Florida Senate - 2022                                    SB 1950
       
       
        
       By Senator Brodeur
       
       
       
       
       
       9-01655-22                                            20221950__
    1                        A bill to be entitled                      
    2         An act relating to the statewide Medicaid managed care
    3         program; amending s. 409.912, F.S.; requiring, rather
    4         than authorizing, that the reimbursement method for
    5         provider service networks be on a prepaid basis;
    6         deleting the authority to reimburse provider service
    7         networks on a fee-for-service basis; conforming
    8         provisions to changes made by the act; providing that
    9         provider service networks are subject to and exempt
   10         from certain requirements; providing construction;
   11         repealing s. 409.9124, F.S., relating to managed care
   12         reimbursement; amending s. 409.964, F.S.; deleting a
   13         requirement that the Agency for Health Care
   14         Administration provide the opportunity for public
   15         feedback on a certain waiver application; amending s.
   16         409.966, F.S.; revising requirements relating to the
   17         databook published by the agency consisting of
   18         Medicaid utilization and spending data; reallocating
   19         regions within the statewide managed care program;
   20         deleting a requirement that the agency negotiate plan
   21         rates or payments to guarantee a certain savings
   22         amount; deleting a requirement for the agency to award
   23         additional contracts to plans in specified regions for
   24         certain purposes; revising a limitation on when plans
   25         may begin serving Medicaid recipients to apply to any
   26         eligible plan that participates in an invitation to
   27         negotiate, rather than plans participating in certain
   28         regions; making technical changes; amending s.
   29         409.967, F.S.; deleting obsolete provisions; revising
   30         provisions relating to agency-defined quality measures
   31         under the achieved savings rebate program for Medicaid
   32         prepaid plans; amending s. 409.968, F.S.; conforming
   33         provisions to changes made by the act; amending s.
   34         409.973, F.S.; revising requirements for healthy
   35         behaviors programs established by plans; deleting an
   36         obsolete provision; amending s. 409.974, F.S.;
   37         requiring the agency to select plans for the managed
   38         medical assistance program through a single statewide
   39         procurement; authorizing the agency to award contracts
   40         to plans on a regional or statewide basis; specifying
   41         requirements for minimum numbers of plans which the
   42         agency must procure for each specified region;
   43         conforming provisions to changes made by the act;
   44         deleting a requirement for the agency to exercise a
   45         preference for certain plans; amending s. 409.975,
   46         F.S.; providing that cancer hospitals meeting certain
   47         criteria are statewide essential providers; amending
   48         s. 409.977, F.S.; revising the circumstances for
   49         maintaining a recipient’s enrollment in a plan;
   50         deleting a requirement for the agency to develop a
   51         process for certain recipients to opt out of managed
   52         care plans; conforming provisions to changes made by
   53         the act; authorizing specialty plans to serve certain
   54         children; amending s. 409.981, F.S.; requiring the
   55         agency to select plans for the long-term care managed
   56         medical assistance program through a single statewide
   57         procurement; authorizing the agency to award contracts
   58         to plans on a regional or statewide basis; specifying
   59         requirements for minimum numbers of plans which the
   60         agency must procure for each specified region;
   61         conforming provisions to changes made by the act;
   62         amending s. 409.8132, F.S.; conforming a cross
   63         reference; reenacting ss. 409.962(1), (7), (13), and
   64         (14) and 641.19(22) relating to definitions, to
   65         incorporate the amendments made by this act to s.
   66         409.912, F.S., in references thereto; reenacting s.
   67         430.2053(3)(h), (i), and (j) and (11), relating to
   68         aging resource centers, to incorporate the amendments
   69         made by this act to s. 409.981, F.S., in references
   70         thereto; providing an effective date.
   71          
   72  Be It Enacted by the Legislature of the State of Florida:
   73  
   74         Section 1. Subsection (1) of section 409.912, Florida
   75  Statutes, is amended to read:
   76         409.912 Cost-effective purchasing of health care.—The
   77  agency shall purchase goods and services for Medicaid recipients
   78  in the most cost-effective manner consistent with the delivery
   79  of quality medical care. To ensure that medical services are
   80  effectively utilized, the agency may, in any case, require a
   81  confirmation or second physician’s opinion of the correct
   82  diagnosis for purposes of authorizing future services under the
   83  Medicaid program. This section does not restrict access to
   84  emergency services or poststabilization care services as defined
   85  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
   86  shall be rendered in a manner approved by the agency. The agency
   87  shall maximize the use of prepaid per capita and prepaid
   88  aggregate fixed-sum basis services when appropriate and other
   89  alternative service delivery and reimbursement methodologies,
   90  including competitive bidding pursuant to s. 287.057, designed
   91  to facilitate the cost-effective purchase of a case-managed
   92  continuum of care. The agency shall also require providers to
   93  minimize the exposure of recipients to the need for acute
   94  inpatient, custodial, and other institutional care and the
   95  inappropriate or unnecessary use of high-cost services. The
   96  agency shall contract with a vendor to monitor and evaluate the
   97  clinical practice patterns of providers in order to identify
   98  trends that are outside the normal practice patterns of a
   99  provider’s professional peers or the national guidelines of a
  100  provider’s professional association. The vendor must be able to
  101  provide information and counseling to a provider whose practice
  102  patterns are outside the norms, in consultation with the agency,
  103  to improve patient care and reduce inappropriate utilization.
  104  The agency may mandate prior authorization, drug therapy
  105  management, or disease management participation for certain
  106  populations of Medicaid beneficiaries, certain drug classes, or
  107  particular drugs to prevent fraud, abuse, overuse, and possible
  108  dangerous drug interactions. The Pharmaceutical and Therapeutics
  109  Committee shall make recommendations to the agency on drugs for
  110  which prior authorization is required. The agency shall inform
  111  the Pharmaceutical and Therapeutics Committee of its decisions
  112  regarding drugs subject to prior authorization. The agency is
  113  authorized to limit the entities it contracts with or enrolls as
  114  Medicaid providers by developing a provider network through
  115  provider credentialing. The agency may competitively bid single
  116  source-provider contracts if procurement of goods or services
  117  results in demonstrated cost savings to the state without
  118  limiting access to care. The agency may limit its network based
  119  on the assessment of beneficiary access to care, provider
  120  availability, provider quality standards, time and distance
  121  standards for access to care, the cultural competence of the
  122  provider network, demographic characteristics of Medicaid
  123  beneficiaries, practice and provider-to-beneficiary standards,
  124  appointment wait times, beneficiary use of services, provider
  125  turnover, provider profiling, provider licensure history,
  126  previous program integrity investigations and findings, peer
  127  review, provider Medicaid policy and billing compliance records,
  128  clinical and medical record audits, and other factors. Providers
  129  are not entitled to enrollment in the Medicaid provider network.
