September 22, 2019
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       CS for CS for SB 1484                            First Engrossed
       
       
       
       
       
       
       
       
       20101484e1
       
    1                        A bill to be entitled                      
    2         An act relating to Medicaid; amending s. 409.912,
    3         F.S.; authorizing the Agency for Health Care
    4         Administration to contract with an entity for the
    5         provision of comprehensive behavioral health care
    6         services to certain Medicaid recipients who are not
    7         enrolled in a Medicaid managed care plan or a Medicaid
    8         provider service network under certain circumstances;
    9         requiring the agency to impose a fine against a person
   10         under contract with the agency who violates certain
   11         provisions; requiring an entity that contracts with
   12         the agency as a managed care plan to post a surety
   13         bond with the agency or maintain an account of a
   14         specified sum; requiring the agency to pursue the
   15         entity if the entity terminates the contract with the
   16         agency before the end date of the contract; amending
   17         s. 409.91211, F.S.; extending by 3 years the statewide
   18         implementation of an enhanced service delivery system
   19         for the Florida Medicaid program; providing for the
   20         expansion of the pilot project into counties that have
   21         two or more plans and the capacity to serve the
   22         designated population; requiring that the agency
   23         provide certain specified data to the recipient when
   24         selecting a capitated managed care plan; revising
   25         certain requirements for entities performing choice
   26         counseling for recipients; requiring the agency to
   27         provide behavioral health care services to Medicaid
   28         eligible children; extending a date by which the
   29         behavioral health care services will be delivered to
   30         children; deleting a provision under which certain
   31         Medicaid recipients who are not currently enrolled in
   32         a capitated managed care plan upon implementation are
   33         not eligible for specified services for the amount of
   34         time that the recipients do not enroll in a capitated
   35         managed care network; authorizing the agency to extend
   36         the time to continue operation of the pilot program;
   37         requiring that the agency seek public input on
   38         extending and expanding the managed care pilot program
   39         and post certain information on its website; amending
   40         s. 409.9122, F.S.; providing that time allotted to any
   41         Medicaid recipient for the selection of, enrollment
   42         in, or disenrollment from a managed care plan or
   43         MediPass is tolled throughout any month in which the
   44         enrollment broker or choice counseling provider
   45         adversely affects a beneficiary’s ability to access
   46         choice counseling or enrollment broker services by its
   47         failure to comply with the terms and conditions of its
   48         contract with the agency or has otherwise acted or
   49         failed to act in a manner that the agency deems likely
   50         to jeopardize its ability to perform certain assigned
   51         responsibilities; requiring the agency to incorporate
   52         certain provisions after a specified date in its
   53         contracts related to sanctions or fines for any action
   54         or the failure to act on the part of an enrollment
   55         broker or choice counselor provider; creating s.
   56         624.35, F.S.; providing a short title; creating s.
   57         624.351, F.S.; providing legislative intent;
   58         establishing the Medicaid and Public Assistance Fraud
   59         Strike Force within the Department of Financial
   60         Services to coordinate efforts to eliminate Medicaid
   61         and public assistance fraud; providing for membership;
   62         providing for meetings; specifying duties; requiring
   63         an annual report to the Legislature and Governor;
   64         creating s. 624.352, F.S.; directing the Chief
   65         Financial Officer to prepare model interagency
   66         agreements that address Medicaid and public assistance
   67         fraud; specifying which agencies can be a party to
   68         such agreements; amending s. 16.59, F.S.; conforming
   69         provisions to changes made by the act; requiring the
   70         Divisions of Insurance Fraud and Public Assistance
   71         Fraud in the Department of Financial Services to be
   72         collocated with the Medicaid Fraud Control Unit if
   73         possible; requiring positions dedicated to Medicaid
   74         managed care fraud to be collocated with the Division
   75         of Insurance Fraud; amending s. 20.121, F.S.;
   76         establishing the Division of Public Assistance Fraud
   77         within the Department of Financial Services; amending
   78         ss. 411.01, 414.33, and 414.39, F.S.; conforming
   79         provisions to changes made by the act; transferring,
   80         renumbering, and amending s. 943.401, F.S.; directing
   81         the Department of Financial Services rather than the
   82         Department of Law Enforcement to investigate public
   83         assistance fraud; directing the Auditor General and
   84         the Office of Program Policy Analysis and Government
   85         Accountability to review the Medicaid fraud and abuse
   86         processes in the Agency for Health Care
   87         Administration; requiring a report to the Legislature
   88         and Governor by a certain date; establishing the
   89         Medicaid claims adjudication project in the Agency for
   90         Health Care Administration to decrease the incidence
   91         of inaccurate payments and to improve the efficiency
   92         of the Medicaid claims processing system; transferring
   93         activities relating to public assistance fraud from
   94         the Department of Law Enforcement to the Division of
   95         Public Assistance Fraud in the Department of Financial
   96         Services by a type two transfer; providing effective
   97         dates.
