HB 727

1	A bill to be entitled
2	An act relating to Medicaid managed care plans;
3	amending s. 409.9122, F.S.; requiring the Agency for
4	Health Care Administration to establish per-member,
5	per-month payments; substituting the Medicare
6	Advantage Coordinated Care Plan for the Medicare
7	Advantage Special Needs Plan; amending s. 409.962,
8	F.S.; revising the definition of "eligible plan" to
9	include certain Medicare plans; amending s. 409.967,
10	F.S.; limiting the penalty that a plan must pay if it
11	leaves a region before the end of the contract term;
12	amending s. 409.974, F.S.; correcting a cross-
13	reference; providing that certain Medicare plans are
14	not subject to procurement requirements or plan
15	limits; amending s. 409.977, F.S.; requiring dually
16	eligible Medicaid recipients to be enrolled in the
17	Medicare plan in which they are already enrolled;
18	amending s. 409.981, F.S.; revising the list of
19	Medicare plans that are not subject to procurement
20	requirements for long-term plans; amending s. 409.984,
21	F.S.; revising the list of Medicare plans in which
22	dually eligible Medicaid recipients are enrolled in
23	order to receive long-term care; providing an
24	effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1.  Subsection (15) of section 409.9122, Florida
29	Statutes, is amended to read:
30	409.9122  Mandatory Medicaid managed care enrollment;
31	programs and procedures.-
32	(15)  The agency shall may establish a per-member, per-
33	month payment for enrollees who are enrolled in a Medicare
34	Advantage Coordinated Care Plan and who Medicare Advantage
35	Special Needs members that are also eligible for Medicaid as a
36	mechanism for meeting the state's cost-sharing obligation. The
37	agency may also develop a per-member, per-month payment only for
38	Medicaid-covered services for which the state is responsible.
39	The agency shall develop a mechanism to ensure that such per-
40	member, per-month payment enhances the value to the state and
41	enrolled members by limiting cost sharing, enhances the scope of
42	Medicare supplemental benefits that are equal to or greater than
43	Medicaid coverage for select services, and improves care
44	coordination.
45	Section 2.  Subsection (6) of section 409.962, Florida
46	Statutes, is amended to read:
47	409.962  Definitions.-As used in this part, except as
48	otherwise specifically provided, the term:
49	(6)  "Eligible plan" means a health insurer authorized
50	under chapter 624, an exclusive provider organization authorized
51	under chapter 627, a health maintenance organization authorized
52	under chapter 641, or a provider service network authorized
53	under s. 409.912(4)(d), or an accountable care organization
54	authorized under federal law. For purposes of the managed
55	medical assistance program, the term also includes the
56	Children's Medical Services Network authorized under chapter
57	391. For purposes of dually eligible Medicaid and Medicare
58	recipients enrolled in the managed medical assistance program
59	and the long-term care managed care program, the term also
60	includes entities qualified under 42 C.F.R. part 422 as Medicare
61	Advantage Preferred Provider Organizations, Medicare Advantage
62	Provider-sponsored Organizations, Medicare Advantage Health
63	Maintenance Organizations, Medicare Advantage Coordinated Care
64	Plans, and Medicare Advantage Special Needs Plans, and the
65	Program of All-inclusive Care for the Elderly.
66	Section 3.  Paragraph (h) of subsection (2) of section
67	409.967, Florida Statutes, is amended to read:
68	409.967  Managed care plan accountability.-
69	(2)  The agency shall establish such contract requirements
70	as are necessary for the operation of the statewide managed care
71	program. In addition to any other provisions the agency may deem
72	necessary, the contract must require:
73	(h)  Penalties.-
74	1.  Withdrawal and enrollment reduction.-Managed care plans
75	that reduce enrollment levels or leave a region before the end
76	of the contract term must reimburse the agency for the cost of
77	enrollment changes and other transition activities. If more than
78	one plan leaves a region at the same time, costs must be shared
79	by the departing plans proportionate to their enrollments. In
80	addition to the payment of costs, departing provider services
81	networks must pay a per-enrollee per enrollee penalty of up to 3
82	months' payment and continue to provide services to the enrollee
83	for 90 days or until the enrollee is enrolled in another plan,
84	whichever occurs first. In addition to payment of costs, all
85	other departing plans must pay a penalty of 25 percent of that
86	portion of the minimum surplus maintained requirement pursuant
87	to s. 641.225(1) which is attributable to the provision of
88	coverage to Medicaid enrollees. Plans shall provide at least 180
89	days' notice to the agency before withdrawing from a region. If
90	a managed care plan leaves a region before the end of the
91	contract term, the agency shall terminate all contracts with
92	that plan in other regions, pursuant to the termination
93	procedures in subparagraph 3.
94	2.  Encounter data.-If a plan fails to comply with the
95	encounter data reporting requirements of this section for 30
96	days, the agency must assess a fine of $5,000 per day for each
97	day of noncompliance beginning on the 31st day. On the 31st day,
98	the agency must notify the plan that the agency will initiate
99	contract termination procedures on the 90th day unless the plan
100	comes into compliance before that date.
101	3.  Termination.-If the agency terminates more than one
102	regional contract with the same managed care plan due to
103	noncompliance with the requirements of this section, the agency
104	shall terminate all the regional contracts held by that plan.
