Florida Senate - 2014         (PROPOSED COMMITTEE BILL) SPB 7100
       
       
        
       FOR CONSIDERATION By the Committee on Appropriations
       
       
       
       
       
       576-02671B-14                                         20147100__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 395.602,
    3         F.S.; revising the definition of rural hospital;
    4         amending s. 409.911, F.S.; updating references to data
    5         to be used for calculations under the disproportionate
    6         share program; amending s. 409.962, F.S.; revising the
    7         term “provider service network”; amending s. 409.972,
    8         F.S.; deleting a requirement relating to medically
    9         needy recipients; amending s. 409.974, F.S.; expressly
   10         providing for contracting with eligible managed care
   11         plans; revising provisions relating to procuring a
   12         provider service network in a region; providing
   13         requirements for termination of a contract with
   14         certain managed care plans; requiring the Children’s
   15         Medical Services Network to operate as a fee-for
   16         service provider service network under certain
   17         conditions; amending s. 409.975, F.S.; deleting a
   18         requirement that a managed care plan accept certain
   19         medically needy recipients; providing effective dates.
   20          
   21  Be It Enacted by the Legislature of the State of Florida:
   22  
   23         Section 1. Paragraph (e) of subsection (2) of section
   24  395.602, Florida Statutes, is amended to read:
   25         395.602 Rural hospitals.—
   26         (2) DEFINITIONS.—As used in this part:
   27         (e) “Rural hospital” means an acute care hospital licensed
   28  under this chapter, having 100 or fewer licensed beds and an
   29  emergency room, which is:
   30         1. The sole provider within a county with a population
   31  density of up to no greater than 100 persons per square mile;
   32         2. An acute care hospital, in a county with a population
   33  density of up to no greater than 100 persons per square mile,
   34  which is at least 30 minutes of travel time, on normally
   35  traveled roads under normal traffic conditions, from any other
   36  acute care hospital within the same county;
   37         3. A hospital supported by a tax district or subdistrict
   38  whose boundaries encompass a population of up to 100 persons or
   39  fewer per square mile;
   40         4. A hospital classified as a sole community hospital under
   41  42 C.F.R. s. 412.92 which has up to 340 licensed beds A hospital
   42  in a constitutional charter county with a population of over 1
   43  million persons that has imposed a local option health service
   44  tax pursuant to law and in an area that was directly impacted by
   45  a catastrophic event on August 24, 1992, for which the Governor
   46  of Florida declared a state of emergency pursuant to chapter
   47  125, and has 120 beds or less that serves an agricultural
   48  community with an emergency room utilization of no less than
   49  20,000 visits and a Medicaid inpatient utilization rate greater
   50  than 15 percent;
   51         5. A hospital with a service area that has a population of
   52  up to 100 persons or fewer per square mile. As used in this
   53  subparagraph, the term “service area” means the fewest number of
   54  zip codes that account for 75 percent of the hospital’s
   55  discharges for the most recent 5-year period, based on
   56  information available from the hospital inpatient discharge
   57  database in the Florida Center for Health Information and Policy
   58  Analysis at the agency; or
   59         6. A hospital designated as a critical access hospital, as
   60  defined in s. 408.07.
   61  
   62  Population densities used in this paragraph must be based upon
   63  the most recently completed United States census. A hospital
   64  that received funds under s. 409.9116 for a quarter beginning no
   65  later than July 1, 2002, is deemed to have been and shall
   66  continue to be a rural hospital from that date through June 30,
   67  2015, if the hospital continues to have up to 100 or fewer
   68  licensed beds and an emergency room, or meets the criteria of
   69  subparagraph 4. An acute care hospital that has not previously
   70  been designated as a rural hospital and that meets the criteria
   71  of this paragraph shall be granted such designation upon
   72  application, including supporting documentation, to the agency.
   73  A hospital that was licensed as a rural hospital during the
   74  2010-2011 or 2011-2012 fiscal year shall continue to be a rural
   75  hospital from the date of designation through June 30, 2015, if
   76  the hospital continues to have up to 100 or fewer licensed beds
   77  and an emergency room.
   78         Section 2. Paragraph (a) of subsection (2) of section
   79  409.911, Florida Statutes, is amended to read:
   80         409.911 Disproportionate share program.—Subject to specific
   81  allocations established within the General Appropriations Act
   82  and any limitations established pursuant to chapter 216, the
   83  agency shall distribute, pursuant to this section, moneys to
