CS/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. 409.9083, F.S.; eliminating
26	the repeal date of the quality assessment on privately
27	operated intermediate care facilities for the
28	developmentally disabled; amending s. 409.911, F.S.;
29	updating the audited data specified for use in calculating
30	disproportionate share; amending s. 409.9112, F.S.;
31	continuing the prohibition against distributing moneys
32	under the perinatal intensive care centers
33	disproportionate share program; amending s. 409.9113,
34	F.S.; continuing authorization for the distribution of
35	moneys to certain teaching hospitals under the
36	disproportionate share program; amending s. 409.9117,
37	F.S.; continuing the prohibition against distributing
38	moneys under the primary care disproportionate share
39	program; amending s. 409.912, F.S.; allowing the agency to
40	continue to contract for electronic access to certain
41	pharmacology drug information; eliminating the requirement
42	to implement a wireless handheld clinical pharmacology
43	drug information database for practitioners; updating the
44	formula used for calculating reimbursement to Medicaid
45	providers for prescribed drugs; authorizing the agency to
46	seek federal approval and to issue a procurement in order
47	to implement a home delivery of pharmacy products program;
48	establishing the provisions for the procurement and the
49	program; eliminating the requirement for the expansion of
50	the mail-order-pharmacy diabetes-supply program;
51	eliminating certain provisions of the Medicaid
52	prescription drug management program; authorizing the
53	agency to contract with an organization to provide certain
54	benefits under a federal program in Palm Beach County;
55	providing an exemption from ch. 641, F.S., for the
56	organization; authorizing, subject to appropriation,
57	enrollment slots for the Program of All-inclusive Care for
58	the Elderly in Palm Beach County; providing an effective
59	date.
60
61	Be It Enacted by the Legislature of the State of Florida:
62
63	Section 1.  Subsections (1) and (2) of section 409.904,
64	Florida Statutes, are amended to read:
65	409.904  Optional payments for eligible persons.-The agency
66	may make payments for medical assistance and related services on
67	behalf of the following persons who are determined to be
68	eligible subject to the income, assets, and categorical
69	eligibility tests set forth in federal and state law. Payment on
70	behalf of these Medicaid eligible persons is subject to the
71	availability of moneys and any limitations established by the
72	General Appropriations Act or chapter 216.
73	(1)  Effective January 1, 2006, and subject to federal
74	waiver approval, a person who is age 65 or older or is
75	determined to be disabled, whose income is at or below 88
76	percent of the federal poverty level, whose assets do not exceed
77	established limitations, and who is not eligible for Medicare
78	or, if eligible for Medicare, is also eligible for and receiving
79	Medicaid-covered institutional care services, hospice services,
80	or home and community-based services. The agency shall seek
81	federal authorization through a waiver to provide this coverage.
82	This subsection expires June 30, 2011.
83	(2)(a)  A family, a pregnant woman, a child under age 21, a
84	person age 65 or over, or a blind or disabled person, who would
85	be eligible under any group listed in s. 409.903(1), (2), or
86	(3), except that the income or assets of such family or person
87	exceed established limitations. For a family or person in one of
88	these coverage groups, medical expenses are deductible from
89	income in accordance with federal requirements in order to make
90	a determination of eligibility. A family or person eligible
91	under the coverage known as the "medically needy," is eligible
92	to receive the same services as other Medicaid recipients, with
93	the exception of services in skilled nursing facilities and
94	intermediate care facilities for the developmentally disabled.
95	This paragraph expires June 30, 2011.
96	(b)  Effective July 1, 2011, a pregnant woman or a child
97	younger than 21 years of age who would be eligible under any
98	group listed in s. 409.903, except that the income or assets of
99	such group exceed established limitations. For a person in one
100	of these coverage groups, medical expenses are deductible from
101	income in accordance with federal requirements in order to make
102	a determination of eligibility. A person eligible under the
103	coverage known as the "medically needy" is eligible to receive
104	the same services as other Medicaid recipients, with the
105	exception of services in skilled nursing facilities and
106	intermediate care facilities for the developmentally disabled.
107	Section 2.  Subsections (7) and (12) of section 409.906,
108	Florida Statutes, are amended to read:
109	409.906  Optional Medicaid services.-Subject to specific
110	appropriations, the agency may make payments for services which
111	are optional to the state under Title XIX of the Social Security
112	Act and are furnished by Medicaid providers to recipients who
113	are determined to be eligible on the dates on which the services
114	were provided. Any optional service that is provided shall be
115	provided only when medically necessary and in accordance with
116	state and federal law. Optional services rendered by providers
117	in mobile units to Medicaid recipients may be restricted or
118	prohibited by the agency. Nothing in this section shall be
119	construed to prevent or limit the agency from adjusting fees,
120	reimbursement rates, lengths of stay, number of visits, or
121	number of services, or making any other adjustments necessary to
122	comply with the availability of moneys and any limitations or
123	directions provided for in the General Appropriations Act or
124	chapter 216. If necessary to safeguard the state's systems of
125	providing services to elderly and disabled persons and subject
126	to the notice and review provisions of s. 216.177, the Governor
127	may direct the Agency for Health Care Administration to amend
128	the Medicaid state plan to delete the optional Medicaid service
129	known as "Intermediate Care Facilities for the Developmentally
130	Disabled." Optional services may include:
131	(7)  CHIROPRACTIC SERVICES.-Effective October 1, 2011, the
132	agency may pay for manual manipulation of the spine and initial
133	services, screening, and X rays provided to a recipient under
134	the age of 21 by a licensed chiropractic physician.
135	(12)  HEARING SERVICES.-Effective October 1, 2011, the
136	agency may pay for hearing and related services, including
137	hearing evaluations, hearing aid devices, dispensing of the
138	hearing aid, and related repairs, if provided to a recipient
139	under the age of 21 by a licensed hearing aid specialist,
140	otolaryngologist, otologist, audiologist, or physician.
141	Section 3.  Subsections (14) and (23) of section 409.908,
142	Florida Statutes, are amended to read:
143	409.908  Reimbursement of Medicaid providers.-Subject to
144	specific appropriations, the agency shall reimburse Medicaid
145	providers, in accordance with state and federal law, according
146	to methodologies set forth in the rules of the agency and in
147	policy manuals and handbooks incorporated by reference therein.
