminal illness, if the services are provided by a
324	hospice that is licensed under part IV of chapter 400 and meets
325	Medicare certification requirements.
326	(19)  PODIATRIC SERVICES.--For 2 fiscal years beginning
327	July 1, 2008, and ending June 30, 2010, the agency may not pay
328	for podiatric services. The agency may pay for services,
329	including diagnosis and medical, surgical, palliative, and
330	mechanical treatment, related to ailments of the human foot and
331	lower leg, if provided to a recipient by a podiatric physician
332	licensed under state law.
333	(26)  ANESTHESIOLOGIST ASSISTANT SERVICES.--The agency may
334	pay for all services provided to a recipient by an
335	anesthesiologist assistant licensed under s. 458.3475 or s.
336	459.023. Reimbursement for such services must be not less than
337	80 percent of the reimbursement that would be paid to a
338	physician who provided the same services.
339	Section 5.  Subsections (13) and (14) of section 409.908,
340	Florida Statutes, as amended by chapter 2007-331, Laws of
341	Florida, are amended, and subsection (23) is added to that
342	section, to read:
343	409.908  Reimbursement of Medicaid providers.--Subject to
344	specific appropriations, the agency shall reimburse Medicaid
345	providers, in accordance with state and federal law, according
346	to methodologies set forth in the rules of the agency and in
347	policy manuals and handbooks incorporated by reference therein.
348	These methodologies may include fee schedules, reimbursement
349	methods based on cost reporting, negotiated fees, competitive
350	bidding pursuant to s. 287.057, and other mechanisms the agency
351	considers efficient and effective for purchasing services or
352	goods on behalf of recipients. If a provider is reimbursed based
353	on cost reporting and submits a cost report late and that cost
354	report would have been used to set a lower reimbursement rate
355	for a rate semester, then the provider's rate for that semester
356	shall be retroactively calculated using the new cost report, and
357	full payment at the recalculated rate shall be effected
358	retroactively. Medicare-granted extensions for filing cost
359	reports, if applicable, shall also apply to Medicaid cost
360	reports. Payment for Medicaid compensable services made on
361	behalf of Medicaid eligible persons is subject to the
362	availability of moneys and any limitations or directions
363	provided for in the General Appropriations Act or chapter 216.
364	Further, nothing in this section shall be construed to prevent
365	or limit the agency from adjusting fees, reimbursement rates,
366	lengths of stay, number of visits, or number of services, or
367	making any other adjustments necessary to comply with the
368	availability of moneys and any limitations or directions
369	provided for in the General Appropriations Act, provided the
370	adjustment is consistent with legislative intent.
371	(13)  Medicare premiums for persons eligible for both
372	Medicare and Medicaid coverage shall be paid at the rates
373	established by Title XVIII of the Social Security Act. For
374	Medicare services rendered to Medicaid-eligible persons,
375	Medicaid shall pay Medicare deductibles and coinsurance as
376	follows:
377	(a)  Medicaid shall make no payment toward deductibles and
378	coinsurance for any service that is not covered by Medicaid.
379	(a)(b)  Medicaid's financial obligation for deductibles and
380	coinsurance payments shall be based on Medicare allowable fees,
381	not on a provider's billed charges.
382	(b)(c)  Medicaid will pay no portion of Medicare
383	deductibles and coinsurance when payment that Medicare has made
384	for the service equals or exceeds what Medicaid would have paid
385	if it had been the sole payor. The combined payment of Medicare
386	and Medicaid shall not exceed the amount Medicaid would have
387	paid had it been the sole payor. The Legislature finds that
388	there has been confusion regarding the reimbursement for
389	services rendered to dually eligible Medicare beneficiaries.
390	Accordingly, the Legislature clarifies that it has always been
391	the intent of the Legislature before and after 1991 that, in
392	reimbursing in accordance with fees established by Title XVIII
393	for premiums, deductibles, and coinsurance for Medicare services
394	rendered by physicians to Medicaid eligible persons, physicians
395	be reimbursed at the lesser of the amount billed by the
396	physician or the Medicaid maximum allowable fee established by
397	the Agency for Health Care Administration, as is permitted by
398	federal law. It has never been the intent of the Legislature
399	with regard to such services rendered by physicians that
400	Medicaid be required to provide any payment for deductibles,
401	coinsurance, or copayments for Medicare cost sharing, or any
402	expenses incurred relating thereto, in excess of the payment
403	amount provided for under the State Medicaid plan for such
404	service. This payment methodology is applicable even in those
405	situations in which the payment for Medicare cost sharing for a
406	qualified Medicare beneficiary with respect to an item or
407	service is reduced or eliminated. This expression of the
408	Legislature is in clarification of existing law and shall apply
409	to payment for, and with respect to provider agreements with
410	respect to, items or services furnished on or after the
411	effective date of this act. This paragraph applies to payment by
412	Medicaid for items and services furnished before the effective
413	date of this act if such payment is the subject of a lawsuit
414	that is based on the provisions of this section, and that is
415	pending as of, or is initiated after, the effective date of this
416	act.
417	(c)(d)  Notwithstanding paragraphs (a) and (b) (a)-(c):
418	1.  Medicaid payments for Nursing Home Medicare part A
419	coinsurance shall be limited to the Medicaid nursing home per
420	diem rate less any amounts paid by Medicare, but only up to the
421	amount of Medicare coinsurance. The Medicaid per diem rate shall
422	be the rate in effect for the dates of service of the crossover
423	claims and may not be subsequently adjusted due to subsequent
424	per diem rate adjustments.
425	2.  Medicaid shall pay all deductibles and coinsurance for
426	Medicare-eligible recipients receiving freestanding end stage
427	renal dialysis center services.
428	3.  Medicaid payments for general hospital inpatient
429	services shall be limited to the Medicare deductible and
430	coinsurance per spell of illness. Medicaid payments for hospital
431	Medicare Part A coinsurance shall be limited to the Medicaid
432	hospital per diem rate less any amounts paid by Medicare, but
433	only up to the amount of Medicare coinsurance. Medicaid payments
434	for coinsurance shall be limited to the Medicaid per diem rate
435	in effect for the dates of service of the crossover claims and
436	may not be subsequently adjusted due to subsequent per diem
437	adjustments. Medicaid shall make no payment toward coinsurance
438	for Medicare general hospital inpatient services.
439	4.  Medicaid shall pay all deductibles and coinsurance for
440	Medicare emergency transportation services provided by
441	ambulances licensed pursuant to chapter 401.
442	(14)  A provider of prescribed drugs shall be reimbursed
443	the least of the amount billed by the provider, the provider's
444	usual and customary charge, or the Medicaid maximum allowable
445	fee established by the agency, plus a dispensing fee. The
446	Medicaid maximum allowable fee for ingredient cost will be based
447	on the lower of: average wholesale price (AWP) minus 16.4 15.4
448	percent, wholesaler acquisition cost (WAC) plus 4.75 5.75
449	percent, the federal upper limit (FUL), the state maximum
450	allowable cost (SMAC), or the usual and customary (UAC) charge
451	billed by the provider. Medicaid providers are required to
452	dispense generic drugs if available at lower cost and the agency
453	has not determined that the branded product is more cost-
454	effective, unless the prescriber has requested and received
455	approval to require the branded product. The agency is directed
456	to implement a variable dispensing fee for payments for
457	prescribed medicines while ensuring continued access for
458	Medicaid recipients. The variable dispensing fee may be based
459	upon, but not limited to, either or both the volume of
460	prescriptions dispensed by a specific pharmacy provider, the
461	volume of prescriptions dispensed to an individual recipient,
462	and dispensing of preferred-drug-list products. The agency may
463	increase the pharmacy dispensing fee authorized by statute and
464	in the annual General Appropriations Act by $0.50 for the
465	dispensing of a Medicaid preferred-drug-list product and reduce
466	the pharmacy dispensing fee by $0.50 for the dispensing of a
467	Medicaid product that is not included on the preferred drug
468	list. The agency may establish a supplemental pharmaceutical
469	dispensing fee to be paid to providers returning unused unit-
470	dose packaged medications to stock and crediting the Medicaid
471	program for the ingredient cost of those medications if the
472	ingredient costs to be credited exceed the value of the
473	supplemental dispensing fee. The agency is authorized to limit
474	reimbursement for prescribed medicine in order to comply with
475	any limitations or directions provided for in the General
476	Appropriations Act, which may include implementing a prospective
477	or concurrent utilization review program.
478	(23)(a)  The agency shall establish rates at a level that
479	ensures no increase in statewide expenditures resulting from a
480	change in unit costs for 2 fiscal years effective July 1, 2008.
481	Reimbursement rates for the 2 fiscal years shall be as provided
482	in the General Appropriations Act.
483	(b)  This subsection applies to the following provider
484	types:
485	1.  Inpatient hospitals.
486	2.  Outpatient hospitals.
487	3.  Nursing homes.
488	4.  County health departments.
489	5.  Community intermediate care facilities for the
490	developmentally disabled.
491
492	The agency shall apply the effect of this subsection to the
493	reimbursement rates for managed care plans and nursing home
494	diversion programs.
495	(c)  The agency shall create a workgroup on hospital
496	reimbursement, a workgroup on nursing facility reimbursement,
497	and a workgroup on managed care plan payment. The workgroups
498	shall evaluate alternative reimbursement and payment
499	methodologies for hospitals, nursing facilities, and managed
500	care plans, including prospective payment methodologies for
501	hospitals and nursing facilities. The nursing facility workgroup
502	shall also consider price-based methodologies for indirect care
503	and acuity adjustments for direct care. The agency shall submit
504	a report on the evaluated alternative reimbursement
505	methodologies to the relevant committees of the Senate and the
506	House of Representatives by November 1, 2009.
507	(d)  This subsection expires June 30, 2010.
508	Section 6.  Paragraph (a) of subsection (2) of section
509	409.911, Florida Statutes, is amended to read:
510	409.911  Disproportionate share program.--Subject to
511	specific allocations established within the General
512	Appropriations Act and any limitations established pursuant to
513	chapter 216, the agency shall distribute, pursuant to this
514	section, moneys to hospitals providing a disproportionate share
515	of Medicaid or charity care services by making quarterly
516	Medicaid payments as required. Notwithstanding the provisions of
517	s. 409.915, counties are exempt from contributing toward the
518	cost of this special reimbursement for hospitals serving a
519	disproportionate share of low-income patients.
520	(2)  The Agency for Health Care Administration shall use
521	the following actual audited data to determine the Medicaid days
522	and charity care to be used in calculating the disproportionate
523	share payment:
524	(a)  The average of the 2002, 2003, and 2004 2000, 2001,
525	and 2002 audited disproportionate share data to determine each
526	hospital's Medicaid days and charity care for the 2008-2009
527	2006-2007 state fiscal year.
528	Section 7.  Section 409.9112, Florida Statutes, is amended
529	to read:
530	409.9112  Disproportionate share program for regional
531	perinatal intensive care centers.--In addition to the payments
532	made under s. 409.911, the Agency for Health Care Administration
533	shall design and implement a system of making disproportionate
534	share payments to those hospitals that participate in the
535	regional perinatal intensive care center program established
536	pursuant to chapter 383. This system of payments shall conform
537	with federal requirements and shall distribute funds in each
538	fiscal year for which an appropriation is made by making
539	quarterly Medicaid payments. Notwithstanding the provisions of
540	s. 409.915, counties are exempt from contributing toward the
541	cost of this special reimbursement for hospitals serving a
542	disproportionate share of low-income patients. For the state
543	fiscal year 2008-2009 2005-2006, the agency shall not distribute
544	moneys under the regional perinatal intensive care centers
545	disproportionate share program.
546	(1)  The following formula shall be used by the agency to
547	calculate the total amount earned for hospitals that participate
548	in the regional perinatal intensive care center program:
549
550	TAE = HDSP/THDSP
551
552	Where:
553	TAE = total amount earned by a regional perinatal intensive
554	care center.
555	HDSP = the prior state fiscal year regional perinatal
556	intensive care center disproportionate share payment to the
557	individual hospital.
558	THDSP = the prior state fiscal year total regional
559	perinatal intensive care center disproportionate share payments
560	to all hospitals.
561	(2)  The total additional payment for hospitals that
562	participate in the regional perinatal intensive care center
563	program shall be calculated by the agency as follows:
564
565	TAP = TAE x TA
566
567	Where:
568	TAP = total additional payment for a regional perinatal
569	intensive care center.
570	TAE = total amount earned by a regional perinatal intensive
571	care center.
572	TA = total appropriation for the regional perinatal
573	intensive care center disproportionate share program.
574	(3)  In order to receive payments under this section, a
575	hospital must be participating in the regional perinatal
576	intensive care center program pursuant to chapter 383 and must
577	meet the following additional requirements:
578	(a)  Agree to conform to all departmental and agency
579	requirements to ensure high quality in the provision of
580	services, including criteria adopted by departmental and agency
581	rule concerning staffing ratios, medical records, standards of
582	care, equipment, space, and such other standards and criteria as
583	the department and agency deem appropriate as specified by rule.
584	(b)  Agree to provide information to the department and
585	agency, in a form and manner to be prescribed by rule of the
586	department and agency, concerning the care provided to all
587	patients in neonatal intensive care centers and high-risk
588	maternity care.
589	(c)  Agree to accept all patients for neonatal intensive
590	care and high-risk maternity care, regardless of ability to pay,
591	on a functional space-available basis.
592	(d)  Agree to develop arrangements with other maternity and
593	neonatal care providers in the hospital's region for the
594	appropriate receipt and transfer of patients in need of
595	specialized maternity and neonatal intensive care services.
596	(e)  Agree to establish and provide a developmental
597	evaluation and services program for certain high-risk neonates,
598	as prescribed and defined by rule of the department.
599	(f)  Agree to sponsor a program of continuing education in
600	perinatal care for health care professionals within the region
601	of the hospital, as specified by rule.
602	(g)  Agree to provide backup and referral services to the
603	department's county health departments and other low-income
604	perinatal providers within the hospital's region, including the
605	development of written agreements between these organizations
606	and the hospital.
607	(h)  Agree to arrange for transportation for high-risk
608	obstetrical patients and neonates in need of transfer from the
609	community to the hospital or from the hospital to another more
610	appropriate facility.
611	(4)  Hospitals which fail to comply with any of the
612	conditions in subsection (3) or the applicable rules of the
613	department and agency shall not receive any payments under this
614	section until full compliance is achieved. A hospital which is
615	not in compliance in two or more consecutive quarters shall not
616	receive its share of the funds. Any forfeited funds shall be
617	distributed by the remaining participating regional perinatal
618	intensive care center program hospitals.
