August 14, 2020
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CS/HB 7047

A bill to be entitled
2An act relating to health care; amending s. 409.911, F.S.;
3revising the method for calculating disproportionate share
4payments to hospitals; amending s. 409.9112, F.S.;
5revising the time period during which the Agency for
6Health Care Administration is prohibited from distributing
7disproportionate share payments to regional perinatal
8intensive care centers; amending s. 409.9113, F.S.;
9revising the time period for distribution of
10disproportionate share payments to teaching hospitals;
11amending s. 409.9117, F.S.; revising the time period
12during which the agency is prohibited from distributing
13certain moneys under the primary care disproportionate
14share program; amending s. 409.906, F.S.; authorizing the
15agency to pay for certain services provided by an
16anesthesiologist assistant; amending s. 393.063, F.S.;
17revising the definition of the term "support coordinator";
18amending s. 393.0661, F.S.; requiring the Agency for
19Persons with Disabilities, in consultation with the Agency
20for Health Care Administration, to implement federal
21waivers to create a model service delivery system pilot
22project for Medicaid recipients with developmental
23disabilities; providing legislative intent; providing for
24implementation of the system on a pilot basis in certain
25areas of the state; providing for administration of the
26system by the Agency for Persons with Disabilities;
27providing requirements for selection of service providers
28to operate the system; providing for mandatory enrollment
29in pilot areas; requiring an evaluation of the system;
30providing for the formation of local and statewide
31advisory committees; requiring the committees to submit
32quarterly reports to the Legislature; requiring the agency
33to submit a report to the Governor and Legislature;
34authorizing the agency to seek federal waivers or Medicaid
35state plan amendments and adopt rules; requiring the
36agency to receive specific authorization from the
37Legislature before expanding the system; providing
38appropriations; providing an effective date.
40Be It Enacted by the Legislature of the State of Florida:
42     Section 1.  Subsection (2) of section 409.911, Florida
43Statutes, is amended to read:
44     409.911  Disproportionate share program.--Subject to
45specific allocations established within the General
46Appropriations Act and any limitations established pursuant to
47chapter 216, the agency shall distribute, pursuant to this
48section, moneys to hospitals providing a disproportionate share
49of Medicaid or charity care services by making quarterly
50Medicaid payments as required. Notwithstanding the provisions of
51s. 409.915, counties are exempt from contributing toward the
52cost of this special reimbursement for hospitals serving a
53disproportionate share of low-income patients.
54     (2)  The Agency for Health Care Administration shall use
55the following actual audited data to determine the Medicaid days
56and charity care to be used in calculating the disproportionate
57share payment:
58     (a)  The average of the 2001, 2002, and 2003 2000, 2001,
59and 2002 audited disproportionate share data to determine each
60hospital's Medicaid days and charity care for the 2007-2008
612006-2007 state fiscal year.
62     (b)  If the Agency for Health Care Administration does not
63have the prescribed 3 years of audited disproportionate share
64data as noted in paragraph (a) for a hospital, the agency shall
65use the average of the years of the audited disproportionate
66share data as noted in paragraph (a) which is available.
67     (c)  In accordance with s. 1923(b) of the Social Security
68Act, a hospital with a Medicaid inpatient utilization rate
69greater than one standard deviation above the statewide mean or
70a hospital with a low-income utilization rate of 25 percent or
71greater shall qualify for reimbursement.
72     Section 2.  Section 409.9112, Florida Statutes, is amended
73to read:
74     409.9112  Disproportionate share program for regional
75perinatal intensive care centers.--In addition to the payments
76made under s. 409.911, the Agency for Health Care Administration
77shall design and implement a system of making disproportionate
78share payments to those hospitals that participate in the
79regional perinatal intensive care center program established
80pursuant to chapter 383. This system of payments shall conform
81with federal requirements and shall distribute funds in each
82fiscal year for which an appropriation is made by making
83quarterly Medicaid payments. Notwithstanding the provisions of
84s. 409.915, counties are exempt from contributing toward the
85cost of this special reimbursement for hospitals serving a
86disproportionate share of low-income patients. For the state
87fiscal year 2007-2008 2005-2006, the agency shall not distribute
88moneys under the regional perinatal intensive care centers
89disproportionate share program.
90     (1)  The following formula shall be used by the agency to
91calculate the total amount earned for hospitals that participate
92in the regional perinatal intensive care center program:
97     TAE = total amount earned by a regional perinatal intensive
98care center.