148	These methodologies may include fee schedules, reimbursement
149	methods based on cost reporting, negotiated fees, competitive
150	bidding pursuant to s. 287.057, and other mechanisms the agency
151	considers efficient and effective for purchasing services or
152	goods on behalf of recipients. If a provider is reimbursed based
153	on cost reporting and submits a cost report late and that cost
154	report would have been used to set a lower reimbursement rate
155	for a rate semester, then the provider's rate for that semester
156	shall be retroactively calculated using the new cost report, and
157	full payment at the recalculated rate shall be effected
158	retroactively. Medicare-granted extensions for filing cost
159	reports, if applicable, shall also apply to Medicaid cost
160	reports. Payment for Medicaid compensable services made on
161	behalf of Medicaid eligible persons is subject to the
162	availability of moneys and any limitations or directions
163	provided for in the General Appropriations Act or chapter 216.
164	Further, nothing in this section shall be construed to prevent
165	or limit the agency from adjusting fees, reimbursement rates,
166	lengths of stay, number of visits, or number of services, or
167	making any other adjustments necessary to comply with the
168	availability of moneys and any limitations or directions
169	provided for in the General Appropriations Act, provided the
170	adjustment is consistent with legislative intent.
171	(14)  A provider of prescribed drugs shall be reimbursed
172	the least of the amount billed by the provider, the provider's
173	usual and customary charge, or the Medicaid maximum allowable
174	fee established by the agency, plus a dispensing fee. The
175	Medicaid maximum allowable fee for ingredient cost shall will be
176	based on the lowest lower of: the average wholesale price (AWP)
177	minus 16.4 percent, the wholesaler acquisition cost (WAC) plus
178	3.75 4.75 percent, the federal upper limit (FUL), the state
179	maximum allowable cost (SMAC), or the usual and customary (UAC)
180	charge billed by the provider. Medicaid providers are required
181	to dispense generic drugs if available at lower cost and the
182	agency has not determined that the branded product is more cost-
183	effective, unless the prescriber has requested and received
184	approval to require the branded product. The agency is directed
185	to implement a variable dispensing fee for payments for
186	prescribed medicines while ensuring continued access for
187	Medicaid recipients. The variable dispensing fee may be based
188	upon, but not limited to, either or both the volume of
189	prescriptions dispensed by a specific pharmacy provider, the
190	volume of prescriptions dispensed to an individual recipient,
191	and dispensing of preferred-drug-list products. The agency may
192	increase the pharmacy dispensing fee authorized by statute and
193	in the annual General Appropriations Act by $0.50 for the
194	dispensing of a Medicaid preferred-drug-list product and reduce
195	the pharmacy dispensing fee by $0.50 for the dispensing of a
196	Medicaid product that is not included on the preferred drug
197	list. The agency may establish a supplemental pharmaceutical
198	dispensing fee to be paid to providers returning unused unit-
199	dose packaged medications to stock and crediting the Medicaid
200	program for the ingredient cost of those medications if the
201	ingredient costs to be credited exceed the value of the
202	supplemental dispensing fee. The agency is authorized to limit
203	reimbursement for prescribed medicine in order to comply with
204	any limitations or directions provided for in the General
205	Appropriations Act, which may include implementing a prospective
206	or concurrent utilization review program.
207	(23)(a)  The agency shall establish rates at a level that
208	ensures no increase in statewide expenditures resulting from a
209	change in unit costs for 2 fiscal years effective July 1, 2011
210	2009. Reimbursement rates for the 2 fiscal years shall be as
211	provided in the General Appropriations Act.
212	(b)  This subsection applies to the following provider
213	types:
214	1.  Inpatient hospitals.
215	2.  Outpatient hospitals.
216	3.  Nursing homes.
217	4.  County health departments.
218	5.  Community intermediate care facilities for the
219	developmentally disabled.
220	6.  Prepaid health plans.
221
222	The agency shall apply the effect of this subsection to the
223	reimbursement rates for nursing home diversion programs.
224	(c)  The agency shall create a workgroup on hospital
225	reimbursement, a workgroup on nursing facility reimbursement,
226	and a workgroup on managed care plan payment. The workgroups
227	shall evaluate alternative reimbursement and payment
228	methodologies for hospitals, nursing facilities, and managed
229	care plans, including prospective payment methodologies for
230	hospitals and nursing facilities. The nursing facility workgroup
231	shall also consider price-based methodologies for indirect care
232	and acuity adjustments for direct care. The agency shall submit
233	a report on the evaluated alternative reimbursement
234	methodologies to the relevant committees of the Senate and the
235	House of Representatives by November 1, 2009.
236	(d)  This subsection expires June 30, 2011.
237	Section 4.  Subsection (2) of section 409.9082, Florida
238	Statutes, is amended to read:
239	409.9082  Quality assessment on nursing home facility
240	providers; exemptions; purpose; federal approval required;
241	remedies.-
242	(2)  Effective April 1, 2009, there is imposed upon each
243	nursing home facility a quality assessment. The aggregated
244	amount of assessments for all nursing home facilities in a given
245	year shall be an amount not exceeding the maximum percentage
246	allowed under federal law 5.5 percent of the total aggregate net
247	patient service revenue of assessed facilities. The agency shall
248	calculate the quality assessment rate annually on a per-
249	resident-day basis, exclusive of those resident days funded by
250	the Medicare program, as reported by the facilities. The per-
251	resident-day assessment rate shall be uniform except as
252	prescribed in subsection (3). Each facility shall report monthly
253	to the agency its total number of resident days, exclusive of
254	Medicare Part A resident days, and shall remit an amount equal
255	to the assessment rate times the reported number of days. The
256	agency shall collect, and each facility shall pay, the quality
257	assessment each month. The agency shall collect the assessment
258	from nursing home facility providers by no later than the 15th
259	of the next succeeding calendar month. The agency shall notify
260	providers of the quality assessment and provide a standardized
261	form to complete and submit with payments. The collection of the
262	nursing home facility quality assessment shall commence no
263	sooner than 5 days after the agency's initial payment of the
264	Medicaid rates containing the elements prescribed in subsection
265	(4). Nursing home facilities may not create a separate line-item
266	charge for the purpose of passing through the assessment to
267	residents.
268	Section 5.  Subsection (8) of section 409.9083, Florida
269	Statutes, is amended to read:
270	409.9083  Quality assessment on privately operated
271	intermediate care facilities for the developmentally disabled;
272	exemptions; purpose; federal approval required; remedies.-
273	(8)  This section is repealed October 1, 2011.
