HB 5311

1	A bill to be entitled
2	An act relating to Medicaid services; amending s. 409.904,
3	F.S.; repealing the sunset of provisions authorizing the
4	federal waiver for certain persons age 65 and older or who
5	have a disability; repealing the sunset of provisions
6	authorizing a specified medically needy program;
7	eliminating the limit to services placed on the medically
8	needy program for pregnant women and children younger than
9	age 21; amending s. 409.906, F.S.; eliminating adult
10	Medicaid optional coverage for chiropractic services;
11	eliminating adult Medicaid optional coverage for hearing
12	services; amending s. 409.908, F.S.; updating the formula
13	used for calculating reimbursements to Medicaid providers
14	for prescribed drugs; continuing the requirement that the
15	Agency for Health Care Administration set certain
16	institutional provider reimbursement rates in a manner
17	that results in no automatic cost-based statewide
18	expenditure increase; deleting an obsolete requirement to
19	establish workgroups to evaluate alternate reimbursement
20	and payment methods; eliminating the repeal date of the
21	suspension of the use of cost data to set certain
22	institutional provider reimbursement rates; amending s.
23	409.9082, F.S.; revising the allowed aggregated amount of
24	assessments for all nursing home facilities to conform
25	with federal law; amending s. 409.911, F.S.; updating the
26	audited data specified for use in calculating
27	disproportionate share; amending s. 409.9112, F.S.;
28	continuing the prohibition against distributing moneys
29	under the perinatal intensive care centers
30	disproportionate share program; amending s. 409.9113,
31	F.S.; continuing authorization for the distribution of
32	moneys to certain teaching hospitals under the
33	disproportionate share program; amending s. 409.9117,
34	F.S.; continuing the prohibition against distributing
35	moneys under the primary care disproportionate share
36	program; amending s. 409.912, F.S.; allowing the agency to
37	continue to contract for electronic access to certain
38	pharmacology drug information; eliminating the requirement
39	to implement a wireless handheld clinical pharmacology
40	drug information database for practitioners; updating the
41	formula used for calculating reimbursement to Medicaid
42	providers for prescribed drugs; authorizing the agency to
43	seek federal approval and to issue a procurement in order
44	to implement a home delivery of pharmacy products program;
45	establishing the provisions for the procurement and the
46	program; eliminating the requirement for the expansion of
47	the mail-order-pharmacy diabetes-supply program;
48	eliminating certain provisions of the Medicaid
49	prescription drug management program; authorizing the
50	agency to contract with an organization to provide certain
51	benefits under a federal program in Palm Beach County;
52	providing an exemption from ch. 641, F.S., for the
53	organization; authorizing, subject to appropriation,
54	enrollment slots for the Program of All-inclusive Care for
55	the Elderly in Palm Beach County; providing an effective
56	date.
57
58	Be It Enacted by the Legislature of the State of Florida:
59
60	Section 1.  Subsections (1) and (2) of section 409.904,
61	Florida Statutes, are amended to read:
62	409.904  Optional payments for eligible persons.-The agency
63	may make payments for medical assistance and related services on
64	behalf of the following persons who are determined to be
65	eligible subject to the income, assets, and categorical
66	eligibility tests set forth in federal and state law. Payment on
67	behalf of these Medicaid eligible persons is subject to the
68	availability of moneys and any limitations established by the
69	General Appropriations Act or chapter 216.
70	(1)  Effective January 1, 2006, and subject to federal
71	waiver approval, a person who is age 65 or older or is
72	determined to be disabled, whose income is at or below 88
73	percent of the federal poverty level, whose assets do not exceed
74	established limitations, and who is not eligible for Medicare
75	or, if eligible for Medicare, is also eligible for and receiving
76	Medicaid-covered institutional care services, hospice services,
77	or home and community-based services. The agency shall seek
78	federal authorization through a waiver to provide this coverage.
79	This subsection expires June 30, 2011.
80	(2)(a)  A family, a pregnant woman, a child under age 21, a
81	person age 65 or over, or a blind or disabled person, who would
82	be eligible under any group listed in s. 409.903(1), (2), or
83	(3), except that the income or assets of such family or person
84	exceed established limitations. For a family or person in one of
85	these coverage groups, medical expenses are deductible from
86	income in accordance with federal requirements in order to make
87	a determination of eligibility. A family or person eligible
88	under the coverage known as the "medically needy," is eligible
89	to receive the same services as other Medicaid recipients, with
90	the exception of services in skilled nursing facilities and
91	intermediate care facilities for the developmentally disabled.
92	This paragraph expires June 30, 2011.
93	(b)  Effective July 1, 2011, a pregnant woman or a child
94	younger than 21 years of age who would be eligible under any
95	group listed in s. 409.903, except that the income or assets of
96	such group exceed established limitations. For a person in one
97	of these coverage groups, medical expenses are deductible from
98	income in accordance with federal requirements in order to make
99	a determination of eligibility. A person eligible under the
100	coverage known as the "medically needy" is eligible to receive
101	the same services as other Medicaid recipients, with the
102	exception of services in skilled nursing facilities and
103	intermediate care facilities for the developmentally disabled.
104	Section 2.  Subsections (7) and (12) of section 409.906,
105	Florida Statutes, are amended to read:
106	409.906  Optional Medicaid services.-Subject to specific
107	appropriations, the agency may make payments for services which
108	are optional to the state under Title XIX of the Social Security
109	Act and are furnished by Medicaid providers to recipients who
110	are determined to be eligible on the dates on which the services
111	were provided. Any optional service that is provided shall be
112	provided only when medically necessary and in accordance with
113	state and federal law. Optional services rendered by providers
114	in mobile units to Medicaid recipients may be restricted or
115	prohibited by the agency. Nothing in this section shall be
116	construed to prevent or limit the agency from adjusting fees,
117	reimbursement rates, lengths of stay, number of visits, or
118	number of services, or making any other adjustments necessary to
119	comply with the availability of moneys and any limitations or
120	directions provided for in the General Appropriations Act or
121	chapter 216. If necessary to safeguard the state's systems of
122	providing services to elderly and disabled persons and subject
123	to the notice and review provisions of s. 216.177, the Governor
124	may direct the Agency for Health Care Administration to amend
125	the Medicaid state plan to delete the optional Medicaid service
126	known as "Intermediate Care Facilities for the Developmentally
127	Disabled." Optional services may include:
128	(7)  CHIROPRACTIC SERVICES.-Effective October 1, 2011, the
129	agency may pay for manual manipulation of the spine and initial
130	services, screening, and X rays provided to a recipient under
131	the age of 21 by a licensed chiropractic physician.