  130  The agency shall determine instances in which allowing Medicaid
  131  beneficiaries to purchase durable medical equipment and other
  132  goods is less expensive to the Medicaid program than long-term
  133  rental of the equipment or goods. The agency may establish rules
  134  to facilitate purchases in lieu of long-term rentals in order to
  135  protect against fraud and abuse in the Medicaid program as
  136  defined in s. 409.913. The agency may seek federal waivers
  137  necessary to administer these policies.
  138         (1) The agency may contract with a provider service
  139  network, which must may be reimbursed on a fee-for-service or
  140  prepaid basis. Prepaid Provider service networks shall receive
  141  per-member, per-month payments. A provider service network that
  142  does not choose to be a prepaid plan shall receive fee-for
  143  service rates with a shared savings settlement. The fee-for
  144  service option shall be available to a provider service network
  145  only for the first 2 years of the plan’s operation or until the
  146  contract year beginning September 1, 2014, whichever is later.
  147  The agency shall annually conduct cost reconciliations to
  148  determine the amount of cost savings achieved by fee-for-service
  149  provider service networks for the dates of service in the period
  150  being reconciled. Only payments for covered services for dates
  151  of service within the reconciliation period and paid within 6
  152  months after the last date of service in the reconciliation
  153  period shall be included. The agency shall perform the necessary
  154  adjustments for the inclusion of claims incurred but not
  155  reported within the reconciliation for claims that could be
  156  received and paid by the agency after the 6-month claims
  157  processing time lag. The agency shall provide the results of the
  158  reconciliations to the fee-for-service provider service networks
  159  within 45 days after the end of the reconciliation period. The
  160  fee-for-service provider service networks shall review and
  161  provide written comments or a letter of concurrence to the
  162  agency within 45 days after receipt of the reconciliation
  163  results. This reconciliation shall be considered final.
  164         (a) A provider service network which is reimbursed by the
  165  agency on a prepaid basis shall be exempt from parts I and III
  166  of chapter 641 but must comply with the solvency requirements in
  167  s. 641.2261(2) and meet appropriate financial reserve, quality
  168  assurance, and patient rights requirements as established by the
  169  agency.
  170         (b) A provider service network is a network established or
  171  organized and operated by a health care provider, or group of
  172  affiliated health care providers, which provides a substantial
  173  proportion of the health care items and services under a
  174  contract directly through the provider or affiliated group of
  175  providers and may make arrangements with physicians or other
  176  health care professionals, health care institutions, or any
  177  combination of such individuals or institutions to assume all or
  178  part of the financial risk on a prospective basis for the
  179  provision of basic health services by the physicians, by other
  180  health professionals, or through the institutions. The health
  181  care providers must have a controlling interest in the governing
  182  body of the provider service network organization.
  183         (a)A provider service network is exempt from parts I and
  184  III of chapter 641 but must comply with the solvency
  185  requirements in s. 641.2261(2) and meet appropriate financial
  186  reserve, quality assurance, and patient rights requirements as
  187  established by the agency.
  188         (b)This subsection does not authorize the agency to
  189  contract with a provider service network outside of the
  190  procurement process described in s. 409.966.
  191         Section 2. Section 409.9124, Florida Statutes, is repealed.
  192         Section 3. Section 409.964, Florida Statutes, is amended to
  193  read:
  194         409.964 Managed care program; state plan; waivers.—The
  195  Medicaid program is established as a statewide, integrated
  196  managed care program for all covered services, including long
  197  term care services. The agency shall apply for and implement
  198  state plan amendments or waivers of applicable federal laws and
  199  regulations necessary to implement the program. Before seeking a
  200  waiver, the agency shall provide public notice and the
  201  opportunity for public comment and include public feedback in
  202  the waiver application. The agency shall hold one public meeting
  203  in each of the regions described in s. 409.966(2), and the time
  204  period for public comment for each region shall end no sooner
  205  than 30 days after the completion of the public meeting in that
  206  region.
  207         Section 4. Subsections (2), (3), and (4) of section
  208  409.966, Florida Statutes, are amended to read:
  209         409.966 Eligible plans; selection.—
  210         (2) ELIGIBLE PLAN SELECTION.—The agency shall select a
  211  limited number of eligible plans to participate in the Medicaid
  212  program using invitations to negotiate in accordance with s.
  213  287.057(1)(c). At least 90 days before issuing an invitation to
  214  negotiate, the agency shall compile and publish a databook
  215  consisting of a comprehensive set of utilization and spending
  216  data consistent with actuarial rate-setting practices and
  217  standards for the 3 most recent contract years consistent with
  218  the rate-setting periods for all Medicaid recipients by region
  219  or county. The source of the data in the databook report must
  220  include, at a minimum, the 24 most recent months of both
  221  historic fee-for-service claims and validated data from the
  222  Medicaid Encounter Data System. The statewide managed care
  223  program includes report must be available in electronic form and
  224  delineate utilization use by age, gender, eligibility group,
  225  geographic area, and aggregate clinical risk score. Separate and
  226  simultaneous procurements shall be conducted in each of the
  227  following regions:
  228         (a) Region A 1, which consists of Bay, Calhoun, Escambia,
  229  Okaloosa, Santa Rosa, and Walton Counties.
  230         (b) Region 2, which consists of Bay, Calhoun, Franklin,
  231  Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty,
  232  Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, and
  233  Washington Counties.
  234         (b)(c) Region B 3, which consists of Alachua, Baker,
  235  Bradford, Citrus, Clay, Columbia, Dixie, Duval, Flagler,
  236  Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion,
  237  Nassau, Putnam, St. Johns, Sumter, Suwannee, and Union Counties.
  238         (d) Region 4, which consists of Baker, Clay, Duval,
  239  Flagler, Nassau, St. Johns, and Volusia Counties.
  240         (c)(e) Region C 5, which consists of Pasco and Pinellas
  241  Counties.
  242         (f) Region 6, which consists of Hardee, Highlands,
  243  Hillsborough, Manatee, Pasco, Pinellas, and Polk Counties.
  244         (d)(g) Region D 7, which consists of Brevard, Orange,
  245  Osceola, and Seminole Counties.
  246         (e)(h) Region E 8, which consists of Charlotte, Collier,
  247  DeSoto, Glades, Hendry, Lee, and Sarasota Counties.
  248         (f)(i) Region F 9, which consists of Indian River, Martin,
  249  Okeechobee, Palm Beach, and St. Lucie Counties.
  250         (g)(j) Region G 10, which consists of Broward County.