274	Section 6.  Paragraph (a) of subsection (2) of section
275	409.911, Florida Statutes, is amended to read:
276	409.911  Disproportionate share program.-Subject to
277	specific allocations established within the General
278	Appropriations Act and any limitations established pursuant to
279	chapter 216, the agency shall distribute, pursuant to this
280	section, moneys to hospitals providing a disproportionate share
281	of Medicaid or charity care services by making quarterly
282	Medicaid payments as required. Notwithstanding the provisions of
283	s. 409.915, counties are exempt from contributing toward the
284	cost of this special reimbursement for hospitals serving a
285	disproportionate share of low-income patients.
286	(2)  The Agency for Health Care Administration shall use
287	the following actual audited data to determine the Medicaid days
288	and charity care to be used in calculating the disproportionate
289	share payment:
290	(a)  The average of the 2004, 2005, and 2006 2003, 2004,
291	and 2005 audited disproportionate share data to determine each
292	hospital's Medicaid days and charity care for the 2011-2012
293	2010-2011 state fiscal year.
294	Section 7.  Section 409.9112, Florida Statutes, is amended
295	to read:
296	409.9112  Disproportionate share program for regional
297	perinatal intensive care centers.-In addition to the payments
298	made under s. 409.911, the agency shall design and implement a
299	system for making disproportionate share payments to those
300	hospitals that participate in the regional perinatal intensive
301	care center program established pursuant to chapter 383. The
302	system of payments must conform to federal requirements and
303	distribute funds in each fiscal year for which an appropriation
304	is made by making quarterly Medicaid payments. Notwithstanding
305	s. 409.915, counties are exempt from contributing toward the
306	cost of this special reimbursement for hospitals serving a
307	disproportionate share of low-income patients. For the 2011-2012
308	2010-2011 state fiscal year, the agency may not distribute
309	moneys under the regional perinatal intensive care centers
310	disproportionate share program.
311	(1)  The following formula shall be used by the agency to
312	calculate the total amount earned for hospitals that participate
313	in the regional perinatal intensive care center program:
314
315	TAE = HDSP/THDSP
316	Where:
317	TAE = total amount earned by a regional perinatal intensive
318	care center.
319	HDSP = the prior state fiscal year regional perinatal
320	intensive care center disproportionate share payment to the
321	individual hospital.
322	THDSP = the prior state fiscal year total regional
323	perinatal intensive care center disproportionate share payments
324	to all hospitals.
325
326	(2)  The total additional payment for hospitals that
327	participate in the regional perinatal intensive care center
328	program shall be calculated by the agency as follows:
329
330	TAP = TAE x TA
331	Where:
332	TAP = total additional payment for a regional perinatal
333	intensive care center.
334	TAE = total amount earned by a regional perinatal intensive
335	care center.
336	TA = total appropriation for the regional perinatal
337	intensive care center disproportionate share program.
338
339	(3)  In order to receive payments under this section, a
340	hospital must be participating in the regional perinatal
341	intensive care center program pursuant to chapter 383 and must
342	meet the following additional requirements:
343	(a)  Agree to conform to all departmental and agency
344	requirements to ensure high quality in the provision of
345	services, including criteria adopted by departmental and agency
346	rule concerning staffing ratios, medical records, standards of
347	care, equipment, space, and such other standards and criteria as
348	the department and agency deem appropriate as specified by rule.
349	(b)  Agree to provide information to the department and
350	agency, in a form and manner to be prescribed by rule of the
351	department and agency, concerning the care provided to all
352	patients in neonatal intensive care centers and high-risk
353	maternity care.
354	(c)  Agree to accept all patients for neonatal intensive
355	care and high-risk maternity care, regardless of ability to pay,
356	on a functional space-available basis.
357	(d)  Agree to develop arrangements with other maternity and
358	neonatal care providers in the hospital's region for the
359	appropriate receipt and transfer of patients in need of
360	specialized maternity and neonatal intensive care services.
361	(e)  Agree to establish and provide a developmental
362	evaluation and services program for certain high-risk neonates,
363	as prescribed and defined by rule of the department.
364	(f)  Agree to sponsor a program of continuing education in
365	perinatal care for health care professionals within the region
366	of the hospital, as specified by rule.
367	(g)  Agree to provide backup and referral services to the
368	county health departments and other low-income perinatal
369	providers within the hospital's region, including the
370	development of written agreements between these organizations
371	and the hospital.
372	(h)  Agree to arrange for transportation for high-risk
373	obstetrical patients and neonates in need of transfer from the
374	community to the hospital or from the hospital to another more
375	appropriate facility.
376	(4)  Hospitals which fail to comply with any of the
377	conditions in subsection (3) or the applicable rules of the
378	department and agency may not receive any payments under this
379	section until full compliance is achieved. A hospital which is
380	not in compliance in two or more consecutive quarters may not
381	receive its share of the funds. Any forfeited funds shall be
382	distributed by the remaining participating regional perinatal
383	intensive care center program hospitals.
384	Section 8.  Section 409.9113, Florida Statutes, is amended
385	to read:
386	409.9113  Disproportionate share program for teaching
387	hospitals.-In addition to the payments made under ss. 409.911
388	and 409.9112, the agency shall make disproportionate share
389	payments to statutorily defined teaching hospitals for their
390	increased costs associated with medical education programs and
391	for tertiary health care services provided to the indigent. This
392	system of payments must conform to federal requirements and
393	distribute funds in each fiscal year for which an appropriation
394	is made by making quarterly Medicaid payments. Notwithstanding
395	s. 409.915, counties are exempt from contributing toward the
396	cost of this special reimbursement for hospitals serving a
397	disproportionate share of low-income patients. For the 2011-2012
398	2010-2011 state fiscal year, the agency shall distribute the
399	moneys provided in the General Appropriations Act to statutorily
400	defined teaching hospitals and family practice teaching
401	hospitals under the teaching hospital disproportionate share
402	program. The funds provided for statutorily defined teaching
403	hospitals shall be distributed in the same proportion as the
404	state fiscal year 2003-2004 teaching hospital disproportionate
405	share funds were distributed or as otherwise provided in the
406	General Appropriations Act. The funds provided for family
407	practice teaching hospitals shall be distributed equally among
408	family practice teaching hospitals.
