Florida Senate - 2017                                     SB 694
       By Senator Hutson
       7-00482A-17                                            2017694__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 409.904,
    3         F.S.; authorizing any state agency or department
    4         involved in providing health, social, or human
    5         services to make payments for medical assistance for
    6         certain persons diagnosed with Acquired Immune
    7         Deficiency Syndrome (AIDS); amending s. 409.906, F.S.;
    8         removing the Agency for Health Care Administration’s
    9         ability to consolidate certain home and community
   10         based services; amending s. 409.912, F.S.; deleting
   11         the requirement that the agency implement a Medicaid
   12         prescription drug management system; amending s.
   13         409.979, F.S.; requiring that Medicaid recipients
   14         enrolled in certain home and community-based service
   15         Medicaid waivers be transitioned into the long-term
   16         care managed care program by January 1, 2018;
   17         requiring the agency to seek federal approval to
   18         terminate certain waiver programs once all eligible
   19         Medicaid recipients have transitioned into the long
   20         term care managed care program; amending ss. 393.0661
   21         and 409.968, F.S.; conforming cross-references;
   22         providing an effective date.
   24  Be It Enacted by the Legislature of the State of Florida:
   26         Section 1. Subsection (11) is added to section 409.904,
   27  Florida Statutes, to read:
   28         409.904 Optional payments for eligible persons.—The agency
   29  may make payments for medical assistance and related services on
   30  behalf of the following persons who are determined to be
   31  eligible subject to the income, assets, and categorical
   32  eligibility tests set forth in federal and state law. Payment on
   33  behalf of these Medicaid eligible persons is subject to the
   34  availability of moneys and any limitations established by the
   35  General Appropriations Act or chapter 216.
   36         (11) Subject to federal waiver approval, a person diagnosed
   37  with Acquired Immune Deficiency Syndrome (AIDS), who has an
   38  AIDS-related opportunistic infection, who is at risk of
   39  hospitalization as determined by the agency or its designee, and
   40  whose income is at, or below, 300 percent of the federal benefit
   41  rate.
   42         Section 2. Paragraph (b) of subsection (13) of section
   43  409.906, Florida Statutes, is amended to read:
   44         409.906 Optional Medicaid services.—Subject to specific
   45  appropriations, the agency may make payments for services which
   46  are optional to the state under Title XIX of the Social Security
   47  Act and are furnished by Medicaid providers to recipients who
   48  are determined to be eligible on the dates on which the services
   49  were provided. Any optional service that is provided shall be
   50  provided only when medically necessary and in accordance with
   51  state and federal law. Optional services rendered by providers
   52  in mobile units to Medicaid recipients may be restricted or
   53  prohibited by the agency. Nothing in this section shall be
   54  construed to prevent or limit the agency from adjusting fees,
   55  reimbursement rates, lengths of stay, number of visits, or
   56  number of services, or making any other adjustments necessary to
   57  comply with the availability of moneys and any limitations or
   58  directions provided for in the General Appropriations Act or
   59  chapter 216. If necessary to safeguard the state’s systems of
   60  providing services to elderly and disabled persons and subject
   61  to the notice and review provisions of s. 216.177, the Governor
   62  may direct the Agency for Health Care Administration to amend
   63  the Medicaid state plan to delete the optional Medicaid service
   64  known as “Intermediate Care Facilities for the Developmentally
   65  Disabled.” Optional services may include:
   67         (b) The agency may consolidate types of services offered in
   68  the Aged and Disabled Waiver, the Channeling Waiver, the Project
   69  AIDS Care Waiver, and the Traumatic Brain and Spinal Cord Injury
   70  Waiver programs in order to group similar services under a
   71  single service, or continue a service upon evidence of the need
   72  for including a particular service type in a particular waiver.
   73  The agency is authorized to seek a Medicaid state plan amendment
   74  or federal waiver approval to implement this policy.