  251         (h)(k) Region H 11, which consists of Miami-Dade and Monroe
  252  Counties.
  253         (3) QUALITY SELECTION CRITERIA.—
  254         (a) The invitation to negotiate must specify the criteria
  255  and the relative weight of the criteria that will be used for
  256  determining the acceptability of the reply and guiding the
  257  selection of the organizations with which the agency negotiates.
  258  In addition to criteria established by the agency, the agency
  259  shall consider the following factors in the selection of
  260  eligible plans:
  261         1. Accreditation by the National Committee for Quality
  262  Assurance, the Joint Commission, or another nationally
  263  recognized accrediting body.
  264         2. Experience serving similar populations, including the
  265  organization’s record in achieving specific quality standards
  266  with similar populations.
  267         3. Availability and accessibility of primary care and
  268  specialty physicians in the provider network.
  269         4. Establishment of community partnerships with providers
  270  that create opportunities for reinvestment in community-based
  271  services.
  272         5. Organization commitment to quality improvement and
  273  documentation of achievements in specific quality improvement
  274  projects, including active involvement by organization
  275  leadership.
  276         6. Provision of additional benefits, particularly dental
  277  care and disease management, and other initiatives that improve
  278  health outcomes.
  279         7. Evidence that an eligible plan has obtained signed
  280  contracts or written agreements or signed contracts or has made
  281  substantial progress in establishing relationships with
  282  providers before the plan submits submitting a response.
  283         8. Comments submitted in writing by any enrolled Medicaid
  284  provider relating to a specifically identified plan
  285  participating in the procurement in the same region as the
  286  submitting provider.
  287         9. Documentation of policies and procedures for preventing
  288  fraud and abuse.
  289         10. The business relationship an eligible plan has with any
  290  other eligible plan that responds to the invitation to
  291  negotiate.
  292         (b) An eligible plan must disclose any business
  293  relationship it has with any other eligible plan that responds
  294  to the invitation to negotiate. The agency may not select plans
  295  in the same region for the same managed care program that have a
  296  business relationship with each other. Failure to disclose any
  297  business relationship shall result in disqualification from
  298  participation in any region for the first full contract period
  299  after the discovery of the business relationship by the agency.
  300  For the purpose of this section, “business relationship” means
  301  an ownership or controlling interest, an affiliate or subsidiary
  302  relationship, a common parent, or any mutual interest in any
  303  limited partnership, limited liability partnership, limited
  304  liability company, or other entity or business association,
  305  including all wholly or partially owned subsidiaries, majority
  306  owned subsidiaries, parent companies, or affiliates of such
  307  entities, business associations, or other enterprises, that
  308  exists for the purpose of making a profit.
  309         (c) After negotiations are conducted, the agency shall
  310  select the eligible plans that are determined to be responsive
  311  and provide the best value to the state. Preference shall be
  312  given to plans that:
  313         1. Have signed contracts with primary and specialty
  314  physicians in sufficient numbers to meet the specific standards
  315  established pursuant to s. 409.967(2)(c).
  316         2. Have well-defined programs for recognizing patient
  317  centered medical homes and providing for increased compensation
  318  for recognized medical homes, as defined by the plan.
  319         3. Are organizations that are based in and perform
  320  operational functions in this state, in-house or through
  321  contractual arrangements, by staff located in this state. Using
  322  a tiered approach, the highest number of points shall be awarded
  323  to a plan that has all or substantially all of its operational
  324  functions performed in the state. The second highest number of
  325  points shall be awarded to a plan that has a majority of its
  326  operational functions performed in the state. The agency may
  327  establish a third tier; however, preference points may not be
  328  awarded to plans that perform only community outreach, medical
  329  director functions, and state administrative functions in the
  330  state. For purposes of this subparagraph, operational functions
  331  include corporate headquarters, claims processing, member
  332  services, provider relations, utilization and prior
  333  authorization, case management, disease and quality functions,
  334  and finance and administration. For purposes of this
  335  subparagraph, the term “corporate headquarters” means the
  336  principal office of the organization, which may not be a
  337  subsidiary, directly or indirectly through one or more
  338  subsidiaries of, or a joint venture with, any other entity whose
  339  principal office is not located in the state.
  340         4. Have contracts or other arrangements for cancer disease
  341  management programs that have a proven record of clinical
  342  efficiencies and cost savings.
  343         5. Have contracts or other arrangements for diabetes
  344  disease management programs that have a proven record of
  345  clinical efficiencies and cost savings.
  346         6. Have a claims payment process that ensures that claims
  347  that are not contested or denied will be promptly paid pursuant
  348  to s. 641.3155.
  349         (d) For the first year of the first contract term, the
  350  agency shall negotiate capitation rates or fee for service
  351  payments with each plan in order to guarantee aggregate savings
  352  of at least 5 percent.
  353         1. For prepaid plans, determination of the amount of
  354  savings shall be calculated by comparison to the Medicaid rates
  355  that the agency paid managed care plans for similar populations
  356  in the same areas in the prior year. In regions containing no
  357  prepaid plans in the prior year, determination of the amount of
  358  savings shall be calculated by comparison to the Medicaid rates
  359  established and certified for those regions in the prior year.
  360         2. For provider service networks operating on a fee-for
  361  service basis, determination of the amount of savings shall be
  362  calculated by comparison to the Medicaid rates that the agency
  363  paid on a fee-for-service basis for the same services in the
  364  prior year.
  365         (e) To ensure managed care plan participation in Regions 1
  366  and 2, the agency shall award an additional contract to each
  367  plan with a contract award in Region 1 or Region 2. Such
  368  contract shall be in any other region in which the plan
  369  submitted a responsive bid and negotiates a rate acceptable to
  370  the agency. If a plan that is awarded an additional contract
  371  pursuant to this paragraph is subject to penalties pursuant to
  372  s. 409.967(2)(i) for activities in Region 1 or Region 2, the
  373  additional contract is automatically terminated 180 days after
  374  the imposition of the penalties. The plan must reimburse the
  375  agency for the cost of enrollment changes and other transition
  376  activities.