409	(1)  On or before September 15 of each year, the agency
410	shall calculate an allocation fraction to be used for
411	distributing funds to state statutory teaching hospitals.
412	Subsequent to the end of each quarter of the state fiscal year,
413	the agency shall distribute to each statutory teaching hospital,
414	as defined in s. 408.07, an amount determined by multiplying
415	one-fourth of the funds appropriated for this purpose by the
416	Legislature times such hospital's allocation fraction. The
417	allocation fraction for each such hospital shall be determined
418	by the sum of the following three primary factors, divided by
419	three:
420	(a)  The number of nationally accredited graduate medical
421	education programs offered by the hospital, including programs
422	accredited by the Accreditation Council for Graduate Medical
423	Education and the combined Internal Medicine and Pediatrics
424	programs acceptable to both the American Board of Internal
425	Medicine and the American Board of Pediatrics at the beginning
426	of the state fiscal year preceding the date on which the
427	allocation fraction is calculated. The numerical value of this
428	factor is the fraction that the hospital represents of the total
429	number of programs, where the total is computed for all state
430	statutory teaching hospitals.
431	(b)  The number of full-time equivalent trainees in the
432	hospital, which comprises two components:
433	1.  The number of trainees enrolled in nationally
434	accredited graduate medical education programs, as defined in
435	paragraph (a). Full-time equivalents are computed using the
436	fraction of the year during which each trainee is primarily
437	assigned to the given institution, over the state fiscal year
438	preceding the date on which the allocation fraction is
439	calculated. The numerical value of this factor is the fraction
440	that the hospital represents of the total number of full-time
441	equivalent trainees enrolled in accredited graduate programs,
442	where the total is computed for all state statutory teaching
443	hospitals.
444	2.  The number of medical students enrolled in accredited
445	colleges of medicine and engaged in clinical activities,
446	including required clinical clerkships and clinical electives.
447	Full-time equivalents are computed using the fraction of the
448	year during which each trainee is primarily assigned to the
449	given institution, over the course of the state fiscal year
450	preceding the date on which the allocation fraction is
451	calculated. The numerical value of this factor is the fraction
452	that the given hospital represents of the total number of full-
453	time equivalent students enrolled in accredited colleges of
454	medicine, where the total is computed for all state statutory
455	teaching hospitals.
456
457	The primary factor for full-time equivalent trainees is computed
458	as the sum of these two components, divided by two.
459	(c)  A service index that comprises three components:
460	1.  The Agency for Health Care Administration Service
461	Index, computed by applying the standard Service Inventory
462	Scores established by the agency to services offered by the
463	given hospital, as reported on Worksheet A-2 for the last fiscal
464	year reported to the agency before the date on which the
465	allocation fraction is calculated. The numerical value of this
466	factor is the fraction that the given hospital represents of the
467	total Agency for Health Care Administration Service Index
468	values, where the total is computed for all state statutory
469	teaching hospitals.
470	2.  A volume-weighted service index, computed by applying
471	the standard Service Inventory Scores established by the Agency
472	for Health Care Administration to the volume of each service,
473	expressed in terms of the standard units of measure reported on
474	Worksheet A-2 for the last fiscal year reported to the agency
475	before the date on which the allocation factor is calculated.
476	The numerical value of this factor is the fraction that the
477	given hospital represents of the total volume-weighted service
478	index values, where the total is computed for all state
479	statutory teaching hospitals.
480	3.  Total Medicaid payments to each hospital for direct
481	inpatient and outpatient services during the fiscal year
482	preceding the date on which the allocation factor is calculated.
483	This includes payments made to each hospital for such services
484	by Medicaid prepaid health plans, whether the plan was
485	administered by the hospital or not. The numerical value of this
486	factor is the fraction that each hospital represents of the
487	total of such Medicaid payments, where the total is computed for
488	all state statutory teaching hospitals.
489
490	The primary factor for the service index is computed as the sum
491	of these three components, divided by three.
492	(2)  By October 1 of each year, the agency shall use the
493	following formula to calculate the maximum additional
494	disproportionate share payment for statutorily defined teaching
495	hospitals:
496	TAP = THAF x A
497	Where:
498	TAP = total additional payment.
499	THAF = teaching hospital allocation factor.
500	A = amount appropriated for a teaching hospital
501	disproportionate share program.
502	Section 9.  Section 409.9117, Florida Statutes, is amended
503	to read:
504	409.9117  Primary care disproportionate share program.-For
505	the 2011-2012 2010-2011 state fiscal year, the agency shall not
506	distribute moneys under the primary care disproportionate share
507	program.
508	(1)  If federal funds are available for disproportionate
509	share programs in addition to those otherwise provided by law,
510	there shall be created a primary care disproportionate share
511	program.
512	(2)  The following formula shall be used by the agency to
513	calculate the total amount earned for hospitals that participate
514	in the primary care disproportionate share program:
515
516	TAE = HDSP/THDSP
517	Where:
518	TAE = total amount earned by a hospital participating in
519	the primary care disproportionate share program.
520	HDSP = the prior state fiscal year primary care
521	disproportionate share payment to the individual hospital.
522	THDSP = the prior state fiscal year total primary care
523	disproportionate share payments to all hospitals.
524
525	(3)  The total additional payment for hospitals that
526	participate in the primary care disproportionate share program
527	shall be calculated by the agency as follows:
528
529	TAP = TAE x TA
530
531	Where:
532	TAP = total additional payment for a primary care hospital.
533	TAE = total amount earned by a primary care hospital.
534	TA = total appropriation for the primary care
535	disproportionate share program.
536
537	(4)  In the establishment and funding of this program, the
538	agency shall use the following criteria in addition to those
539	specified in s. 409.911, and payments may not be made to a
540	hospital unless the hospital agrees to:
541	(a)  Cooperate with a Medicaid prepaid health plan, if one
542	exists in the community.
543	(b)  Ensure the availability of primary and specialty care
544	physicians to Medicaid recipients who are not enrolled in a
545	prepaid capitated arrangement and who are in need of access to
546	such physicians.
547	(c)  Coordinate and provide primary care services free of
548	charge, except copayments, to all persons with incomes up to 100
549	percent of the federal poverty level who are not otherwise
550	covered by Medicaid or another program administered by a
551	governmental entity, and to provide such services based on a
552	sliding fee scale to all persons with incomes up to 200 percent
553	of the federal poverty level who are not otherwise covered by
554	Medicaid or another program administered by a governmental
555	entity, except that eligibility may be limited to persons who
556	reside within a more limited area, as agreed to by the agency
557	and the hospital.