   75         Section 3. Paragraph (a) of subsection (8) of section
   76  409.912, Florida Statutes, is amended to read:
   77         409.912 Cost-effective purchasing of health care.—The
   78  agency shall purchase goods and services for Medicaid recipients
   79  in the most cost-effective manner consistent with the delivery
   80  of quality medical care. To ensure that medical services are
   81  effectively utilized, the agency may, in any case, require a
   82  confirmation or second physician’s opinion of the correct
   83  diagnosis for purposes of authorizing future services under the
   84  Medicaid program. This section does not restrict access to
   85  emergency services or poststabilization care services as defined
   86  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
   87  shall be rendered in a manner approved by the agency. The agency
   88  shall maximize the use of prepaid per capita and prepaid
   89  aggregate fixed-sum basis services when appropriate and other
   90  alternative service delivery and reimbursement methodologies,
   91  including competitive bidding pursuant to s. 287.057, designed
   92  to facilitate the cost-effective purchase of a case-managed
   93  continuum of care. The agency shall also require providers to
   94  minimize the exposure of recipients to the need for acute
   95  inpatient, custodial, and other institutional care and the
   96  inappropriate or unnecessary use of high-cost services. The
   97  agency shall contract with a vendor to monitor and evaluate the
   98  clinical practice patterns of providers in order to identify
   99  trends that are outside the normal practice patterns of a
  100  provider’s professional peers or the national guidelines of a
  101  provider’s professional association. The vendor must be able to
  102  provide information and counseling to a provider whose practice
  103  patterns are outside the norms, in consultation with the agency,
  104  to improve patient care and reduce inappropriate utilization.
  105  The agency may mandate prior authorization, drug therapy
  106  management, or disease management participation for certain
  107  populations of Medicaid beneficiaries, certain drug classes, or
  108  particular drugs to prevent fraud, abuse, overuse, and possible
  109  dangerous drug interactions. The Pharmaceutical and Therapeutics
  110  Committee shall make recommendations to the agency on drugs for
  111  which prior authorization is required. The agency shall inform
  112  the Pharmaceutical and Therapeutics Committee of its decisions
  113  regarding drugs subject to prior authorization. The agency is
  114  authorized to limit the entities it contracts with or enrolls as
  115  Medicaid providers by developing a provider network through
  116  provider credentialing. The agency may competitively bid single
  117  source-provider contracts if procurement of goods or services
  118  results in demonstrated cost savings to the state without
  119  limiting access to care. The agency may limit its network based
  120  on the assessment of beneficiary access to care, provider
  121  availability, provider quality standards, time and distance
  122  standards for access to care, the cultural competence of the
  123  provider network, demographic characteristics of Medicaid
  124  beneficiaries, practice and provider-to-beneficiary standards,
  125  appointment wait times, beneficiary use of services, provider
  126  turnover, provider profiling, provider licensure history,
  127  previous program integrity investigations and findings, peer
  128  review, provider Medicaid policy and billing compliance records,
  129  clinical and medical record audits, and other factors. Providers
  130  are not entitled to enrollment in the Medicaid provider network.
  131  The agency shall determine instances in which allowing Medicaid
  132  beneficiaries to purchase durable medical equipment and other
  133  goods is less expensive to the Medicaid program than long-term
  134  rental of the equipment or goods. The agency may establish rules
  135  to facilitate purchases in lieu of long-term rentals in order to
  136  protect against fraud and abuse in the Medicaid program as
  137  defined in s. 409.913. The agency may seek federal waivers
  138  necessary to administer these policies.
  139         (8)(a) The agency shall implement a Medicaid prescribed
  140  drug spending-control program that includes the following
  141  components:
  142         1. A Medicaid preferred drug list, which shall be a listing
  143  of cost-effective therapeutic options recommended by the
  144  Medicaid Pharmacy and Therapeutics Committee established
  145  pursuant to s. 409.91195 and adopted by the agency for each
  146  therapeutic class on the preferred drug list. At the discretion
  147  of the committee, and when feasible, the preferred drug list
  148  should include at least two products in a therapeutic class. The
  149  agency may post the preferred drug list and updates to the list
  150  on an Internet website without following the rulemaking
  151  procedures of chapter 120. Antiretroviral agents are excluded
  152  from the preferred drug list. The agency shall also limit the
  153  amount of a prescribed drug dispensed to no more than a 34-day
  154  supply unless the drug products’ smallest marketed package is
  155  greater than a 34-day supply, or the drug is determined by the
  156  agency to be a maintenance drug in which case a 100-day maximum
  157  supply may be authorized. The agency may seek any federal
  158  waivers necessary to implement these cost-control programs and
  159  to continue participation in the federal Medicaid rebate
  160  program, or alternatively to negotiate state-only manufacturer
  161  rebates. The agency may adopt rules to administer this
  162  subparagraph. The agency shall continue to provide unlimited
  163  contraceptive drugs and items. The agency must establish
  164  procedures to ensure that:
  165         a. There is a response to a request for prior consultation
  166  by telephone or other telecommunication device within 24 hours
  167  after receipt of a request for prior consultation; and
  168         b. A 72-hour supply of the drug prescribed is provided in
  169  an emergency or when the agency does not provide a response
  170  within 24 hours as required by sub-subparagraph a.
