Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1972
       
       
       
       
       
       
                                Barcode 851150                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/15/2011           .                                
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       The Committee on Budget (Negron and Sobel) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete lines 3771 - 3813
    4  and insert:
    5         (2) The agency shall implement the following thresholds and
    6  consequences of various spending patterns for qualified plans
    7  under the managed medical assistance component of the Medicaid
    8  managed care program:
    9         (a) The minimum medical loss ratio shall be 90 percent.
   10         (b) A plan and its subcontractors that spend less than 90
   11  percent of the plan’s Medicaid capitation revenue on medical
   12  services and direct care management, as determined by the
   13  agency, must pay back to the agency a share of the dollar
   14  difference between the plan’s actual medical loss ratio and the
   15  minimum medical loss ratio, as follows:
   16         1. If the plan’s actual medical loss ratio is not lower
   17  than 87 percent, the plan must pay back 50 percent of the dollar
   18  difference between the actual medical loss ratio and the minimum
   19  medical loss ratio of 90 percent.
   20         2. If the plan’s actual medical loss ratio is lower than 87
   21  percent, the plan must pay back 50 percent of the dollar
   22  difference between a medical loss ratio of 87 percent and the
   23  minimum medical loss ratio of 90 percent, plus 100 percent of
   24  the dollar difference between the actual medical loss ratio and
   25  a medical loss ratio of 87 percent.
   26         (c) To administer this subsection, the agency shall adopt
   27  rules that specify a methodology for calculating medical loss
   28  ratios and the requirements for plans to annually report
   29  information related to medical loss ratios. Repayments required
   30  by this subsection must be made annually.
   31  
   32  ================= T I T L E  A M E N D M E N T ================
   33         And the title is amended as follows:
   34         Delete line 183
   35  and insert:
   36         establishing a medical loss ratio; requiring that a
   37         plan pay back to the agency a specified amount in
   38         specified circumstances; authorizing