558	(d)  Contract with any federally qualified health center,
559	if one exists within the agreed geopolitical boundaries,
560	concerning the provision of primary care services, in order to
561	guarantee delivery of services in a nonduplicative fashion, and
562	to provide for referral arrangements, privileges, and
563	admissions, as appropriate. The hospital shall agree to provide
564	at an onsite or offsite facility primary care services within 24
565	hours to which all Medicaid recipients and persons eligible
566	under this paragraph who do not require emergency room services
567	are referred during normal daylight hours.
568	(e)  Cooperate with the agency, the county, and other
569	entities to ensure the provision of certain public health
570	services, case management, referral and acceptance of patients,
571	and sharing of epidemiological data, as the agency and the
572	hospital find mutually necessary and desirable to promote and
573	protect the public health within the agreed geopolitical
574	boundaries.
575	(f)  In cooperation with the county in which the hospital
576	resides, develop a low-cost, outpatient, prepaid health care
577	program to persons who are not eligible for the Medicaid
578	program, and who reside within the area.
579	(g)  Provide inpatient services to residents within the
580	area who are not eligible for Medicaid or Medicare, and who do
581	not have private health insurance, regardless of ability to pay,
582	on the basis of available space, except that hospitals may not
583	be prevented from establishing bill collection programs based on
584	ability to pay.
585	(h)  Work with the Florida Healthy Kids Corporation, the
586	Florida Health Care Purchasing Cooperative, and business health
587	coalitions, as appropriate, to develop a feasibility study and
588	plan to provide a low-cost comprehensive health insurance plan
589	to persons who reside within the area and who do not have access
590	to such a plan.
591	(i)  Work with public health officials and other experts to
592	provide community health education and prevention activities
593	designed to promote healthy lifestyles and appropriate use of
594	health services.
595	(j)  Work with the local health council to develop a plan
596	for promoting access to affordable health care services for all
597	persons who reside within the area, including, but not limited
598	to, public health services, primary care services, inpatient
599	services, and affordable health insurance generally.
600
601	Any hospital that fails to comply with any of the provisions of
602	this subsection, or any other contractual condition, may not
603	receive payments under this section until full compliance is
604	achieved.
605	Section 10.  Paragraph (b) of subsection (16) and paragraph
606	(a) of subsection (39) of section 409.912, Florida Statutes, are
607	amended to read:
608	409.912  Cost-effective purchasing of health care.-The
609	agency shall purchase goods and services for Medicaid recipients
610	in the most cost-effective manner consistent with the delivery
611	of quality medical care. To ensure that medical services are
612	effectively utilized, the agency may, in any case, require a
613	confirmation or second physician's opinion of the correct
614	diagnosis for purposes of authorizing future services under the
615	Medicaid program. This section does not restrict access to
616	emergency services or poststabilization care services as defined
617	in 42 C.F.R. part 438.114. Such confirmation or second opinion
618	shall be rendered in a manner approved by the agency. The agency
619	shall maximize the use of prepaid per capita and prepaid
620	aggregate fixed-sum basis services when appropriate and other
621	alternative service delivery and reimbursement methodologies,
622	including competitive bidding pursuant to s. 287.057, designed
623	to facilitate the cost-effective purchase of a case-managed
624	continuum of care. The agency shall also require providers to
625	minimize the exposure of recipients to the need for acute
626	inpatient, custodial, and other institutional care and the
627	inappropriate or unnecessary use of high-cost services. The
628	agency shall contract with a vendor to monitor and evaluate the
629	clinical practice patterns of providers in order to identify
630	trends that are outside the normal practice patterns of a
631	provider's professional peers or the national guidelines of a
632	provider's professional association. The vendor must be able to
633	provide information and counseling to a provider whose practice
634	patterns are outside the norms, in consultation with the agency,
635	to improve patient care and reduce inappropriate utilization.
636	The agency may mandate prior authorization, drug therapy
637	management, or disease management participation for certain
638	populations of Medicaid beneficiaries, certain drug classes, or
639	particular drugs to prevent fraud, abuse, overuse, and possible
640	dangerous drug interactions. The Pharmaceutical and Therapeutics
641	Committee shall make recommendations to the agency on drugs for
642	which prior authorization is required. The agency shall inform
643	the Pharmaceutical and Therapeutics Committee of its decisions
644	regarding drugs subject to prior authorization. The agency is
645	authorized to limit the entities it contracts with or enrolls as
646	Medicaid providers by developing a provider network through
647	provider credentialing. The agency may competitively bid single-
648	source-provider contracts if procurement of goods or services
649	results in demonstrated cost savings to the state without
650	limiting access to care. The agency may limit its network based
651	on the assessment of beneficiary access to care, provider
652	availability, provider quality standards, time and distance
653	standards for access to care, the cultural competence of the
654	provider network, demographic characteristics of Medicaid
655	beneficiaries, practice and provider-to-beneficiary standards,
656	appointment wait times, beneficiary use of services, provider
657	turnover, provider profiling, provider licensure history,
658	previous program integrity investigations and findings, peer
659	review, provider Medicaid policy and billing compliance records,
660	clinical and medical record audits, and other factors. Providers
661	shall not be entitled to enrollment in the Medicaid provider
662	network. The agency shall determine instances in which allowing
663	Medicaid beneficiaries to purchase durable medical equipment and
664	other goods is less expensive to the Medicaid program than long-
665	term rental of the equipment or goods. The agency may establish
666	rules to facilitate purchases in lieu of long-term rentals in
667	order to protect against fraud and abuse in the Medicaid program
668	as defined in s. 409.913. The agency may seek federal waivers
669	necessary to administer these policies.
670	(16)
671	(b)  The responsibility of the agency under this subsection
672	shall include the development of capabilities to identify actual
673	and optimal practice patterns; patient and provider educational
674	initiatives; methods for determining patient compliance with
675	prescribed treatments; fraud, waste, and abuse prevention and
676	detection programs; and beneficiary case management programs.