99     HDSP = the prior state fiscal year regional perinatal
100intensive care center disproportionate share payment to the
101individual hospital.
102     THDSP = the prior state fiscal year total regional
103perinatal intensive care center disproportionate share payments
104to all hospitals.
105     (2)  The total additional payment for hospitals that
106participate in the regional perinatal intensive care center
107program shall be calculated by the agency as follows:
112     TAP = total additional payment for a regional perinatal
113intensive care center.
114     TAE = total amount earned by a regional perinatal intensive
115care center.
116     TA = total appropriation for the regional perinatal
117intensive care center disproportionate share program.
118     (3)  In order to receive payments under this section, a
119hospital must be participating in the regional perinatal
120intensive care center program pursuant to chapter 383 and must
121meet the following additional requirements:
122     (a)  Agree to conform to all departmental and agency
123requirements to ensure high quality in the provision of
124services, including criteria adopted by departmental and agency
125rule concerning staffing ratios, medical records, standards of
126care, equipment, space, and such other standards and criteria as
127the department and agency deem appropriate as specified by rule.
128     (b)  Agree to provide information to the department and
129agency, in a form and manner to be prescribed by rule of the
130department and agency, concerning the care provided to all
131patients in neonatal intensive care centers and high-risk
132maternity care.
133     (c)  Agree to accept all patients for neonatal intensive
134care and high-risk maternity care, regardless of ability to pay,
135on a functional space-available basis.
136     (d)  Agree to develop arrangements with other maternity and
137neonatal care providers in the hospital's region for the
138appropriate receipt and transfer of patients in need of
139specialized maternity and neonatal intensive care services.
140     (e)  Agree to establish and provide a developmental
141evaluation and services program for certain high-risk neonates,
142as prescribed and defined by rule of the department.
143     (f)  Agree to sponsor a program of continuing education in
144perinatal care for health care professionals within the region
145of the hospital, as specified by rule.
146     (g)  Agree to provide backup and referral services to the
147department's county health departments and other low-income
148perinatal providers within the hospital's region, including the
149development of written agreements between these organizations
150and the hospital.
151     (h)  Agree to arrange for transportation for high-risk
152obstetrical patients and neonates in need of transfer from the
153community to the hospital or from the hospital to another more
154appropriate facility.
155     (4)  Hospitals which fail to comply with any of the
156conditions in subsection (3) or the applicable rules of the
157department and agency shall not receive any payments under this
158section until full compliance is achieved. A hospital which is
159not in compliance in two or more consecutive quarters shall not
160receive its share of the funds. Any forfeited funds shall be
161distributed by the remaining participating regional perinatal
162intensive care center program hospitals.
163     Section 3.  Section 409.9113, Florida Statutes, is amended
164to read:
165     409.9113  Disproportionate share program for teaching
166hospitals.--In addition to the payments made under ss. 409.911
167and 409.9112, the Agency for Health Care Administration shall
168make disproportionate share payments to statutorily defined
169teaching hospitals for their increased costs associated with
170medical education programs and for tertiary health care services
171provided to the indigent. This system of payments shall conform
172with federal requirements and shall distribute funds in each
173fiscal year for which an appropriation is made by making
174quarterly Medicaid payments. Notwithstanding s. 409.915,
175counties are exempt from contributing toward the cost of this
176special reimbursement for hospitals serving a disproportionate
177share of low-income patients. For the state fiscal year 2007-
1782008 2006-2007, the agency shall distribute the moneys provided
179in the General Appropriations Act to statutorily defined
180teaching hospitals and family practice teaching hospitals under
181the teaching hospital disproportionate share program. The funds
182provided for statutorily defined teaching hospitals shall be
183distributed in the same proportion as the state fiscal year
1842003-2004 teaching hospital disproportionate share funds were
185distributed. The funds provided for family practice teaching
186hospitals shall be distributed equally among family practice
187teaching hospitals.