  377         (d)(f) The agency may not execute contracts with managed
  378  care plans at payment rates not supported by the General
  379  Appropriations Act.
  380         (4) ADMINISTRATIVE CHALLENGE.—Any eligible plan that
  381  participates in an invitation to negotiate in more than one
  382  region and is selected in at least one region may not begin
  383  serving Medicaid recipients in any region for which it was
  384  selected until all administrative challenges to procurements
  385  required by this section to which the eligible plan is a party
  386  have been finalized. If the number of plans selected is less
  387  than the maximum amount of plans permitted in the region, the
  388  agency may contract with other selected plans in the region not
  389  participating in the administrative challenge before resolution
  390  of the administrative challenge. For purposes of this
  391  subsection, an administrative challenge is finalized if an order
  392  granting voluntary dismissal with prejudice has been entered by
  393  any court established under Article V of the State Constitution
  394  or by the Division of Administrative Hearings, a final order has
  395  been entered into by the agency and the deadline for appeal has
  396  expired, a final order has been entered by the First District
  397  Court of Appeal and the time to seek any available review by the
  398  Florida Supreme Court has expired, or a final order has been
  399  entered by the Florida Supreme Court and a warrant has been
  400  issued.
  401         Section 5. Paragraphs (c) and (f) of subsection (2) and
  402  subsection (3) of section 409.967, Florida Statutes, are amended
  403  to read:
  404         409.967 Managed care plan accountability.—
  405         (2) The agency shall establish such contract requirements
  406  as are necessary for the operation of the statewide managed care
  407  program. In addition to any other provisions the agency may deem
  408  necessary, the contract must require:
  409         (c) Access.—
  410         1. The agency shall establish specific standards for the
  411  number, type, and regional distribution of providers in managed
  412  care plan networks to ensure access to care for both adults and
  413  children. Each plan must maintain a regionwide network of
  414  providers in sufficient numbers to meet the access standards for
  415  specific medical services for all recipients enrolled in the
  416  plan. The exclusive use of mail-order pharmacies may not be
  417  sufficient to meet network access standards. Consistent with the
  418  standards established by the agency, provider networks may
  419  include providers located outside the region. A plan may
  420  contract with a new hospital facility before the date the
  421  hospital becomes operational if the hospital has commenced
  422  construction, will be licensed and operational by January 1,
  423  2013, and a final order has issued in any civil or
  424  administrative challenge. Each plan shall establish and maintain
  425  an accurate and complete electronic database of contracted
  426  providers, including information about licensure or
  427  registration, locations and hours of operation, specialty
  428  credentials and other certifications, specific performance
  429  indicators, and such other information as the agency deems
  430  necessary. The database must be available online to both the
  431  agency and the public and have the capability to compare the
  432  availability of providers to network adequacy standards and to
  433  accept and display feedback from each provider’s patients. Each
  434  plan shall submit quarterly reports to the agency identifying
  435  the number of enrollees assigned to each primary care provider.
  436  The agency shall conduct, or contract for, systematic and
  437  continuous testing of the provider network databases maintained
  438  by each plan to confirm accuracy, confirm that behavioral health
  439  providers are accepting enrollees, and confirm that enrollees
  440  have access to behavioral health services.
  441         2. Each managed care plan must publish any prescribed drug
  442  formulary or preferred drug list on the plan’s website in a
  443  manner that is accessible to and searchable by enrollees and
  444  providers. The plan must update the list within 24 hours after
  445  making a change. Each plan must ensure that the prior
  446  authorization process for prescribed drugs is readily accessible
  447  to health care providers, including posting appropriate contact
  448  information on its website and providing timely responses to
  449  providers. For Medicaid recipients diagnosed with hemophilia who
  450  have been prescribed anti-hemophilic-factor replacement
  451  products, the agency shall provide for those products and
  452  hemophilia overlay services through the agency’s hemophilia
  453  disease management program.
  454         3. Managed care plans, and their fiscal agents or
  455  intermediaries, must accept prior authorization requests for any
  456  service electronically.
  457         4. Managed care plans serving children in the care and
  458  custody of the Department of Children and Families must maintain
  459  complete medical, dental, and behavioral health encounter
  460  information and participate in making such information available
  461  to the department or the applicable contracted community-based
  462  care lead agency for use in providing comprehensive and
  463  coordinated case management. The agency and the department shall
  464  establish an interagency agreement to provide guidance for the
  465  format, confidentiality, recipient, scope, and method of
  466  information to be made available and the deadlines for
  467  submission of the data. The scope of information available to
  468  the department shall be the data that managed care plans are
  469  required to submit to the agency. The agency shall determine the
  470  plan’s compliance with standards for access to medical, dental,
  471  and behavioral health services; the use of medications; and
  472  followup on all medically necessary services recommended as a
  473  result of early and periodic screening, diagnosis, and
  474  treatment.
  475         (f) Continuous improvement.—The agency shall establish
  476  specific performance standards and expected milestones or
  477  timelines for improving performance over the term of the
  478  contract.
  479         1. Each managed care plan shall establish an internal
  480  health care quality improvement system, including enrollee
  481  satisfaction and disenrollment surveys. The quality improvement
  482  system must include incentives and disincentives for network
  483  providers.
  484         2. Each plan must collect and report the Health Plan
  485  Employer Data and Information Set (HEDIS) measures, as specified
  486  by the agency. These measures must be published on the plan’s
  487  website in a manner that allows recipients to reliably compare
  488  the performance of plans. The agency shall use the HEDIS
  489  measures as a tool to monitor plan performance.
  490         3. Each managed care plan must be accredited by the
  491  National Committee for Quality Assurance, the Joint Commission,
  492  or another nationally recognized accrediting body, or have
  493  initiated the accreditation process, within 1 year after the
  494  contract is executed. For any plan not accredited within 18
  495  months after executing the contract, the agency shall suspend
  496  automatic assignment under s. 409.977 and 409.984.
  497         4. By the end of the fourth year of the first contract
  498  term, the agency shall issue a request for information to
  499  determine whether cost savings could be achieved by contracting
  500  for plan oversight and monitoring, including analysis of
  501  encounter data, assessment of performance measures, and
  502  compliance with other contractual requirements.
  503         (3) ACHIEVED SAVINGS REBATE.—
  504         (a) The agency is responsible for verifying the achieved
  505  savings rebate for all Medicaid prepaid plans. To assist the
  506  agency, a prepaid plan shall:
  507         1. Submit an annual financial audit conducted by an
  508  independent certified public accountant in accordance with
  509  generally accepted auditing standards to the agency on or before
  510  June 1 for the preceding year; and
  511         2. Submit an annual statement prepared in accordance with
  512  statutory accounting principles on or before March 1 pursuant to
  513  s. 624.424 if the plan is regulated by the Office of Insurance
  514  Regulation.
  515         (b) The agency shall contract with independent certified
  516  public accountants to conduct compliance audits for the purpose
  517  of auditing financial information, including but not limited to:
  518  annual premium revenue, medical and administrative costs, and
  519  income or losses reported by each prepaid plan, in order to
  520  determine and validate the achieved savings rebate.