   98  
   99         WHEREAS, Florida’s Medicaid program is one of the largest
  100  in the country, serving approximately 2.7 million persons each
  101  month. The program provides health care benefits to families and
  102  individuals below certain income and resource levels. For the
  103  2008-2009 fiscal year, the Legislature appropriated $18.81
  104  billion to operate the Medicaid program which is funded from
  105  general revenue, trust funds that include federal matching
  106  funds, and other state funds, and
  107         WHEREAS, Medicaid fraud in Florida is epidemic, far
  108  reaching, and costs the state and the Federal Government
  109  billions of dollars annually. Medicaid fraud not only drives up
  110  the cost of health care and reduces the availability of funds to
  111  support needed services, but undermines the long-term solvency
  112  of both health care providers and the state’s Medicaid program,
  113  and
  114         WHEREAS, the state’s public assistance programs serve
  115  approximately 1.8 million Floridians each month by providing
  116  benefits for food, cash assistance for needy families, home
  117  health care for disabled adults, and grants to individuals and
  118  communities affected by natural disasters. For the 2008-2009
  119  fiscal year, the Legislature appropriated $626 million to
  120  operate public assistance programs, and
  121         WHEREAS, public assistance fraud costs taxpayers millions
  122  of dollars annually, which significantly and negatively impacts
  123  the various assistance programs by taking dollars that could be
  124  used to provide services for those people who have a legitimate
  125  need for assistance, and
  126         WHEREAS, both Medicaid and public assistance programs are
  127  vulnerable to fraudulent practices that can take many forms. For
  128  Medicaid, these practices range from providers who bill for
  129  services never rendered and who pay kickbacks to other providers
  130  for client referrals, to fraud occurring at the corporate level
  131  of a managed care organization. Fraudulent practices involving
  132  public assistance involve persons not disclosing material facts
  133  when obtaining assistance or not disclosing changes in
  134  circumstances while on public assistance, and
  135         WHEREAS, ridding the system of perpetrators who prey on the
  136  state’s Medicaid and public assistance programs helps reduce the
  137  state’s skyrocketing costs, makes more funds available for
  138  essential services, and improves the quality of care and the
  139  health status of our residents, and
  140         WHEREAS, aggressive and comprehensive measures are needed
  141  at the state level to investigate and prosecute Medicaid and
  142  public assistance fraud and to recover dollars stolen from these
  143  programs, and
  144         WHEREAS, new statewide initiatives and coordinated efforts
  145  are necessary to focus resources in order to aid law enforcement
  146  and investigative agencies in detecting and deterring this type
  147  of fraudulent activity, NOW, THEREFORE,
  148  
  149  Be It Enacted by the Legislature of the State of Florida:
  150  
  151         Section 1. Paragraph (b) of subsection (4) of section
  152  409.912, Florida Statutes, is amended, paragraph (d) of
  153  subsection (4) of that section is reenacted, present subsections
  154  (23) through (53) of that section are renumbered as subsections
  155  (24) through (54), respectively, a new subsection (23) is added
  156  to that section, and present subsections (21) and (22) of that
  157  section are amended, to read:
  158         409.912 Cost-effective purchasing of health care.—The
  159  agency shall purchase goods and services for Medicaid recipients
  160  in the most cost-effective manner consistent with the delivery
  161  of quality medical care. To ensure that medical services are
  162  effectively utilized, the agency may, in any case, require a
  163  confirmation or second physician’s opinion of the correct
  164  diagnosis for purposes of authorizing future services under the
  165  Medicaid program. This section does not restrict access to
  166  emergency services or poststabilization care services as defined
  167  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  168  shall be rendered in a manner approved by the agency. The agency
  169  shall maximize the use of prepaid per capita and prepaid
  170  aggregate fixed-sum basis services when appropriate and other
  171  alternative service delivery and reimbursement methodologies,
  172  including competitive bidding pursuant to s. 287.057, designed
  173  to facilitate the cost-effective purchase of a case-managed
  174  continuum of care. The agency shall also require providers to
  175  minimize the exposure of recipients to the need for acute
  176  inpatient, custodial, and other institutional care and the
  177  inappropriate or unnecessary use of high-cost services. The
  178  agency shall contract with a vendor to monitor and evaluate the
  179  clinical practice patterns of providers in order to identify
  180  trends that are outside the normal practice patterns of a
  181  provider’s professional peers or the national guidelines of a
  182  provider’s professional association. The vendor must be able to
  183  provide information and counseling to a provider whose practice
  184  patterns are outside the norms, in consultation with the agency,
  185  to improve patient care and reduce inappropriate utilization.