188     (1)  On or before September 15 of each year, the Agency for
189Health Care Administration shall calculate an allocation
190fraction to be used for distributing funds to state statutory
191teaching hospitals. Subsequent to the end of each quarter of the
192state fiscal year, the agency shall distribute to each statutory
193teaching hospital, as defined in s. 408.07, an amount determined
194by multiplying one-fourth of the funds appropriated for this
195purpose by the Legislature times such hospital's allocation
196fraction. The allocation fraction for each such hospital shall
197be determined by the sum of three primary factors, divided by
198three. The primary factors are:
199     (a)  The number of nationally accredited graduate medical
200education programs offered by the hospital, including programs
201accredited by the Accreditation Council for Graduate Medical
202Education and the combined Internal Medicine and Pediatrics
203programs acceptable to both the American Board of Internal
204Medicine and the American Board of Pediatrics at the beginning
205of the state fiscal year preceding the date on which the
206allocation fraction is calculated. The numerical value of this
207factor is the fraction that the hospital represents of the total
208number of programs, where the total is computed for all state
209statutory teaching hospitals.
210     (b)  The number of full-time equivalent trainees in the
211hospital, which comprises two components:
212     1.  The number of trainees enrolled in nationally
213accredited graduate medical education programs, as defined in
214paragraph (a). Full-time equivalents are computed using the
215fraction of the year during which each trainee is primarily
216assigned to the given institution, over the state fiscal year
217preceding the date on which the allocation fraction is
218calculated. The numerical value of this factor is the fraction
219that the hospital represents of the total number of full-time
220equivalent trainees enrolled in accredited graduate programs,
221where the total is computed for all state statutory teaching
223     2.  The number of medical students enrolled in accredited
224colleges of medicine and engaged in clinical activities,
225including required clinical clerkships and clinical electives.
226Full-time equivalents are computed using the fraction of the
227year during which each trainee is primarily assigned to the
228given institution, over the course of the state fiscal year
229preceding the date on which the allocation fraction is
230calculated. The numerical value of this factor is the fraction
231that the given hospital represents of the total number of full-
232time equivalent students enrolled in accredited colleges of
233medicine, where the total is computed for all state statutory
234teaching hospitals.
236The primary factor for full-time equivalent trainees is computed
237as the sum of these two components, divided by two.
238     (c)  A service index that comprises three components:
239     1.  The Agency for Health Care Administration Service
240Index, computed by applying the standard Service Inventory
241Scores established by the Agency for Health Care Administration
242to services offered by the given hospital, as reported on
243Worksheet A-2 for the last fiscal year reported to the agency
244before the date on which the allocation fraction is calculated.
245The numerical value of this factor is the fraction that the
246given hospital represents of the total Agency for Health Care
247Administration Service Index values, where the total is computed
248for all state statutory teaching hospitals.
249     2.  A volume-weighted service index, computed by applying
250the standard Service Inventory Scores established by the Agency
251for Health Care Administration to the volume of each service,
252expressed in terms of the standard units of measure reported on
253Worksheet A-2 for the last fiscal year reported to the agency
254before the date on which the allocation factor is calculated.
255The numerical value of this factor is the fraction that the
256given hospital represents of the total volume-weighted service
257index values, where the total is computed for all state
258statutory teaching hospitals.
259     3.  Total Medicaid payments to each hospital for direct
260inpatient and outpatient services during the fiscal year
261preceding the date on which the allocation factor is calculated.
262This includes payments made to each hospital for such services
263by Medicaid prepaid health plans, whether the plan was
264administered by the hospital or not. The numerical value of this
265factor is the fraction that each hospital represents of the
266total of such Medicaid payments, where the total is computed for
267all state statutory teaching hospitals.
269The primary factor for the service index is computed as the sum
270of these three components, divided by three.
271     (2)  By October 1 of each year, the agency shall use the
272following formula to calculate the maximum additional
273disproportionate share payment for statutorily defined teaching
279     TAP = total additional payment.
280     THAF = teaching hospital allocation factor.
281     A = amount appropriated for a teaching hospital
282disproportionate share program.
283     Section 4.  Section 409.9117, Florida Statutes, is amended
284to read:
285     409.9117  Primary care disproportionate share program.--For
286the state fiscal year 2007-2008 2006-2007, the agency shall not
287distribute moneys under the primary care disproportionate share
289     (1)  If federal funds are available for disproportionate
290share programs in addition to those otherwise provided by law,
291there shall be created a primary care disproportionate share
293     (2)  The following formula shall be used by the agency to
294calculate the total amount earned for hospitals that participate
295in the primary care disproportionate share program:
300     TAE = total amount earned by a hospital participating in
301the primary care disproportionate share program.
302     HDSP = the prior state fiscal year primary care
303disproportionate share payment to the individual hospital.
304     THDSP = the prior state fiscal year total primary care
305disproportionate share payments to all hospitals.