677	1.  The practice pattern identification program shall
678	evaluate practitioner prescribing patterns based on national and
679	regional practice guidelines, comparing practitioners to their
680	peer groups. The agency and its Drug Utilization Review Board
681	shall consult with the Department of Health and a panel of
682	practicing health care professionals consisting of the
683	following: the Speaker of the House of Representatives and the
684	President of the Senate shall each appoint three physicians
685	licensed under chapter 458 or chapter 459; and the Governor
686	shall appoint two pharmacists licensed under chapter 465 and one
687	dentist licensed under chapter 466 who is an oral surgeon. Terms
688	of the panel members shall expire at the discretion of the
689	appointing official. The advisory panel shall be responsible for
690	evaluating treatment guidelines and recommending ways to
691	incorporate their use in the practice pattern identification
692	program. Practitioners who are prescribing inappropriately or
693	inefficiently, as determined by the agency, may have their
694	prescribing of certain drugs subject to prior authorization or
695	may be terminated from all participation in the Medicaid
696	program.
697	2.  The agency shall also develop educational interventions
698	designed to promote the proper use of medications by providers
699	and beneficiaries.
700	3.  The agency shall implement a pharmacy fraud, waste, and
701	abuse initiative that may include a surety bond or letter of
702	credit requirement for participating pharmacies, enhanced
703	provider auditing practices, the use of additional fraud and
704	abuse software, recipient management programs for beneficiaries
705	inappropriately using their benefits, and other steps that will
706	eliminate provider and recipient fraud, waste, and abuse. The
707	initiative shall address enforcement efforts to reduce the
708	number and use of counterfeit prescriptions.
709	4.  By September 30, 2002, The agency may shall contract
710	with an entity in the state to provide electronic access to
711	Medicaid prescription refill data and information relating to
712	the Medicaid Preferred Drug List to Medicaid providers implement
713	a wireless handheld clinical pharmacology drug information
714	database for practitioners. The initiative shall be designed to
715	enhance the agency's efforts to reduce fraud, abuse, and errors
716	in the prescription drug benefit program and to otherwise
717	further the intent of this paragraph.
718	5.  By April 1, 2006, the agency shall contract with an
719	entity to design a database of clinical utilization information
720	or electronic medical records for Medicaid providers. This
721	system must be web-based and allow providers to review on a
722	real-time basis the utilization of Medicaid services, including,
723	but not limited to, physician office visits, inpatient and
724	outpatient hospitalizations, laboratory and pathology services,
725	radiological and other imaging services, dental care, and
726	patterns of dispensing prescription drugs in order to coordinate
727	care and identify potential fraud and abuse.
728	6.  The agency may apply for any federal waivers needed to
729	administer this paragraph.
730	(39)(a)  The agency shall implement a Medicaid prescribed-
731	drug spending-control program that includes the following
732	components:
733	1.  A Medicaid preferred drug list, which shall be a
734	listing of cost-effective therapeutic options recommended by the
735	Medicaid Pharmacy and Therapeutics Committee established
736	pursuant to s. 409.91195 and adopted by the agency for each
737	therapeutic class on the preferred drug list. At the discretion
738	of the committee, and when feasible, the preferred drug list
739	should include at least two products in a therapeutic class. The
740	agency may post the preferred drug list and updates to the
741	preferred drug list on an Internet website without following the
742	rulemaking procedures of chapter 120. Antiretroviral agents are
743	excluded from the preferred drug list. The agency shall also
744	limit the amount of a prescribed drug dispensed to no more than
745	a 34-day supply unless the drug products' smallest marketed
746	package is greater than a 34-day supply, or the drug is
747	determined by the agency to be a maintenance drug in which case
748	a 100-day maximum supply may be authorized. The agency is
749	authorized to seek any federal waivers necessary to implement
750	these cost-control programs and to continue participation in the
751	federal Medicaid rebate program, or alternatively to negotiate
752	state-only manufacturer rebates. The agency may adopt rules to
753	implement this subparagraph. The agency shall continue to
754	provide unlimited contraceptive drugs and items. The agency must
755	establish procedures to ensure that:
756	a.  There is a response to a request for prior consultation
757	by telephone or other telecommunication device within 24 hours
758	after receipt of a request for prior consultation; and
759	b.  A 72-hour supply of the drug prescribed is provided in
760	an emergency or when the agency does not provide a response
761	within 24 hours as required by sub-subparagraph a.
762	2.  Reimbursement to pharmacies for Medicaid prescribed
763	drugs shall be set at the lowest lesser of: the average
764	wholesale price (AWP) minus 16.4 percent, the wholesaler
765	acquisition cost (WAC) plus 3.75 4.75 percent, the federal upper
766	limit (FUL), the state maximum allowable cost (SMAC), or the
767	usual and customary (UAC) charge billed by the provider.
768	3.  The agency shall develop and implement a process for
769	managing the drug therapies of Medicaid recipients who are using
770	significant numbers of prescribed drugs each month. The
771	management process may include, but is not limited to,
772	comprehensive, physician-directed medical-record reviews, claims
773	analyses, and case evaluations to determine the medical
774	necessity and appropriateness of a patient's treatment plan and
775	drug therapies. The agency may contract with a private
776	organization to provide drug-program-management services. The
777	Medicaid drug benefit management program shall include
778	initiatives to manage drug therapies for HIV/AIDS patients,
779	patients using 20 or more unique prescriptions in a 180-day
780	period, and the top 1,000 patients in annual spending. The
781	agency shall enroll any Medicaid recipient in the drug benefit
782	management program if he or she meets the specifications of this
783	provision and is not enrolled in a Medicaid health maintenance
784	organization.
785	4.  The agency may limit the size of its pharmacy network
786	based on need, competitive bidding, price negotiations,
787	credentialing, or similar criteria. The agency shall give
788	special consideration to rural areas in determining the size and
789	location of pharmacies included in the Medicaid pharmacy
790	network. A pharmacy credentialing process may include criteria
791	such as a pharmacy's full-service status, location, size,
792	patient educational programs, patient consultation, disease
793	management services, and other characteristics. The agency may
794	impose a moratorium on Medicaid pharmacy enrollment when it is
795	determined that it has a sufficient number of Medicaid-
796	participating providers. The agency must allow dispensing
797	practitioners to participate as a part of the Medicaid pharmacy
798	network regardless of the practitioner's proximity to any other
799	entity that is dispensing prescription drugs under the Medicaid
800	program. A dispensing practitioner must meet all credentialing
801	requirements applicable to his or her practice, as determined by
802	the agency.
803	5.  The agency shall develop and implement a program that
804	requires Medicaid practitioners who prescribe drugs to use a
805	counterfeit-proof prescription pad for Medicaid prescriptions.