132	(12)  HEARING SERVICES.-Effective October 1, 2011, the
133	agency may pay for hearing and related services, including
134	hearing evaluations, hearing aid devices, dispensing of the
135	hearing aid, and related repairs, if provided to a recipient
136	under the age of 21 by a licensed hearing aid specialist,
137	otolaryngologist, otologist, audiologist, or physician.
138	Section 3.  Subsections (14) and (23) of section 409.908,
139	Florida Statutes, are amended to read:
140	409.908  Reimbursement of Medicaid providers.-Subject to
141	specific appropriations, the agency shall reimburse Medicaid
142	providers, in accordance with state and federal law, according
143	to methodologies set forth in the rules of the agency and in
144	policy manuals and handbooks incorporated by reference therein.
145	These methodologies may include fee schedules, reimbursement
146	methods based on cost reporting, negotiated fees, competitive
147	bidding pursuant to s. 287.057, and other mechanisms the agency
148	considers efficient and effective for purchasing services or
149	goods on behalf of recipients. If a provider is reimbursed based
150	on cost reporting and submits a cost report late and that cost
151	report would have been used to set a lower reimbursement rate
152	for a rate semester, then the provider's rate for that semester
153	shall be retroactively calculated using the new cost report, and
154	full payment at the recalculated rate shall be effected
155	retroactively. Medicare-granted extensions for filing cost
156	reports, if applicable, shall also apply to Medicaid cost
157	reports. Payment for Medicaid compensable services made on
158	behalf of Medicaid eligible persons is subject to the
159	availability of moneys and any limitations or directions
160	provided for in the General Appropriations Act or chapter 216.
161	Further, nothing in this section shall be construed to prevent
162	or limit the agency from adjusting fees, reimbursement rates,
163	lengths of stay, number of visits, or number of services, or
164	making any other adjustments necessary to comply with the
165	availability of moneys and any limitations or directions
166	provided for in the General Appropriations Act, provided the
167	adjustment is consistent with legislative intent.
168	(14)  A provider of prescribed drugs shall be reimbursed
169	the least of the amount billed by the provider, the provider's
170	usual and customary charge, or the Medicaid maximum allowable
171	fee established by the agency, plus a dispensing fee. The
172	Medicaid maximum allowable fee for ingredient cost shall will be
173	based on the lowest lower of: the average wholesale price (AWP)
174	minus 16.4 percent, the wholesaler acquisition cost (WAC) plus
175	3.75 4.75 percent, the federal upper limit (FUL), the state
176	maximum allowable cost (SMAC), or the usual and customary (UAC)
177	charge billed by the provider. Medicaid providers are required
178	to dispense generic drugs if available at lower cost and the
179	agency has not determined that the branded product is more cost-
180	effective, unless the prescriber has requested and received
181	approval to require the branded product. The agency is directed
182	to implement a variable dispensing fee for payments for
183	prescribed medicines while ensuring continued access for
184	Medicaid recipients. The variable dispensing fee may be based
185	upon, but not limited to, either or both the volume of
186	prescriptions dispensed by a specific pharmacy provider, the
187	volume of prescriptions dispensed to an individual recipient,
188	and dispensing of preferred-drug-list products. The agency may
189	increase the pharmacy dispensing fee authorized by statute and
190	in the annual General Appropriations Act by $0.50 for the
191	dispensing of a Medicaid preferred-drug-list product and reduce
192	the pharmacy dispensing fee by $0.50 for the dispensing of a
193	Medicaid product that is not included on the preferred drug
194	list. The agency may establish a supplemental pharmaceutical
195	dispensing fee to be paid to providers returning unused unit-
196	dose packaged medications to stock and crediting the Medicaid
197	program for the ingredient cost of those medications if the
198	ingredient costs to be credited exceed the value of the
199	supplemental dispensing fee. The agency is authorized to limit
200	reimbursement for prescribed medicine in order to comply with
201	any limitations or directions provided for in the General
202	Appropriations Act, which may include implementing a prospective
203	or concurrent utilization review program.
204	(23)(a)  The agency shall establish rates at a level that
205	ensures no increase in statewide expenditures resulting from a
206	change in unit costs for 2 fiscal years effective July 1, 2011
207	2009. Reimbursement rates for the 2 fiscal years shall be as
208	provided in the General Appropriations Act.
209	(b)  This subsection applies to the following provider
210	types:
211	1.  Inpatient hospitals.
212	2.  Outpatient hospitals.
213	3.  Nursing homes.
214	4.  County health departments.
215	5.  Community intermediate care facilities for the
216	developmentally disabled.
217	6.  Prepaid health plans.
218
219	The agency shall apply the effect of this subsection to the
220	reimbursement rates for nursing home diversion programs.
221	(c)  The agency shall create a workgroup on hospital
222	reimbursement, a workgroup on nursing facility reimbursement,
223	and a workgroup on managed care plan payment. The workgroups
224	shall evaluate alternative reimbursement and payment
225	methodologies for hospitals, nursing facilities, and managed
226	care plans, including prospective payment methodologies for
227	hospitals and nursing facilities. The nursing facility workgroup
228	shall also consider price-based methodologies for indirect care
229	and acuity adjustments for direct care. The agency shall submit
230	a report on the evaluated alternative reimbursement
231	methodologies to the relevant committees of the Senate and the
232	House of Representatives by November 1, 2009.
233	(d)  This subsection expires June 30, 2011.
234	Section 4.  Subsection (2) of section 409.9082, Florida
235	Statutes, is amended to read:
236	409.9082  Quality assessment on nursing home facility
237	providers; exemptions; purpose; federal approval required;
238	remedies.-
239	(2)  Effective April 1, 2009, there is imposed upon each
240	nursing home facility a quality assessment. The aggregated
241	amount of assessments for all nursing home facilities in a given
242	year shall be an amount not exceeding the maximum percentage
243	allowed under federal law 5.5 percent of the total aggregate net
244	patient service revenue of assessed facilities. The agency shall
245	calculate the quality assessment rate annually on a per-
246	resident-day basis, exclusive of those resident days funded by
247	the Medicare program, as reported by the facilities. The per-
248	resident-day assessment rate shall be uniform except as
249	prescribed in subsection (3). Each facility shall report monthly
250	to the agency its total number of resident days, exclusive of
251	Medicare Part A resident days, and shall remit an amount equal
252	to the assessment rate times the reported number of days. The
253	agency shall collect, and each facility shall pay, the quality
254	assessment each month. The agency shall collect the assessment
255	from nursing home facility providers by no later than the 15th
256	of the next succeeding calendar month. The agency shall notify
257	providers of the quality assessment and provide a standardized
258	form to complete and submit with payments. The collection of the
259	nursing home facility quality assessment shall commence no
260	sooner than 5 days after the agency's initial payment of the
261	Medicaid rates containing the elements prescribed in subsection
262	(4). Nursing home facilities may not create a separate line-item
263	charge for the purpose of passing through the assessment to
264	residents.