  171         2. Reimbursement to pharmacies for Medicaid prescribed
  172  drugs shall be set at the lowest of: the average wholesale price
  173  (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
  174  plus 1.5 percent, the federal upper limit (FUL), the state
  175  maximum allowable cost (SMAC), or the usual and customary (UAC)
  176  charge billed by the provider.
  177         3. The agency shall develop and implement a process for
  178  managing the drug therapies of Medicaid recipients who are using
  179  significant numbers of prescribed drugs each month. The
  180  management process may include, but is not limited to,
  181  comprehensive, physician-directed medical-record reviews, claims
  182  analyses, and case evaluations to determine the medical
  183  necessity and appropriateness of a patient’s treatment plan and
  184  drug therapies. The agency may contract with a private
  185  organization to provide drug-program-management services. The
  186  Medicaid drug benefit management program shall include
  187  initiatives to manage drug therapies for HIV/AIDS patients,
  188  patients using 20 or more unique prescriptions in a 180-day
  189  period, and the top 1,000 patients in annual spending. The
  190  agency shall enroll any Medicaid recipient in the drug benefit
  191  management program if he or she meets the specifications of this
  192  provision and is not enrolled in a Medicaid health maintenance
  193  organization.
  194         4. The agency may limit the size of its pharmacy network
  195  based on need, competitive bidding, price negotiations,
  196  credentialing, or similar criteria. The agency shall give
  197  special consideration to rural areas in determining the size and
  198  location of pharmacies included in the Medicaid pharmacy
  199  network. A pharmacy credentialing process may include criteria
  200  such as a pharmacy’s full-service status, location, size,
  201  patient educational programs, patient consultation, disease
  202  management services, and other characteristics. The agency may
  203  impose a moratorium on Medicaid pharmacy enrollment if it is
  204  determined that it has a sufficient number of Medicaid
  205  participating providers. The agency must allow dispensing
  206  practitioners to participate as a part of the Medicaid pharmacy
  207  network regardless of the practitioner’s proximity to any other
  208  entity that is dispensing prescription drugs under the Medicaid
  209  program. A dispensing practitioner must meet all credentialing
  210  requirements applicable to his or her practice, as determined by
  211  the agency.
  212         5. The agency shall develop and implement a program that
  213  requires Medicaid practitioners who prescribe drugs to use a
  214  counterfeit-proof prescription pad for Medicaid prescriptions.
  215  The agency shall require the use of standardized counterfeit
  216  proof prescription pads by Medicaid-participating prescribers or
  217  prescribers who write prescriptions for Medicaid recipients. The
  218  agency may implement the program in targeted geographic areas or
  219  statewide.
  220         6. The agency may enter into arrangements that require
  221  manufacturers of generic drugs prescribed to Medicaid recipients
  222  to provide rebates of at least 15.1 percent of the average
  223  manufacturer price for the manufacturer’s generic products.
  224  These arrangements shall require that if a generic-drug
  225  manufacturer pays federal rebates for Medicaid-reimbursed drugs
  226  at a level below 15.1 percent, the manufacturer must provide a
  227  supplemental rebate to the state in an amount necessary to
  228  achieve a 15.1-percent rebate level.
  229         7. The agency may establish a preferred drug list as
  230  described in this subsection, and, pursuant to the establishment
  231  of such preferred drug list, negotiate supplemental rebates from
  232  manufacturers that are in addition to those required by Title
  233  XIX of the Social Security Act and at no less than 14 percent of
  234  the average manufacturer price as defined in 42 U.S.C. s. 1936
  235  on the last day of a quarter unless the federal or supplemental
  236  rebate, or both, equals or exceeds 29 percent. There is no upper
  237  limit on the supplemental rebates the agency may negotiate. The
  238  agency may determine that specific products, brand-name or
  239  generic, are competitive at lower rebate percentages. Agreement
  240  to pay the minimum supplemental rebate percentage guarantees a
  241  manufacturer that the Medicaid Pharmaceutical and Therapeutics
  242  Committee will consider a product for inclusion on the preferred
  243  drug list. However, a pharmaceutical manufacturer is not
  244  guaranteed placement on the preferred drug list by simply paying
  245  the minimum supplemental rebate. Agency decisions will be made
  246  on the clinical efficacy of a drug and recommendations of the
  247  Medicaid Pharmaceutical and Therapeutics Committee, as well as
  248  the price of competing products minus federal and state rebates.