  186  The agency may mandate prior authorization, drug therapy
  187  management, or disease management participation for certain
  188  populations of Medicaid beneficiaries, certain drug classes, or
  189  particular drugs to prevent fraud, abuse, overuse, and possible
  190  dangerous drug interactions. The Pharmaceutical and Therapeutics
  191  Committee shall make recommendations to the agency on drugs for
  192  which prior authorization is required. The agency shall inform
  193  the Pharmaceutical and Therapeutics Committee of its decisions
  194  regarding drugs subject to prior authorization. The agency is
  195  authorized to limit the entities it contracts with or enrolls as
  196  Medicaid providers by developing a provider network through
  197  provider credentialing. The agency may competitively bid single
  198  source-provider contracts if procurement of goods or services
  199  results in demonstrated cost savings to the state without
  200  limiting access to care. The agency may limit its network based
  201  on the assessment of beneficiary access to care, provider
  202  availability, provider quality standards, time and distance
  203  standards for access to care, the cultural competence of the
  204  provider network, demographic characteristics of Medicaid
  205  beneficiaries, practice and provider-to-beneficiary standards,
  206  appointment wait times, beneficiary use of services, provider
  207  turnover, provider profiling, provider licensure history,
  208  previous program integrity investigations and findings, peer
  209  review, provider Medicaid policy and billing compliance records,
  210  clinical and medical record audits, and other factors. Providers
  211  shall not be entitled to enrollment in the Medicaid provider
  212  network. The agency shall determine instances in which allowing
  213  Medicaid beneficiaries to purchase durable medical equipment and
  214  other goods is less expensive to the Medicaid program than long
  215  term rental of the equipment or goods. The agency may establish
  216  rules to facilitate purchases in lieu of long-term rentals in
  217  order to protect against fraud and abuse in the Medicaid program
  218  as defined in s. 409.913. The agency may seek federal waivers
  219  necessary to administer these policies.
  220         (4) The agency may contract with:
  221         (b) An entity that is providing comprehensive behavioral
  222  health care services to certain Medicaid recipients through a
  223  capitated, prepaid arrangement pursuant to the federal waiver
  224  provided for by s. 409.905(5). Such entity must be licensed
  225  under chapter 624, chapter 636, or chapter 641, or authorized
  226  under paragraph (c) or paragraph (d), and must possess the
  227  clinical systems and operational competence to manage risk and
  228  provide comprehensive behavioral health care to Medicaid
  229  recipients. As used in this paragraph, the term “comprehensive
  230  behavioral health care services” means covered mental health and
  231  substance abuse treatment services that are available to
  232  Medicaid recipients. The secretary of the Department of Children
  233  and Family Services shall approve provisions of procurements
  234  related to children in the department’s care or custody before
  235  enrolling such children in a prepaid behavioral health plan. Any
  236  contract awarded under this paragraph must be competitively
  237  procured. In developing the behavioral health care prepaid plan
  238  procurement document, the agency shall ensure that the
  239  procurement document requires the contractor to develop and
  240  implement a plan to ensure compliance with s. 394.4574 related
  241  to services provided to residents of licensed assisted living
  242  facilities that hold a limited mental health license. Except as
  243  provided in subparagraph 8., and except in counties where the
  244  Medicaid managed care pilot program is authorized pursuant to s.
  245  409.91211, the agency shall seek federal approval to contract
  246  with a single entity meeting these requirements to provide
  247  comprehensive behavioral health care services to all Medicaid
  248  recipients not enrolled in a Medicaid managed care plan
  249  authorized under s. 409.91211, a provider service network
  250  authorized under paragraph (d), or a Medicaid health maintenance
  251  organization in an AHCA area. In an AHCA area where the Medicaid
  252  managed care pilot program is authorized pursuant to s.
  253  409.91211 in one or more counties, the agency may procure a
  254  contract with a single entity to serve the remaining counties as
  255  an AHCA area or the remaining counties may be included with an
  256  adjacent AHCA area and are subject to this paragraph. Each
  257  entity must offer a sufficient choice of providers in its
  258  network to ensure recipient access to care and the opportunity
  259  to select a provider with whom they are satisfied. The network
  260  shall include all public mental health hospitals. To ensure
  261  unimpaired access to behavioral health care services by Medicaid
  262  recipients, all contracts issued pursuant to this paragraph must
  263  require 80 percent of the capitation paid to the managed care
  264  plan, including health maintenance organizations and capitated
  265  provider service networks, to be expended for the provision of
  266  behavioral health care services. If the managed care plan
  267  expends less than 80 percent of the capitation paid for the
  268  provision of behavioral health care services, the difference
  269  shall be returned to the agency. The agency shall provide the
  270  plan with a certification letter indicating the amount of
  271  capitation paid during each calendar year for behavioral health
  272  care services pursuant to this section. The agency may reimburse
  273  for substance abuse treatment services on a fee-for-service
  274  basis until the agency finds that adequate funds are available
  275  for capitated, prepaid arrangements.