806	The agency shall require the use of standardized counterfeit-
807	proof prescription pads by Medicaid-participating prescribers or
808	prescribers who write prescriptions for Medicaid recipients. The
809	agency may implement the program in targeted geographic areas or
810	statewide.
811	6.  The agency may enter into arrangements that require
812	manufacturers of generic drugs prescribed to Medicaid recipients
813	to provide rebates of at least 15.1 percent of the average
814	manufacturer price for the manufacturer's generic products.
815	These arrangements shall require that if a generic-drug
816	manufacturer pays federal rebates for Medicaid-reimbursed drugs
817	at a level below 15.1 percent, the manufacturer must provide a
818	supplemental rebate to the state in an amount necessary to
819	achieve a 15.1-percent rebate level.
820	7.  The agency may establish a preferred drug list as
821	described in this subsection, and, pursuant to the establishment
822	of such preferred drug list, it is authorized to negotiate
823	supplemental rebates from manufacturers that are in addition to
824	those required by Title XIX of the Social Security Act and at no
825	less than 14 percent of the average manufacturer price as
826	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
827	the federal or supplemental rebate, or both, equals or exceeds
828	29 percent. There is no upper limit on the supplemental rebates
829	the agency may negotiate. The agency may determine that specific
830	products, brand-name or generic, are competitive at lower rebate
831	percentages. Agreement to pay the minimum supplemental rebate
832	percentage will guarantee a manufacturer that the Medicaid
833	Pharmaceutical and Therapeutics Committee will consider a
834	product for inclusion on the preferred drug list. However, a
835	pharmaceutical manufacturer is not guaranteed placement on the
836	preferred drug list by simply paying the minimum supplemental
837	rebate. Agency decisions will be made on the clinical efficacy
838	of a drug and recommendations of the Medicaid Pharmaceutical and
839	Therapeutics Committee, as well as the price of competing
840	products minus federal and state rebates. The agency is
841	authorized to contract with an outside agency or contractor to
842	conduct negotiations for supplemental rebates. For the purposes
843	of this section, the term "supplemental rebates" means cash
844	rebates. Effective July 1, 2004, value-added programs as a
845	substitution for supplemental rebates are prohibited. The agency
846	is authorized to seek any federal waivers to implement this
847	initiative.
848	8.  The Agency for Health Care Administration shall expand
849	home delivery of pharmacy products. The agency is authorized to
850	amend the state plan and issue a procurement, as necessary, in
851	order to implement this program. The procurements shall include
852	agreements with a pharmacy or pharmacies located in the state to
853	provide mail order delivery services at no cost to the
854	recipients who elect to receive home delivery of pharmacy
855	products. The procurement shall focus on serving recipients with
856	chronic diseases for which pharmacy expenditures represent a
857	significant portion of Medicaid pharmacy expenditures or which
858	impact a significant portion of the Medicaid population. To
859	assist Medicaid patients in securing their prescriptions and
860	reduce program costs, the agency shall expand its current mail-
861	order-pharmacy diabetes-supply program to include all generic
862	and brand-name drugs used by Medicaid patients with diabetes.
863	Medicaid recipients in the current program may obtain
864	nondiabetes drugs on a voluntary basis. This initiative is
865	limited to the geographic area covered by the current contract.
866	The agency may seek and implement any federal waivers necessary
867	to implement this subparagraph.
868	9.  The agency shall limit to one dose per month any drug
869	prescribed to treat erectile dysfunction.
870	10.a.  The agency may implement a Medicaid behavioral drug
871	management system. The agency may contract with a vendor that
872	has experience in operating behavioral drug management systems
873	to implement this program. The agency is authorized to seek
874	federal waivers to implement this program.
875	b.  The agency, in conjunction with the Department of
876	Children and Family Services, may implement the Medicaid
877	behavioral drug management system that is designed to improve
878	the quality of care and behavioral health prescribing practices
879	based on best practice guidelines, improve patient adherence to
880	medication plans, reduce clinical risk, and lower prescribed
881	drug costs and the rate of inappropriate spending on Medicaid
882	behavioral drugs. The program may include the following
883	elements:
884	(I)  Provide for the development and adoption of best
885	practice guidelines for behavioral health-related drugs such as
886	antipsychotics, antidepressants, and medications for treating
887	bipolar disorders and other behavioral conditions; translate
888	them into practice; review behavioral health prescribers and
889	compare their prescribing patterns to a number of indicators
890	that are based on national standards; and determine deviations
891	from best practice guidelines.
892	(II)  Implement processes for providing feedback to and
893	educating prescribers using best practice educational materials
894	and peer-to-peer consultation.
895	(III)  Assess Medicaid beneficiaries who are outliers in
896	their use of behavioral health drugs with regard to the numbers
897	and types of drugs taken, drug dosages, combination drug
898	therapies, and other indicators of improper use of behavioral
899	health drugs.
900	(IV)  Alert prescribers to patients who fail to refill
901	prescriptions in a timely fashion, are prescribed multiple same-
902	class behavioral health drugs, and may have other potential
903	medication problems.
904	(V)  Track spending trends for behavioral health drugs and
905	deviation from best practice guidelines.
906	(VI)  Use educational and technological approaches to
907	promote best practices, educate consumers, and train prescribers
908	in the use of practice guidelines.
909	(VII)  Disseminate electronic and published materials.
910	(VIII)  Hold statewide and regional conferences.
911	(IX)  Implement a disease management program with a model
912	quality-based medication component for severely mentally ill
913	individuals and emotionally disturbed children who are high
914	users of care.
915	11.a.  The agency shall implement a Medicaid prescription
916	drug management system. The agency may contract with a vendor
917	that has experience in operating prescription drug management
918	systems in order to implement this system. Any management system
919	that is implemented in accordance with this subparagraph must
920	rely on cooperation between physicians and pharmacists to
921	determine appropriate practice patterns and clinical guidelines
922	to improve the prescribing, dispensing, and use of drugs in the
923	Medicaid program. The agency may seek federal waivers to
924	implement this program.