265	Section 5.  Paragraph (a) of subsection (2) of section
266	409.911, Florida Statutes, is amended to read:
267	409.911  Disproportionate share program.-Subject to
268	specific allocations established within the General
269	Appropriations Act and any limitations established pursuant to
270	chapter 216, the agency shall distribute, pursuant to this
271	section, moneys to hospitals providing a disproportionate share
272	of Medicaid or charity care services by making quarterly
273	Medicaid payments as required. Notwithstanding the provisions of
274	s. 409.915, counties are exempt from contributing toward the
275	cost of this special reimbursement for hospitals serving a
276	disproportionate share of low-income patients.
277	(2)  The Agency for Health Care Administration shall use
278	the following actual audited data to determine the Medicaid days
279	and charity care to be used in calculating the disproportionate
280	share payment:
281	(a)  The average of the 2004, 2005, and 2006 2003, 2004,
282	and 2005 audited disproportionate share data to determine each
283	hospital's Medicaid days and charity care for the 2011-2012
284	2010-2011 state fiscal year.
285	Section 6.  Section 409.9112, Florida Statutes, is amended
286	to read:
287	409.9112  Disproportionate share program for regional
288	perinatal intensive care centers.-In addition to the payments
289	made under s. 409.911, the agency shall design and implement a
290	system for making disproportionate share payments to those
291	hospitals that participate in the regional perinatal intensive
292	care center program established pursuant to chapter 383. The
293	system of payments must conform to federal requirements and
294	distribute funds in each fiscal year for which an appropriation
295	is made by making quarterly Medicaid payments. Notwithstanding
296	s. 409.915, counties are exempt from contributing toward the
297	cost of this special reimbursement for hospitals serving a
298	disproportionate share of low-income patients. For the 2011-2012
299	2010-2011 state fiscal year, the agency may not distribute
300	moneys under the regional perinatal intensive care centers
301	disproportionate share program.
302	(1)  The following formula shall be used by the agency to
303	calculate the total amount earned for hospitals that participate
304	in the regional perinatal intensive care center program:
305
306	TAE = HDSP/THDSP
307	Where:
308	TAE = total amount earned by a regional perinatal intensive
309	care center.
310	HDSP = the prior state fiscal year regional perinatal
311	intensive care center disproportionate share payment to the
312	individual hospital.
313	THDSP = the prior state fiscal year total regional
314	perinatal intensive care center disproportionate share payments
315	to all hospitals.
316
317	(2)  The total additional payment for hospitals that
318	participate in the regional perinatal intensive care center
319	program shall be calculated by the agency as follows:
320
321	TAP = TAE x TA
322	Where:
323	TAP = total additional payment for a regional perinatal
324	intensive care center.
325	TAE = total amount earned by a regional perinatal intensive
326	care center.
327	TA = total appropriation for the regional perinatal
328	intensive care center disproportionate share program.
329
330	(3)  In order to receive payments under this section, a
331	hospital must be participating in the regional perinatal
332	intensive care center program pursuant to chapter 383 and must
333	meet the following additional requirements:
334	(a)  Agree to conform to all departmental and agency
335	requirements to ensure high quality in the provision of
336	services, including criteria adopted by departmental and agency
337	rule concerning staffing ratios, medical records, standards of
338	care, equipment, space, and such other standards and criteria as
339	the department and agency deem appropriate as specified by rule.
340	(b)  Agree to provide information to the department and
341	agency, in a form and manner to be prescribed by rule of the
342	department and agency, concerning the care provided to all
343	patients in neonatal intensive care centers and high-risk
344	maternity care.
345	(c)  Agree to accept all patients for neonatal intensive
346	care and high-risk maternity care, regardless of ability to pay,
347	on a functional space-available basis.
348	(d)  Agree to develop arrangements with other maternity and
349	neonatal care providers in the hospital's region for the
350	appropriate receipt and transfer of patients in need of
351	specialized maternity and neonatal intensive care services.
352	(e)  Agree to establish and provide a developmental
353	evaluation and services program for certain high-risk neonates,
354	as prescribed and defined by rule of the department.
355	(f)  Agree to sponsor a program of continuing education in
356	perinatal care for health care professionals within the region
357	of the hospital, as specified by rule.
358	(g)  Agree to provide backup and referral services to the
359	county health departments and other low-income perinatal
360	providers within the hospital's region, including the
361	development of written agreements between these organizations
362	and the hospital.
363	(h)  Agree to arrange for transportation for high-risk
364	obstetrical patients and neonates in need of transfer from the
365	community to the hospital or from the hospital to another more
366	appropriate facility.
367	(4)  Hospitals which fail to comply with any of the
368	conditions in subsection (3) or the applicable rules of the
369	department and agency may not receive any payments under this
370	section until full compliance is achieved. A hospital which is
371	not in compliance in two or more consecutive quarters may not
372	receive its share of the funds. Any forfeited funds shall be
373	distributed by the remaining participating regional perinatal
374	intensive care center program hospitals.
375	Section 7.  Section 409.9113, Florida Statutes, is amended
376	to read:
377	409.9113  Disproportionate share program for teaching
378	hospitals.-In addition to the payments made under ss. 409.911
379	and 409.9112, the agency shall make disproportionate share
380	payments to statutorily defined teaching hospitals for their
381	increased costs associated with medical education programs and
382	for tertiary health care services provided to the indigent. This
383	system of payments must conform to federal requirements and
384	distribute funds in each fiscal year for which an appropriation
385	is made by making quarterly Medicaid payments. Notwithstanding
386	s. 409.915, counties are exempt from contributing toward the
387	cost of this special reimbursement for hospitals serving a
388	disproportionate share of low-income patients. For the 2011-2012
389	2010-2011 state fiscal year, the agency shall distribute the
390	moneys provided in the General Appropriations Act to statutorily
391	defined teaching hospitals and family practice teaching
392	hospitals under the teaching hospital disproportionate share
393	program. The funds provided for statutorily defined teaching
394	hospitals shall be distributed in the same proportion as the
395	state fiscal year 2003-2004 teaching hospital disproportionate
396	share funds were distributed or as otherwise provided in the
397	General Appropriations Act. The funds provided for family
398	practice teaching hospitals shall be distributed equally among
399	family practice teaching hospitals.