  521         (c) Any audit required under this subsection must be
  522  conducted by an independent certified public accountant who
  523  meets criteria specified by rule. The rules must also provide
  524  that:
  525         1. The entity selected by the agency to conduct the audit
  526  may not have a conflict of interest that might affect its
  527  ability to perform its responsibilities with respect to an
  528  examination.
  529         2. The rates charged to the prepaid plan being audited are
  530  consistent with rates charged by other certified public
  531  accountants and are comparable with the rates charged for
  532  comparable examinations.
  533         3. Each prepaid plan audited shall pay to the agency the
  534  expenses of the audit at the rates established by the agency by
  535  rule. Such expenses include actual travel expenses, reasonable
  536  living expense allowances, compensation of the certified public
  537  accountant, and necessary attendant administrative costs of the
  538  agency directly related to the examination. Travel expense and
  539  living expense allowances are limited to those expenses incurred
  540  on account of the audit and must be paid by the examined prepaid
  541  plan together with compensation upon presentation by the agency
  542  to the prepaid plan of a detailed account of the charges and
  543  expenses after a detailed statement has been filed by the
  544  auditor and approved by the agency.
  545         4. All moneys collected from prepaid plans for such audits
  546  shall be deposited into the Grants and Donations Trust Fund, and
  547  the agency may make deposits into such fund from moneys
  548  appropriated for the operation of the agency.
  549         (d) At a location in this state, the prepaid plan shall
  550  make available to the agency and the agency’s contracted
  551  certified public accountant all books, accounts, documents,
  552  files, and information that relate to the prepaid plan’s
  553  Medicaid transactions. Records not in the prepaid plan’s
  554  immediate possession must be made available to the agency or the
  555  certified public accountant in this state within 3 days after a
  556  request is made by the agency or certified public accountant
  557  engaged by the agency. A prepaid plan has an obligation to
  558  cooperate in good faith with the agency and the certified public
  559  accountant. Failure to comply to such record requests shall be
  560  deemed a breach of contract.
  561         (e) Once the certified public accountant completes the
  562  audit, the certified public accountant shall submit an audit
  563  report to the agency attesting to the achieved savings of the
  564  plan. The results of the audit report are dispositive.
  565         (f) Achieved savings rebates validated by the certified
  566  public accountant are due within 30 days after the report is
  567  submitted. Except as provided in paragraph (h), the achieved
  568  savings rebate is established by determining pretax income as a
  569  percentage of revenues and applying the following income sharing
  570  ratios:
  571         1. One hundred percent of income up to and including 3 5
  572  percent of revenue shall be retained by the plan.
  573         2. Fifty percent of income above 3 5 percent and up to 10
  574  percent shall be retained by the plan, and the other 50 percent
  575  refunded to the state and transferred to the General Revenue
  576  Fund, unallocated.
  577         3. One hundred percent of income above 10 percent of
  578  revenue shall be refunded to the state and transferred to the
  579  General Revenue Fund, unallocated.
  580         (g) A plan that exceeds agency-defined quality measures in
  581  the reporting period may retain up to an additional 2 1 percent
  582  of revenue. For the purpose of this paragraph, the quality
  583  measures must include two tiers and must include plan
  584  performance for preventing or managing complex, chronic
  585  conditions that are associated with an elevated likelihood of
  586  requiring high-cost medical treatments.
  587         1. If the agency-defined quality or performance targets
  588  identified in tier one are met, the plan may retain up to 4
  589  percent of revenue. Fifty percent of income above 4 percent and
  590  up to 10 percent must be retained by the plan, and the other 50
  591  percent refunded to the state and transferred to the General
  592  Revenue Fund, unallocated.
  593         2. If the agency-defined quality or performance targets
  594  identified in tier two are met, the plan may retain up to 5
  595  percent of revenue. Fifty percent of income above 5 percent and
  596  up to 10 percent must be retained by the plan, and the other 50
  597  percent refunded to the state and transferred to the General
  598  Revenue Fund, unallocated.
  599         (h) The following may not be included as allowable expenses
  600  in calculating income for determining the achieved savings
  601  rebate:
  602         1. Payment of achieved savings rebates.
  603         2. Any financial incentive payments made to the plan
  604  outside of the capitation rate.
  605         3. Any financial disincentive payments levied by the state
  606  or federal government.
  607         4. Expenses associated with any lobbying or political
  608  activities.
  609         5. The cash value or equivalent cash value of bonuses of
  610  any type paid or awarded to the plan’s executive staff, other
  611  than base salary.
  612         6. Reserves and reserve accounts.
  613         7. Administrative costs, including, but not limited to,
  614  reinsurance expenses, interest payments, depreciation expenses,
  615  bad debt expenses, and outstanding claims expenses in excess of
  616  actuarially sound maximum amounts set by the agency.
  617  
  618  The agency shall consider these and other factors in developing
  619  contracts that establish shared savings arrangements.
  620         (i) Prepaid plans that incur a loss in the first contract
  621  year may apply the full amount of the loss as an offset to
  622  income in the second contract year.
  623         (j) If, after an audit, the agency determines that a
  624  prepaid plan owes an additional rebate, the plan has 30 days
  625  after notification to make the payment. Upon failure to timely
  626  pay the rebate, the agency shall withhold future payments to the
  627  plan until the entire amount is recouped. If the agency
  628  determines that a prepaid plan has made an overpayment, the
  629  agency shall return the overpayment within 30 days.
  630         Section 6. Subsection (2) of section 409.968, Florida
  631  Statutes, is amended to read:
  632         409.968 Managed care plan payments.—
  633         (2) Provider service networks must may be prepaid plans and
  634  receive per-member, per-month payments negotiated pursuant to
  635  the procurement process described in s. 409.966. Provider
  636  service networks that choose not to be prepaid plans shall
  637  receive fee-for-service rates with a shared savings settlement.
  638  The fee-for-service option shall be available to a provider
  639  service network only for the first 2 years of its operation. The
  640  agency shall annually conduct cost reconciliations to determine
  641  the amount of cost savings achieved by fee-for-service provider
  642  service networks for the dates of service within the period
  643  being reconciled. Only payments for covered services for dates
  644  of service within the reconciliation period and paid within 6
  645  months after the last date of service in the reconciliation
  646  period must be included. The agency shall perform the necessary
  647  adjustments for the inclusion of claims incurred but not
  648  reported within the reconciliation period for claims that could
  649  be received and paid by the agency after the 6-month claims
  650  processing time lag. The agency shall provide the results of the
  651  reconciliations to the fee-for-service provider service networks
  652  within 45 days after the end of the reconciliation period. The
  653  fee-for-service provider service networks shall review and
  654  provide written comments or a letter of concurrence to the
  655  agency within 45 days after receipt of the reconciliation
  656  results. This reconciliation is considered final.