619	Section 8.  Section 409.9113, Florida Statutes, is amended
620	to read:
621	409.9113  Disproportionate share program for teaching
622	hospitals.--In addition to the payments made under ss. 409.911
623	and 409.9112, the Agency for Health Care Administration shall
624	make disproportionate share payments to statutorily defined
625	teaching hospitals for their increased costs associated with
626	medical education programs and for tertiary health care services
627	provided to the indigent. This system of payments shall conform
628	with federal requirements and shall distribute funds in each
629	fiscal year for which an appropriation is made by making
630	quarterly Medicaid payments. Notwithstanding s. 409.915,
631	counties are exempt from contributing toward the cost of this
632	special reimbursement for hospitals serving a disproportionate
633	share of low-income patients. For the state fiscal year 2008-
634	2009 2006-2007, the agency shall distribute the moneys provided
635	in the General Appropriations Act to statutorily defined
636	teaching hospitals and family practice teaching hospitals under
637	the teaching hospital disproportionate share program. The funds
638	provided for statutorily defined teaching hospitals shall be
639	distributed in the same proportion as the state fiscal year
640	2003-2004 teaching hospital disproportionate share funds were
641	distributed or as otherwise provided in the General
642	Appropriations Act. The funds provided for family practice
643	teaching hospitals shall be distributed equally among family
644	practice teaching hospitals.
645	(1)  On or before September 15 of each year, the Agency for
646	Health Care Administration shall calculate an allocation
647	fraction to be used for distributing funds to state statutory
648	teaching hospitals. Subsequent to the end of each quarter of the
649	state fiscal year, the agency shall distribute to each statutory
650	teaching hospital, as defined in s. 408.07, an amount determined
651	by multiplying one-fourth of the funds appropriated for this
652	purpose by the Legislature times such hospital's allocation
653	fraction. The allocation fraction for each such hospital shall
654	be determined by the sum of three primary factors, divided by
655	three. The primary factors are:
656	(a)  The number of nationally accredited graduate medical
657	education programs offered by the hospital, including programs
658	accredited by the Accreditation Council for Graduate Medical
659	Education and the combined Internal Medicine and Pediatrics
660	programs acceptable to both the American Board of Internal
661	Medicine and the American Board of Pediatrics at the beginning
662	of the state fiscal year preceding the date on which the
663	allocation fraction is calculated. The numerical value of this
664	factor is the fraction that the hospital represents of the total
665	number of programs, where the total is computed for all state
666	statutory teaching hospitals.
667	(b)  The number of full-time equivalent trainees in the
668	hospital, which comprises two components:
669	1.  The number of trainees enrolled in nationally
670	accredited graduate medical education programs, as defined in
671	paragraph (a). Full-time equivalents are computed using the
672	fraction of the year during which each trainee is primarily
673	assigned to the given institution, over the state fiscal year
674	preceding the date on which the allocation fraction is
675	calculated. The numerical value of this factor is the fraction
676	that the hospital represents of the total number of full-time
677	equivalent trainees enrolled in accredited graduate programs,
678	where the total is computed for all state statutory teaching
679	hospitals.
680	2.  The number of medical students enrolled in accredited
681	colleges of medicine and engaged in clinical activities,
682	including required clinical clerkships and clinical electives.
683	Full-time equivalents are computed using the fraction of the
684	year during which each trainee is primarily assigned to the
685	given institution, over the course of the state fiscal year
686	preceding the date on which the allocation fraction is
687	calculated. The numerical value of this factor is the fraction
688	that the given hospital represents of the total number of full-
689	time equivalent students enrolled in accredited colleges of
690	medicine, where the total is computed for all state statutory
691	teaching hospitals.
692
693	The primary factor for full-time equivalent trainees is computed
694	as the sum of these two components, divided by two.
695	(c)  A service index that comprises three components:
696	1.  The Agency for Health Care Administration Service
697	Index, computed by applying the standard Service Inventory
698	Scores established by the Agency for Health Care Administration
699	to services offered by the given hospital, as reported on
700	Worksheet A-2 for the last fiscal year reported to the agency
701	before the date on which the allocation fraction is calculated.
702	The numerical value of this factor is the fraction that the
703	given hospital represents of the total Agency for Health Care
704	Administration Service Index values, where the total is computed
705	for all state statutory teaching hospitals.
706	2.  A volume-weighted service index, computed by applying
707	the standard Service Inventory Scores established by the Agency
708	for Health Care Administration to the volume of each service,
709	expressed in terms of the standard units of measure reported on
710	Worksheet A-2 for the last fiscal year reported to the agency
711	before the date on which the allocation factor is calculated.
712	The numerical value of this factor is the fraction that the
713	given hospital represents of the total volume-weighted service
714	index values, where the total is computed for all state
715	statutory teaching hospitals.
716	3.  Total Medicaid payments to each hospital for direct
717	inpatient and outpatient services during the fiscal year
718	preceding the date on which the allocation factor is calculated.
719	This includes payments made to each hospital for such services
720	by Medicaid prepaid health plans, whether the plan was
721	administered by the hospital or not. The numerical value of this
722	factor is the fraction that each hospital represents of the
723	total of such Medicaid payments, where the total is computed for
724	all state statutory teaching hospitals.
725
726	The primary factor for the service index is computed as the sum
727	of these three components, divided by three.
728	(2)  By October 1 of each year, the agency shall use the
729	following formula to calculate the maximum additional
730	disproportionate share payment for statutorily defined teaching
731	hospitals:
732
733	TAP = THAF x A
734
735	Where:
736	TAP = total additional payment.
737	THAF = teaching hospital allocation factor.
738	A = amount appropriated for a teaching hospital
739	disproportionate share program.
740	Section 9.  Section 409.9117, Florida Statutes, is amended
741	to read:
742	409.9117  Primary care disproportionate share program.--For
743	the state fiscal year 2008-2009 2006-2007, the agency shall not
744	distribute moneys under the primary care disproportionate share
745	program.
746	(1)  If federal funds are available for disproportionate
747	share programs in addition to those otherwise provided by law,
748	there shall be created a primary care disproportionate share
749	program.
750	(2)  The following formula shall be used by the agency to
751	calculate the total amount earned for hospitals that participate
752	in the primary care disproportionate share program:
753
754	TAE = HDSP/THDSP
755
756	Where:
757	TAE = total amount earned by a hospital participating in
758	the primary care disproportionate share program.
759	HDSP = the prior state fiscal year primary care
760	disproportionate share payment to the individual hospital.
761	THDSP = the prior state fiscal year total primary care
762	disproportionate share payments to all hospitals.
763	(3)  The total additional payment for hospitals that
764	participate in the primary care disproportionate share program
765	shall be calculated by the agency as follows:
766
767	TAP = TAE x TA
768
769	Where:
770	TAP = total additional payment for a primary care hospital.
771	TAE = total amount earned by a primary care hospital.
772	TA = total appropriation for the primary care
773	disproportionate share program.
774	(4)  In the establishment and funding of this program, the
775	agency shall use the following criteria in addition to those
776	specified in s. 409.911, payments may not be made to a hospital
777	unless the hospital agrees to:
778	(a)  Cooperate with a Medicaid prepaid health plan, if one
779	exists in the community.
780	(b)  Ensure the availability of primary and specialty care
781	physicians to Medicaid recipients who are not enrolled in a
782	prepaid capitated arrangement and who are in need of access to
783	such physicians.
784	(c)  Coordinate and provide primary care services free of
785	charge, except copayments, to all persons with incomes up to 100
786	percent of the federal poverty level who are not otherwise
787	covered by Medicaid or another program administered by a
788	governmental entity, and to provide such services based on a
789	sliding fee scale to all persons with incomes up to 200 percent
790	of the federal poverty level who are not otherwise covered by
791	Medicaid or another program administered by a governmental
792	entity, except that eligibility may be limited to persons who
793	reside within a more limited area, as agreed to by the agency
794	and the hospital.
795	(d)  Contract with any federally qualified health center,
796	if one exists within the agreed geopolitical boundaries,
797	concerning the provision of primary care services, in order to
798	guarantee delivery of services in a nonduplicative fashion, and
799	to provide for referral arrangements, privileges, and
800	admissions, as appropriate. The hospital shall agree to provide
801	at an onsite or offsite facility primary care services within 24
802	hours to which all Medicaid recipients and persons eligible
803	under this paragraph who do not require emergency room services
804	are referred during normal daylight hours.
805	(e)  Cooperate with the agency, the county, and other
806	entities to ensure the provision of certain public health
807	services, case management, referral and acceptance of patients,
808	and sharing of epidemiological data, as the agency and the
809	hospital find mutually necessary and desirable to promote and
810	protect the public health within the agreed geopolitical
811	boundaries.
812	(f)  In cooperation with the county in which the hospital
813	resides, develop a low-cost, outpatient, prepaid health care
814	program to persons who are not eligible for the Medicaid
815	program, and who reside within the area.
816	(g)  Provide inpatient services to residents within the
817	area who are not eligible for Medicaid or Medicare, and who do
818	not have private health insurance, regardless of ability to pay,
819	on the basis of available space, except that nothing shall
820	prevent the hospital from establishing bill collection programs
821	based on ability to pay.
822	(h)  Work with the Florida Healthy Kids Corporation, the
823	Florida Health Care Purchasing Cooperative, and business health
824	coalitions, as appropriate, to develop a feasibility study and
825	plan to provide a low-cost comprehensive health insurance plan
826	to persons who reside within the area and who do not have access
827	to such a plan.
828	(i)  Work with public health officials and other experts to
829	provide community health education and prevention activities
830	designed to promote healthy lifestyles and appropriate use of
831	health services.
832	(j)  Work with the local health council to develop a plan
833	for promoting access to affordable health care services for all
834	persons who reside within the area, including, but not limited
835	to, public health services, primary care services, inpatient
836	services, and affordable health insurance generally.
837
838	Any hospital that fails to comply with any of the provisions of
839	this subsection, or any other contractual condition, may not
840	receive payments under this section until full compliance is
841	achieved.
842	Section 10.  Paragraph (b) of subsection (4) and paragraph
843	(a) of subsection (39) of section 409.912, Florida Statutes, are
844	amended, and subsection (53) is added to that section, to read:
845	409.912  Cost-effective purchasing of health care.--The
846	agency shall purchase goods and services for Medicaid recipients
847	in the most cost-effective manner consistent with the delivery
848	of quality medical care. To ensure that medical services are
849	effectively utilized, the agency may, in any case, require a
850	confirmation or second physician's opinion of the correct
851	diagnosis for purposes of authorizing future services under the
852	Medicaid program. This section does not restrict access to
853	emergency services or poststabilization care services as defined
854	in 42 C.F.R. part 438.114. Such confirmation or second opinion
855	shall be rendered in a manner approved by the agency. The agency
856	shall maximize the use of prepaid per capita and prepaid
857	aggregate fixed-sum basis services when appropriate and other
858	alternative service delivery and reimbursement methodologies,
859	including competitive bidding pursuant to s. 287.057, designed
860	to facilitate the cost-effective purchase of a case-managed
861	continuum of care. The agency shall also require providers to
862	minimize the exposure of recipients to the need for acute
863	inpatient, custodial, and other institutional care and the
864	inappropriate or unnecessary use of high-cost services. The
865	agency shall contract with a vendor to monitor and evaluate the
866	clinical practice patterns of providers in order to identify
867	trends that are outside the normal practice patterns of a
868	provider's professional peers or the national guidelines of a
869	provider's professional association. The vendor must be able to
870	provide information and counseling to a provider whose practice
871	patterns are outside the norms, in consultation with the agency,
872	to improve patient care and reduce inappropriate utilization.
873	The agency may mandate prior authorization, drug therapy
874	management, or disease management participation for certain
875	populations of Medicaid beneficiaries, certain drug classes, or
876	particular drugs to prevent fraud, abuse, overuse, and possible
877	dangerous drug interactions. The Pharmaceutical and Therapeutics
878	Committee shall make recommendations to the agency on drugs for
879	which prior authorization is required. The agency shall inform
880	the Pharmaceutical and Therapeutics Committee of its decisions
881	regarding drugs subject to prior authorization. The agency is
882	authorized to limit the entities it contracts with or enrolls as
883	Medicaid providers by developing a provider network through
884	provider credentialing. The agency may competitively bid single-
885	source-provider contracts if procurement of goods or services
886	results in demonstrated cost savings to the state without
887	limiting access to care. The agency may limit its network based
888	on the assessment of beneficiary access to care, provider
889	availability, provider quality standards, time and distance
890	standards for access to care, the cultural competence of the
891	provider network, demographic characteristics of Medicaid
892	beneficiaries, practice and provider-to-beneficiary standards,
893	appointment wait times, beneficiary use of services, provider
894	turnover, provider profiling, provider licensure history,
895	previous program integrity investigations and findings, peer
896	review, provider Medicaid policy and billing compliance records,
897	clinical and medical record audits, and other factors. Providers
898	shall not be entitled to enrollment in the Medicaid provider
899	network. The agency shall determine instances in which allowing
900	Medicaid beneficiaries to purchase durable medical equipment and
901	other goods is less expensive to the Medicaid program than long-
902	term rental of the equipment or goods. The agency may establish
903	rules to facilitate purchases in lieu of long-term rentals in
904	order to protect against fraud and abuse in the Medicaid program
905	as defined in s. 409.913. The agency may seek federal waivers
906	necessary to administer these policies.
907	(4)  The agency may contract with:
908	(b)  An entity that is providing comprehensive behavioral
909	health care services to certain Medicaid recipients through a
910	capitated, prepaid arrangement pursuant to the federal waiver
911	provided for by s. 409.905(5). Such an entity must be licensed
912	under chapter 624, chapter 636, or chapter 641 and must possess
913	the clinical systems and operational competence to manage risk
914	and provide comprehensive behavioral health care to Medicaid
915	recipients. As used in this paragraph, the term "comprehensive
916	behavioral health care services" means covered mental health and
917	substance abuse treatment services that are available to
918	Medicaid recipients. The secretary of the Department of Children
919	and Family Services shall approve provisions of procurements
920	related to children in the department's care or custody prior to
921	enrolling such children in a prepaid behavioral health plan. Any
922	contract awarded under this paragraph must be competitively
923	procured. In developing the behavioral health care prepaid plan
924	procurement document, the agency shall ensure that the
925	procurement document requires the contractor to develop and
926	implement a plan to ensure compliance with s. 394.4574 related
927	to services provided to residents of licensed assisted living
928	facilities that hold a limited mental health license. Except as
929	provided in subparagraph 8., and except in counties where the
930	Medicaid managed care pilot program is authorized pursuant to s.
931	409.91211, the agency shall seek federal approval to contract
932	with a single entity meeting these requirements to provide
933	comprehensive behavioral health care services to all Medicaid
934	recipients not enrolled in a Medicaid managed care plan
935	authorized under s. 409.91211 or a Medicaid health maintenance
936	organization in an AHCA area. In an AHCA area where the Medicaid
937	managed care pilot program is authorized pursuant to s.