400	(1)  On or before September 15 of each year, the agency
401	shall calculate an allocation fraction to be used for
402	distributing funds to state statutory teaching hospitals.
403	Subsequent to the end of each quarter of the state fiscal year,
404	the agency shall distribute to each statutory teaching hospital,
405	as defined in s. 408.07, an amount determined by multiplying
406	one-fourth of the funds appropriated for this purpose by the
407	Legislature times such hospital's allocation fraction. The
408	allocation fraction for each such hospital shall be determined
409	by the sum of the following three primary factors, divided by
410	three:
411	(a)  The number of nationally accredited graduate medical
412	education programs offered by the hospital, including programs
413	accredited by the Accreditation Council for Graduate Medical
414	Education and the combined Internal Medicine and Pediatrics
415	programs acceptable to both the American Board of Internal
416	Medicine and the American Board of Pediatrics at the beginning
417	of the state fiscal year preceding the date on which the
418	allocation fraction is calculated. The numerical value of this
419	factor is the fraction that the hospital represents of the total
420	number of programs, where the total is computed for all state
421	statutory teaching hospitals.
422	(b)  The number of full-time equivalent trainees in the
423	hospital, which comprises two components:
424	1.  The number of trainees enrolled in nationally
425	accredited graduate medical education programs, as defined in
426	paragraph (a). Full-time equivalents are computed using the
427	fraction of the year during which each trainee is primarily
428	assigned to the given institution, over the state fiscal year
429	preceding the date on which the allocation fraction is
430	calculated. The numerical value of this factor is the fraction
431	that the hospital represents of the total number of full-time
432	equivalent trainees enrolled in accredited graduate programs,
433	where the total is computed for all state statutory teaching
434	hospitals.
435	2.  The number of medical students enrolled in accredited
436	colleges of medicine and engaged in clinical activities,
437	including required clinical clerkships and clinical electives.
438	Full-time equivalents are computed using the fraction of the
439	year during which each trainee is primarily assigned to the
440	given institution, over the course of the state fiscal year
441	preceding the date on which the allocation fraction is
442	calculated. The numerical value of this factor is the fraction
443	that the given hospital represents of the total number of full-
444	time equivalent students enrolled in accredited colleges of
445	medicine, where the total is computed for all state statutory
446	teaching hospitals.
447
448	The primary factor for full-time equivalent trainees is computed
449	as the sum of these two components, divided by two.
450	(c)  A service index that comprises three components:
451	1.  The Agency for Health Care Administration Service
452	Index, computed by applying the standard Service Inventory
453	Scores established by the agency to services offered by the
454	given hospital, as reported on Worksheet A-2 for the last fiscal
455	year reported to the agency before the date on which the
456	allocation fraction is calculated. The numerical value of this
457	factor is the fraction that the given hospital represents of the
458	total Agency for Health Care Administration Service Index
459	values, where the total is computed for all state statutory
460	teaching hospitals.
461	2.  A volume-weighted service index, computed by applying
462	the standard Service Inventory Scores established by the Agency
463	for Health Care Administration to the volume of each service,
464	expressed in terms of the standard units of measure reported on
465	Worksheet A-2 for the last fiscal year reported to the agency
466	before the date on which the allocation factor is calculated.
467	The numerical value of this factor is the fraction that the
468	given hospital represents of the total volume-weighted service
469	index values, where the total is computed for all state
470	statutory teaching hospitals.
471	3.  Total Medicaid payments to each hospital for direct
472	inpatient and outpatient services during the fiscal year
473	preceding the date on which the allocation factor is calculated.
474	This includes payments made to each hospital for such services
475	by Medicaid prepaid health plans, whether the plan was
476	administered by the hospital or not. The numerical value of this
477	factor is the fraction that each hospital represents of the
478	total of such Medicaid payments, where the total is computed for
479	all state statutory teaching hospitals.
480
481	The primary factor for the service index is computed as the sum
482	of these three components, divided by three.
483	(2)  By October 1 of each year, the agency shall use the
484	following formula to calculate the maximum additional
485	disproportionate share payment for statutorily defined teaching
486	hospitals:
487	TAP = THAF x A
488	Where:
489	TAP = total additional payment.
490	THAF = teaching hospital allocation factor.
491	A = amount appropriated for a teaching hospital
492	disproportionate share program.
493	Section 8.  Section 409.9117, Florida Statutes, is amended
494	to read:
495	409.9117  Primary care disproportionate share program.-For
496	the 2011-2012 2010-2011 state fiscal year, the agency shall not
497	distribute moneys under the primary care disproportionate share
498	program.
499	(1)  If federal funds are available for disproportionate
500	share programs in addition to those otherwise provided by law,
501	there shall be created a primary care disproportionate share
502	program.
503	(2)  The following formula shall be used by the agency to
504	calculate the total amount earned for hospitals that participate
505	in the primary care disproportionate share program:
506
507	TAE = HDSP/THDSP
508	Where:
509	TAE = total amount earned by a hospital participating in
510	the primary care disproportionate share program.
511	HDSP = the prior state fiscal year primary care
512	disproportionate share payment to the individual hospital.
513	THDSP = the prior state fiscal year total primary care
514	disproportionate share payments to all hospitals.
515
516	(3)  The total additional payment for hospitals that
517	participate in the primary care disproportionate share program
518	shall be calculated by the agency as follows:
519
520	TAP = TAE x TA
521
522	Where:
523	TAP = total additional payment for a primary care hospital.
524	TAE = total amount earned by a primary care hospital.
525	TA = total appropriation for the primary care
526	disproportionate share program.
527
528	(4)  In the establishment and funding of this program, the
529	agency shall use the following criteria in addition to those
530	specified in s. 409.911, and payments may not be made to a
531	hospital unless the hospital agrees to:
532	(a)  Cooperate with a Medicaid prepaid health plan, if one
533	exists in the community.
534	(b)  Ensure the availability of primary and specialty care
535	physicians to Medicaid recipients who are not enrolled in a
536	prepaid capitated arrangement and who are in need of access to
537	such physicians.