   84  hospitals providing a disproportionate share of Medicaid or
   85  charity care services by making quarterly Medicaid payments as
   86  required. Notwithstanding the provisions of s. 409.915, counties
   87  are exempt from contributing toward the cost of this special
   88  reimbursement for hospitals serving a disproportionate share of
   89  low-income patients.
   90         (2) The Agency for Health Care Administration shall use the
   91  following actual audited data to determine the Medicaid days and
   92  charity care to be used in calculating the disproportionate
   93  share payment:
   94         (a) The average of the 2006, 2007, and 2008 2005, 2006, and
   95  2007 audited disproportionate share data to determine each
   96  hospital’s Medicaid days and charity care for the 2014-2015
   97  2013-2014 state fiscal year.
   98         Section 3. Subsection (13) of section 409.962, Florida
   99  Statutes, is amended to read:
  100         409.962 Definitions.—As used in this part, except as
  101  otherwise specifically provided, the term:
  102         (13) “Provider service network” means an entity qualified
  103  pursuant to s. 409.912(4)(d) of which a controlling interest is
  104  owned by a health care provider, or group of affiliated
  105  providers affiliated for the purpose of providing health care,
  106  or a public agency or entity that delivers health services.
  107  Health care providers include Florida-licensed health care
  108  practitioners professionals or licensed health care facilities,
  109  federally qualified health care centers, and home health care
  110  agencies.
  111         Section 4. Effective upon becoming law, Section 409.972,
  112  Florida Statutes, is amended to read:
  113         409.972 Mandatory and voluntary enrollment.—
  114         (1) Persons eligible for the program known as “medically
  115  needy” pursuant to s. 409.904(2) shall enroll in managed care
  116  plans. Medically needy recipients shall meet the share of the
  117  cost by paying the plan premium, up to the share of the cost
  118  amount, contingent upon federal approval.
  119         (1)(2) The following Medicaid-eligible persons are exempt
  120  from mandatory managed care enrollment required by s. 409.965,
  121  and may voluntarily choose to participate in the managed medical
  122  assistance program:
  123         (a) Medicaid recipients who have other creditable health
  124  care coverage, excluding Medicare.
  125         (b) Medicaid recipients residing in residential commitment
  126  facilities operated through the Department of Juvenile Justice
  127  or mental health treatment facilities as defined by s.
  128  394.455(32).
  129         (c) Persons eligible for refugee assistance.
  130         (d) Medicaid recipients who are residents of a
  131  developmental disability center, including Sunland Center in
  132  Marianna and Tacachale in Gainesville.
  133         (e) Medicaid recipients enrolled in the home and community
  134  based services waiver pursuant to chapter 393, and Medicaid
  135  recipients waiting for waiver services.
  136         (f) Medicaid recipients residing in a group home facility
  137  licensed under chapter 393.
  138         (2)(3) Persons eligible for Medicaid but exempt from
  139  mandatory participation who do not choose to enroll in managed
  140  care shall be served in the Medicaid fee-for-service program as
  141  provided under in part III of this chapter.
  142         (3)(4) The agency shall seek federal approval to require
  143  Medicaid recipients enrolled in managed care plans, as a
  144  condition of Medicaid eligibility, to pay the Medicaid program a
  145  share of the premium of $10 per month.
  146         Section 5. Subsection (1) of section 409.974, Florida
  147  Statutes, is amended to read:
  148         409.974 Eligible plans.—
  149         (1) ELIGIBLE PLAN SELECTION.—The agency shall select and
  150  contract with eligible plans through the procurement process
  151  described in s. 409.966. The agency shall notice invitations to
  152  negotiate by no later than January 1, 2013.
  153         (a) The agency shall procure and contract with two plans
  154  for Region 1. At least one plan shall be a provider service
  155  network if any provider service networks submit a responsive
  156  bid.
  157         (b) The agency shall procure and contract with two plans
  158  for Region 2. At least one plan shall be a provider service
  159  network if any provider service networks submit a responsive
  160  bid.
  161         (c) The agency shall procure and contract with at least
  162  three plans and up to five plans for Region 3. At least one plan
  163  must be a provider service network if any provider service
  164  networks submit a responsive bid.
  165         (d) The agency shall procure and contract with at least
  166  three plans and up to five plans for Region 4. At least one plan
  167  must be a provider service network if any provider service
  168  networks submit a responsive bid.
  169         (e) The agency shall procure and contract with at least two
  170  plans and up to four plans for Region 5. At least one plan must
  171  be a provider service network if any provider service networks