938	409.91211 in one or more counties, the agency may procure a
939	contract with a single entity to serve the remaining counties as
940	an AHCA area or the remaining counties may be included with an
941	adjacent AHCA area and shall be subject to this paragraph. Each
942	entity must offer sufficient choice of providers in its network
943	to ensure recipient access to care and the opportunity to select
944	a provider with whom they are satisfied. The network shall
945	include all public mental health hospitals. To ensure unimpaired
946	access to behavioral health care services by Medicaid
947	recipients, all contracts issued pursuant to this paragraph
948	shall require 80 percent of the capitation paid to the managed
949	care plan, including health maintenance organizations, to be
950	expended for the provision of behavioral health care services.
951	In the event the managed care plan expends less than 80 percent
952	of the capitation paid pursuant to this paragraph for the
953	provision of behavioral health care services, the difference
954	shall be returned to the agency. The agency shall provide the
955	managed care plan with a certification letter indicating the
956	amount of capitation paid during each calendar year for the
957	provision of behavioral health care services pursuant to this
958	section. The agency may reimburse for substance abuse treatment
959	services on a fee-for-service basis until the agency finds that
960	adequate funds are available for capitated, prepaid
961	arrangements.
962	1.  By January 1, 2001, the agency shall modify the
963	contracts with the entities providing comprehensive inpatient
964	and outpatient mental health care services to Medicaid
965	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
966	Counties, to include substance abuse treatment services.
967	2.  By July 1, 2003, the agency and the Department of
968	Children and Family Services shall execute a written agreement
969	that requires collaboration and joint development of all policy,
970	budgets, procurement documents, contracts, and monitoring plans
971	that have an impact on the state and Medicaid community mental
972	health and targeted case management programs.
973	3.  Except as provided in subparagraph 8., by July 1, 2006,
974	the agency and the Department of Children and Family Services
975	shall contract with managed care entities in each AHCA area
976	except area 6 or arrange to provide comprehensive inpatient and
977	outpatient mental health and substance abuse services through
978	capitated prepaid arrangements to all Medicaid recipients who
979	are eligible to participate in such plans under federal law and
980	regulation. In AHCA areas where eligible individuals number less
981	than 150,000, the agency shall contract with a single managed
982	care plan to provide comprehensive behavioral health services to
983	all recipients who are not enrolled in a Medicaid health
984	maintenance organization or a Medicaid capitated managed care
985	plan authorized under s. 409.91211. The agency may contract with
986	more than one comprehensive behavioral health provider to
987	provide care to recipients who are not enrolled in a Medicaid
988	capitated managed care plan authorized under s. 409.91211 or a
989	Medicaid health maintenance organization in AHCA areas where the
990	eligible population exceeds 150,000. In an AHCA area where the
991	Medicaid managed care pilot program is authorized pursuant to s.
992	409.91211 in one or more counties, the agency may procure a
993	contract with a single entity to serve the remaining counties as
994	an AHCA area or the remaining counties may be included with an
995	adjacent AHCA area and shall be subject to this paragraph.
996	Contracts for comprehensive behavioral health providers awarded
997	pursuant to this section shall be competitively procured. Both
998	for-profit and not-for-profit corporations shall be eligible to
999	compete. Managed care plans contracting with the agency under
1000	subsection (3) shall provide and receive payment for the same
1001	comprehensive behavioral health benefits as provided in AHCA
1002	rules, including handbooks incorporated by reference. In AHCA
1003	area 11, the agency shall contract with at least two
1004	comprehensive behavioral health care providers to provide
1005	behavioral health care to recipients in that area who are
1006	enrolled in, or assigned to, the MediPass program. One of the
1007	behavioral health care contracts shall be with the existing
1008	provider service network pilot project, as described in
1009	paragraph (d), for the purpose of demonstrating the cost-
1010	effectiveness of the provision of quality mental health services
1011	through a public hospital-operated managed care model. Payment
1012	shall be at an agreed-upon capitated rate to ensure cost
1013	savings. Of the recipients in area 11 who are assigned to
1014	MediPass under the provisions of s. 409.9122(2)(k), a minimum of
1015	50,000 of those MediPass-enrolled recipients shall be assigned
1016	to the existing provider service network in area 11 for their
1017	behavioral care.
1018	4.  By October 1, 2003, the agency and the department shall
1019	submit a plan to the Governor, the President of the Senate, and
1020	the Speaker of the House of Representatives which provides for
1021	the full implementation of capitated prepaid behavioral health
1022	care in all areas of the state.
1023	a.  Implementation shall begin in 2003 in those AHCA areas
1024	of the state where the agency is able to establish sufficient
1025	capitation rates.
1026	b.  If the agency determines that the proposed capitation
1027	rate in any area is insufficient to provide appropriate
1028	services, the agency may adjust the capitation rate to ensure
1029	that care will be available. The agency and the department may
1030	use existing general revenue to address any additional required
1031	match but may not over-obligate existing funds on an annualized
1032	basis.
1033	c.  Subject to any limitations provided for in the General
1034	Appropriations Act, the agency, in compliance with appropriate
1035	federal authorization, shall develop policies and procedures
1036	that allow for certification of local and state funds.
1037	5.  Children residing in a statewide inpatient psychiatric
1038	program, or in a Department of Juvenile Justice or a Department
1039	of Children and Family Services residential program approved as
1040	a Medicaid behavioral health overlay services provider shall not
1041	be included in a behavioral health care prepaid health plan or
1042	any other Medicaid managed care plan pursuant to this paragraph.
1043	6.  In converting to a prepaid system of delivery, the
1044	agency shall in its procurement document require an entity
1045	providing only comprehensive behavioral health care services to
1046	prevent the displacement of indigent care patients by enrollees
1047	in the Medicaid prepaid health plan providing behavioral health
1048	care services from facilities receiving state funding to provide
1049	indigent behavioral health care, to facilities licensed under
1050	chapter 395 which do not receive state funding for indigent
1051	behavioral health care, or reimburse the unsubsidized facility
1052	for the cost of behavioral health care provided to the displaced
1053	indigent care patient.
1054	7.  Traditional community mental health providers under
1055	contract with the Department of Children and Family Services
1056	pursuant to part IV of chapter 394, child welfare providers
1057	under contract with the Department of Children and Family
1058	Services in areas 1 and 6, and inpatient mental health providers
1059	licensed pursuant to chapter 395 must be offered an opportunity
1060	to accept or decline a contract to participate in any provider
1061	network for prepaid behavioral health services.
1062	8.  All Medicaid-eligible children, except children in area
1063	1 and children in Highlands, Hardee, Polk, or Manatee Counties
1064	of area 6 For fiscal year 2004-2005, all Medicaid eligible
1065	children, except children in areas 1 and 6, whose cases are open
1066	for child welfare services in the HomeSafeNet system, shall be
1067	enrolled in MediPass or in Medicaid fee-for-service and all
1068	their behavioral health care services including inpatient,
1069	outpatient psychiatric, community mental health, and case
1070	management shall be reimbursed on a fee-for-service basis.
1071	Beginning July 1, 2005, such children, who are open for child
1072	welfare services in the HomeSafeNet system, shall receive their
1073	behavioral health care services through a specialty prepaid plan
1074	operated by community-based lead agencies either through a
1075	single agency or formal agreements among several agencies. The
1076	specialty prepaid plan must result in savings to the state
1077	comparable to savings achieved in other Medicaid managed care
1078	and prepaid programs. Such plan must provide mechanisms to
1079	maximize state and local revenues. The specialty prepaid plan
1080	shall be developed by the agency and the Department of Children
1081	and Family Services. The agency is authorized to seek any
1082	federal waivers to implement this initiative. Medicaid-eligible
1083	children whose cases are open for child welfare services in the
1084	HomeSafeNet system and who reside in AHCA area 10 are exempt
1085	from the specialty prepaid plan upon the development of a
1086	service delivery mechanism for children who reside in area 10 as
1087	specified in s. 409.91211(3)(dd).
1088	(39)(a)  The agency shall implement a Medicaid prescribed-
1089	drug spending-control program that includes the following
1090	components:
1091	1.  A Medicaid preferred drug list, which shall be a
1092	listing of cost-effective therapeutic options recommended by the
1093	Medicaid Pharmacy and Therapeutics Committee established
1094	pursuant to s. 409.91195 and adopted by the agency for each
1095	therapeutic class on the preferred drug list. At the discretion
1096	of the committee, and when feasible, the preferred drug list
1097	should include at least two products in a therapeutic class. The
1098	agency may post the preferred drug list and updates to the
1099	preferred drug list on an Internet website without following the
1100	rulemaking procedures of chapter 120. Antiretroviral agents are
1101	excluded from the preferred drug list. The agency shall also
1102	limit the amount of a prescribed drug dispensed to no more than
1103	a 34-day supply unless the drug products' smallest marketed
1104	package is greater than a 34-day supply, or the drug is
1105	determined by the agency to be a maintenance drug in which case
1106	a 100-day maximum supply may be authorized. The agency is
1107	authorized to seek any federal waivers necessary to implement
1108	these cost-control programs and to continue participation in the
1109	federal Medicaid rebate program, or alternatively to negotiate
1110	state-only manufacturer rebates. The agency may adopt rules to
1111	implement this subparagraph. The agency shall continue to
1112	provide unlimited contraceptive drugs and items. The agency must
1113	establish procedures to ensure that:
1114	a.  There will be a response to a request for prior
1115	consultation by telephone or other telecommunication device
1116	within 24 hours after receipt of a request for prior
1117	consultation; and
1118	b.  A 72-hour supply of the drug prescribed will be
1119	provided in an emergency or when the agency does not provide a
1120	response within 24 hours as required by sub-subparagraph a.
1121	2.  Reimbursement to pharmacies for Medicaid prescribed
1122	drugs shall be set at the lesser of: the average wholesale price
1123	(AWP) minus 16.4 15.4 percent, the wholesaler acquisition cost
1124	(WAC) plus 4.75 5.75 percent, the federal upper limit (FUL), the
1125	state maximum allowable cost (SMAC), or the usual and customary
1126	(UAC) charge billed by the provider.
1127	3.  The agency shall develop and implement a process for
1128	managing the drug therapies of Medicaid recipients who are using
1129	significant numbers of prescribed drugs each month. The
1130	management process may include, but is not limited to,
1131	comprehensive, physician-directed medical-record reviews, claims
1132	analyses, and case evaluations to determine the medical
1133	necessity and appropriateness of a patient's treatment plan and
1134	drug therapies. The agency may contract with a private
1135	organization to provide drug-program-management services. The
1136	Medicaid drug benefit management program shall include
1137	initiatives to manage drug therapies for HIV/AIDS patients,
1138	patients using 20 or more unique prescriptions in a 180-day
1139	period, and the top 1,000 patients in annual spending. The
1140	agency shall enroll any Medicaid recipient in the drug benefit
1141	management program if he or she meets the specifications of this
1142	provision and is not enrolled in a Medicaid health maintenance
1143	organization.
1144	4.  The agency may limit the size of its pharmacy network
1145	based on need, competitive bidding, price negotiations,
1146	credentialing, or similar criteria. The agency shall give
1147	special consideration to rural areas in determining the size and
1148	location of pharmacies included in the Medicaid pharmacy
1149	network. A pharmacy credentialing process may include criteria
1150	such as a pharmacy's full-service status, location, size,
1151	patient educational programs, patient consultation, disease
1152	management services, and other characteristics. The agency may
1153	impose a moratorium on Medicaid pharmacy enrollment when it is
1154	determined that it has a sufficient number of Medicaid-
1155	participating providers. The agency must allow dispensing
1156	practitioners to participate as a part of the Medicaid pharmacy
1157	network regardless of the practitioner's proximity to any other
1158	entity that is dispensing prescription drugs under the Medicaid
1159	program. A dispensing practitioner must meet all credentialing
1160	requirements applicable to his or her practice, as determined by
1161	the agency.
1162	5.  The agency shall develop and implement a program that
1163	requires Medicaid practitioners who prescribe drugs to use a
1164	counterfeit-proof prescription pad for Medicaid prescriptions.
1165	The agency shall require the use of standardized counterfeit-
1166	proof prescription pads by Medicaid-participating prescribers or
1167	prescribers who write prescriptions for Medicaid recipients. The
1168	agency may implement the program in targeted geographic areas or
1169	statewide.
1170	6.  The agency may enter into arrangements that require
1171	manufacturers of generic drugs prescribed to Medicaid recipients
1172	to provide rebates of at least 15.1 percent of the average
1173	manufacturer price for the manufacturer's generic products.
1174	These arrangements shall require that if a generic-drug
1175	manufacturer pays federal rebates for Medicaid-reimbursed drugs
1176	at a level below 15.1 percent, the manufacturer must provide a
1177	supplemental rebate to the state in an amount necessary to
1178	achieve a 15.1-percent rebate level.
1179	7.  The agency may establish a preferred drug list as
1180	described in this subsection, and, pursuant to the establishment
1181	of such preferred drug list, it is authorized to negotiate
1182	supplemental rebates from manufacturers that are in addition to
1183	those required by Title XIX of the Social Security Act and at no
1184	less than 14 percent of the average manufacturer price as
1185	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
1186	the federal or supplemental rebate, or both, equals or exceeds
1187	29 percent. There is no upper limit on the supplemental rebates
1188	the agency may negotiate. The agency may determine that specific
1189	products, brand-name or generic, are competitive at lower rebate
1190	percentages. Agreement to pay the minimum supplemental rebate
1191	percentage will guarantee a manufacturer that the Medicaid
1192	Pharmaceutical and Therapeutics Committee will consider a
1193	product for inclusion on the preferred drug list. However, a
1194	pharmaceutical manufacturer is not guaranteed placement on the
1195	preferred drug list by simply paying the minimum supplemental
1196	rebate. Agency decisions will be made on the clinical efficacy
1197	of a drug and recommendations of the Medicaid Pharmaceutical and
1198	Therapeutics Committee, as well as the price of competing
1199	products minus federal and state rebates. The agency is
1200	authorized to contract with an outside agency or contractor to
1201	conduct negotiations for supplemental rebates. For the purposes
1202	of this section, the term "supplemental rebates" means cash
1203	rebates. Effective July 1, 2004, value-added programs as a
1204	substitution for supplemental rebates are prohibited. The agency
1205	is authorized to seek any federal waivers to implement this
1206	initiative.
1207	8.  The Agency for Health Care Administration shall expand
1208	home delivery of pharmacy products. To assist Medicaid patients
1209	in securing their prescriptions and reduce program costs, the
1210	agency shall expand its current mail-order-pharmacy diabetes-
1211	supply program to include all generic and brand-name drugs used
1212	by Medicaid patients with diabetes. Medicaid recipients in the
1213	current program may obtain nondiabetes drugs on a voluntary
1214	basis. This initiative is limited to the geographic area covered
1215	by the current contract. The agency may seek and implement any
1216	federal waivers necessary to implement this subparagraph.