538	(c)  Coordinate and provide primary care services free of
539	charge, except copayments, to all persons with incomes up to 100
540	percent of the federal poverty level who are not otherwise
541	covered by Medicaid or another program administered by a
542	governmental entity, and to provide such services based on a
543	sliding fee scale to all persons with incomes up to 200 percent
544	of the federal poverty level who are not otherwise covered by
545	Medicaid or another program administered by a governmental
546	entity, except that eligibility may be limited to persons who
547	reside within a more limited area, as agreed to by the agency
548	and the hospital.
549	(d)  Contract with any federally qualified health center,
550	if one exists within the agreed geopolitical boundaries,
551	concerning the provision of primary care services, in order to
552	guarantee delivery of services in a nonduplicative fashion, and
553	to provide for referral arrangements, privileges, and
554	admissions, as appropriate. The hospital shall agree to provide
555	at an onsite or offsite facility primary care services within 24
556	hours to which all Medicaid recipients and persons eligible
557	under this paragraph who do not require emergency room services
558	are referred during normal daylight hours.
559	(e)  Cooperate with the agency, the county, and other
560	entities to ensure the provision of certain public health
561	services, case management, referral and acceptance of patients,
562	and sharing of epidemiological data, as the agency and the
563	hospital find mutually necessary and desirable to promote and
564	protect the public health within the agreed geopolitical
565	boundaries.
566	(f)  In cooperation with the county in which the hospital
567	resides, develop a low-cost, outpatient, prepaid health care
568	program to persons who are not eligible for the Medicaid
569	program, and who reside within the area.
570	(g)  Provide inpatient services to residents within the
571	area who are not eligible for Medicaid or Medicare, and who do
572	not have private health insurance, regardless of ability to pay,
573	on the basis of available space, except that hospitals may not
574	be prevented from establishing bill collection programs based on
575	ability to pay.
576	(h)  Work with the Florida Healthy Kids Corporation, the
577	Florida Health Care Purchasing Cooperative, and business health
578	coalitions, as appropriate, to develop a feasibility study and
579	plan to provide a low-cost comprehensive health insurance plan
580	to persons who reside within the area and who do not have access
581	to such a plan.
582	(i)  Work with public health officials and other experts to
583	provide community health education and prevention activities
584	designed to promote healthy lifestyles and appropriate use of
585	health services.
586	(j)  Work with the local health council to develop a plan
587	for promoting access to affordable health care services for all
588	persons who reside within the area, including, but not limited
589	to, public health services, primary care services, inpatient
590	services, and affordable health insurance generally.
591
592	Any hospital that fails to comply with any of the provisions of
593	this subsection, or any other contractual condition, may not
594	receive payments under this section until full compliance is
595	achieved.
596	Section 9.  Paragraph (b) of subsection (16) and paragraph
597	(a) of subsection (39) of section 409.912, Florida Statutes, are
598	amended to read:
599	409.912  Cost-effective purchasing of health care.-The
600	agency shall purchase goods and services for Medicaid recipients
601	in the most cost-effective manner consistent with the delivery
602	of quality medical care. To ensure that medical services are
603	effectively utilized, the agency may, in any case, require a
604	confirmation or second physician's opinion of the correct
605	diagnosis for purposes of authorizing future services under the
606	Medicaid program. This section does not restrict access to
607	emergency services or poststabilization care services as defined
608	in 42 C.F.R. part 438.114. Such confirmation or second opinion
609	shall be rendered in a manner approved by the agency. The agency
610	shall maximize the use of prepaid per capita and prepaid
611	aggregate fixed-sum basis services when appropriate and other
612	alternative service delivery and reimbursement methodologies,
613	including competitive bidding pursuant to s. 287.057, designed
614	to facilitate the cost-effective purchase of a case-managed
615	continuum of care. The agency shall also require providers to
616	minimize the exposure of recipients to the need for acute
617	inpatient, custodial, and other institutional care and the
618	inappropriate or unnecessary use of high-cost services. The
619	agency shall contract with a vendor to monitor and evaluate the
620	clinical practice patterns of providers in order to identify
621	trends that are outside the normal practice patterns of a
622	provider's professional peers or the national guidelines of a
623	provider's professional association. The vendor must be able to
624	provide information and counseling to a provider whose practice
625	patterns are outside the norms, in consultation with the agency,
626	to improve patient care and reduce inappropriate utilization.
627	The agency may mandate prior authorization, drug therapy
628	management, or disease management participation for certain
629	populations of Medicaid beneficiaries, certain drug classes, or
630	particular drugs to prevent fraud, abuse, overuse, and possible
631	dangerous drug interactions. The Pharmaceutical and Therapeutics
632	Committee shall make recommendations to the agency on drugs for
633	which prior authorization is required. The agency shall inform
634	the Pharmaceutical and Therapeutics Committee of its decisions
635	regarding drugs subject to prior authorization. The agency is
636	authorized to limit the entities it contracts with or enrolls as
637	Medicaid providers by developing a provider network through
638	provider credentialing. The agency may competitively bid single-
639	source-provider contracts if procurement of goods or services
640	results in demonstrated cost savings to the state without
641	limiting access to care. The agency may limit its network based
642	on the assessment of beneficiary access to care, provider
643	availability, provider quality standards, time and distance
644	standards for access to care, the cultural competence of the
645	provider network, demographic characteristics of Medicaid
646	beneficiaries, practice and provider-to-beneficiary standards,
647	appointment wait times, beneficiary use of services, provider
648	turnover, provider profiling, provider licensure history,
649	previous program integrity investigations and findings, peer
650	review, provider Medicaid policy and billing compliance records,
651	clinical and medical record audits, and other factors. Providers
652	shall not be entitled to enrollment in the Medicaid provider
653	network. The agency shall determine instances in which allowing
654	Medicaid beneficiaries to purchase durable medical equipment and
655	other goods is less expensive to the Medicaid program than long-
656	term rental of the equipment or goods. The agency may establish
657	rules to facilitate purchases in lieu of long-term rentals in
658	order to protect against fraud and abuse in the Medicaid program
659	as defined in s. 409.913. The agency may seek federal waivers
660	necessary to administer these policies.
661	(16)
662	(b)  The responsibility of the agency under this subsection
663	shall include the development of capabilities to identify actual
664	and optimal practice patterns; patient and provider educational
665	initiatives; methods for determining patient compliance with
666	prescribed treatments; fraud, waste, and abuse prevention and
667	detection programs; and beneficiary case management programs.