  249  The agency may contract with an outside agency or contractor to
  250  conduct negotiations for supplemental rebates. For the purposes
  251  of this section, the term “supplemental rebates” means cash
  252  rebates. Value-added programs as a substitution for supplemental
  253  rebates are prohibited. The agency may seek any federal waivers
  254  to implement this initiative.
  255         8. The agency shall expand home delivery of pharmacy
  256  products. The agency may amend the state plan and issue a
  257  procurement, as necessary, in order to implement this program.
  258  The procurements must include agreements with a pharmacy or
  259  pharmacies located in the state to provide mail order delivery
  260  services at no cost to the recipients who elect to receive home
  261  delivery of pharmacy products. The procurement must focus on
  262  serving recipients with chronic diseases for which pharmacy
  263  expenditures represent a significant portion of Medicaid
  264  pharmacy expenditures or which impact a significant portion of
  265  the Medicaid population. The agency may seek and implement any
  266  federal waivers necessary to implement this subparagraph.
  267         9. The agency shall limit to one dose per month any drug
  268  prescribed to treat erectile dysfunction.
  269         10.a. The agency may implement a Medicaid behavioral drug
  270  management system. The agency may contract with a vendor that
  271  has experience in operating behavioral drug management systems
  272  to implement this program. The agency may seek federal waivers
  273  to implement this program.
  274         b. The agency, in conjunction with the Department of
  275  Children and Families, may implement the Medicaid behavioral
  276  drug management system that is designed to improve the quality
  277  of care and behavioral health prescribing practices based on
  278  best practice guidelines, improve patient adherence to
  279  medication plans, reduce clinical risk, and lower prescribed
  280  drug costs and the rate of inappropriate spending on Medicaid
  281  behavioral drugs. The program may include the following
  282  elements:
  283         (I) Provide for the development and adoption of best
  284  practice guidelines for behavioral health-related drugs such as
  285  antipsychotics, antidepressants, and medications for treating
  286  bipolar disorders and other behavioral conditions; translate
  287  them into practice; review behavioral health prescribers and
  288  compare their prescribing patterns to a number of indicators
  289  that are based on national standards; and determine deviations
  290  from best practice guidelines.
  291         (II) Implement processes for providing feedback to and
  292  educating prescribers using best practice educational materials
  293  and peer-to-peer consultation.
  294         (III) Assess Medicaid beneficiaries who are outliers in
  295  their use of behavioral health drugs with regard to the numbers
  296  and types of drugs taken, drug dosages, combination drug
  297  therapies, and other indicators of improper use of behavioral
  298  health drugs.
  299         (IV) Alert prescribers to patients who fail to refill
  300  prescriptions in a timely fashion, are prescribed multiple same
  301  class behavioral health drugs, and may have other potential
  302  medication problems.
  303         (V) Track spending trends for behavioral health drugs and
  304  deviation from best practice guidelines.
  305         (VI) Use educational and technological approaches to
  306  promote best practices, educate consumers, and train prescribers
  307  in the use of practice guidelines.
  308         (VII) Disseminate electronic and published materials.
  309         (VIII) Hold statewide and regional conferences.
  310         (IX) Implement a disease management program with a model
  311  quality-based medication component for severely mentally ill
  312  individuals and emotionally disturbed children who are high
  313  users of care.
  314         11. The agency shall implement a Medicaid prescription drug
  315  management system.
  316         a. The agency may contract with a vendor that has
  317  experience in operating prescription drug management systems in
  318  order to implement this system. Any management system that is
  319  implemented in accordance with this subparagraph must rely on
  320  cooperation between physicians and pharmacists to determine
  321  appropriate practice patterns and clinical guidelines to improve
  322  the prescribing, dispensing, and use of drugs in the Medicaid
  323  program. The agency may seek federal waivers to implement this
  324  program.