1217	9.  The agency shall limit to one dose per month any drug
1218	prescribed to treat erectile dysfunction.
1219	10.a.  The agency may implement a Medicaid behavioral drug
1220	management system. The agency may contract with a vendor that
1221	has experience in operating behavioral drug management systems
1222	to implement this program. The agency is authorized to seek
1223	federal waivers to implement this program.
1224	b.  The agency, in conjunction with the Department of
1225	Children and Family Services, may implement the Medicaid
1226	behavioral drug management system that is designed to improve
1227	the quality of care and behavioral health prescribing practices
1228	based on best practice guidelines, improve patient adherence to
1229	medication plans, reduce clinical risk, and lower prescribed
1230	drug costs and the rate of inappropriate spending on Medicaid
1231	behavioral drugs. The program may include the following
1232	elements:
1233	(I)  Provide for the development and adoption of best
1234	practice guidelines for behavioral health-related drugs such as
1235	antipsychotics, antidepressants, and medications for treating
1236	bipolar disorders and other behavioral conditions; translate
1237	them into practice; review behavioral health prescribers and
1238	compare their prescribing patterns to a number of indicators
1239	that are based on national standards; and determine deviations
1240	from best practice guidelines.
1241	(II)  Implement processes for providing feedback to and
1242	educating prescribers using best practice educational materials
1243	and peer-to-peer consultation.
1244	(III)  Assess Medicaid beneficiaries who are outliers in
1245	their use of behavioral health drugs with regard to the numbers
1246	and types of drugs taken, drug dosages, combination drug
1247	therapies, and other indicators of improper use of behavioral
1248	health drugs.
1249	(IV)  Alert prescribers to patients who fail to refill
1250	prescriptions in a timely fashion, are prescribed multiple same-
1251	class behavioral health drugs, and may have other potential
1252	medication problems.
1253	(V)  Track spending trends for behavioral health drugs and
1254	deviation from best practice guidelines.
1255	(VI)  Use educational and technological approaches to
1256	promote best practices, educate consumers, and train prescribers
1257	in the use of practice guidelines.
1258	(VII)  Disseminate electronic and published materials.
1259	(VIII)  Hold statewide and regional conferences.
1260	(IX)  Implement a disease management program with a model
1261	quality-based medication component for severely mentally ill
1262	individuals and emotionally disturbed children who are high
1263	users of care.
1264	11.a.  The agency shall implement a Medicaid prescription
1265	drug management system. The agency may contract with a vendor
1266	that has experience in operating prescription drug management
1267	systems in order to implement this system. Any management system
1268	that is implemented in accordance with this subparagraph must
1269	rely on cooperation between physicians and pharmacists to
1270	determine appropriate practice patterns and clinical guidelines
1271	to improve the prescribing, dispensing, and use of drugs in the
1272	Medicaid program. The agency may seek federal waivers to
1273	implement this program.
1274	b.  The drug management system must be designed to improve
1275	the quality of care and prescribing practices based on best
1276	practice guidelines, improve patient adherence to medication
1277	plans, reduce clinical risk, and lower prescribed drug costs and
1278	the rate of inappropriate spending on Medicaid prescription
1279	drugs. The program must:
1280	(I)  Provide for the development and adoption of best
1281	practice guidelines for the prescribing and use of drugs in the
1282	Medicaid program, including translating best practice guidelines
1283	into practice; reviewing prescriber patterns and comparing them
1284	to indicators that are based on national standards and practice
1285	patterns of clinical peers in their community, statewide, and
1286	nationally; and determine deviations from best practice
1287	guidelines.
1288	(II)  Implement processes for providing feedback to and
1289	educating prescribers using best practice educational materials
1290	and peer-to-peer consultation.
1291	(III)  Assess Medicaid recipients who are outliers in their
1292	use of a single or multiple prescription drugs with regard to
1293	the numbers and types of drugs taken, drug dosages, combination
1294	drug therapies, and other indicators of improper use of
1295	prescription drugs.
1296	(IV)  Alert prescribers to patients who fail to refill
1297	prescriptions in a timely fashion, are prescribed multiple drugs
1298	that may be redundant or contraindicated, or may have other
1299	potential medication problems.
1300	(V)  Track spending trends for prescription drugs and
1301	deviation from best practice guidelines.
1302	(VI)  Use educational and technological approaches to
1303	promote best practices, educate consumers, and train prescribers
1304	in the use of practice guidelines.
1305	(VII)  Disseminate electronic and published materials.
1306	(VIII)  Hold statewide and regional conferences.
1307	(IX)  Implement disease management programs in cooperation
1308	with physicians and pharmacists, along with a model quality-
1309	based medication component for individuals having chronic
1310	medical conditions.
1311	12.  The agency is authorized to contract for drug rebate
1312	administration, including, but not limited to, calculating
1313	rebate amounts, invoicing manufacturers, negotiating disputes
1314	with manufacturers, and maintaining a database of rebate
1315	collections.
1316	13.  The agency may specify the preferred daily dosing form
1317	or strength for the purpose of promoting best practices with
1318	regard to the prescribing of certain drugs as specified in the
1319	General Appropriations Act and ensuring cost-effective
1320	prescribing practices.
1321	14.  The agency may require prior authorization for
1322	Medicaid-covered prescribed drugs. The agency may, but is not
1323	required to, prior-authorize the use of a product:
1324	a.  For an indication not approved in labeling;
1325	b.  To comply with certain clinical guidelines; or
1326	c.  If the product has the potential for overuse, misuse,
1327	or abuse.
1328
1329	The agency may require the prescribing professional to provide
1330	information about the rationale and supporting medical evidence
1331	for the use of a drug. The agency may post prior authorization
1332	criteria and protocol and updates to the list of drugs that are
1333	subject to prior authorization on an Internet website without
1334	amending its rule or engaging in additional rulemaking.
1335	15.  The agency, in conjunction with the Pharmaceutical and
1336	Therapeutics Committee, may require age-related prior
1337	authorizations for certain prescribed drugs. The agency may
1338	preauthorize the use of a drug for a recipient who may not meet
1339	the age requirement or may exceed the length of therapy for use
1340	of this product as recommended by the manufacturer and approved
1341	by the Food and Drug Administration. Prior authorization may
1342	require the prescribing professional to provide information
1343	about the rationale and supporting medical evidence for the use
1344	of a drug.
1345	16.  The agency shall implement a step-therapy prior
1346	authorization approval process for medications excluded from the
1347	preferred drug list. Medications listed on the preferred drug
1348	list must be used within the previous 12 months prior to the
1349	alternative medications that are not listed. The step-therapy
1350	prior authorization may require the prescriber to use the
1351	medications of a similar drug class or for a similar medical
1352	indication unless contraindicated in the Food and Drug
1353	Administration labeling. The trial period between the specified
1354	steps may vary according to the medical indication. The step-
1355	therapy approval process shall be developed in accordance with
1356	the committee as stated in s. 409.91195(7) and (8). A drug
1357	product may be approved without meeting the step-therapy prior
1358	authorization criteria if the prescribing physician provides the
1359	agency with additional written medical or clinical documentation
1360	that the product is medically necessary because:
1361	a.  There is not a drug on the preferred drug list to treat
1362	the disease or medical condition which is an acceptable clinical
1363	alternative;
1364	b.  The alternatives have been ineffective in the treatment
1365	of the beneficiary's disease; or
1366	c.  Based on historic evidence and known characteristics of
1367	the patient and the drug, the drug is likely to be ineffective,
1368	or the number of doses have been ineffective.
1369
1370	The agency shall work with the physician to determine the best
1371	alternative for the patient. The agency may adopt rules waiving
1372	the requirements for written clinical documentation for specific
1373	drugs in limited clinical situations.
1374	17.  The agency shall implement a return and reuse program
1375	for drugs dispensed by pharmacies to institutional recipients,
1376	which includes payment of a $5 restocking fee for the
1377	implementation and operation of the program. The return and
1378	reuse program shall be implemented electronically and in a
1379	manner that promotes efficiency. The program must permit a
1380	pharmacy to exclude drugs from the program if it is not
1381	practical or cost-effective for the drug to be included and must
1382	provide for the return to inventory of drugs that cannot be
1383	credited or returned in a cost-effective manner. The agency
1384	shall determine if the program has reduced the amount of
1385	Medicaid prescription drugs which are destroyed on an annual
1386	basis and if there are additional ways to ensure more
1387	prescription drugs are not destroyed which could safely be
1388	reused. The agency's conclusion and recommendations shall be
1389	reported to the Legislature by December 1, 2005.
1390	(53)  Before seeking an amendment to the state plan for
1391	purposes of implementing programs authorized by the Deficit
1392	Reduction Act of 2005, the agency shall notify the Legislature.
1393	Section 11.  Section 409.91206, Florida Statutes, is
1394	created to read:
1395	409.91206  Alternatives for health and long-term care
1396	reforms.--The Governor, the President of the Senate, and the
1397	Speaker of the House of Representatives may convene workgroups
1398	to propose alternatives for cost-effective health and long-term
1399	care reforms, including, but not limited to, reforms for
1400	Medicaid.
1401	Section 12.  Section 409.91211, Florida Statutes, as
1402	amended by chapter 2007-331, Laws of Florida, is amended to
1403	read:
1404	409.91211  Medicaid managed care pilot program.--
1405	(1)(a)  The agency is authorized to seek and implement
1406	experimental, pilot, or demonstration project waivers, pursuant
1407	to s. 1115 of the Social Security Act, to create a statewide
1408	initiative to provide for a more efficient and effective service
1409	delivery system that enhances quality of care and client
1410	outcomes in the Florida Medicaid program pursuant to this
1411	section. Phase one of the demonstration shall be implemented in
1412	two geographic areas. One demonstration site shall include only
1413	Broward County. A second demonstration site shall initially
1414	include Duval County and shall be expanded to include Baker,
1415	Clay, and Nassau Counties within 1 year after the Duval County
1416	program becomes operational. A third demonstration site shall
1417	include Hardee, Highlands, Hillsborough, Manatee, Miami-Dade,
1418	Monroe, Pasco, Pinellas, and Polk Counties. The agency shall
1419	begin enrolling recipients in the third demonstration site by
1420	September 1, 2010. The agency shall implement expansion of the
1421	program to include the remaining counties of the state and
1422	remaining eligibility groups in accordance with the process
1423	specified in the federally approved special terms and conditions
1424	numbered 11-W-00206/4, as approved by the federal Centers for
1425	Medicare and Medicaid Services on October 19, 2005, with a goal
1426	of full statewide implementation by June 30, 2011.
1427	(b)  This waiver authority is contingent upon federal
1428	approval to preserve the upper-payment-limit funding mechanism
1429	for hospitals, including a guarantee of a reasonable growth
1430	factor, a methodology to allow the use of a portion of these
1431	funds to serve as a risk pool for demonstration sites,
1432	provisions to preserve the state's ability to use
1433	intergovernmental transfers, and provisions to protect the
1434	disproportionate share program authorized pursuant to this
1435	chapter. Upon completion of the evaluation conducted under s. 3,
1436	ch. 2005-133, Laws of Florida, the agency may request statewide
1437	expansion of the demonstration projects. Statewide phase-in to
1438	additional counties shall be contingent upon review and approval
1439	by the Legislature. Under the upper-payment-limit program, or
1440	the low-income pool as implemented by the Agency for Health Care
1441	Administration pursuant to federal waiver, the state matching
1442	funds required for the program shall be provided by local
1443	governmental entities through intergovernmental transfers in
1444	accordance with published federal statutes and regulations. The
1445	Agency for Health Care Administration shall distribute upper-
1446	payment-limit, disproportionate share hospital, and low-income
1447	pool funds according to published federal statutes, regulations,
1448	and waivers and the low-income pool methodology approved by the
1449	federal Centers for Medicare and Medicaid Services.
1450	(c)  It is the intent of the Legislature that the low-
1451	income pool plan required by the terms and conditions of the
1452	Medicaid reform waiver and submitted to the federal Centers for
1453	Medicare and Medicaid Services propose the distribution of the
1454	above-mentioned program funds based on the following objectives:
1455	1.  Assure a broad and fair distribution of available funds
1456	based on the access provided by Medicaid participating
1457	hospitals, regardless of their ownership status, through their
1458	delivery of inpatient or outpatient care for Medicaid
1459	beneficiaries and uninsured and underinsured individuals;
1460	2.  Assure accessible emergency inpatient and outpatient
1461	care for Medicaid beneficiaries and uninsured and underinsured
1462	individuals;
1463	3.  Enhance primary, preventive, and other ambulatory care
1464	coverages for uninsured individuals;
1465	4.  Promote teaching and specialty hospital programs;
1466	5.  Promote the stability and viability of statutorily
1467	defined rural hospitals and hospitals that serve as sole
1468	community hospitals;
1469	6.  Recognize the extent of hospital uncompensated care
1470	costs;
1471	7.  Maintain and enhance essential community hospital care;
1472	8.  Maintain incentives for local governmental entities to
1473	contribute to the cost of uncompensated care;
1474	9.  Promote measures to avoid preventable hospitalizations;
1475	10.  Account for hospital efficiency; and
1476	11.  Contribute to a community's overall health system.
1477	(2)  The Legislature intends for the capitated managed care
1478	pilot program to:
1479	(a)  Provide recipients in Medicaid fee-for-service or the
1480	MediPass program a comprehensive and coordinated capitated
1481	managed care system for all health care services specified in
1482	ss. 409.905 and 409.906.
1483	(b)  Stabilize Medicaid expenditures under the pilot
1484	program compared to Medicaid expenditures in the pilot area for
1485	the 3 years before implementation of the pilot program, while
1486	ensuring:
1487	1.  Consumer education and choice.
1488	2.  Access to medically necessary services.
1489	3.  Coordination of preventative, acute, and long-term
1490	care.
1491	4.  Reductions in unnecessary service utilization.
1492	(c)  Provide an opportunity to evaluate the feasibility of
1493	statewide implementation of capitated managed care networks as a
1494	replacement for the current Medicaid fee-for-service and
1495	MediPass systems.
1496	(3)  The agency shall have the following powers, duties,
1497	and responsibilities with respect to the pilot program:
1498	(a)  To implement a system to deliver all mandatory
1499	services specified in s. 409.905 and optional services specified
1500	in s. 409.906, as approved by the Centers for Medicare and
1501	Medicaid Services and the Legislature in the waiver pursuant to
1502	this section. Services to recipients under plan benefits shall
1503	include emergency services provided under s. 409.9128.
1504	(b)  To implement a pilot program, including Medicaid
1505	eligibility categories specified in ss. 409.903 and 409.904, as
1506	authorized in an approved federal waiver.