668	1.  The practice pattern identification program shall
669	evaluate practitioner prescribing patterns based on national and
670	regional practice guidelines, comparing practitioners to their
671	peer groups. The agency and its Drug Utilization Review Board
672	shall consult with the Department of Health and a panel of
673	practicing health care professionals consisting of the
674	following: the Speaker of the House of Representatives and the
675	President of the Senate shall each appoint three physicians
676	licensed under chapter 458 or chapter 459; and the Governor
677	shall appoint two pharmacists licensed under chapter 465 and one
678	dentist licensed under chapter 466 who is an oral surgeon. Terms
679	of the panel members shall expire at the discretion of the
680	appointing official. The advisory panel shall be responsible for
681	evaluating treatment guidelines and recommending ways to
682	incorporate their use in the practice pattern identification
683	program. Practitioners who are prescribing inappropriately or
684	inefficiently, as determined by the agency, may have their
685	prescribing of certain drugs subject to prior authorization or
686	may be terminated from all participation in the Medicaid
687	program.
688	2.  The agency shall also develop educational interventions
689	designed to promote the proper use of medications by providers
690	and beneficiaries.
691	3.  The agency shall implement a pharmacy fraud, waste, and
692	abuse initiative that may include a surety bond or letter of
693	credit requirement for participating pharmacies, enhanced
694	provider auditing practices, the use of additional fraud and
695	abuse software, recipient management programs for beneficiaries
696	inappropriately using their benefits, and other steps that will
697	eliminate provider and recipient fraud, waste, and abuse. The
698	initiative shall address enforcement efforts to reduce the
699	number and use of counterfeit prescriptions.
700	4.  By September 30, 2002, The agency may shall contract
701	with an entity in the state to provide electronic access to
702	Medicaid prescription refill data and information relating to
703	the Medicaid Preferred Drug List to Medicaid providers implement
704	a wireless handheld clinical pharmacology drug information
705	database for practitioners. The initiative shall be designed to
706	enhance the agency's efforts to reduce fraud, abuse, and errors
707	in the prescription drug benefit program and to otherwise
708	further the intent of this paragraph.
709	5.  By April 1, 2006, the agency shall contract with an
710	entity to design a database of clinical utilization information
711	or electronic medical records for Medicaid providers. This
712	system must be web-based and allow providers to review on a
713	real-time basis the utilization of Medicaid services, including,
714	but not limited to, physician office visits, inpatient and
715	outpatient hospitalizations, laboratory and pathology services,
716	radiological and other imaging services, dental care, and
717	patterns of dispensing prescription drugs in order to coordinate
718	care and identify potential fraud and abuse.
719	6.  The agency may apply for any federal waivers needed to
720	administer this paragraph.
721	(39)(a)  The agency shall implement a Medicaid prescribed-
722	drug spending-control program that includes the following
723	components:
724	1.  A Medicaid preferred drug list, which shall be a
725	listing of cost-effective therapeutic options recommended by the
726	Medicaid Pharmacy and Therapeutics Committee established
727	pursuant to s. 409.91195 and adopted by the agency for each
728	therapeutic class on the preferred drug list. At the discretion
729	of the committee, and when feasible, the preferred drug list
730	should include at least two products in a therapeutic class. The
731	agency may post the preferred drug list and updates to the
732	preferred drug list on an Internet website without following the
733	rulemaking procedures of chapter 120. Antiretroviral agents are
734	excluded from the preferred drug list. The agency shall also
735	limit the amount of a prescribed drug dispensed to no more than
736	a 34-day supply unless the drug products' smallest marketed
737	package is greater than a 34-day supply, or the drug is
738	determined by the agency to be a maintenance drug in which case
739	a 100-day maximum supply may be authorized. The agency is
740	authorized to seek any federal waivers necessary to implement
741	these cost-control programs and to continue participation in the
742	federal Medicaid rebate program, or alternatively to negotiate
743	state-only manufacturer rebates. The agency may adopt rules to
744	implement this subparagraph. The agency shall continue to
745	provide unlimited contraceptive drugs and items. The agency must
746	establish procedures to ensure that:
747	a.  There is a response to a request for prior consultation
748	by telephone or other telecommunication device within 24 hours
749	after receipt of a request for prior consultation; and
750	b.  A 72-hour supply of the drug prescribed is provided in
751	an emergency or when the agency does not provide a response
752	within 24 hours as required by sub-subparagraph a.
753	2.  Reimbursement to pharmacies for Medicaid prescribed
754	drugs shall be set at the lowest lesser of: the average
755	wholesale price (AWP) minus 16.4 percent, the wholesaler
756	acquisition cost (WAC) plus 3.75 4.75 percent, the federal upper
757	limit (FUL), the state maximum allowable cost (SMAC), or the
758	usual and customary (UAC) charge billed by the provider.
759	3.  The agency shall develop and implement a process for
760	managing the drug therapies of Medicaid recipients who are using
761	significant numbers of prescribed drugs each month. The
762	management process may include, but is not limited to,
763	comprehensive, physician-directed medical-record reviews, claims
764	analyses, and case evaluations to determine the medical
765	necessity and appropriateness of a patient's treatment plan and
766	drug therapies. The agency may contract with a private
767	organization to provide drug-program-management services. The
768	Medicaid drug benefit management program shall include
769	initiatives to manage drug therapies for HIV/AIDS patients,
770	patients using 20 or more unique prescriptions in a 180-day
771	period, and the top 1,000 patients in annual spending. The
772	agency shall enroll any Medicaid recipient in the drug benefit
773	management program if he or she meets the specifications of this
774	provision and is not enrolled in a Medicaid health maintenance
775	organization.
776	4.  The agency may limit the size of its pharmacy network
777	based on need, competitive bidding, price negotiations,
778	credentialing, or similar criteria. The agency shall give
779	special consideration to rural areas in determining the size and
780	location of pharmacies included in the Medicaid pharmacy
781	network. A pharmacy credentialing process may include criteria
782	such as a pharmacy's full-service status, location, size,
783	patient educational programs, patient consultation, disease
784	management services, and other characteristics. The agency may
785	impose a moratorium on Medicaid pharmacy enrollment when it is
786	determined that it has a sufficient number of Medicaid-
787	participating providers. The agency must allow dispensing
788	practitioners to participate as a part of the Medicaid pharmacy
789	network regardless of the practitioner's proximity to any other
790	entity that is dispensing prescription drugs under the Medicaid
791	program. A dispensing practitioner must meet all credentialing
792	requirements applicable to his or her practice, as determined by
793	the agency.