  325         b. The drug management system must be designed to improve
  326  the quality of care and prescribing practices based on best
  327  practice guidelines, improve patient adherence to medication
  328  plans, reduce clinical risk, and lower prescribed drug costs and
  329  the rate of inappropriate spending on Medicaid prescription
  330  drugs. The program must:
  331         (I) Provide for the adoption of best practice guidelines
  332  for the prescribing and use of drugs in the Medicaid program,
  333  including translating best practice guidelines into practice;
  334  reviewing prescriber patterns and comparing them to indicators
  335  that are based on national standards and practice patterns of
  336  clinical peers in their community, statewide, and nationally;
  337  and determine deviations from best practice guidelines.
  338         (II) Implement processes for providing feedback to and
  339  educating prescribers using best practice educational materials
  340  and peer-to-peer consultation.
  341         (III) Assess Medicaid recipients who are outliers in their
  342  use of a single or multiple prescription drugs with regard to
  343  the numbers and types of drugs taken, drug dosages, combination
  344  drug therapies, and other indicators of improper use of
  345  prescription drugs.
  346         (IV) Alert prescribers to recipients who fail to refill
  347  prescriptions in a timely fashion, are prescribed multiple drugs
  348  that may be redundant or contraindicated, or may have other
  349  potential medication problems.
  350         11.12. The agency may contract for drug rebate
  351  administration, including, but not limited to, calculating
  352  rebate amounts, invoicing manufacturers, negotiating disputes
  353  with manufacturers, and maintaining a database of rebate
  354  collections.
  355         12.13. The agency may specify the preferred daily dosing
  356  form or strength for the purpose of promoting best practices
  357  with regard to the prescribing of certain drugs as specified in
  358  the General Appropriations Act and ensuring cost-effective
  359  prescribing practices.
  360         13.14. The agency may require prior authorization for
  361  Medicaid-covered prescribed drugs. The agency may prior
  362  authorize the use of a product:
  363         a. For an indication not approved in labeling;
  364         b. To comply with certain clinical guidelines; or
  365         c. If the product has the potential for overuse, misuse, or
  366  abuse.
  368  The agency may require the prescribing professional to provide
  369  information about the rationale and supporting medical evidence
  370  for the use of a drug. The agency shall post prior
  371  authorization, step-edit criteria and protocol, and updates to
  372  the list of drugs that are subject to prior authorization on the
  373  agency’s Internet website within 21 days after the prior
  374  authorization and step-edit criteria and protocol and updates
  375  are approved by the agency. For purposes of this subparagraph,
  376  the term “step-edit” means an automatic electronic review of
  377  certain medications subject to prior authorization.
  378         14.15. The agency, in conjunction with the Pharmaceutical
  379  and Therapeutics Committee, may require age-related prior
  380  authorizations for certain prescribed drugs. The agency may
  381  preauthorize the use of a drug for a recipient who may not meet
  382  the age requirement or may exceed the length of therapy for use
  383  of this product as recommended by the manufacturer and approved
  384  by the Food and Drug Administration. Prior authorization may
  385  require the prescribing professional to provide information
  386  about the rationale and supporting medical evidence for the use
  387  of a drug.
  388         15.16. The agency shall implement a step-therapy prior
  389  authorization approval process for medications excluded from the
  390  preferred drug list. Medications listed on the preferred drug
  391  list must be used within the previous 12 months before the
  392  alternative medications that are not listed. The step-therapy
  393  prior authorization may require the prescriber to use the
  394  medications of a similar drug class or for a similar medical
  395  indication unless contraindicated in the Food and Drug
  396  Administration labeling. The trial period between the specified
  397  steps may vary according to the medical indication. The step
  398  therapy approval process shall be developed in accordance with
  399  the committee as stated in s. 409.91195(7) and (8). A drug
  400  product may be approved without meeting the step-therapy prior
  401  authorization criteria if the prescribing physician provides the
  402  agency with additional written medical or clinical documentation
  403  that the product is medically necessary because:
  404         a. There is not a drug on the preferred drug list to treat
  405  the disease or medical condition which is an acceptable clinical
  406  alternative;
  407         b. The alternatives have been ineffective in the treatment
  408  of the beneficiary’s disease; or
  409         c. Based on historic evidence and known characteristics of
  410  the patient and the drug, the drug is likely to be ineffective,
  411  or the number of doses have been ineffective.
  413  The agency shall work with the physician to determine the best
  414  alternative for the patient. The agency may adopt rules waiving
  415  the requirements for written clinical documentation for specific
  416  drugs in limited clinical situations.