1507	(c)  To implement the managed care pilot program that
1508	maximizes all available state and federal funds, including those
1509	obtained through intergovernmental transfers, the low-income
1510	pool, supplemental Medicaid payments, and the disproportionate
1511	share program. Within the parameters allowed by federal statute
1512	and rule, the agency may seek options for making direct payments
1513	to hospitals and physicians employed by or under contract with
1514	the state's medical schools for the costs associated with
1515	graduate medical education under Medicaid reform.
1516	(d)  To implement actuarially sound, risk-adjusted
1517	capitation rates for Medicaid recipients in the pilot program
1518	which cover comprehensive care, enhanced services, and
1519	catastrophic care.
1520	(e)  To implement policies and guidelines for phasing in
1521	financial risk for approved provider service networks over a 3-
1522	year period. These policies and guidelines must include an
1523	option for a provider service network to be paid fee-for-service
1524	rates. For any provider service network established in a managed
1525	care pilot area, the option to be paid fee-for-service rates
1526	shall include a savings-settlement mechanism that is consistent
1527	with s. 409.912(44). Provider service networks opting to be paid
1528	fee-for-service rates shall have the option to be reimbursed for
1529	prescribed drugs and transportation services on a risk-adjusted
1530	captitated basis. This model shall be converted to a risk-
1531	adjusted capitated rate no later than the beginning of the
1532	fourth year of operation, and may be converted earlier at the
1533	option of the provider service network. Federally qualified
1534	health centers may be offered an opportunity to accept or
1535	decline a contract to participate in any provider network for
1536	prepaid primary care services. The agency shall encourage the
1537	development of innovative methods by provider service networks
1538	to perform administrative functions in a cost-effective manner,
1539	including coordination and consolidation of such functions
1540	between provider service networks and across demonstration
1541	sites.
1542	(f)  To implement stop-loss requirements and the transfer
1543	of excess cost to catastrophic coverage that accommodates the
1544	risks associated with the development of the pilot program.
1545	(g)  To recommend a process to be used by the Social
1546	Services Estimating Conference to determine and validate the
1547	rate of growth of the per-member costs of providing Medicaid
1548	services under the managed care pilot program.
1549	(h)  To implement program standards and credentialing
1550	requirements for capitated managed care networks to participate
1551	in the pilot program, including those related to fiscal
1552	solvency, quality of care, and adequacy of access to health care
1553	providers. The agency shall monitor quarterly and evaluate
1554	annually each plan based on the program standards and
1555	credentialing requirements for adequacy of access to health care
1556	providers to ensure consistent compliance. It is the intent of
1557	the Legislature that, to the extent possible, any pilot program
1558	authorized by the state under this section include any federally
1559	qualified health center, federally qualified rural health
1560	clinic, county health department, the Children's Medical
1561	Services Network within the Department of Health, or other
1562	federally, state, or locally funded entity that serves the
1563	geographic areas within the boundaries of the pilot program that
1564	requests to participate. This paragraph does not relieve an
1565	entity that qualifies as a capitated managed care network under
1566	this section from any other licensure or regulatory requirements
1567	contained in state or federal law which would otherwise apply to
1568	the entity. The standards and credentialing requirements shall
1569	be based upon, but are not limited to:
1570	1.  Compliance with the accreditation requirements as
1571	provided in s. 641.512.
1572	2.  Compliance with early and periodic screening,
1573	diagnosis, and treatment screening requirements under federal
1574	law.
1575	3.  The percentage of voluntary disenrollments.
1576	4.  Immunization rates.
1577	5.  Standards of the National Committee for Quality
1578	Assurance and other approved accrediting bodies.
1579	6.  Recommendations of other authoritative bodies.
1580	7.  Specific requirements of the Medicaid program, or
1581	standards designed to specifically meet the unique needs of
1582	Medicaid recipients.
1583	8.  Compliance with the health quality improvement system
1584	as established by the agency, which incorporates standards and
1585	guidelines developed by the Centers for Medicare and Medicaid
1586	Services as part of the quality assurance reform initiative.
1587	9.  The network's infrastructure capacity to manage
1588	financial transactions, recordkeeping, data collection, and
1589	other administrative functions.
1590	10.  The network's ability to submit any financial,
1591	programmatic, or patient-encounter data or other information
1592	required by the agency to determine the actual services provided
1593	and the cost of administering the plan.
1594	(i)  To implement a mechanism for providing information to
1595	Medicaid recipients for the purpose of selecting a capitated
1596	managed care plan. For each plan available to a recipient, the
1597	agency, at a minimum, shall ensure that the recipient is
1598	provided with:
1599	1.  A list and description of the benefits provided.
1600	2.  Information about cost sharing.
1601	3.  Plan performance data, if available.
1602	4.  An explanation of benefit limitations.
1603	5.  Contact information, including identification of
1604	providers participating in the network, geographic locations,
1605	and transportation limitations.
1606	6.  Specific information about covered prescription drugs
1607	for each plan.
1608	7.6.  Any other information the agency determines would
1609	facilitate a recipient's understanding of the plan or insurance
1610	that would best meet his or her needs.
1611	(j)  To implement a system to ensure that there is a record
1612	of recipient acknowledgment that choice counseling has been
1613	provided.
1614	(k)  To implement a choice counseling system to ensure that
1615	the choice counseling process and related material are designed
1616	to provide counseling through face-to-face interaction, by
1617	telephone, and in writing and through other forms of relevant
1618	media. Materials shall be written at the fourth-grade reading
1619	level and available in a language other than English when 5
1620	percent of the county speaks a language other than English.
1621	Choice counseling shall also use language lines and other
1622	services for impaired recipients, such as TTD/TTY.
1623	(l)  To implement a system that prohibits capitated managed
1624	care plans, their representatives, and providers employed by or
1625	contracted with the capitated managed care plans from recruiting
1626	persons eligible for or enrolled in Medicaid, from providing
1627	inducements to Medicaid recipients to select a particular
1628	capitated managed care plan, and from prejudicing Medicaid
1629	recipients against other capitated managed care plans. The
1630	system shall require the entity performing choice counseling to
1631	determine if the recipient has made a choice of a plan or has
1632	opted out because of duress, threats, payment to the recipient,
1633	or incentives promised to the recipient by a third party. If the
1634	choice counseling entity determines that the decision to choose
1635	a plan was unlawfully influenced or a plan violated any of the
1636	provisions of s. 409.912(21), the choice counseling entity shall
1637	immediately report the violation to the agency's program
1638	integrity section for investigation. Verification of choice
1639	counseling by the recipient shall include a stipulation that the
1640	recipient acknowledges the provisions of this subsection.
1641	(m)  To implement a choice counseling system that promotes
1642	health literacy and provides information aimed to reduce
1643	minority health disparities through outreach activities for
1644	Medicaid recipients.
1645	(n)  To contract with entities to perform choice
1646	counseling. The agency may establish standards and performance
1647	contracts, including standards requiring the contractor to hire
1648	choice counselors who are representative of the state's diverse
1649	population and to train choice counselors in working with
1650	culturally diverse populations.
1651	(o)  To implement eligibility assignment processes to
1652	facilitate client choice while ensuring pilot programs of
1653	adequate enrollment levels. These processes shall ensure that
1654	pilot sites have sufficient levels of enrollment to conduct a
1655	valid test of the managed care pilot program within a 2-year
1656	timeframe.
1657	(p)  To implement standards for plan compliance, including,
1658	but not limited to, standards for quality assurance and
1659	performance improvement, standards for peer or professional
1660	reviews, grievance policies, and policies for maintaining
1661	program integrity. The agency shall set reasonable standards for
1662	prompt payment of provider claims. The agency shall develop a
1663	data-reporting system, seek input from managed care plans in
1664	order to establish requirements for patient-encounter reporting,
1665	and ensure that the data reported is accurate and complete.
1666	1.  In performing the duties required under this section,
1667	the agency shall work with managed care plans to establish a
1668	uniform system to measure and monitor outcomes for a recipient
1669	of Medicaid services.
1670	2.  The system shall use financial, clinical, and other
1671	criteria based on pharmacy, medical services, and other data
1672	that is related to the provision of Medicaid services,
1673	including, but not limited to:
1674	a.  The Health Plan Employer Data and Information Set
1675	(HEDIS) or measures that are similar to HEDIS.
1676	b.  Member satisfaction.
1677	c.  Provider satisfaction.
1678	d.  Report cards on plan performance and best practices.
1679	e.  Compliance with the requirements for prompt payment of
1680	claims under ss. 627.613, 641.3155, and 641.513.
1681	f.  Utilization and quality data for the purpose of
1682	ensuring access to medically necessary services, including
1683	underutilization or inappropriate denial of services.
1684	3.  The agency shall require the managed care plans that
1685	have contracted with the agency to establish a quality assurance
1686	system that incorporates the provisions of s. 409.912(27) and
1687	any standards, rules, and guidelines developed by the agency.
1688	4.  The agency shall establish an encounter database in
1689	order to compile data on health services rendered by health care
1690	practitioners who provide services to patients enrolled in
1691	managed care plans in the demonstration sites. The encounter
1692	database shall:
1693	a.  Collect the following for each type of patient
1694	encounter with a health care practitioner or facility,
1695	including:
1696	(I)  The demographic characteristics of the patient.
1697	(II)  The principal, secondary, and tertiary diagnosis.
1698	(III)  The procedure performed.
1699	(IV)  The date and location where the procedure was
1700	performed.
1701	(V)  The payment for the procedure, if any.
1702	(VI)  If applicable, the health care practitioner's
1703	universal identification number.
1704	(VII)  If the health care practitioner rendering the
1705	service is a dependent practitioner, the modifiers appropriate
1706	to indicate that the service was delivered by the dependent
1707	practitioner.
1708	b.  Collect appropriate information relating to
1709	prescription drugs for each type of patient encounter.
1710	c.  Collect appropriate information related to health care
1711	costs and utilization from managed care plans participating in
1712	the demonstration sites.
1713	5.  To the extent practicable, when collecting the data the
1714	agency shall use a standardized claim form or electronic
1715	transfer system that is used by health care practitioners,
1716	facilities, and payors.
1717	6.  Health care practitioners and facilities in the
1718	demonstration sites shall electronically submit, and managed
1719	care plans participating in the demonstration sites shall
1720	electronically receive, information concerning claims payments
1721	and any other information reasonably related to the encounter
1722	database using a standard format as required by the agency.
1723	7.  The agency shall establish reasonable deadlines for
1724	phasing in the electronic transmittal of full encounter data.
1725	8.  The system must ensure that the data reported is
1726	accurate and complete.
1727	(q)  To implement a grievance resolution process for
1728	Medicaid recipients enrolled in a capitated managed care network
1729	under the pilot program modeled after the subscriber assistance
1730	panel, as created in s. 408.7056. This process shall include a
1731	mechanism for an expedited review of no greater than 24 hours
1732	after notification of a grievance if the life of a Medicaid
1733	recipient is in imminent and emergent jeopardy.
1734	(r)  To implement a grievance resolution process for health
1735	care providers employed by or contracted with a capitated
1736	managed care network under the pilot program in order to settle
1737	disputes among the provider and the managed care network or the
1738	provider and the agency.
1739	(s)  To implement criteria in an approved federal waiver to
1740	designate health care providers as eligible to participate in
1741	the pilot program. These criteria must include at a minimum
1742	those criteria specified in s. 409.907.
1743	(t)  To use health care provider agreements for
1744	participation in the pilot program.
1745	(u)  To require that all health care providers under
1746	contract with the pilot program be duly licensed in the state,
1747	if such licensure is available, and meet other criteria as may
1748	be established by the agency. These criteria shall include at a
1749	minimum those criteria specified in s. 409.907.
1750	(v)  To ensure that managed care organizations work
1751	collaboratively with other state or local governmental programs
1752	or institutions for the coordination of health care to eligible
1753	individuals receiving services from such programs or
1754	institutions.
1755	(w)  To implement procedures to minimize the risk of
1756	Medicaid fraud and abuse in all plans operating in the Medicaid
1757	managed care pilot program authorized in this section.
1758	1.  The agency shall ensure that applicable provisions of
1759	this chapter and chapters 414, 626, 641, and 932 which relate to
1760	Medicaid fraud and abuse are applied and enforced at the
1761	demonstration project sites.
1762	2.  Providers must have the certification, license, and
1763	credentials that are required by law and waiver requirements.
1764	3.  The agency shall ensure that the plan is in compliance
1765	with s. 409.912(21) and (22).
1766	4.  The agency shall require that each plan establish
1767	functions and activities governing program integrity in order to
1768	reduce the incidence of fraud and abuse. Plans must report
1769	instances of fraud and abuse pursuant to chapter 641.
1770	5.  The plan shall have written administrative and
1771	management arrangements or procedures, including a mandatory
1772	compliance plan, which are designed to guard against fraud and
1773	abuse. The plan shall designate a compliance officer who has
1774	sufficient experience in health care.
1775	6.a.  The agency shall require all managed care plan
1776	contractors in the pilot program to report all instances of
1777	suspected fraud and abuse. A failure to report instances of
1778	suspected fraud and abuse is a violation of law and subject to
1779	the penalties provided by law.
1780	b.  An instance of fraud and abuse in the managed care
1781	plan, including, but not limited to, defrauding the state health
1782	care benefit program by misrepresentation of fact in reports,
1783	claims, certifications, enrollment claims, demographic
1784	statistics, or patient-encounter data; misrepresentation of the
1785	qualifications of persons rendering health care and ancillary
1786	services; bribery and false statements relating to the delivery
1787	of health care; unfair and deceptive marketing practices; and
1788	false claims actions in the provision of managed care, is a
1789	violation of law and subject to the penalties provided by law.
1790	c.  The agency shall require that all contractors make all
1791	files and relevant billing and claims data accessible to state
1792	regulators and investigators and that all such data is linked
1793	into a unified system to ensure consistent reviews and
1794	investigations.
1795	(x)  To develop and provide actuarial and benefit design
1796	analyses that indicate the effect on capitation rates and
1797	benefits offered in the pilot program over a prospective 5-year
1798	period based on the following assumptions:
1799	1.  Growth in capitation rates which is limited to the
1800	estimated growth rate in general revenue.
1801	2.  Growth in capitation rates which is limited to the
1802	average growth rate over the last 3 years in per-recipient
1803	Medicaid expenditures.
1804	3.  Growth in capitation rates which is limited to the
1805	growth rate of aggregate Medicaid expenditures between the 2003-
1806	2004 fiscal year and the 2004-2005 fiscal year.
1807	(y)  To develop a mechanism to require capitated managed
1808	care plans to reimburse qualified emergency service providers,
1809	including, but not limited to, ambulance services, in accordance
1810	with ss. 409.908 and 409.9128. The pilot program must include a
1811	provision for continuing fee-for-service payments for emergency
1812	services, including, but not limited to, individuals who access
1813	ambulance services or emergency departments and who are
1814	subsequently determined to be eligible for Medicaid services.
