HB 933

1	A bill to be entitled
2	An act relating to the Medicaid rural county pilot
3	project; creating s. 409.91212, F.S.; authorizing the
4	Agency for Health Care Administration to seek a Medicaid
5	pilot project waiver; creating a Medicaid rural county
6	pilot project; providing definitions; providing duties and
7	responsibilities of the agency and the boards of county
8	commissioners with respect to implementing the project;
9	providing requirements for county contracts with home
10	maintenance organizations; authorizing the board of county
11	commissioners of a rural county participating in the pilot
12	project to consult with the agency regarding
13	implementation of the project; authorizing the agency to
14	adopt rules to implement the project; requiring the agency
15	to submit a report to the Legislature; providing
16	conditions under which a rural county may provide health
17	care if a federal health reform plan is adopted; providing
18	an effective date.
19
20	Be It Enacted by the Legislature of the State of Florida:
21
22	Section 1.  Section 409.91212, Florida Statutes, is created
23	to read:
24	409.91212  Medicaid rural county pilot project.-
25	(1)  The Agency for Health Care Administration is
26	authorized to seek a Medicaid waiver, pursuant to s. 1115 of the
27	Social Security Act, to implement a 5-year pilot project to
28	improve access to health care in each of the rural counties in
29	this state. For the purposes of this section, the term "rural
30	county" means a county having a population of fewer than 95,000
31	residents.
32	(2)  The agency shall implement a pilot program that:
33	(a)  Includes Medicaid eligibility categories specified in
34	ss. 409.903 and 409.904, as authorized in an approved federal
35	waiver. Once approved, this waiver shall replace the current
36	Medicaid reform waiver for a county having a population of fewer
37	than 95,000 residents.
38	(b)  Delivers all mandatory services specified in s.
39	409.905 and optional services specified in s. 409.906, as
40	approved by the Centers for Medicare and Medicaid Services and
41	the Legislature in the waiver pursuant to this section. Services
42	to recipients under plan benefits shall include emergency
43	services provided under s. 409.9128.
44	(c)  Permits a pharmacy licensed by the state in a rural
45	county to purchase drugs at the same price as a federally
46	qualified health center that serves Medicaid recipients who
47	reside in that county. The agency shall work with independent
48	retail pharmacies and the Florida Pharmacy Association to
49	develop criteria and eligibility for access to the preferred
50	pricing for drugs sold to Medicaid and Medicare Part D plan
51	participants.
52	(3)  The agency shall award contracts in each participating
53	county for a term of not less than 3 years and not more than 5
54	years. In each county where a health maintenance organization is
55	the successful bidder, the contract shall:
56	(a)  Include requirements for the health maintenance
57	organization to make investments in the community-based care
58	infrastructure, help develop and implement training on best
59	practices so as to improve home care, and develop the skills of
60	nonlicensed caregivers that are critical to controlling costs.
61	(b)  Incorporate the medical home model as a method for
62	managing care.
63	(c)  Include hospital, pharmacy, mental health,
64	transportation, and specialty care.
65	(d)  Include risk-adjusted rates to ensure the adequate
66	provision of care to individuals considered to be a higher risk
67	or part of an adversely affected subgroup, such as adults with
68	chronic mental illness or persons with HIV.
69	(e)  Include incentives for the development of innovation
70	and require the development of provider systems located in the
71	rural counties.
72	(f)  Include requirements for the development of local or
73	regional electronic health records, pursuant to the Florida
74	Electronic Health Records Exchange Act as provided in s.
75	408.051, for all health care providers.
76	(g)  Demonstrate cost savings.
77	(h)  Require the health maintenance organization to provide
78	the collected encounter data to the local health authority
79	advisory board and post the data on the county's website for
80	public review.
81	(i)  Establish a toll-free complaint line, the number of
82	which shall be distributed to enrolled members.
83	(j)  Provide for a process that permits the health
84	maintenance organization or the agency, in consultation with the
85	board of county commissioners, to terminate the contract.
86	(k)  Provide incentives to encourage the use of downward
87	substitution of services as a means of offering comparable
88	services at a lower cost and invest in innovative and promising
89	practices to reduce the cost of and expand access to health care
90	and improve customer satisfaction. For purposes of this section,
91	the term "downward substitution" means the use of less
92	restrictive, lower cost, and medically appropriate services
93	provided as an alternative to higher cost state plan services.
94	(4)  At the discretion of its board of county
95	commissioners, a rural county may participate in or decline to
96	participate in the pilot project. The board of county
97	commissioners of a county that chooses to participate in the
98	pilot project is authorized to:
99	(a)  Develop, in consultation with the agency, a single-
100	source request for proposal for the provision of all Medicaid
101	services in each county.
102	(b)  Collaborate with boards of county commissioners in
103	other rural counties to create a regional request for proposal
104	for the provision of Medicaid services if that collaboration
105	would improve access to health care.
106	(c)  Establish, in consultation with the agency, a local
107	health advisory council the functions of which are to review
108	encounter data; review network adequacy for local impact; offer
109	recommendations for improving access to health care; accept and
110	process consumer complaints; keep minutes of each meeting of the
111	council, which shall be subject to the provisions of chapter
112	119; and conduct monthly meetings and workshops that are open to
113	the public in accordance with the provisions of chapter 286. The
114	board of county commissioners shall appoint the members of the
115	council, which shall include a representative of the agency as a
116	nonvoting member.
117	(5)  Upon review and approval of the applications for
118	waivers of applicable federal laws and regulations to implement
119	the managed care pilot program by the Legislature, the agency
120	may initiate adoption of rules pursuant to ss. 120.536(1) and
121	120.54 to implement and administer the managed care pilot
122	program as provided in this section.
123	(6)  The agency shall submit a report on the progress of
124	the pilot project to the President of the Senate and the Speaker
125	of the House of Representatives by February 1, 2011.
126	Section 2.  If a federal health reform plan is adopted, a
127	rural county health care plan is authorized to provide health
128	care as a state option, and any waiver sought under s.
129	409.91212, Florida Statutes, shall permit the state to exercise
130	flexibility regarding access to cost-effective health care in
131	rural counties, as defined in s. 409.91212, Florida Statutes.
132	Section 3.  This act shall take effect July 1, 2010.

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