  417         16.17. The agency shall implement a return and reuse
  418  program for drugs dispensed by pharmacies to institutional
  419  recipients, which includes payment of a $5 restocking fee for
  420  the implementation and operation of the program. The return and
  421  reuse program shall be implemented electronically and in a
  422  manner that promotes efficiency. The program must permit a
  423  pharmacy to exclude drugs from the program if it is not
  424  practical or cost-effective for the drug to be included and must
  425  provide for the return to inventory of drugs that cannot be
  426  credited or returned in a cost-effective manner. The agency
  427  shall determine if the program has reduced the amount of
  428  Medicaid prescription drugs that which are destroyed on an
  429  annual basis and if there are additional ways to ensure more
  430  prescription drugs are not destroyed which could safely be
  431  reused.
  432         Section 4. Subsections (1) and (2) of section 409.979,
  433  Florida Statutes, are amended to read:
  434         409.979 Eligibility.—
  436  recipients who meet all of the following criteria are eligible
  437  to receive long-term care services and must receive long-term
  438  care services by participating in the long-term care managed
  439  care program. The recipient must be:
  440         (a) Sixty-five years of age or older, or age 18 or older
  441  and eligible for Medicaid by reason of a disability.
  442         (b) Determined by the Comprehensive Assessment Review and
  443  Evaluation for Long-Term Care Services (CARES) preadmission
  444  screening program to require nursing facility care as defined in
  445  s. 409.985(3) or, in the case of individuals diagnosed with
  446  cystic fibrosis, determined by the CARES program to require
  447  hospital-level of care.
  448         (2) ENROLLMENT OFFERS.—
  449         (a) Subject to the availability of funds, the Department of
  450  Elderly Affairs shall make offers for enrollment to eligible
  451  individuals based on a wait-list prioritization. Before making
  452  enrollment offers, the agency and the Department of Elderly
  453  Affairs shall determine that sufficient funds exist to support
  454  additional enrollment into plans.
  455         (b) Medicaid recipients enrolled in one of the following
  456  home and community-based service Medicaid waivers are eligible
  457  to participate in the long-term care managed care program when
  458  all eligibility criteria requirements established in paragraph
  459  (1) of this subsection are met and shall be transitioned into
  460  the long-term care managed care program by January 1, 2018:
  461         1. Traumatic Brain and Spinal Cord Injury Waiver.
  462         2. Adult Cystic Fibrosis Waiver.
  463         3.Project AIDS Care Waiver.
  465  The agency shall seek federal approval to terminate the
  466  Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic
  467  Fibrosis Waiver, and the Project AIDS Care Waiver after all
  468  eligible Medicaid recipients have transitioned into the long
  469  term care managed care program.
  470         Section 5. Subsection (7) of section 393.0661, Florida
  471  Statutes, is amended to read:
  472         393.0661 Home and community-based services delivery system;
  473  comprehensive redesign.—The Legislature finds that the home and
  474  community-based services delivery system for persons with
  475  developmental disabilities and the availability of appropriated
  476  funds are two of the critical elements in making services
  477  available. Therefore, it is the intent of the Legislature that
  478  the Agency for Persons with Disabilities shall develop and
  479  implement a comprehensive redesign of the system.
  480         (7) The agency shall collect premiums or cost sharing
  481  pursuant to s. 409.906(13)(c) s. 409.906(13)(d).
  482         Section 6. Paragraph (a) of subsection (4) of section
  483  409.968, Florida Statutes, is amended to read:
  484         409.968 Managed care plan payments.—
  485         (4)(a) Subject to a specific appropriation and federal
  486  approval under s. 409.906(13)(d) s. 409.906(13)(e), the agency
  487  shall establish a payment methodology to fund managed care plans
  488  for flexible services for persons with severe mental illness and
  489  substance use disorders, including, but not limited to,
  490  temporary housing assistance. A managed care plan eligible for
  491  these payments must do all of the following:
  492         1. Participate as a specialty plan for severe mental
  493  illness or substance use disorders or participate in counties
  494  designated by the General Appropriations Act;
  495         2. Include providers of behavioral health services pursuant
  496  to chapters 394 and 397 in the managed care plan’s provider
  497  network; and
  498         3. Document a capability to provide housing assistance
  499  through agreements with housing providers, relationships with
  500  local housing coalitions, and other appropriate arrangements.
  501         Section 7. This act shall take effect July 1, 2017.