1815	(z)  To ensure that school districts participating in the
1816	certified school match program pursuant to ss. 409.908(21) and
1817	1011.70 shall be reimbursed by Medicaid, subject to the
1818	limitations of s. 1011.70(1), for a Medicaid-eligible child
1819	participating in the services as authorized in s. 1011.70, as
1820	provided for in s. 409.9071, regardless of whether the child is
1821	enrolled in a capitated managed care network. Capitated managed
1822	care networks must make a good faith effort to execute
1823	agreements with school districts regarding the coordinated
1824	provision of services authorized under s. 1011.70. County health
1825	departments and federally qualified health centers delivering
1826	school-based services pursuant to ss. 381.0056 and 381.0057 must
1827	be reimbursed by Medicaid for the federal share for a Medicaid-
1828	eligible child who receives Medicaid-covered services in a
1829	school setting, regardless of whether the child is enrolled in a
1830	capitated managed care network. Capitated managed care networks
1831	must make a good faith effort to execute agreements with county
1832	health departments and federally qualified health centers
1833	regarding the coordinated provision of services to a Medicaid-
1834	eligible child. To ensure continuity of care for Medicaid
1835	patients, the agency, the Department of Health, and the
1836	Department of Education shall develop procedures for ensuring
1837	that a student's capitated managed care network provider
1838	receives information relating to services provided in accordance
1839	with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
1840	(aa)  To implement a mechanism whereby Medicaid recipients
1841	who are already enrolled in a managed care plan or the MediPass
1842	program in the pilot areas shall be offered the opportunity to
1843	change to capitated managed care plans on a staggered basis, as
1844	defined by the agency. All Medicaid recipients shall have 30
1845	days in which to make a choice of capitated managed care plans.
1846	Those Medicaid recipients who do not make a choice shall be
1847	assigned to a capitated managed care plan in accordance with
1848	paragraph (4)(a) and shall be exempt from s. 409.9122. To
1849	facilitate continuity of care for a Medicaid recipient who is
1850	also a recipient of Supplemental Security Income (SSI), prior to
1851	assigning the SSI recipient to a capitated managed care plan,
1852	the agency shall determine whether the SSI recipient has an
1853	ongoing relationship with a provider or capitated managed care
1854	plan, and, if so, the agency shall assign the SSI recipient to
1855	that provider or capitated managed care plan where feasible.
1856	Those SSI recipients who do not have such a provider
1857	relationship shall be assigned to a capitated managed care plan
1858	provider in accordance with paragraph (4)(a) and shall be exempt
1859	from s. 409.9122.
1860	(bb)  To develop and recommend a service delivery
1861	alternative for children having chronic medical conditions which
1862	establishes a medical home project to provide primary care
1863	services to this population. The project shall provide
1864	community-based primary care services that are integrated with
1865	other subspecialties to meet the medical, developmental, and
1866	emotional needs for children and their families. This project
1867	shall include an evaluation component to determine impacts on
1868	hospitalizations, length of stays, emergency room visits, costs,
1869	and access to care, including specialty care and patient and
1870	family satisfaction.
1871	(cc)  To develop and recommend service delivery mechanisms
1872	within capitated managed care plans to provide Medicaid services
1873	as specified in ss. 409.905 and 409.906 to persons with
1874	developmental disabilities sufficient to meet the medical,
1875	developmental, and emotional needs of these persons.
1876	(dd)  To implement service delivery mechanisms within
1877	capitated managed care plans to provide Medicaid services as
1878	specified in ss. 409.905 and 409.906 to Medicaid-eligible
1879	children whose cases are open for child welfare services in the
1880	HomeSafeNet system. These services must be coordinated with
1881	community-based care providers as specified in s. 409.1671,
1882	where available, and be sufficient to meet the medical,
1883	developmental, behavioral, and emotional needs of these
1884	children. These service delivery mechanisms must be implemented
1885	no later than July 1, 2008, in AHCA area 10 in order for the
1886	children in AHCA area 10 to remain exempt from the statewide
1887	plan under s. 409.912(4)(b)8.
1888	(4)(a)  A Medicaid recipient in the pilot area who is not
1889	currently enrolled in a capitated managed care plan upon
1890	implementation is not eligible for services as specified in ss.
1891	409.905 and 409.906, for the amount of time that the recipient
1892	does not enroll in a capitated managed care network. If a
1893	Medicaid recipient has not enrolled in a capitated managed care
1894	plan within 30 days after eligibility, the agency shall assign
1895	the Medicaid recipient to a provider service network. The agency
1896	shall assign such recipients to provider service networks for
1897	the first 5 years of implementation of each demonstration site
1898	or until the number of recipients enrolled in provider service
1899	networks in that demonstration site reaches 10 percent of the
1900	total number of participating Medicaid recipients in that
1901	demonstration site, whichever is first. After that time, if a
1902	Medicaid recipient has not enrolled in a capitated managed care
1903	plan within 30 days after eligibility, the agency shall assign
1904	the Medicaid recipient to a capitated managed care plan based on
1905	the assessed needs of the recipient as determined by the agency,
1906	and the recipient shall be exempt from s. 409.9122. When making
1907	such assignments, the agency shall take into account the
1908	following criteria:
1909	1.  A capitated managed care network has sufficient network
1910	capacity to meet the needs of members.
1911	2.  The capitated managed care network has previously
1912	enrolled the recipient as a member, or one of the capitated
1913	managed care network's primary care providers has previously
1914	provided health care to the recipient.
1915	3.  The agency has knowledge that the member has previously
1916	expressed a preference for a particular capitated managed care
1917	network as indicated by Medicaid fee-for-service claims data,
1918	but has failed to make a choice.
1919	4.  The capitated managed care network's primary care
1920	providers are geographically accessible to the recipient's
1921	residence.
1922	(b)  When more than one capitated managed care network
1923	provider meets the criteria specified in paragraph (3)(h), the
1924	agency shall make recipient assignments consecutively by family
1925	unit.
1926	(c)  If a recipient is currently enrolled with a Medicaid
1927	managed care organization that also operates an approved reform
1928	plan within a demonstration area and the recipient fails to
1929	choose a plan during the reform enrollment process or during
1930	redetermination of eligibility, the recipient shall be
1931	automatically assigned by the agency to a provider service
1932	network. The agency shall assign such recipients to provider
1933	service networks for the first 5 years of implementation of each
1934	demonstration site or until the number of recipients enrolled in
1935	provider service networks in that demonstration site reaches 10
1936	percent of the total number of participating Medicaid recipients
1937	in that demonstration site, whichever is first. After that time
1938	into the most appropriate reform plan operated by the
1939	recipient's current Medicaid managed care plan. If the
1940	recipient's current managed care plan does not operate a reform
1941	plan in the demonstration area which adequately meets the needs
1942	of the Medicaid recipient, the agency shall use the automatic
1943	assignment process as prescribed in the special terms and
1944	conditions numbered 11-W-00206/4. All enrollment and choice
1945	counseling materials provided by the agency must contain an
1946	explanation of the provisions of this paragraph for current
1947	managed care recipients.
1948	(d)  The agency may not engage in practices that are
1949	designed to favor one capitated managed care plan over another
1950	or that are designed to influence Medicaid recipients to enroll
1951	in a particular capitated managed care network in order to
1952	strengthen its particular fiscal viability.
1953	(e)  After a recipient has made a selection or has been
1954	enrolled in a capitated managed care network, the recipient
1955	shall have 90 days in which to voluntarily disenroll and select
1956	another capitated managed care network. After 90 days, no
1957	further changes may be made except for cause. Cause shall
1958	include, but not be limited to, poor quality of care, lack of
1959	access to necessary specialty services, an unreasonable delay or
1960	denial of service, inordinate or inappropriate changes of
1961	primary care providers, service access impairments due to
1962	significant changes in the geographic location of services, or
1963	fraudulent enrollment. The agency may require a recipient to use
1964	the capitated managed care network's grievance process as
1965	specified in paragraph (3)(q) prior to the agency's
1966	determination of cause, except in cases in which immediate risk
1967	of permanent damage to the recipient's health is alleged. The
1968	grievance process, when used, must be completed in time to
1969	permit the recipient to disenroll no later than the first day of
1970	the second month after the month the disenrollment request was
1971	made. If the capitated managed care network, as a result of the
1972	grievance process, approves an enrollee's request to disenroll,
1973	the agency is not required to make a determination in the case.
1974	The agency must make a determination and take final action on a
1975	recipient's request so that disenrollment occurs no later than
1976	the first day of the second month after the month the request
1977	was made. If the agency fails to act within the specified
1978	timeframe, the recipient's request to disenroll is deemed to be
1979	approved as of the date agency action was required. Recipients
1980	who disagree with the agency's finding that cause does not exist
1981	for disenrollment shall be advised of their right to pursue a
1982	Medicaid fair hearing to dispute the agency's finding.
1983	(f)  The agency shall apply for federal waivers from the
1984	Centers for Medicare and Medicaid Services to lock eligible
1985	Medicaid recipients into a capitated managed care network for 12
1986	months after an open enrollment period. After 12 months of
1987	enrollment, a recipient may select another capitated managed
1988	care network. However, nothing shall prevent a Medicaid
1989	recipient from changing primary care providers within the
1990	capitated managed care network during the 12-month period.
1991	(g)  The agency shall apply for federal waivers from the
1992	Centers for Medicare and Medicaid Services to allow recipients
1993	to purchase health care coverage through an employer-sponsored
1994	health insurance plan instead of through a Medicaid-certified
1995	plan. This provision shall be known as the opt-out option.
1996	1.  A recipient who chooses the Medicaid opt-out option
1997	shall have an opportunity for a specified period of time, as
1998	authorized under a waiver granted by the Centers for Medicare
1999	and Medicaid Services, to select and enroll in a Medicaid-
2000	certified plan. If the recipient remains in the employer-
2001	sponsored plan after the specified period, the recipient shall
2002	remain in the opt-out program for at least 1 year or until the
2003	recipient no longer has access to employer-sponsored coverage,
2004	until the employer's open enrollment period for a person who
2005	opts out in order to participate in employer-sponsored coverage,
2006	or until the person is no longer eligible for Medicaid,
2007	whichever time period is shorter.
2008	2.  Notwithstanding any other provision of this section,
2009	coverage, cost sharing, and any other component of employer-
2010	sponsored health insurance shall be governed by applicable state
2011	and federal laws.
2012	(5)  This section does not authorize the agency to
2013	implement any provision of s. 1115 of the Social Security Act
2014	experimental, pilot, or demonstration project waiver to reform
2015	the state Medicaid program in any part of the state other than
2016	the two geographic areas specified in this section unless
2017	approved by the Legislature.
2018	(6)  The agency shall develop and submit for approval
2019	applications for waivers of applicable federal laws and
2020	regulations as necessary to implement the managed care pilot
2021	project as defined in this section. The agency shall post all
2022	waiver applications under this section on its Internet website
2023	30 days before submitting the applications to the United States
2024	Centers for Medicare and Medicaid Services. All waiver
2025	applications shall be provided for review and comment to the
2026	appropriate committees of the Senate and House of
2027	Representatives for at least 10 working days prior to
2028	submission. All waivers submitted to and approved by the United
2029	States Centers for Medicare and Medicaid Services under this
2030	section must be approved by the Legislature. Federally approved
2031	waivers must be submitted to the President of the Senate and the
2032	Speaker of the House of Representatives for referral to the
2033	appropriate legislative committees. The appropriate committees
2034	shall recommend whether to approve the implementation of any
2035	waivers to the Legislature as a whole. The agency shall submit a
2036	plan containing a recommended timeline for implementation of any
2037	waivers and budgetary projections of the effect of the pilot
2038	program under this section on the total Medicaid budget for the
2039	2006-2007 through 2009-2010 state fiscal years. This
2040	implementation plan shall be submitted to the President of the
2041	Senate and the Speaker of the House of Representatives at the
2042	same time any waivers are submitted for consideration by the
2043	Legislature. The agency may implement the waiver and special
2044	terms and conditions numbered 11-W-00206/4, as approved by the
2045	federal Centers for Medicare and Medicaid Services. If the
2046	agency seeks approval by the Federal Government of any
2047	modifications to these special terms and conditions, the agency
2048	must provide written notification of its intent to modify these
2049	terms and conditions to the President of the Senate and the
2050	Speaker of the House of Representatives at least 15 days before
2051	submitting the modifications to the Federal Government for
2052	consideration. The notification must identify all modifications
2053	being pursued and the reason the modifications are needed. Upon
2054	receiving federal approval of any modifications to the special
2055	terms and conditions, the agency shall provide a report to the
2056	Legislature describing the federally approved modifications to
2057	the special terms and conditions within 7 days after approval by
2058	the Federal Government.
2059	(7)(a)  The Secretary of Health Care Administration shall
2060	convene a technical advisory panel to advise the agency in the
2061	areas of risk-adjusted-rate setting, benefit design, and choice
2062	counseling. The panel shall include representatives from the
2063	Florida Association of Health Plans, representatives from
2064	provider-sponsored networks, a Medicaid consumer representative,
2065	and a representative from the Office of Insurance Regulation.
2066	(b)  The technical advisory panel shall advise the agency
2067	concerning:
2068	1.  The risk-adjusted rate methodology to be used by the
2069	agency, including recommendations on mechanisms to recognize the
2070	risk of all Medicaid enrollees and for the transition to a risk-
2071	adjustment system, including recommendations for phasing in risk
2072	adjustment and the use of risk corridors.
2073	2.  Implementation of an encounter data system to be used
2074	for risk-adjusted rates.
2075	3.  Administrative and implementation issues regarding the
2076	use of risk-adjusted rates, including, but not limited to, cost,
2077	simplicity, client privacy, data accuracy, and data exchange.
2078	4.  Issues of benefit design, including the actuarial
2079	equivalence and sufficiency standards to be used.
2080	5.  The implementation plan for the proposed choice-
2081	counseling system, including the information and materials to be
2082	provided to recipients, the methodologies by which recipients
2083	will be counseled regarding choice, criteria to be used to
2084	assess plan quality, the methodology to be used to assign
2085	recipients into plans if they fail to choose a managed care
2086	plan, and the standards to be used for responsiveness to
2087	recipient inquiries.
2088	(c)  The technical advisory panel shall continue in
2089	existence and advise the agency on matters outlined in this
2090	subsection.
2091	(8)  The agency must ensure, in the first two state fiscal
2092	years in which a risk-adjusted methodology is a component of
2093	rate setting, that no managed care plan providing comprehensive
2094	benefits to TANF and SSI recipients has an aggregate risk score
2095	that varies by more than 10 percent from the aggregate weighted
2096	mean of all managed care plans providing comprehensive benefits
2097	to TANF and SSI recipients in a reform area. The agency's
2098	payment to a managed care plan shall be based on such revised
2099	aggregate risk score.