306     (3)  The total additional payment for hospitals that
307participate in the primary care disproportionate share program
308shall be calculated by the agency as follows:
313     TAP = total additional payment for a primary care hospital.
314     TAE = total amount earned by a primary care hospital.
315     TA = total appropriation for the primary care
316disproportionate share program.
317     (4)  In the establishment and funding of this program, the
318agency shall use the following criteria in addition to those
319specified in s. 409.911, payments may not be made to a hospital
320unless the hospital agrees to:
321     (a)  Cooperate with a Medicaid prepaid health plan, if one
322exists in the community.
323     (b)  Ensure the availability of primary and specialty care
324physicians to Medicaid recipients who are not enrolled in a
325prepaid capitated arrangement and who are in need of access to
326such physicians.
327     (c)  Coordinate and provide primary care services free of
328charge, except copayments, to all persons with incomes up to 100
329percent of the federal poverty level who are not otherwise
330covered by Medicaid or another program administered by a
331governmental entity, and to provide such services based on a
332sliding fee scale to all persons with incomes up to 200 percent
333of the federal poverty level who are not otherwise covered by
334Medicaid or another program administered by a governmental
335entity, except that eligibility may be limited to persons who
336reside within a more limited area, as agreed to by the agency
337and the hospital.
338     (d)  Contract with any federally qualified health center,
339if one exists within the agreed geopolitical boundaries,
340concerning the provision of primary care services, in order to
341guarantee delivery of services in a nonduplicative fashion, and
342to provide for referral arrangements, privileges, and
343admissions, as appropriate. The hospital shall agree to provide
344at an onsite or offsite facility primary care services within 24
345hours to which all Medicaid recipients and persons eligible
346under this paragraph who do not require emergency room services
347are referred during normal daylight hours.
348     (e)  Cooperate with the agency, the county, and other
349entities to ensure the provision of certain public health
350services, case management, referral and acceptance of patients,
351and sharing of epidemiological data, as the agency and the
352hospital find mutually necessary and desirable to promote and
353protect the public health within the agreed geopolitical
355     (f)  In cooperation with the county in which the hospital
356resides, develop a low-cost, outpatient, prepaid health care
357program to persons who are not eligible for the Medicaid
358program, and who reside within the area.
359     (g)  Provide inpatient services to residents within the
360area who are not eligible for Medicaid or Medicare, and who do
361not have private health insurance, regardless of ability to pay,
362on the basis of available space, except that nothing shall
363prevent the hospital from establishing bill collection programs
364based on ability to pay.
365     (h)  Work with the Florida Healthy Kids Corporation, the
366Florida Health Care Purchasing Cooperative, and business health
367coalitions, as appropriate, to develop a feasibility study and
368plan to provide a low-cost comprehensive health insurance plan
369to persons who reside within the area and who do not have access
370to such a plan.
371     (i)  Work with public health officials and other experts to
372provide community health education and prevention activities
373designed to promote healthy lifestyles and appropriate use of
374health services.
375     (j)  Work with the local health council to develop a plan
376for promoting access to affordable health care services for all
377persons who reside within the area, including, but not limited
378to, public health services, primary care services, inpatient
379services, and affordable health insurance generally.
381Any hospital that fails to comply with any of the provisions of
382this subsection, or any other contractual condition, may not
383receive payments under this section until full compliance is
385     Section 5.  Subsection (26) is added to section 409.906,
386Florida Statutes, to read:
387     409.906  Optional Medicaid services.--Subject to specific
388appropriations, the agency may make payments for services which
389are optional to the state under Title XIX of the Social Security
390Act and are furnished by Medicaid providers to recipients who
391are determined to be eligible on the dates on which the services
392were provided. Any optional service that is provided shall be
393provided only when medically necessary and in accordance with
394state and federal law. Optional services rendered by providers
395in mobile units to Medicaid recipients may be restricted or
396prohibited by the agency. Nothing in this section shall be
397construed to prevent or limit the agency from adjusting fees,
398reimbursement rates, lengths of stay, number of visits, or
399number of services, or making any other adjustments necessary to
400comply with the availability of moneys and any limitations or
401directions provided for in the General Appropriations Act or
402chapter 216. If necessary to safeguard the state's systems of
403providing services to elderly and disabled persons and subject
404to the notice and review provisions of s. 216.177, the Governor
405may direct the Agency for Health Care Administration to amend
406the Medicaid state plan to delete the optional Medicaid service
407known as "Intermediate Care Facilities for the Developmentally
408Disabled." Optional services may include:
410pay for all services provided to a recipient by an
411anesthesiologist assistant licensed under s. 458.3475 or s.