794	5.  The agency shall develop and implement a program that
795	requires Medicaid practitioners who prescribe drugs to use a
796	counterfeit-proof prescription pad for Medicaid prescriptions.
797	The agency shall require the use of standardized counterfeit-
798	proof prescription pads by Medicaid-participating prescribers or
799	prescribers who write prescriptions for Medicaid recipients. The
800	agency may implement the program in targeted geographic areas or
801	statewide.
802	6.  The agency may enter into arrangements that require
803	manufacturers of generic drugs prescribed to Medicaid recipients
804	to provide rebates of at least 15.1 percent of the average
805	manufacturer price for the manufacturer's generic products.
806	These arrangements shall require that if a generic-drug
807	manufacturer pays federal rebates for Medicaid-reimbursed drugs
808	at a level below 15.1 percent, the manufacturer must provide a
809	supplemental rebate to the state in an amount necessary to
810	achieve a 15.1-percent rebate level.
811	7.  The agency may establish a preferred drug list as
812	described in this subsection, and, pursuant to the establishment
813	of such preferred drug list, it is authorized to negotiate
814	supplemental rebates from manufacturers that are in addition to
815	those required by Title XIX of the Social Security Act and at no
816	less than 14 percent of the average manufacturer price as
817	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
818	the federal or supplemental rebate, or both, equals or exceeds
819	29 percent. There is no upper limit on the supplemental rebates
820	the agency may negotiate. The agency may determine that specific
821	products, brand-name or generic, are competitive at lower rebate
822	percentages. Agreement to pay the minimum supplemental rebate
823	percentage will guarantee a manufacturer that the Medicaid
824	Pharmaceutical and Therapeutics Committee will consider a
825	product for inclusion on the preferred drug list. However, a
826	pharmaceutical manufacturer is not guaranteed placement on the
827	preferred drug list by simply paying the minimum supplemental
828	rebate. Agency decisions will be made on the clinical efficacy
829	of a drug and recommendations of the Medicaid Pharmaceutical and
830	Therapeutics Committee, as well as the price of competing
831	products minus federal and state rebates. The agency is
832	authorized to contract with an outside agency or contractor to
833	conduct negotiations for supplemental rebates. For the purposes
834	of this section, the term "supplemental rebates" means cash
835	rebates. Effective July 1, 2004, value-added programs as a
836	substitution for supplemental rebates are prohibited. The agency
837	is authorized to seek any federal waivers to implement this
838	initiative.
839	8.  The Agency for Health Care Administration shall expand
840	home delivery of pharmacy products. The agency is authorized to
841	amend the state plan and issue a procurement, as necessary, in
842	order to implement this program. The procurements shall include
843	agreements with a pharmacy or pharmacies located in the state to
844	provide mail order delivery services at no cost to the
845	recipients who elect to receive home delivery of pharmacy
846	products. The procurement shall focus on serving recipients with
847	chronic diseases for which pharmacy expenditures represent a
848	significant portion of Medicaid pharmacy expenditures or which
849	impact a significant portion of the Medicaid population. To
850	assist Medicaid patients in securing their prescriptions and
851	reduce program costs, the agency shall expand its current mail-
852	order-pharmacy diabetes-supply program to include all generic
853	and brand-name drugs used by Medicaid patients with diabetes.
854	Medicaid recipients in the current program may obtain
855	nondiabetes drugs on a voluntary basis. This initiative is
856	limited to the geographic area covered by the current contract.
857	The agency may seek and implement any federal waivers necessary
858	to implement this subparagraph.
859	9.  The agency shall limit to one dose per month any drug
860	prescribed to treat erectile dysfunction.
861	10.a.  The agency may implement a Medicaid behavioral drug
862	management system. The agency may contract with a vendor that
863	has experience in operating behavioral drug management systems
864	to implement this program. The agency is authorized to seek
865	federal waivers to implement this program.
866	b.  The agency, in conjunction with the Department of
867	Children and Family Services, may implement the Medicaid
868	behavioral drug management system that is designed to improve
869	the quality of care and behavioral health prescribing practices
870	based on best practice guidelines, improve patient adherence to
871	medication plans, reduce clinical risk, and lower prescribed
872	drug costs and the rate of inappropriate spending on Medicaid
873	behavioral drugs. The program may include the following
874	elements:
875	(I)  Provide for the development and adoption of best
876	practice guidelines for behavioral health-related drugs such as
877	antipsychotics, antidepressants, and medications for treating
878	bipolar disorders and other behavioral conditions; translate
879	them into practice; review behavioral health prescribers and
880	compare their prescribing patterns to a number of indicators
881	that are based on national standards; and determine deviations
882	from best practice guidelines.
883	(II)  Implement processes for providing feedback to and
884	educating prescribers using best practice educational materials
885	and peer-to-peer consultation.
886	(III)  Assess Medicaid beneficiaries who are outliers in
887	their use of behavioral health drugs with regard to the numbers
888	and types of drugs taken, drug dosages, combination drug
889	therapies, and other indicators of improper use of behavioral
890	health drugs.
891	(IV)  Alert prescribers to patients who fail to refill
892	prescriptions in a timely fashion, are prescribed multiple same-
893	class behavioral health drugs, and may have other potential
894	medication problems.
895	(V)  Track spending trends for behavioral health drugs and
896	deviation from best practice guidelines.
897	(VI)  Use educational and technological approaches to
898	promote best practices, educate consumers, and train prescribers
899	in the use of practice guidelines.
900	(VII)  Disseminate electronic and published materials.
901	(VIII)  Hold statewide and regional conferences.
902	(IX)  Implement a disease management program with a model
903	quality-based medication component for severely mentally ill
904	individuals and emotionally disturbed children who are high
905	users of care.
906	11.a.  The agency shall implement a Medicaid prescription
907	drug management system. The agency may contract with a vendor
908	that has experience in operating prescription drug management
909	systems in order to implement this system. Any management system
910	that is implemented in accordance with this subparagraph must
911	rely on cooperation between physicians and pharmacists to
912	determine appropriate practice patterns and clinical guidelines
913	to improve the prescribing, dispensing, and use of drugs in the
914	Medicaid program. The agency may seek federal waivers to
915	implement this program.
