Florida Senate - 2014                                    SB 1726
       By the Committee on Children, Families, and Elder Affairs
       586-03534-14                                          20141726__
    1                        A bill to be entitled                      
    2         An act relating to reimbursement for crisis
    3         stabilization unit services; amending s. 394.9082,
    4         F.S.; requiring the Department of Children and
    5         Families to require that managing entities implement a
    6         specified reimbursement methodology by a specified
    7         date; providing requirements for managing entities,
    8         providers, and the reimbursement methodology;
    9         requiring the department to establish uniform
   10         standards for claims data submitted by providers;
   11         requiring the department to establish a statewide
   12         database of claims data; requiring the department and
   13         managing entities to maintain the security of claims
   14         data; requiring the department to submit a report to
   15         the Legislature by a specified date; providing
   16         requirements for such report; providing an effective
   17         date.
   19  Be It Enacted by the Legislature of the State of Florida:
   21         Section 1. Present subsections (10) and (11) of section
   22  394.9082, Florida Statutes, are redesignated as subsections (11)
   23  and (12), respectively, and a new subsection (10) is added to
   24  that section, to read:
   25         394.9082 Behavioral health managing entities.—
   27  department shall require managing entities to implement a
   28  reimbursement methodology for crisis stabilization unit services
   29  consistent with this subsection by January 1, 2015.
   30         (a) Each managing entity shall enter into agreements with
   31  all providers qualified to serve as receiving facilities as
   32  defined in s. 394.455 and located within the managing entity’s
   33  designated service area. If a private receiving facility does
   34  not choose to participate it cannot be paid by the managing
   35  entity for involuntary care. A crisis stabilization unit may not
   36  be a private receiving facility pursuant to s. 394.875.
   37         (b) Using no more than one-quarter of the funds provided to
   38  the managing entity for crisis stabilization services, the
   39  managing entity shall allocate a base funding amount to each
   40  receiving facility with a signed agreement entered into pursuant
   41  to paragraph (a) which exceeded a minimum utilization level
   42  specified by the managing entity. The amount of the base funding
   43  for each receiving facility shall be proportionate to the number
   44  of involuntary admissions to the receiving facility in the prior
   45  fiscal year and shall be updated annually.
   46         (c) The remainder of the funds provided for crisis
   47  stabilization services shall be used by the managing entity to
   48  provide per diem reimbursement to receiving facilities with a
   49  signed agreement entered into pursuant to paragraph (a). The per
   50  diem payment shall be made when a claim is submitted by the
   51  receiving facility following a patient’s discharge and verified
   52  by the managing entity. The claim must document the following:
   53         1. The identity of the patient;
   54         2. The date of the admission;
   55         3. The date of discharge;
   56         4. The lack of any third-party coverage;
   57         5. The services provided during the patient’s stay; and
   58         6. The status of the patient’s discharge, whether to his or
   59  her home or to another receiving facility.
   60         (d) Each managing entity shall define a standard per diem
   61  reimbursement rate for the service area based on the available
   62  funds, cost of service, and the expected total days of care in
   63  the area.
   64         (e) The total payment for each claim shall be the per diem
   65  rate set by the managing entity multiplied by the days of care
   66  provided.
   67         (f) The managing entity may establish caps for the amount
   68  of reimbursements each receiving facility with a signed
   69  agreement entered into pursuant to paragraph (a) may earn each
   70  month. Such caps must be part of the written agreement and must
   71  be proportionate to the days of care provided by each receiving
   72  facility.
   73         (g) If, after 3 months, the total paid reimbursements
   74  during the period are less than one-quarter of the funds
   75  available for this purpose, the managing entity shall distribute
   76  the remaining funds in an amount proportionate to the days of
   77  care provided by each receiving facility with a signed agreement
   78  entered into pursuant to paragraph (a).
   79         (h) By signing an agreement entered into pursuant to
   80  paragraph (a), a provider certifies its willingness to accept
   81  all patients and agrees that the base funding plus the claims
   82  based reimbursement as adjudicated by the managing entity
   83  constitutes payment in full for services rendered to involuntary
   84  patients.
   85         (i) The department shall establish uniform standards for
   86  the data that providers must submit with reimbursement claims
   87  and shall establish a statewide database to compile claims data
   88  from all managing entities in order to track use of crisis
   89  stabilization services regardless of available funding.
   90         (j) The department and the managing entities shall maintain
   91  the security of the claims data consistent with state and
   92  federal law.
   93         (k) By January 31, 2016, and annually thereafter, the
   94  department shall submit a report to the Governor, the President
   95  of the Senate, and the Speaker of the House of Representatives
   96  which provides details on the provider participation and patient
   97  services provided in each service area. The report must describe
   98  the expenditure of funds pursuant to this section, including the
   99  base allocations and per diem rates in each service area, the
  100  total per diem reimbursements by provider, the amount of any
  101  quarterly disbursements, and the amount of unfunded care in each
  102  service area.
  103         Section 2. This act shall take effect July 1, 2014.