2100	(9)  After any calculations of aggregate risk scores or
2101	revised aggregate risk scores in subsection (8), the capitation
2102	rates for plans participating under this section shall be phased
2103	in as follows:
2104	(a)  In the first year, the capitation rates shall be
2105	weighted so that 75 percent of each capitation rate is based on
2106	the current methodology and 25 percent is based on a new risk-
2107	adjusted capitation rate methodology.
2108	(b)  In the second year, the capitation rates shall be
2109	weighted so that 50 percent of each capitation rate is based on
2110	the current methodology and 50 percent is based on a new risk-
2111	adjusted rate methodology.
2112	(c)  In the following fiscal year, the risk-adjusted
2113	capitation methodology may be fully implemented.
2114	(10)  Subsections (8) and (9) do not apply to managed care
2115	plans offering benefits exclusively to high-risk, specialty
2116	populations. The agency may set risk-adjusted rates immediately
2117	for such plans.
2118	(11)  Before the implementation of risk-adjusted rates, the
2119	rates shall be certified by an actuary and approved by the
2120	federal Centers for Medicare and Medicaid Services.
2121	(12)  For purposes of this section, the term "capitated
2122	managed care plan" includes health insurers authorized under
2123	chapter 624, exclusive provider organizations authorized under
2124	chapter 627, health maintenance organizations authorized under
2125	chapter 641, the Children's Medical Services Network under
2126	chapter 391, and provider service networks that elect to be paid
2127	fee-for-service for up to 3 years as authorized under this
2128	section.
2129	(13)  Upon review and approval of the applications for
2130	waivers of applicable federal laws and regulations to implement
2131	the managed care pilot program by the Legislature, the agency
2132	may initiate adoption of rules pursuant to ss. 120.536(1) and
2133	120.54 to implement and administer the managed care pilot
2134	program as provided in this section.
2135	(14)  It is the intent of the Legislature that if any
2136	conflict exists between the provisions contained in this section
2137	and other provisions of this chapter which relate to the
2138	implementation of the Medicaid managed care pilot program, the
2139	provisions contained in this section shall control. The agency
2140	shall provide a written report to the Legislature by April 1,
2141	2006, identifying any provisions of this chapter which conflict
2142	with the implementation of the Medicaid managed care pilot
2143	program created in this section. After April 1, 2006, the agency
2144	shall provide a written report to the Legislature immediately
2145	upon identifying any provisions of this chapter which conflict
2146	with the implementation of the Medicaid managed care pilot
2147	program created in this section.
2148	Section 13.  Subsection (2) of section 409.9124, Florida
2149	Statutes, is amended to read:
2150	409.9124  Managed care reimbursement.--The agency shall
2151	develop and adopt by rule a methodology for reimbursing managed
2152	care plans.
2153	(2)  Each year prior to establishing new managed care
2154	rates, the agency shall review all prior year adjustments for
2155	changes in trend, and shall reduce or eliminate those
2156	adjustments which are not reasonable and which reflect policies
2157	or programs which are not in effect. In addition, the agency
2158	shall apply only those policy reductions applicable to the
2159	fiscal year for which the rates are being set, which can be
2160	accurately estimated and verified by an independent actuary, and
2161	which have been implemented prior to or will be implemented
2162	during the fiscal year. The agency shall pay rates at per-
2163	member, per-month averages that do not exceed the amounts
2164	allowed for in the General Appropriations Act applicable to the
2165	fiscal year for which the rates will be in effect.
2166	Section 14.  Subsection (36) of section 409.913, Florida
2167	Statutes, is amended to read:
2168	409.913  Oversight of the integrity of the Medicaid
2169	program.--The agency shall operate a program to oversee the
2170	activities of Florida Medicaid recipients, and providers and
2171	their representatives, to ensure that fraudulent and abusive
2172	behavior and neglect of recipients occur to the minimum extent
2173	possible, and to recover overpayments and impose sanctions as
2174	appropriate. Beginning January 1, 2003, and each year
2175	thereafter, the agency and the Medicaid Fraud Control Unit of
2176	the Department of Legal Affairs shall submit a joint report to
2177	the Legislature documenting the effectiveness of the state's
2178	efforts to control Medicaid fraud and abuse and to recover
2179	Medicaid overpayments during the previous fiscal year. The
2180	report must describe the number of cases opened and investigated
2181	each year; the sources of the cases opened; the disposition of
2182	the cases closed each year; the amount of overpayments alleged
2183	in preliminary and final audit letters; the number and amount of
2184	fines or penalties imposed; any reductions in overpayment
2185	amounts negotiated in settlement agreements or by other means;
2186	the amount of final agency determinations of overpayments; the
2187	amount deducted from federal claiming as a result of
2188	overpayments; the amount of overpayments recovered each year;
2189	the amount of cost of investigation recovered each year; the
2190	average length of time to collect from the time the case was
2191	opened until the overpayment is paid in full; the amount
2192	determined as uncollectible and the portion of the uncollectible
2193	amount subsequently reclaimed from the Federal Government; the
2194	number of providers, by type, that are terminated from
2195	participation in the Medicaid program as a result of fraud and
2196	abuse; and all costs associated with discovering and prosecuting
2197	cases of Medicaid overpayments and making recoveries in such
2198	cases. The report must also document actions taken to prevent
2199	overpayments and the number of providers prevented from
2200	enrolling in or reenrolling in the Medicaid program as a result
2201	of documented Medicaid fraud and abuse and must recommend
2202	changes necessary to prevent or recover overpayments.
2203	(36)  The agency shall provide to each Medicaid recipient
2204	or his or her representative an explanation of benefits in the
2205	form of a letter that is mailed to the most recent address of
2206	the recipient on the record with the Department of Children and
2207	Family Services. The explanation of benefits must include the
2208	patient's name, the name of the health care provider and the
2209	address of the location where the service was provided, a
2210	description of all services billed to Medicaid in terminology
2211	that should be understood by a reasonable person, and
2212	information on how to report inappropriate or incorrect billing
2213	to the agency or other law enforcement entities for review or
2214	investigation. The explanation of benefits may not be mailed for
2215	Medicaid independent laboratory services as described in s.
2216	409.905(7) or for Medicaid certified match services as described
2217	in ss. 409.9071 and 1011.70.
2218	Section 15.  Paragraph (a) of subsection (8) of section
2219	39.001, Florida Statutes, is amended to read:
2220	39.001  Purposes and intent; personnel standards and
2221	screening.--
2222	(8)  PLAN FOR COMPREHENSIVE APPROACH.--
2223	(a)  The office shall develop a state plan for the
2224	promotion of adoption, support of adoptive families, and
2225	prevention of abuse, abandonment, and neglect of children and
2226	shall submit the state plan to the Speaker of the House of
2227	Representatives, the President of the Senate, and the Governor
2228	no later than December 31, 2008. The Department of Children and
2229	Family Services, the Department of Corrections, the Department
2230	of Education, the Department of Health, the Department of
2231	Juvenile Justice, the Department of Law Enforcement, the Agency
2232	for Persons with Disabilities, and the Agency for Workforce
2233	Innovation shall participate and fully cooperate in the
2234	development of the state plan at both the state and local
2235	levels. Furthermore, appropriate local agencies and
2236	organizations shall be provided an opportunity to participate in
2237	the development of the state plan at the local level.
2238	Appropriate local groups and organizations shall include, but
2239	not be limited to, community mental health centers; guardian ad
2240	litem programs for children under the circuit court; the school
2241	boards of the local school districts; the Florida local advocacy
2242	councils; community-based care lead agencies; private or public
2243	organizations or programs with recognized expertise in working
2244	with child abuse prevention programs for children and families;
2245	private or public organizations or programs with recognized
2246	expertise in working with children who are sexually abused,
2247	physically abused, emotionally abused, abandoned, or neglected
2248	and with expertise in working with the families of such
2249	children; private or public programs or organizations with
2250	expertise in maternal and infant health care; multidisciplinary
2251	child protection teams; child day care centers; law enforcement
2252	agencies; and the circuit courts, when guardian ad litem
2253	programs are not available in the local area. The state plan to
2254	be provided to the Legislature and the Governor shall include,
2255	as a minimum, the information required of the various groups in
2256	paragraph (b).
2257	Section 16.  Subsection (2) of section 39.0011, Florida
2258	Statutes, is amended to read:
2259	39.0011  Direct-support organization.--
2260	(2)  The number of members on the board of directors of the
2261	direct-support organization shall be determined by the Chief
2262	Child Advocate. Membership on the board of directors of the
2263	direct-support organization shall include, but not be limited
2264	to, a guardian ad litem; a member of a local advocacy council; a
2265	representative from a community-based care lead agency; a
2266	representative from a private or public organization or program
2267	with recognized expertise in working with child abuse prevention
2268	programs for children and families; a representative of a
2269	private or public organization or program with recognized
2270	expertise in working with children who are sexually abused,
2271	physically abused, emotionally abused, abandoned, or neglected
2272	and with expertise in working with the families of such
2273	children; an individual working at a state adoption agency; and
2274	the parent of a child adopted from within the child welfare
2275	system.
2276	Section 17.  Paragraph (k) of subsection (2) of section
2277	39.202, Florida Statutes, is amended to read:
2278	39.202  Confidentiality of reports and records in cases of
2279	child abuse or neglect.--
2280	(2)  Except as provided in subsection (4), access to such
2281	records, excluding the name of the reporter which shall be
2282	released only as provided in subsection (5), shall be granted
2283	only to the following persons, officials, and agencies:
2284	(k)  Any appropriate official of a Florida advocacy council
2285	investigating a report of known or suspected child abuse,
2286	abandonment, or neglect; The Auditor General or the Office of
2287	Program Policy Analysis and Government Accountability for the
2288	purpose of conducting audits or examinations pursuant to law; or
2289	the guardian ad litem for the child.
2290	Section 18.  Subsections (5), (6), and (7) of section
2291	39.302, Florida Statutes, are renumbered as subsections (4),
2292	(5), and (6), respectively, and present subsection (4) is
2293	amended to read:
2294	39.302  Protective investigations of institutional child
2295	abuse, abandonment, or neglect.--
2296	(4)  The department shall notify the Florida local advocacy
2297	council in the appropriate district of the department as to
2298	every report of institutional child abuse, abandonment, or
2299	neglect in the district in which a client of the department is
2300	alleged or shown to have been abused, abandoned, or neglected,
2301	which notification shall be made within 48 hours after the
2302	department commences its investigation.
2303	Section 19.  Paragraph (v) of subsection (1) of section
2304	215.22, Florida Statutes, is redesignated as paragraph (u), and
2305	present paragraph (u) of that subsection is amended to read:
2306	215.22  Certain income and certain trust funds exempt.--
2307	(1)  The following income of a revenue nature or the
2308	following trust funds shall be exempt from the appropriation
2309	required by s. 215.20(1):
2310	(u)  The Florida Center for Nursing Trust Fund.
2311	Section 20.  Paragraph (c) of subsection (5) and subsection
2312	(12) of section 394.459, Florida Statutes, are amended to read:
2313	394.459  Rights of patients.--
2314	(5)  COMMUNICATION, ABUSE REPORTING, AND VISITS.--
2315	(c)  Each facility must permit immediate access to any
2316	patient, subject to the patient's right to deny or withdraw
2317	consent at any time, by the patient's family members, guardian,
2318	guardian advocate, representative, Florida statewide or local
2319	advocacy council, or attorney, unless such access would be
2320	detrimental to the patient. If a patient's right to communicate
2321	or to receive visitors is restricted by the facility, written
2322	notice of such restriction and the reasons for the restriction
2323	shall be served on the patient, the patient's attorney, and the
2324	patient's guardian, guardian advocate, or representative; and
2325	such restriction shall be recorded on the patient's clinical
2326	record with the reasons therefor. The restriction of a patient's
2327	right to communicate or to receive visitors shall be reviewed at
2328	least every 7 days. The right to communicate or receive visitors
2329	shall not be restricted as a means of punishment. Nothing in
2330	this paragraph shall be construed to limit the provisions of
2331	paragraph (d).
2332	(12)  POSTING OF NOTICE OF RIGHTS OF PATIENTS.--Each
2333	facility shall post a notice listing and describing, in the
2334	language and terminology that the persons to whom the notice is
2335	addressed can understand, the rights provided in this section.
2336	This notice shall include a statement that provisions of the
2337	federal Americans with Disabilities Act apply and the name and
2338	telephone number of a person to contact for further information.
2339	This notice shall be posted in a place readily accessible to
2340	patients and in a format easily seen by patients. This notice
2341	shall include the telephone number numbers of the Florida local
2342	advocacy council and Advocacy Center for Persons with
2343	Disabilities, Inc.
2344	Section 21.  Paragraph (d) of subsection (2) of section
2345	394.4597, Florida Statutes, is amended to read:
2346	394.4597  Persons to be notified; patient's
2347	representative.--
2348	(2)  INVOLUNTARY PATIENTS.--
2349	(d)  When the receiving or treatment facility selects a
2350	representative, first preference shall be given to a health care
2351	surrogate, if one has been previously selected by the patient.
2352	If the patient has not previously selected a health care
2353	surrogate, the selection, except for good cause documented in
2354	the patient's clinical record, shall be made from the following
2355	list in the order of listing:
2356	1.  The patient's spouse.
2357	2.  An adult child of the patient.
2358	3.  A parent of the patient.
2359	4.  The adult next of kin of the patient.
2360	5.  An adult friend of the patient.
2361	6.  The appropriate Florida local advocacy council as
2362	provided in s. 402.166.
2363	Section 22.  Subsection (1) of section 394.4598, Florida
2364	Statutes, is amended to read:
2365	394.4598  Guardian advocate.--
2366	(1)  The administrator may petition the court for the
2367	appointment of a guardian advocate based upon the opinion of a
2368	psychiatrist that the patient is incompetent to consent to
2369	treatment. If the court finds that a patient is incompetent to
2370	consent to treatment and has not been adjudicated incapacitated
2371	and a guardian with the authority to consent to mental health
2372	treatment appointed, it shall appoint a guardian advocate. The
2373	patient has the right to have an attorney represent him or her
2374	at the hearing. If the person is indigent, the court shall
2375	appoint the office of the public defender to represent him or
2376	her at the hearing. The patient has the right to testify, cross-
2377	examine witnesses, and present witnesses. The proceeding shall
2378	be recorded either electronically or stenographically, and
2379	testimony shall be provided under oath. One of the professionals
2380	authorized to give an opinion in support of a petition for
2381	involuntary placement, as described in s. 394.4655 or s.