  657         Section 7. Subsections (3) and (4) of section 409.973,
  658  Florida Statutes, are amended to read:
  659         409.973 Benefits.—
  660         (3) HEALTHY BEHAVIORS.—Each plan operating in the managed
  661  medical assistance program shall establish a program to
  662  encourage and reward healthy behaviors. At a minimum, each plan
  663  must establish a medically approved tobacco smoking cessation
  664  program, a medically directed weight loss program, and a
  665  medically approved alcohol recovery program or substance abuse
  666  recovery program that must include, but may not be limited to,
  667  opioid abuse recovery. Each plan must identify enrollees who
  668  smoke, are morbidly obese, or are diagnosed with alcohol or
  669  substance abuse in order to establish written agreements to
  670  secure the enrollees’ commitment to participation in these
  671  programs.
  672         (4) PRIMARY CARE INITIATIVE.—Each plan operating in the
  673  managed medical assistance program shall establish a program to
  674  encourage enrollees to establish a relationship with their
  675  primary care provider. Each plan shall:
  676         (a) Provide information to each enrollee on the importance
  677  of and procedure for selecting a primary care provider, and
  678  thereafter automatically assign to a primary care provider any
  679  enrollee who fails to choose a primary care provider.
  680         (b) If the enrollee was not a Medicaid recipient before
  681  enrollment in the plan, assist the enrollee in scheduling an
  682  appointment with the primary care provider. If possible the
  683  appointment should be made within 30 days after enrollment in
  684  the plan. For enrollees who become eligible for Medicaid between
  685  January 1, 2014, and December 31, 2015, the appointment should
  686  be scheduled within 6 months after enrollment in the plan.
  687         (c) Report to the agency the number of enrollees assigned
  688  to each primary care provider within the plan’s network.
  689         (d) Report to the agency the number of enrollees who have
  690  not had an appointment with their primary care provider within
  691  their first year of enrollment.
  692         (e) Report to the agency the number of emergency room
  693  visits by enrollees who have not had at least one appointment
  694  with their primary care provider.
  695         Section 8. Subsections (1) and (2) of section 409.974,
  696  Florida Statutes, are amended to read:
  697         409.974 Eligible plans.—
  698         (1) ELIGIBLE PLAN SELECTION.—The agency shall select
  699  eligible plans for the managed medical assistance program
  700  through the procurement process described in s. 409.966 through
  701  a single statewide procurement. The agency may award contracts
  702  to plans selected through the procurement process either on a
  703  regional or statewide basis. The awards must include at least
  704  one provider service network in each of the eight regions
  705  outlined in this subsection. The agency shall procure:
  706         (a) At least 3 plans and up to 4 plans for Region A.
  707         (b) At least 3 plans and up to 6 plans for Region B.
  708         (c) At least 5 plans and up to 10 plans for Region C.
  709         (d) At least 3 plans and up to 6 plans for Region D.
  710         (e) At least 3 plans and up to 4 plans for Region E.
  711         (f) At least 3 plans and up to 5 plans for Region F.
  712         (g) At least 3 plans and up to 5 plans for Region G.
  713         (h) At least 5 plans and up to 10 plans for Region H. The
  714  agency shall notice invitations to negotiate no later than
  715  January 1, 2013.
  716         (a) The agency shall procure two plans for Region 1. At
  717  least one plan shall be a provider service network if any
  718  provider service networks submit a responsive bid.
  719         (b) The agency shall procure two plans for Region 2. At
  720  least one plan shall be a provider service network if any
  721  provider service networks submit a responsive bid.
  722         (c) The agency shall procure at least three plans and up to
  723  five plans for Region 3. At least one plan must be a provider
  724  service network if any provider service networks submit a
  725  responsive bid.
  726         (d) The agency shall procure at least three plans and up to
  727  five plans for Region 4. At least one plan must be a provider
  728  service network if any provider service networks submit a
  729  responsive bid.
  730         (e) The agency shall procure at least two plans and up to
  731  four plans for Region 5. At least one plan must be a provider
  732  service network if any provider service networks submit a
  733  responsive bid.
  734         (f) The agency shall procure at least four plans and up to
  735  seven plans for Region 6. At least one plan must be a provider
  736  service network if any provider service networks submit a
  737  responsive bid.
  738         (g) The agency shall procure at least three plans and up to
  739  six plans for Region 7. At least one plan must be a provider
  740  service network if any provider service networks submit a
  741  responsive bid.
  742         (h) The agency shall procure at least two plans and up to
  743  four plans for Region 8. At least one plan must be a provider
  744  service network if any provider service networks submit a
  745  responsive bid.
  746         (i) The agency shall procure at least two plans and up to
  747  four plans for Region 9. At least one plan must be a provider
  748  service network if any provider service networks submit a
  749  responsive bid.
  750         (j) The agency shall procure at least two plans and up to
  751  four plans for Region 10. At least one plan must be a provider
  752  service network if any provider service networks submit a
  753  responsive bid.
  754         (k) The agency shall procure at least five plans and up to
  755  10 plans for Region 11. At least one plan must be a provider
  756  service network if any provider service networks submit a
  757  responsive bid.
  758  
  759  If no provider service network submits a responsive bid, the
  760  agency shall procure no more than one less than the maximum
  761  number of eligible plans permitted in that region. Within 12
  762  months after the initial invitation to negotiate, the agency
  763  shall attempt to procure a provider service network. The agency
  764  shall notice another invitation to negotiate only with provider
  765  service networks in those regions where no provider service
  766  network has been selected.
  767         (2) QUALITY SELECTION CRITERIA.—In addition to the criteria
  768  established in s. 409.966, the agency shall consider evidence
  769  that an eligible plan has written agreements or signed contracts
  770  or has made substantial progress in establishing relationships
  771  with providers before the plan submitting a response. The agency
  772  shall evaluate and give special weight to evidence of signed
  773  contracts with essential providers as defined by the agency
  774  pursuant to s. 409.975(1). The agency shall exercise a
  775  preference for plans with a provider network in which over 10
  776  percent of the providers use electronic health records, as
  777  defined in s. 408.051. When all other factors are equal, the
  778  agency shall consider whether the organization has a contract to
  779  provide managed long-term care services in the same region and
  780  shall exercise a preference for such plans.