412459.023. Reimbursement for such services must be not less than
41380 percent of the reimbursement that would be paid to a
414physician who provided the same services.
415     Section 6.  Subsection (36) of section 393.063, Florida
416Statutes, is amended to read:
417     393.063  Definitions.--For the purposes of this chapter,
418the term:
419     (36)  "Support coordinator" means a person who is
420designated by or under contract with the agency to serve as case
421manager for assist individuals served in programs administered
422by the agency, including, but not limited to, Medicaid waiver
423programs, and to identify individuals' families in identifying
424their capacities, needs, and resources, as well as finding and
425gaining access to necessary supports and services; coordinating
426the delivery of supports and services; advocating on behalf of
427the individual and family; maintaining relevant records; and
428monitoring and evaluating the delivery of supports and services.
429A support coordinator is responsible for assisting the agency in
430meeting the needs of individuals served while managing
431expenditures within available resources to determine the extent
432to which they meet the needs and expectations identified by the
433individual, family, and others who participated in the
434development of the support plan.
435     Section 7.  Paragraph (c) is added to subsection (1) of
436section 393.0661, Florida Statutes, to read:
437     393.0661  Home and community-based services delivery
438system; comprehensive redesign.--The Legislature finds that the
439home and community-based services delivery system for persons
440with developmental disabilities and the availability of
441appropriated funds are two of the critical elements in making
442services available. Therefore, it is the intent of the
443Legislature that the Agency for Persons with Disabilities shall
444develop and implement a comprehensive redesign of the system.
445     (1)  The redesign of the home and community-based services
446system shall include, at a minimum, all actions necessary to
447achieve an appropriate rate structure, client choice within a
448specified service package, appropriate assessment strategies, an
449efficient billing process that contains reconciliation and
450monitoring components, a redefined role for support coordinators
451that avoids potential conflicts of interest, and ensures that
452family/client budgets are linked to levels of need.
453     (c)  By December 1, 2007, the Agency for Persons with
454Disabilities, in consultation with the Agency for Health Care
455Administration, shall create a model service delivery system
456pilot project for persons with developmental disabilities who
457receive services under the developmental disabilities waiver
458program administered by the Agency for Persons with
459Disabilities. Persons with developmental disabilities who
460receive services under the family and supported living waiver
461program or the consumer-directed care plus waiver program
462administered by the Agency for Persons with Disabilities may
463also be included in the system if the agency determines that
464such inclusion is feasible and will improve coordination of care
465and management of costs. The system must transfer and combine
466all services funded by Medicaid waiver programs and services
467funded only by the state, including room and board and supported
468living payments, for individuals who participate in the system.
469The pilot project shall document increased client outcomes that
470are known to be associated with a valid needs assessment of the
471level of need of the client, rate setting based on the level of
472need, and encouragement of the use of community-centered
473services and supports. The pilot project shall implement strong
474utilization control, such as capped rates, in order to ensure
475predictable and controlled annual costs. Medicaid service
476delivery, including, but not limited to, service authorization,
477care management, and monitoring shall be managed locally through
478the area office of the Agency for Persons with Disabilities in
479order to encourage provider development. Support coordination
480services shall be available to individuals participating in the
481pilot program.
482     1.  The Legislature intends that the service delivery
483system provide recipients in Medicaid waiver programs with a
484coordinated system of services, increased cost predictability,
485and a stabilized rate of increase in Medicaid expenditures while
487     a.  Consumer choice.
488     b.  Opportunities for consumer-directed services.
489     c.  Access to medically necessary services.
490     d.  Coordination of community-based services.
491     e.  Reductions in the unnecessary use of services.
492     2.  The Agency for Persons with Disabilities shall
493implement the system on a pilot basis in Area 1 and may conduct
494a similar pilot in an urban area of the Agency for Persons with
495Disabilities, in consultation with the Agency for Health Care
496Administration. After completion of the development phase of the
497system, attainment of necessary federal approval, selection of
498qualified providers, and rate setting, the Agency for Persons
499with Disabilities shall delegate administration of the system to
500the administrator of the agency's local area office. The Agency
501for Persons with Disabilities shall set standards for qualified
502providers and provide quality assurance, monitoring oversight,
503and other duties necessary for the system. The enrollment of
504Medicaid waiver recipients into the system in pilot areas shall
505be mandatory.