2382	394.467, must testify. A guardian advocate must meet the
2383	qualifications of a guardian contained in part IV of chapter
2384	744, except that a professional referred to in this part, an
2385	employee of the facility providing direct services to the
2386	patient under this part, a departmental employee, or a facility
2387	administrator, or member of the Florida local advocacy council
2388	shall not be appointed. A person who is appointed as a guardian
2389	advocate must agree to the appointment.
2390	Section 23.  Paragraph (b) of subsection (2) of section
2391	394.4599, Florida Statutes, is amended to read:
2392	394.4599  Notice.--
2393	(2)  INVOLUNTARY PATIENTS.--
2394	(b)  A receiving facility shall give prompt notice of the
2395	whereabouts of a patient who is being involuntarily held for
2396	examination, by telephone or in person within 24 hours after the
2397	patient's arrival at the facility, unless the patient requests
2398	that no notification be made. Contact attempts shall be
2399	documented in the patient's clinical record and shall begin as
2400	soon as reasonably possible after the patient's arrival. Notice
2401	that a patient is being admitted as an involuntary patient shall
2402	be given to the Florida local advocacy council no later than the
2403	next working day after the patient is admitted.
2404	Section 24.  Subsection (5) of section 394.4615, Florida
2405	Statutes, is amended to read:
2406	394.4615  Clinical records; confidentiality.--
2407	(5)  Information from clinical records may be used by the
2408	Agency for Health Care Administration and, the department, and
2409	the Florida advocacy councils for the purpose of monitoring
2410	facility activity and complaints concerning facilities.
2411	Section 25.  Paragraphs (h) and (i) of subsection (2) of
2412	section 400.0065, Florida Statutes, are redesignated as
2413	paragraphs (g) and (h), respectively, and present paragraph (g)
2414	of that subsection is amended to read:
2415	400.0065  State Long-Term Care Ombudsman; duties and
2416	responsibilities.--
2417	(2)  The State Long-Term Care Ombudsman shall have the duty
2418	and authority to:
2419	(g)  Enter into a cooperative agreement with the Statewide
2420	Advocacy Council for the purpose of coordinating and avoiding
2421	duplication of advocacy services provided to residents.
2422	Section 26.  Paragraph (a) of subsection (2) of section
2423	400.118, Florida Statutes, is amended to read:
2424	400.118  Quality assurance; early warning system;
2425	monitoring; rapid response teams.--
2426	(2)(a)  The agency shall establish within each district
2427	office one or more quality-of-care monitors, based on the number
2428	of nursing facilities in the district, to monitor all nursing
2429	facilities in the district on a regular, unannounced, aperiodic
2430	basis, including nights, evenings, weekends, and holidays.
2431	Quality-of-care monitors shall visit each nursing facility at
2432	least quarterly. Priority for additional monitoring visits shall
2433	be given to nursing facilities with a history of resident care
2434	deficiencies. Quality-of-care monitors shall be registered
2435	nurses who are trained and experienced in nursing facility
2436	regulation, standards of practice in long-term care, and
2437	evaluation of patient care. Individuals in these positions shall
2438	not be deployed by the agency as a part of the district survey
2439	team in the conduct of routine, scheduled surveys, but shall
2440	function solely and independently as quality-of-care monitors.
2441	Quality-of-care monitors shall assess the overall quality of
2442	life in the nursing facility and shall assess specific
2443	conditions in the facility directly related to resident care,
2444	including the operations of internal quality improvement and
2445	risk management programs and adverse incident reports. The
2446	quality-of-care monitor shall include in an assessment visit
2447	observation of the care and services rendered to residents and
2448	formal and informal interviews with residents, family members,
2449	facility staff, resident guests, volunteers, other regulatory
2450	staff, and representatives of a long-term care ombudsman council
2451	or Florida advocacy council.
2452	Section 27.  Subsections (13) and (20) of section 400.141,
2453	Florida Statutes, are amended to read:
2454	400.141  Administration and management of nursing home
2455	facilities.--Every licensed facility shall comply with all
2456	applicable standards and rules of the agency and shall:
2457	(13)  Publicly display a poster provided by the agency
2458	containing the names, addresses, and telephone numbers for the
2459	state's abuse hotline, the State Long-Term Care Ombudsman, the
2460	Agency for Health Care Administration consumer hotline, the
2461	Advocacy Center for Persons with Disabilities, the Florida
2462	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
2463	with a clear description of the assistance to be expected from
2464	each.
2465	(20)  Maintain general and professional liability insurance
2466	coverage that is in force at all times. In lieu of general and
2467	professional liability insurance coverage, a state-designated
2468	teaching nursing home and its affiliated assisted living
2469	facilities created under s. 430.80 may demonstrate proof of
2470	financial responsibility as provided in s. 430.80(3)(h).
2471
2472	Facilities that have been awarded a Gold Seal under the program
2473	established in s. 400.235 may develop a plan to provide
2474	certified nursing assistant training as prescribed by federal
2475	regulations and state rules and may apply to the agency for
2476	approval of their program.
2477	Section 28.  Paragraph (a) of subsection (1) of section
2478	415.1034, Florida Statutes, is amended to read:
2479	415.1034  Mandatory reporting of abuse, neglect, or
2480	exploitation of vulnerable adults; mandatory reports of death.--
2481	(1)  MANDATORY REPORTING.--
2482	(a)  Any person, including, but not limited to, any:
2483	1.  Physician, osteopathic physician, medical examiner,
2484	chiropractic physician, nurse, paramedic, emergency medical
2485	technician, or hospital personnel engaged in the admission,
2486	examination, care, or treatment of vulnerable adults;
2487	2.  Health professional or mental health professional other
2488	than one listed in subparagraph 1.;
2489	3.  Practitioner who relies solely on spiritual means for
2490	healing;
2491	4.  Nursing home staff; assisted living facility staff;
2492	adult day care center staff; adult family-care home staff;
2493	social worker; or other professional adult care, residential, or
2494	institutional staff;
2495	5.  State, county, or municipal criminal justice employee
2496	or law enforcement officer;
2497	6.  An employee of the Department of Business and
2498	Professional Regulation conducting inspections of public lodging
2499	establishments under s. 509.032;
2500	7.  Florida advocacy council member or Long-term care
2501	ombudsman council member; or
2502	8.  Bank, savings and loan, or credit union officer,
2503	trustee, or employee,
2504
2505	who knows, or has reasonable cause to suspect, that a vulnerable
2506	adult has been or is being abused, neglected, or exploited shall
2507	immediately report such knowledge or suspicion to the central
2508	abuse hotline.
2509	Section 29.  Subsection (1) of section 415.104, Florida
2510	Statutes, is amended to read:
2511	415.104  Protective investigations of cases of abuse,
2512	neglect, or exploitation of vulnerable adults; transmittal of
2513	records to state attorney.--
2514	(1)  The department shall, upon receipt of a report
2515	alleging abuse, neglect, or exploitation of a vulnerable adult,
2516	begin within 24 hours a protective investigation of the facts
2517	alleged therein. If a caregiver refuses to allow the department
2518	to begin a protective investigation or interferes with the
2519	conduct of such an investigation, the appropriate law
2520	enforcement agency shall be contacted for assistance. If, during
2521	the course of the investigation, the department has reason to
2522	believe that the abuse, neglect, or exploitation is perpetrated
2523	by a second party, the appropriate law enforcement agency and
2524	state attorney shall be orally notified. The department and the
2525	law enforcement agency shall cooperate to allow the criminal
2526	investigation to proceed concurrently with, and not be hindered
2527	by, the protective investigation. The department shall make a
2528	preliminary written report to the law enforcement agencies
2529	within 5 working days after the oral report. The department
2530	shall, within 24 hours after receipt of the report, notify the
2531	appropriate Florida local advocacy council, or long-term care
2532	ombudsman council, when appropriate, that an alleged abuse,
2533	neglect, or exploitation perpetrated by a second party has
2534	occurred. Notice to the Florida local advocacy council or long-
2535	term care ombudsman council may be accomplished orally or in
2536	writing and shall include the name and location of the
2537	vulnerable adult alleged to have been abused, neglected, or
2538	exploited and the nature of the report.
2539	Section 30.  Subsection (8) of section 415.1055, Florida
2540	Statutes, is amended to read:
2541	415.1055  Notification to administrative entities.--
2542	(8)  At the conclusion of a protective investigation at a
2543	facility, the department shall notify either the Florida local
2544	advocacy council or long-term care ombudsman council of the
2545	results of the investigation. This notification must be in
2546	writing.
2547	Section 31.  Subsection (2) of section 415.106, Florida
2548	Statutes, is amended to read:
2549	415.106  Cooperation by the department and criminal justice
2550	and other agencies.--
2551	(2)  To ensure coordination, communication, and cooperation
2552	with the investigation of abuse, neglect, or exploitation of
2553	vulnerable adults, the department shall develop and maintain
2554	interprogram agreements or operational procedures among
2555	appropriate departmental programs and the State Long-Term Care
2556	Ombudsman Council, the Florida Statewide Advocacy Council, and
2557	other agencies that provide services to vulnerable adults. These
2558	agreements or procedures must cover such subjects as the
2559	appropriate roles and responsibilities of the department in
2560	identifying and responding to reports of abuse, neglect, or
2561	exploitation of vulnerable adults; the provision of services;
2562	and related coordinated activities.
2563	Section 32.  Paragraph (g) of subsection (3) of section
2564	415.107, Florida Statutes, is amended to read:
2565	415.107  Confidentiality of reports and records.--
2566	(3)  Access to all records, excluding the name of the
2567	reporter which shall be released only as provided in subsection
2568	(6), shall be granted only to the following persons, officials,
2569	and agencies:
2570	(g)  Any appropriate official of the Florida advocacy
2571	council or long-term care ombudsman council investigating a
2572	report of known or suspected abuse, neglect, or exploitation of
2573	a vulnerable adult.
2574	Section 33.  Subsection (9) of section 429.19, Florida
2575	Statutes, is amended to read:
2576	429.19  Violations; imposition of administrative fines;
2577	grounds.--
2578	(9)  The agency shall develop and disseminate an annual
2579	list of all facilities sanctioned or fined $5,000 or more for
2580	violations of state standards, the number and class of
2581	violations involved, the penalties imposed, and the current
2582	status of cases. The list shall be disseminated, at no charge,
2583	to the Department of Elderly Affairs, the Department of Health,
2584	the Department of Children and Family Services, the Agency for
2585	Persons with Disabilities, the area agencies on aging, the
2586	Florida Statewide Advocacy Council, and the state and local
2587	ombudsman councils. The Department of Children and Family
2588	Services shall disseminate the list to service providers under
2589	contract to the department who are responsible for referring
2590	persons to a facility for residency. The agency may charge a fee
2591	commensurate with the cost of printing and postage to other
2592	interested parties requesting a copy of this list.
2593	Section 34.  Subsection (2) of section 429.28, Florida
2594	Statutes, is amended to read:
2595	429.28  Resident bill of rights.--
2596	(2)  The administrator of a facility shall ensure that a
2597	written notice of the rights, obligations, and prohibitions set
2598	forth in this part is posted in a prominent place in each
2599	facility and read or explained to residents who cannot read.
2600	This notice shall include the name, address, and telephone
2601	numbers of the local ombudsman council and central abuse hotline
2602	and, when applicable, and the Advocacy Center for Persons with
2603	Disabilities, Inc., and the Florida local advocacy council,
2604	where complaints may be lodged. The facility must ensure a
2605	resident's access to a telephone to call the local ombudsman
2606	council, central abuse hotline, and the Advocacy Center for
2607	Persons with Disabilities, Inc., and the Florida local advocacy
2608	council.
2609	Section 35.  Section 429.34, Florida Statutes, is amended
2610	to read:
2611	429.34  Right of entry and inspection.--In addition to the
2612	requirements of s. 408.811, any duly designated officer or
2613	employee of the department, the Department of Children and
2614	Family Services, the Medicaid Fraud Control Unit of the Office
2615	of the Attorney General, the state or local fire marshal, or a
2616	member of the state or local long-term care ombudsman council
2617	shall have the right to enter unannounced upon and into the
2618	premises of any facility licensed pursuant to this part in order
2619	to determine the state of compliance with the provisions of this
2620	part, part II of chapter 408, and applicable rules. Data
2621	collected by the state or local long-term care ombudsman
2622	councils or the state or local advocacy councils may be used by
2623	the agency in investigations involving violations of regulatory
2624	standards.
2625	Section 36.  Subsection (3) of section 430.04, Florida
2626	Statutes, is amended to read:
2627	430.04  Duties and responsibilities of the Department of
2628	Elderly Affairs.--The Department of Elderly Affairs shall:
2629	(3)  Prepare and submit to the Governor, each Cabinet
2630	member, the President of the Senate, the Speaker of the House of
2631	Representatives, the minority leaders of the House and Senate,
2632	and chairpersons of appropriate House and Senate committees a
2633	master plan for policies and programs in the state related to
2634	aging. The plan must identify and assess the needs of the
2635	elderly population in the areas of housing, employment,
2636	education and training, medical care, long-term care, preventive
2637	care, protective services, social services, mental health,
2638	transportation, and long-term care insurance, and other areas
2639	considered appropriate by the department. The plan must assess
2640	the needs of particular subgroups of the population and evaluate
2641	the capacity of existing programs, both public and private and
2642	in state and local agencies, to respond effectively to
2643	identified needs. If the plan recommends the transfer of any
2644	program or service from the Department of Children and Family
2645	Services to another state department, the plan must also include
2646	recommendations that provide for an independent third-party
2647	mechanism, as currently exists in the Florida advocacy councils
2648	established in ss. 402.165 and 402.166, for protecting the
2649	constitutional and human rights of recipients of departmental
2650	services. The plan must include policy goals and program
2651	strategies designed to respond efficiently to current and
2652	projected needs. The plan must also include policy goals and
2653	program strategies to promote intergenerational relationships
2654	and activities. Public hearings and other appropriate processes
2655	shall be utilized by the department to solicit input for the
2656	development and updating of the master plan from parties
2657	including, but not limited to, the following:
2658	(a)  Elderly citizens and their families and caregivers.
2659	(b)  Local-level public and private service providers,
2660	advocacy organizations, and other organizations relating to the
2661	elderly.
2662	(c)  Local governments.
2663	(d)  All state agencies that provide services to the
2664	elderly.
2665	(e)  University centers on aging.
2666	(f)  Area agency on aging and community care for the
2667	elderly lead agencies.
2668	Section 37.  Sections 381.0271, 381.0273, 394.4595,
2669	402.164, 402.165, 402.166, 402.167, 409.9061, 430.80, 430.83,
2670	464.0195, 464.0196, 464.0197, and 464.0198, Florida Statutes,
2671	are repealed.
2672	Section 38.  This act shall take effect July 1, 2008.

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