  172  submit a responsive bid.
  173         (f) The agency shall procure and contract with at least
  174  four plans and up to seven plans for Region 6. At least one plan
  175  must be a provider service network if any provider service
  176  networks submit a responsive bid.
  177         (g) The agency shall procure and contract with at least
  178  three plans and up to six plans for Region 7. At least one plan
  179  must be a provider service network if any provider service
  180  networks submit a responsive bid.
  181         (h) The agency shall procure and contract with at least two
  182  plans and up to four plans for Region 8. At least one plan must
  183  be a provider service network if any provider service networks
  184  submit a responsive bid.
  185         (i) The agency shall procure and contract with at least two
  186  plans and up to four plans for Region 9. At least one plan must
  187  be a provider service network if any provider service networks
  188  submit a responsive bid.
  189         (j) The agency shall procure and contract with at least two
  190  plans and up to four plans for Region 10. At least one plan must
  191  be a provider service network if any provider service networks
  192  submit a responsive bid.
  193         (k) The agency shall procure and contract with at least
  194  five plans and up to 10 plans for Region 11. At least one plan
  195  must be a provider service network if any provider service
  196  networks submit a responsive bid.
  197  
  198  If no provider service network submits a responsive bid, the
  199  agency shall procure up to no more than one less than the
  200  maximum number of eligible plans permitted in that region and,.
  201  within the next 12 months after the initial invitation to
  202  negotiate, shall issue an invitation to negotiate in order the
  203  agency shall attempt to procure and contract with a provider
  204  service network. In a region in which the agency has contracted
  205  with only one provider service network and changes in the
  206  ownership or business structure of the network result in the
  207  network no longer meeting the definition of a provider service
  208  network under s. 409.962, the agency must, within the next 12
  209  months, terminate the contract, provide shall notice of another
  210  invitation to negotiate, and procure and contract only with a
  211  provider service network in that region networks in those
  212  regions where no provider service network has been selected.
  213         Section 6. Effective upon becoming law, subsection (4) of
  214  section 409.974, Florida Statutes, is amended to read:
  215         409.974 Eligible plans.—
  216         (4) CHILDREN’S MEDICAL SERVICES NETWORK.— Participation by
  217  the Children’s Medical Services Network shall be pursuant to a
  218  single, statewide contract with the agency that is not subject
  219  to the procurement requirements or regional plan number limits
  220  of this section. Following the successful completion of a
  221  readiness review, the Children’s Medical Services Network shall
  222  operate as a fee-for-service provider service network with
  223  periodic reconciliations until July 1 of the fiscal year
  224  following the date on which the network qualifies to operate as
  225  a prepaid plan. While operating as a fee-for-service provider
  226  service network, the Children’s Medical Services Network shall
  227  use the agency’s third-party administrator for paying claims and
  228  related duties. The Children’s Medical Services Network must
  229  meet all other plan requirements for the managed medical
  230  assistance program.
  231         Section 7. Effective upon becoming law, subsection (7) of
  232  section 409.975, Florida Statutes, is amended to read:
  233         409.975 Managed care plan accountability.—In addition to
  234  the requirements of s. 409.967, plans and providers
  235  participating in the managed medical assistance program shall
  236  comply with the requirements of this section.
  237         (7) MEDICALLY NEEDY ENROLLEES.—Each managed care plan must
  238  accept any medically needy recipient who selects or is assigned
  239  to the plan and provide that recipient with continuous
  240  enrollment for 12 months. After the first month of qualifying as
  241  a medically needy recipient and enrolling in a plan, and
  242  contingent upon federal approval, the enrollee shall pay the
  243  plan a portion of the monthly premium equal to the enrollee’s
  244  share of the cost as determined by the department. The agency
  245  shall pay any remaining portion of the monthly premium. Plans
  246  are not obligated to pay claims for medically needy patients for
  247  services provided before enrollment in the plan. Medically needy
  248  patients are responsible for payment of incurred claims that are
  249  used to determine eligibility. Plans must provide a grace period
  250  of at least 90 days before disenrolling recipients who fail to
  251  pay their shares of the premium.
  252         Section 8. Except as otherwise expressly provided in this
  253  act and except for this section, which shall take effect upon
  254  this act becoming law, this act shall take effect July 1, 2014.