  781         Section 9. Paragraph (b) of subsection (1) of section
  782  409.975, Florida Statutes, is amended to read:
  783         409.975 Managed care plan accountability.—In addition to
  784  the requirements of s. 409.967, plans and providers
  785  participating in the managed medical assistance program shall
  786  comply with the requirements of this section.
  787         (1) PROVIDER NETWORKS.—Managed care plans must develop and
  788  maintain provider networks that meet the medical needs of their
  789  enrollees in accordance with standards established pursuant to
  790  s. 409.967(2)(c). Except as provided in this section, managed
  791  care plans may limit the providers in their networks based on
  792  credentials, quality indicators, and price.
  793         (b) Certain providers are statewide resources and essential
  794  providers for all managed care plans in all regions. All managed
  795  care plans must include these essential providers in their
  796  networks. Statewide essential providers include:
  797         1. Faculty plans of Florida medical schools.
  798         2. Regional perinatal intensive care centers as defined in
  799  s. 383.16(2).
  800         3. Hospitals licensed as specialty children’s hospitals as
  801  defined in s. 395.002(28).
  802         4. Accredited and integrated systems serving medically
  803  complex children which comprise separately licensed, but
  804  commonly owned, health care providers delivering at least the
  805  following services: medical group home, in-home and outpatient
  806  nursing care and therapies, pharmacy services, durable medical
  807  equipment, and Prescribed Pediatric Extended Care.
  808         5. Florida cancer hospitals that meet the criteria in 42
  809  U.S.C. s. 1395ww(d)(1)(B)(v).
  810  
  811  Managed care plans that have not contracted with all statewide
  812  essential providers in all regions as of the first date of
  813  recipient enrollment must continue to negotiate in good faith.
  814  Payments to physicians on the faculty of nonparticipating
  815  Florida medical schools shall be made at the applicable Medicaid
  816  rate. Payments for services rendered by regional perinatal
  817  intensive care centers shall be made at the applicable Medicaid
  818  rate as of the first day of the contract between the agency and
  819  the plan. Except for payments for emergency services, payments
  820  to nonparticipating specialty children’s hospitals shall equal
  821  the highest rate established by contract between that provider
  822  and any other Medicaid managed care plan.
  823         Section 10. Subsections (1), (2), (4), and (5) of section
  824  409.977, Florida Statutes, are amended to read:
  825         409.977 Enrollment.—
  826         (1) The agency shall automatically enroll into a managed
  827  care plan those Medicaid recipients who do not voluntarily
  828  choose a plan pursuant to s. 409.969. The agency shall
  829  automatically enroll recipients in plans that meet or exceed the
  830  performance or quality standards established pursuant to s.
  831  409.967 and may not automatically enroll recipients in a plan
  832  that is deficient in those performance or quality standards.
  833  When a specialty plan is available to accommodate a specific
  834  condition or diagnosis of a recipient, the agency shall assign
  835  the recipient to that plan. In the first year of the first
  836  contract term only, if a recipient was previously enrolled in a
  837  plan that is still available in the region, the agency shall
  838  automatically enroll the recipient in that plan unless an
  839  applicable specialty plan is available. Except as otherwise
  840  provided in this part, the agency may not engage in practices
  841  that are designed to favor one managed care plan over another.
  842         (2) When automatically enrolling recipients in managed care
  843  plans, if a recipient was enrolled in a plan immediately before
  844  the recipient′s choice period and that plan is still available
  845  in the region, the agency must maintain the recipient′s
  846  enrollment in that plan unless an applicable specialty plan is
  847  available. Otherwise, the agency shall automatically enroll
  848  based on the following criteria:
  849         (a) Whether the plan has sufficient network capacity to
  850  meet the needs of the recipients.
  851         (b) Whether the recipient has previously received services
  852  from one of the plan’s primary care providers.
  853         (c) Whether primary care providers in one plan are more
  854  geographically accessible to the recipient’s residence than
  855  those in other plans.
  856         (4) The agency shall develop a process to enable a
  857  recipient with access to employer-sponsored health care coverage
  858  to opt out of all managed care plans and to use Medicaid
  859  financial assistance to pay for the recipient’s share of the
  860  cost in such employer-sponsored coverage. Contingent upon
  861  federal approval, the agency shall also enable recipients with
  862  access to other insurance or related products providing access
  863  to health care services created pursuant to state law, including
  864  any product available under the Florida Health Choices Program,
  865  or any health exchange, to opt out. The amount of financial
  866  assistance provided for each recipient may not exceed the amount
  867  of the Medicaid premium that would have been paid to a managed
  868  care plan for that recipient. The agency shall seek federal
  869  approval to require Medicaid recipients with access to employer
  870  sponsored health care coverage to enroll in that coverage and
  871  use Medicaid financial assistance to pay for the recipient’s
  872  share of the cost for such coverage. The amount of financial
  873  assistance provided for each recipient may not exceed the amount
  874  of the Medicaid premium that would have been paid to a managed
  875  care plan for that recipient.
  876         (4)(5) Specialty plans serving children in the care and
  877  custody of the department may serve such children as long as
  878  they remain in care, including those remaining in extended
  879  foster care pursuant to s. 39.6251, or are in subsidized
  880  adoption and continue to be eligible for Medicaid pursuant to s.
  881  409.903, or are receiving guardianship assistance payments and
  882  continue to be eligible for Medicaid pursuant to s. 409.903.
  883         Section 11. Subsection (2) of section 409.981, Florida
  884  Statutes, is amended to read:
  885         409.981 Eligible long-term care plans.—
  886         (2) ELIGIBLE PLAN SELECTION.—The agency shall select
  887  eligible plans for the long-term care managed care program
  888  through the procurement process described in s. 409.966 through
  889  a single statewide procurement. The agency may award contracts
  890  to plans selected through the procurement process on a regional
  891  or statewide basis. The awards must include at least one
  892  provider service network in each of the eight regions outlined
  893  in this subsection. The agency shall procure:
  894         (a) At least 3 plans and up to 4 plans for Region A.
  895         (b) At least 3 plans and up to 6 plans for Region B.
  896         (c) At least 5 plans and up to 10 plans for Region C.
  897         (d) At least 3 plans and up to 6 plans for Region D.
  898         (e) At least 3 plans and up to 4 plans for Region E.
  899         (f) At least 3 plans and up to 5 plans for Region F.
  900         (g) At least 3 plans and up to 4 plans for Region G.
  901         (h) At least 5 plans and up to 10 plans for Region H.
  902         Two plans for Region 1. At least one plan must be a
  903  provider service network if any provider service networks submit
  904  a responsive bid.