506     3.  The local area office shall administer the pilot
507program and shall be responsible for ensuring that the costs of
508the program do not exceed the amount of funds allocated for the
509program. The agency area administrator shall also:
510     a.  Identify the needs of the recipients using a
511standardized assessment process approved by the agency.
512     b.  Allow a recipient to select any provider that has been
513qualified by the agency, provided that the service offered by
514the provider is appropriate to meet the needs of the recipient.
515     c.  Make a good faith effort to select qualified providers
516currently providing Medicaid waiver services for the agency in
517the pilot area.
518     d.  Develop and use a service provider qualification system
519approved by the agency that describes the quality of care
520standards that providers of service to persons with
521developmental disabilities must meet in order to provide
522services within the pilot area.
523     e.  Exclude, when feasible, chronically poor-performing
524providers and facilities as determined by the agency.
525     f.  Demonstrate a quality assurance system and a
526performance improvement system that are satisfactory to the
528     4.  The agency must ensure that the rate-setting
529methodology for the system reflects the intent to provide
530quality care in the least restrictive setting appropriate for
531the recipient and provide for choice by the recipient. The
532agency may choose to limit financial risk for the pilot area
533operating the system to cover high-cost recipients or to address
534the catastrophic care needs of recipients enrolled in the
536     5.  Within 24 months after implementation, the agency shall
537contract for a comprehensive evaluation of the system. The
538evaluation must include assessments of cost savings, cost-
539effectiveness, recipient outcomes, consumer choice, access to
540services, coordination of care, and quality of care. The
541evaluation shall include, but not be limited to, an assessment
542of the following aspects:
543     a.  A study of the funding patterns of the cost-prediction
544methodology before and after implementation of the pilot
546     b.  A study of the service utilization patterns of the
547cost-prediction methodology before and after implementation of
548the pilot program;
549     c.  The accuracy of the cost-prediction methodology in
550explaining and predicting funding levels for individuals
551receiving each of the three waivers in the pilot areas;
552     d.  The accuracy of the cost-prediction methodology and a
553plan for dealing with cases involving individuals with the
554highest and lowest support needs and funding levels;
555     e.  A survey of consumer satisfaction regarding consumer
556choice, scope of services, and proposed funding levels generated
557by the cost-prediction methodology in the pilot areas;
558     f.  The applicability of the cost-prediction  methodology
559to explain and predict funding levels for all individuals
560receiving the waivers;
561     g.  The robustness of the cost-prediction methodology to
562withstand appeals and grievances; and
563     h.  A systematic comparison of the outcomes in both pilot
564areas and the different models that are demonstrated.
565     6.  Each pilot area shall form an advisory committee that
566includes representatives from the stakeholder community,
567including persons with disabilities, family members of persons
568with disabilities, members of disability advocacy groups, and
569representatives of program service providers to provide feedback
570and monitor the implementation of the pilot program on at least
571a quarterly basis.
572     7.  The Agency for Persons with Disabilities shall form an
573advisory committee that includes representatives from the
574stakeholder community, including persons with disabilities,
575family members of persons with disabilities, members of
576disability advocacy groups, and representatives of program
577service providers to provide feedback and monitor the
578implementation of the pilot program from a statewide
580     8.  The advisory committees shall submit reports evaluating
581the progress of the pilot programs to the President of the
582Senate and the Speaker of the House of Representatives on a
583quarterly basis.
584     9.  The agency shall submit a report that describes the
585administrative or legal barriers to the implementation and
586operation of the system, including recommendations regarding
587statewide expansion of the system and a recommendation for the
588model service delivery system to be implemented statewide, to
589the Governor, the President of the Senate, and the Speaker of
590the House of Representatives no later than December 31, 2008.
591     10.  The agency, in coordination with the Agency for Health
592Care Administration, may seek federal waivers or Medicaid state
593plan amendments and adopt rules as necessary to administer the
594system on a pilot basis. The agency must receive specific
595authorization from the Legislature prior to expanding beyond the
596area one pilot designated for the implementation of this system.
597Further expansion of this pilot project requires approval by the
599     Section 8.  The sum of $250,000 in nonrecurring funds from
600the General Revenue Fund and $250,000 in nonrecurring funds from
601the Administrative Trust Fund are appropriated to the Agency for
602Persons with Disabilities to implement the provisions of this
604     Section 9.  This act shall take effect July 1, 2007.

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