925	b.  The drug management system must be designed to improve
926	the quality of care and prescribing practices based on best
927	practice guidelines, improve patient adherence to medication
928	plans, reduce clinical risk, and lower prescribed drug costs and
929	the rate of inappropriate spending on Medicaid prescription
930	drugs. The program must:
931	(I)  Provide for the development and adoption of best
932	practice guidelines for the prescribing and use of drugs in the
933	Medicaid program, including translating best practice guidelines
934	into practice; reviewing prescriber patterns and comparing them
935	to indicators that are based on national standards and practice
936	patterns of clinical peers in their community, statewide, and
937	nationally; and determine deviations from best practice
938	guidelines.
939	(II)  Implement processes for providing feedback to and
940	educating prescribers using best practice educational materials
941	and peer-to-peer consultation.
942	(III)  Assess Medicaid recipients who are outliers in their
943	use of a single or multiple prescription drugs with regard to
944	the numbers and types of drugs taken, drug dosages, combination
945	drug therapies, and other indicators of improper use of
946	prescription drugs.
947	(IV)  Alert prescribers to patients who fail to refill
948	prescriptions in a timely fashion, are prescribed multiple drugs
949	that may be redundant or contraindicated, or may have other
950	potential medication problems.
951	(V)  Track spending trends for prescription drugs and
952	deviation from best practice guidelines.
953	(VI)  Use educational and technological approaches to
954	promote best practices, educate consumers, and train prescribers
955	in the use of practice guidelines.
956	(VII)  Disseminate electronic and published materials.
957	(VIII)  Hold statewide and regional conferences.
958	(IX)  Implement disease management programs in cooperation
959	with physicians and pharmacists, along with a model quality-
960	based medication component for individuals having chronic
961	medical conditions.
962	12.  The agency is authorized to contract for drug rebate
963	administration, including, but not limited to, calculating
964	rebate amounts, invoicing manufacturers, negotiating disputes
965	with manufacturers, and maintaining a database of rebate
966	collections.
967	13.  The agency may specify the preferred daily dosing form
968	or strength for the purpose of promoting best practices with
969	regard to the prescribing of certain drugs as specified in the
970	General Appropriations Act and ensuring cost-effective
971	prescribing practices.
972	14.  The agency may require prior authorization for
973	Medicaid-covered prescribed drugs. The agency may, but is not
974	required to, prior-authorize the use of a product:
975	a.  For an indication not approved in labeling;
976	b.  To comply with certain clinical guidelines; or
977	c.  If the product has the potential for overuse, misuse,
978	or abuse.
979
980	The agency may require the prescribing professional to provide
981	information about the rationale and supporting medical evidence
982	for the use of a drug. The agency may post prior authorization
983	criteria and protocol and updates to the list of drugs that are
984	subject to prior authorization on an Internet website without
985	amending its rule or engaging in additional rulemaking.
986	15.  The agency, in conjunction with the Pharmaceutical and
987	Therapeutics Committee, may require age-related prior
988	authorizations for certain prescribed drugs. The agency may
989	preauthorize the use of a drug for a recipient who may not meet
990	the age requirement or may exceed the length of therapy for use
991	of this product as recommended by the manufacturer and approved
992	by the Food and Drug Administration. Prior authorization may
993	require the prescribing professional to provide information
994	about the rationale and supporting medical evidence for the use
995	of a drug.
996	16.  The agency shall implement a step-therapy prior
997	authorization approval process for medications excluded from the
998	preferred drug list. Medications listed on the preferred drug
999	list must be used within the previous 12 months prior to the
1000	alternative medications that are not listed. The step-therapy
1001	prior authorization may require the prescriber to use the
1002	medications of a similar drug class or for a similar medical
1003	indication unless contraindicated in the Food and Drug
1004	Administration labeling. The trial period between the specified
1005	steps may vary according to the medical indication. The step-
1006	therapy approval process shall be developed in accordance with
1007	the committee as stated in s. 409.91195(7) and (8). A drug
1008	product may be approved without meeting the step-therapy prior
1009	authorization criteria if the prescribing physician provides the
1010	agency with additional written medical or clinical documentation
1011	that the product is medically necessary because:
1012	a.  There is not a drug on the preferred drug list to treat
1013	the disease or medical condition which is an acceptable clinical
1014	alternative;
1015	b.  The alternatives have been ineffective in the treatment
1016	of the beneficiary's disease; or
1017	c.  Based on historic evidence and known characteristics of
1018	the patient and the drug, the drug is likely to be ineffective,
1019	or the number of doses have been ineffective.
1020
1021	The agency shall work with the physician to determine the best
1022	alternative for the patient. The agency may adopt rules waiving
1023	the requirements for written clinical documentation for specific
1024	drugs in limited clinical situations.
1025	17.  The agency shall implement a return and reuse program
1026	for drugs dispensed by pharmacies to institutional recipients,
1027	which includes payment of a $5 restocking fee for the
1028	implementation and operation of the program. The return and
1029	reuse program shall be implemented electronically and in a
1030	manner that promotes efficiency. The program must permit a
1031	pharmacy to exclude drugs from the program if it is not
1032	practical or cost-effective for the drug to be included and must
1033	provide for the return to inventory of drugs that cannot be
1034	credited or returned in a cost-effective manner. The agency
1035	shall determine if the program has reduced the amount of
1036	Medicaid prescription drugs which are destroyed on an annual
1037	basis and if there are additional ways to ensure more
1038	prescription drugs are not destroyed which could safely be
1039	reused. The agency's conclusion and recommendations shall be
1040	reported to the Legislature by December 1, 2005.
1041	Section 11.  Notwithstanding s. 430.707, Florida Statutes,
1042	and subject to federal approval of the application to be a site
1043	for the Program of All-inclusive Care for the Elderly, the
1044	Agency for Health Care Administration shall contract with one
1045	private health care organization, the sole member of which is a
1046	private, not-for-profit corporation that owns and manages health
1047	care organizations which provide comprehensive long-term care
1048	services, including nursing home, assisted living, independent
1049	housing, home care, adult day care, and care management, with a
1050	board-certified, trained geriatrician as the medical director.
1051	This organization shall provide these services to frail and
1052	elderly persons who reside in Palm Beach County. The
1053	organization shall be exempt from the requirements of chapter
1054	641, Florida Statutes. The agency, in consultation with the
1055	Department of Elderly Affairs and subject to an appropriation,
1056	shall approve up to 150 initial enrollees in the Program of All-
1057	inclusive Care for the Elderly established by this organization
1058	to serve elderly persons who reside in Palm Beach County.
1059	Section 12.  This act shall take effect July 1, 2011.

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