916	b.  The drug management system must be designed to improve
917	the quality of care and prescribing practices based on best
918	practice guidelines, improve patient adherence to medication
919	plans, reduce clinical risk, and lower prescribed drug costs and
920	the rate of inappropriate spending on Medicaid prescription
921	drugs. The program must:
922	(I)  Provide for the development and adoption of best
923	practice guidelines for the prescribing and use of drugs in the
924	Medicaid program, including translating best practice guidelines
925	into practice; reviewing prescriber patterns and comparing them
926	to indicators that are based on national standards and practice
927	patterns of clinical peers in their community, statewide, and
928	nationally; and determine deviations from best practice
929	guidelines.
930	(II)  Implement processes for providing feedback to and
931	educating prescribers using best practice educational materials
932	and peer-to-peer consultation.
933	(III)  Assess Medicaid recipients who are outliers in their
934	use of a single or multiple prescription drugs with regard to
935	the numbers and types of drugs taken, drug dosages, combination
936	drug therapies, and other indicators of improper use of
937	prescription drugs.
938	(IV)  Alert prescribers to patients who fail to refill
939	prescriptions in a timely fashion, are prescribed multiple drugs
940	that may be redundant or contraindicated, or may have other
941	potential medication problems.
942	(V)  Track spending trends for prescription drugs and
943	deviation from best practice guidelines.
944	(VI)  Use educational and technological approaches to
945	promote best practices, educate consumers, and train prescribers
946	in the use of practice guidelines.
947	(VII)  Disseminate electronic and published materials.
948	(VIII)  Hold statewide and regional conferences.
949	(IX)  Implement disease management programs in cooperation
950	with physicians and pharmacists, along with a model quality-
951	based medication component for individuals having chronic
952	medical conditions.
953	12.  The agency is authorized to contract for drug rebate
954	administration, including, but not limited to, calculating
955	rebate amounts, invoicing manufacturers, negotiating disputes
956	with manufacturers, and maintaining a database of rebate
957	collections.
958	13.  The agency may specify the preferred daily dosing form
959	or strength for the purpose of promoting best practices with
960	regard to the prescribing of certain drugs as specified in the
961	General Appropriations Act and ensuring cost-effective
962	prescribing practices.
963	14.  The agency may require prior authorization for
964	Medicaid-covered prescribed drugs. The agency may, but is not
965	required to, prior-authorize the use of a product:
966	a.  For an indication not approved in labeling;
967	b.  To comply with certain clinical guidelines; or
968	c.  If the product has the potential for overuse, misuse,
969	or abuse.
970
971	The agency may require the prescribing professional to provide
972	information about the rationale and supporting medical evidence
973	for the use of a drug. The agency may post prior authorization
974	criteria and protocol and updates to the list of drugs that are
975	subject to prior authorization on an Internet website without
976	amending its rule or engaging in additional rulemaking.
977	15.  The agency, in conjunction with the Pharmaceutical and
978	Therapeutics Committee, may require age-related prior
979	authorizations for certain prescribed drugs. The agency may
980	preauthorize the use of a drug for a recipient who may not meet
981	the age requirement or may exceed the length of therapy for use
982	of this product as recommended by the manufacturer and approved
983	by the Food and Drug Administration. Prior authorization may
984	require the prescribing professional to provide information
985	about the rationale and supporting medical evidence for the use
986	of a drug.
987	16.  The agency shall implement a step-therapy prior
988	authorization approval process for medications excluded from the
989	preferred drug list. Medications listed on the preferred drug
990	list must be used within the previous 12 months prior to the
991	alternative medications that are not listed. The step-therapy
992	prior authorization may require the prescriber to use the
993	medications of a similar drug class or for a similar medical
994	indication unless contraindicated in the Food and Drug
995	Administration labeling. The trial period between the specified
996	steps may vary according to the medical indication. The step-
997	therapy approval process shall be developed in accordance with
998	the committee as stated in s. 409.91195(7) and (8). A drug
999	product may be approved without meeting the step-therapy prior
1000	authorization criteria if the prescribing physician provides the
1001	agency with additional written medical or clinical documentation
1002	that the product is medically necessary because:
1003	a.  There is not a drug on the preferred drug list to treat
1004	the disease or medical condition which is an acceptable clinical
1005	alternative;
1006	b.  The alternatives have been ineffective in the treatment
1007	of the beneficiary's disease; or
1008	c.  Based on historic evidence and known characteristics of
1009	the patient and the drug, the drug is likely to be ineffective,
1010	or the number of doses have been ineffective.
1011
1012	The agency shall work with the physician to determine the best
1013	alternative for the patient. The agency may adopt rules waiving
1014	the requirements for written clinical documentation for specific
1015	drugs in limited clinical situations.
1016	17.  The agency shall implement a return and reuse program
1017	for drugs dispensed by pharmacies to institutional recipients,
1018	which includes payment of a $5 restocking fee for the
1019	implementation and operation of the program. The return and
1020	reuse program shall be implemented electronically and in a
1021	manner that promotes efficiency. The program must permit a
1022	pharmacy to exclude drugs from the program if it is not
1023	practical or cost-effective for the drug to be included and must
1024	provide for the return to inventory of drugs that cannot be
1025	credited or returned in a cost-effective manner. The agency
1026	shall determine if the program has reduced the amount of
1027	Medicaid prescription drugs which are destroyed on an annual
1028	basis and if there are additional ways to ensure more
1029	prescription drugs are not destroyed which could safely be
1030	reused. The agency's conclusion and recommendations shall be
1031	reported to the Legislature by December 1, 2005.
1032	Section 10.  Notwithstanding s. 430.707, Florida Statutes,
1033	and subject to federal approval of the application to be a site
1034	for the Program of All-inclusive Care for the Elderly, the
1035	Agency for Health Care Administration shall contract with one
1036	private health care organization, the sole member of which is a
1037	private, not-for-profit corporation that owns and manages health
1038	care organizations which provide comprehensive long-term care
1039	services, including nursing home, assisted living, independent
1040	housing, home care, adult day care, and care management, with a
1041	board-certified, trained geriatrician as the medical director.
1042	This organization shall provide these services to frail and
1043	elderly persons who reside in Palm Beach County. The
1044	organization shall be exempt from the requirements of chapter
1045	641, Florida Statutes. The agency, in consultation with the
1046	Department of Elderly Affairs and subject to an appropriation,
1047	shall approve up to 150 initial enrollees in the Program of All-
1048	inclusive Care for the Elderly established by this organization
1049	to serve elderly persons who reside in Palm Beach County.
1050	Section 11.  This act shall take effect July 1, 2011.

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