105	When terminating multiple contracts, the agency must develop a
106	plan to provide for the transition of enrollees to other plans,
107	and phase in phase-in the terminations over a time period
108	sufficient to ensure a smooth transition.
109	Section 4.  Subsection (2) of section 409.974, Florida
110	Statutes, is amended, and subsection (5) is added to that
111	section, to read:
112	409.974  Eligible plans.-
113	(2)  QUALITY SELECTION CRITERIA.-In addition to the
114	criteria established in s. 409.966, the agency shall consider
115	evidence that an eligible plan has written agreements or signed
116	contracts or has made substantial progress in establishing
117	relationships with providers before the plan submitted
118	submitting a response. The agency shall evaluate and give
119	special weight to evidence of signed contracts with essential
120	providers as determined defined by the agency pursuant to s.
121	409.975(1) 409.975(2). The agency shall exercise a preference
122	for plans with a provider network in which more than over 10
123	percent of the providers use electronic health records, as
124	defined in s. 408.051. When all other factors are equal, the
125	agency shall consider whether the organization has a contract to
126	provide managed long-term care services in the same region and
127	shall exercise a preference for such plans.
128	(5)  MEDICARE PLANS.-Participation by an entity qualified
129	under 42 C.F.R. PART 422 as a Medicare Advantage Preferred
130	Provider Organization, Medicare Advantage Provider-sponsored
131	Organization, Medicare Advantage Health Maintenance
132	Organization, Medicare Advantage Coordinated Care Plan, or
133	Medicare Advantage Special Needs Plan shall be pursuant to a
134	contract with the agency and is not subject to the procurement
135	requirements or regional plan limits of this section if the
136	plan's Medicaid enrollees in the region consist exclusively of
137	recipients who are dually eligible for Medicaid and Medicare
138	services. Otherwise, such organizations and plans must meet all
139	other plan requirements.
140	Section 5.  Subsection (1) of section 409.977, Florida
141	Statutes, is amended to read:
142	409.977  Enrollment.-
143	(1)  The agency shall automatically enroll into a managed
144	care plan those Medicaid recipients who do not voluntarily
145	choose a plan pursuant to s. 409.969. The agency shall
146	automatically enroll recipients in plans that meet or exceed the
147	performance or quality standards established pursuant to s.
148	409.967 and may not automatically enroll recipients in a plan
149	that is deficient in those performance or quality standards. If
150	When a specialty plan is available to accommodate a specific
151	condition or diagnosis of a recipient, the agency shall assign
152	the recipient to that plan. In the first year of the first
153	contract term only, if a recipient was previously enrolled in a
154	plan that is still available in the region, the agency shall
155	automatically enroll the recipient in that plan unless an
156	applicable specialty plan is available. If a recipient is dually
157	eligible for Medicaid and Medicare services and is currently
158	receiving Medicare services from an entity listed in s.
159	409.974(5), the agency shall automatically enroll the recipient
160	in that plan for Medicaid services if the plan is currently
161	under contract with the agency pursuant to s. 409.974(5). Except
162	as otherwise provided in this part, the agency may not engage in
163	practices that are designed to favor one managed care plan over
164	another.
165	Section 6.  Subsection (5) of section 409.981, Florida
166	Statutes, is amended to read:
167	409.981  Eligible long-term care plans.-
168	(5)  MEDICARE PLANS.-Participation by a Medicare Advantage
169	Preferred Provider Organization, Medicare Advantage Provider-
170	sponsored Organization, Medicare Advantage Health Maintenance
171	Organization, Medicare Advantage Coordinated Care Plan, or
172	Medicare Advantage Special Needs Plan shall be pursuant to a
173	contract with the agency and is not subject to the procurement
174	requirements if the plan's Medicaid enrollees consist
175	exclusively of recipients who are deemed dually eligible for
176	Medicaid and Medicare services. Otherwise, such organizations
177	and plans Medicare Advantage Preferred Provider Organizations,
178	Medicare Advantage Provider-sponsored Organizations, and
179	Medicare Advantage Special Needs Plans are subject to all
180	procurement requirements.
181	Section 7.  Subsection (1) of section 409.984, Florida
182	Statutes, is amended to read:
183	409.984  Enrollment in a long-term care managed care plan.-
184	(1)  The agency shall automatically enroll into a long-term
185	care managed care plan those Medicaid recipients who do not
186	voluntarily choose a plan pursuant to s. 409.969. The agency
187	shall automatically enroll recipients in plans that meet or
188	exceed the performance or quality standards established pursuant
189	to s. 409.967 and may not automatically enroll recipients in a
190	plan that is deficient in those performance or quality
191	standards. If a recipient is deemed dually eligible for Medicaid
192	and Medicare services and is currently receiving Medicare
193	services from an entity qualified under 42 C.F.R. part 422 as a
194	Medicare Advantage Preferred Provider Organization, Medicare
195	Advantage Provider-sponsored Organization, Medicare Advantage
196	Health Maintenance Organization, Medicare Advantage Coordinated
197	Care Plan, or Medicare Advantage Special Needs Plan, the agency
198	shall automatically enroll the recipient in such plan for
199	Medicaid services if the plan is under contract with the agency
200	currently participating in the long-term care managed care
201	program. Except as otherwise provided in this part, the agency
202	may not engage in practices that are designed to favor one
203	managed care plan over another.
204	Section 8.  This act shall take effect July 1, 2012.

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