Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1972
                                Barcode 882812                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/06/2011           .                                

       The Committee on Budget Subcommittee on Health and Human
       Services Appropriations (Garcia) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete lines 3774 - 3799
    4  and insert:
    5         (2) The agency shall establish and the qualified plans
    6  shall use a uniform method for annually reporting premium
    7  revenue, medical and administrative costs, and income or losses
    8  across all state Medicaid prepaid plan lines of business in all
    9  regions. The reports are due to the agency within 270 days after
   10  the conclusion of the reporting period, and the agency may audit
   11  the reports. Achieved savings rebates are due within 30 days
   12  after the report is submitted.
   13         (a) Except as provided in paragraph (b), the achieved
   14  savings rebate is established by determining pretax income as a
   15  percentage of revenues and applying the following income sharing
   16  ratios:
   17         1. One hundred percent of income up to and including 5
   18  percent of revenue shall be retained by the plan.
   19         2. Fifty percent of income above 5 percent and up to 10
   20  percent shall be retained by the plan, with the other 50 percent
   21  refunded to the state.
   22         3. One hundred percent of income above 10 percent of
   23  revenue shall be refunded to the state.
   24         (b) A plan that meets or exceeds agency defined quality
   25  measures in the reporting period may retain an additional 1
   26  percent of revenue.
   27         (c) The following expenses may not be included in
   28  calculating income to the plan:
   29         1. Payment of achieved savings rebates.
   30         2. Any financial incentive payments made to the plan
   31  outside of the capitation rate.
   32         3. Any financial disincentive payments levied by the state
   33  or federal governments.
   34         4. Expenses associated with lobbying activities.
   35         5. Administrative, reinsurance, and outstanding claims
   36  expenses in excess of actuarially sound maximum amounts set by
   37  the agency.
   38         (d) Qualified plans that incur a loss in the first contract
   39  year may apply the full amount of the loss as an offset to
   40  income in the second contract year.
   41         (e) If, after an audit or other reconciliation, the agency
   42  determines that a qualified plan owes an additional rebate, the
   43  plan has 30 days after notification to make payment. Upon
   44  failure to timely pay the rebate, the agency shall withhold
   45  future payments to the plan until the entire amount is recouped.
   46  If the agency determines that a plan has made an overpayment,
   47  the agency shall return the overpayment within 30 days.
   49  ================= T I T L E  A M E N D M E N T ================
   50         And the title is amended as follows:
   51         Delete lines 183 - 185
   52  and insert:
   53         providing for achieved savings rebates; authorizing
   54         plans to limit