  905         (b) Two plans for Region 2. At least one plan must be a
  906  provider service network if any provider service networks submit
  907  a responsive bid.
  908         (c) At least three plans and up to five plans for Region 3.
  909  At least one plan must be a provider service network if any
  910  provider service networks submit a responsive bid.
  911         (d) At least three plans and up to five plans for Region 4.
  912  At least one plan must be a provider service network if any
  913  provider service network submits a responsive bid.
  914         (e) At least two plans and up to four plans for Region 5.
  915  At least one plan must be a provider service network if any
  916  provider service networks submit a responsive bid.
  917         (f) At least four plans and up to seven plans for Region 6.
  918  At least one plan must be a provider service network if any
  919  provider service networks submit a responsive bid.
  920         (g) At least three plans and up to six plans for Region 7.
  921  At least one plan must be a provider service network if any
  922  provider service networks submit a responsive bid.
  923         (h) At least two plans and up to four plans for Region 8.
  924  At least one plan must be a provider service network if any
  925  provider service networks submit a responsive bid.
  926         (i) At least two plans and up to four plans for Region 9.
  927  At least one plan must be a provider service network if any
  928  provider service networks submit a responsive bid.
  929         (j) At least two plans and up to four plans for Region 10.
  930  At least one plan must be a provider service network if any
  931  provider service networks submit a responsive bid.
  932         (k) At least five plans and up to 10 plans for Region 11.
  933  At least one plan must be a provider service network if any
  934  provider service networks submit a responsive bid.
  935  
  936  If no provider service network submits a responsive bid in a
  937  region other than Region 1 or Region 2, the agency shall procure
  938  no more than one less than the maximum number of eligible plans
  939  permitted in that region. Within 12 months after the initial
  940  invitation to negotiate, the agency shall attempt to procure a
  941  provider service network. The agency shall notice another
  942  invitation to negotiate only with provider service networks in
  943  regions where no provider service network has been selected.
  944         Section 12. Subsection (4) of section 409.8132, Florida
  945  Statutes, is amended to read:
  946         409.8132 Medikids program component.—
  947         (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.—The
  948  provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,
  949  409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127,
  950  409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205 apply
  951  to the administration of the Medikids program component of the
  952  Florida Kidcare program, except that s. 409.9122 applies to
  953  Medikids as modified by the provisions of subsection (7).
  954         Section 13. For the purpose of incorporating the amendment
  955  made by this act to section 409.912, Florida Statutes, in
  956  references thereto, subsections (1), (7), (13), and (14) of
  957  section 409.962, Florida Statutes, are reenacted to read:
  958         409.962 Definitions.—As used in this part, except as
  959  otherwise specifically provided, the term:
  960         (1) “Accountable care organization” means an entity
  961  qualified as an accountable care organization in accordance with
  962  federal regulations, and which meets the requirements of a
  963  provider service network as described in s. 409.912(1).
  964         (7) “Eligible plan” means a health insurer authorized under
  965  chapter 624, an exclusive provider organization authorized under
  966  chapter 627, a health maintenance organization authorized under
  967  chapter 641, or a provider service network authorized under s.
  968  409.912(1) or an accountable care organization authorized under
  969  federal law. For purposes of the managed medical assistance
  970  program, the term also includes the Children’s Medical Services
  971  Network authorized under chapter 391 and entities qualified
  972  under 42 C.F.R. part 422 as Medicare Advantage Preferred
  973  Provider Organizations, Medicare Advantage Provider-sponsored
  974  Organizations, Medicare Advantage Health Maintenance
  975  Organizations, Medicare Advantage Coordinated Care Plans, and
  976  Medicare Advantage Special Needs Plans, and the Program of All
  977  inclusive Care for the Elderly.
  978         (13) “Prepaid plan” means a managed care plan that is
  979  licensed or certified as a risk-bearing entity, or qualified
  980  pursuant to s. 409.912(1), in the state and is paid a
  981  prospective per-member, per-month payment by the agency.
  982         (14) “Provider service network” means an entity qualified
  983  pursuant to s. 409.912(1) of which a controlling interest is
  984  owned by a health care provider, or group of affiliated
  985  providers, or a public agency or entity that delivers health
  986  services. Health care providers include Florida-licensed health
  987  care professionals or licensed health care facilities, federally
  988  qualified health care centers, and home health care agencies.
  989         Section 14. For the purpose of incorporating the amendment
  990  made by this act to section 409.912, Florida Statutes, in a
  991  reference thereto, subsection (22) of section 641.19, Florida
  992  Statutes, is reenacted to read:
  993         641.19 Definitions.—As used in this part, the term:
  994         (22) “Provider service network” means a network authorized
  995  under s. 409.912(1), reimbursed on a prepaid basis, operated by
  996  a health care provider or group of affiliated health care
  997  providers, and which directly provides health care services
  998  under a Medicare, Medicaid, or Healthy Kids contract.
  999         Section 15. For the purpose of incorporating the amendments
 1000  made by this act to section 409.981, Florida Statutes, in
 1001  references thereto, paragraphs (h), (i), and (j) of subsection
 1002  (3) and subsection (11) of section 430.2053, Florida Statutes,
 1003  are reenacted to read:
 1004         430.2053 Aging resource centers.—
 1005         (3) The duties of an aging resource center are to:
 1006         (h) Assist clients who request long-term care services in
 1007  being evaluated for eligibility for enrollment in the Medicaid
 1008  long-term care managed care program as eligible plans become
 1009  available in each of the regions pursuant to s. 409.981(2).
 1010         (i) Provide enrollment and coverage information to Medicaid
 1011  managed long-term care enrollees as qualified plans become
 1012  available in each of the regions pursuant to s. 409.981(2).
 1013         (j) Assist Medicaid recipients enrolled in the Medicaid
 1014  long-term care managed care program with informally resolving
 1015  grievances with a managed care network and assist Medicaid
 1016  recipients in accessing the managed care network’s formal
 1017  grievance process as eligible plans become available in each of
 1018  the regions defined in s. 409.981(2).
 1019         (11) In an area in which the department has designated an
 1020  area agency on aging as an aging resource center, the department
 1021  and the agency shall not make payments for the services listed
 1022  in subsection (9) and the Long-Term Care Community Diversion
 1023  Project for such persons who were not screened and enrolled
 1024  through the aging resource center. The department shall cease
 1025  making payments for recipients in eligible plans as eligible
 1026  plans become available in each of the regions defined in s.
 1027  409.981(2).
 1028         Section 16. This act shall take effect July 1, 2022.