  276         1. By January 1, 2001, the agency shall modify the
  277  contracts with the entities providing comprehensive inpatient
  278  and outpatient mental health care services to Medicaid
  279  recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
  280  Counties, to include substance abuse treatment services.
  281         2. By July 1, 2003, the agency and the Department of
  282  Children and Family Services shall execute a written agreement
  283  that requires collaboration and joint development of all policy,
  284  budgets, procurement documents, contracts, and monitoring plans
  285  that have an impact on the state and Medicaid community mental
  286  health and targeted case management programs.
  287         3. Except as provided in subparagraph 8., by July 1, 2006,
  288  the agency and the Department of Children and Family Services
  289  shall contract with managed care entities in each AHCA area
  290  except area 6 or arrange to provide comprehensive inpatient and
  291  outpatient mental health and substance abuse services through
  292  capitated prepaid arrangements to all Medicaid recipients who
  293  are eligible to participate in such plans under federal law and
  294  regulation. In AHCA areas where eligible individuals number less
  295  than 150,000, the agency shall contract with a single managed
  296  care plan to provide comprehensive behavioral health services to
  297  all recipients who are not enrolled in a Medicaid health
  298  maintenance organization, a provider service network authorized
  299  under paragraph (d), or a Medicaid capitated managed care plan
  300  authorized under s. 409.91211. The agency may contract with more
  301  than one comprehensive behavioral health provider to provide
  302  care to recipients who are not enrolled in a Medicaid capitated
  303  managed care plan authorized under s. 409.91211, a provider
  304  service network authorized under paragraph (d), or a Medicaid
  305  health maintenance organization in AHCA areas where the eligible
  306  population exceeds 150,000. In an AHCA area where the Medicaid
  307  managed care pilot program is authorized pursuant to s.
  308  409.91211 in one or more counties, the agency may procure a
  309  contract with a single entity to serve the remaining counties as
  310  an AHCA area or the remaining counties may be included with an
  311  adjacent AHCA area and shall be subject to this paragraph.
  312  Contracts for comprehensive behavioral health providers awarded
  313  pursuant to this section shall be competitively procured. Both
  314  for-profit and not-for-profit corporations are eligible to
  315  compete. Managed care plans contracting with the agency under
  316  subsection (3) or paragraph (d), shall provide and receive
  317  payment for the same comprehensive behavioral health benefits as
  318  provided in AHCA rules, including handbooks incorporated by
  319  reference. In AHCA area 11, the agency shall contract with at
  320  least two comprehensive behavioral health care providers to
  321  provide behavioral health care to recipients in that area who
  322  are enrolled in, or assigned to, the MediPass program. One of
  323  the behavioral health care contracts must be with the existing
  324  provider service network pilot project, as described in
  325  paragraph (d), for the purpose of demonstrating the cost
  326  effectiveness of the provision of quality mental health services
  327  through a public hospital-operated managed care model. Payment
  328  shall be at an agreed-upon capitated rate to ensure cost
  329  savings. Of the recipients in area 11 who are assigned to
  330  MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those
  331  MediPass-enrolled recipients shall be assigned to the existing
  332  provider service network in area 11 for their behavioral care.
  333         4. By October 1, 2003, the agency and the department shall
  334  submit a plan to the Governor, the President of the Senate, and
  335  the Speaker of the House of Representatives which provides for
  336  the full implementation of capitated prepaid behavioral health
  337  care in all areas of the state.
  338         a. Implementation shall begin in 2003 in those AHCA areas
  339  of the state where the agency is able to establish sufficient
  340  capitation rates.
  341         b. If the agency determines that the proposed capitation
  342  rate in any area is insufficient to provide appropriate
  343  services, the agency may adjust the capitation rate to ensure
  344  that care will be available. The agency and the department may
  345  use existing general revenue to address any additional required
  346  match but may not over-obligate existing funds on an annualized
  347  basis.
  348         c. Subject to any limitations provided in the General
  349  Appropriations Act, the agency, in compliance with appropriate
  350  federal authorization, shall develop policies and procedures
  351  that allow for certification of local and state funds.
  352         5. Children residing in a statewide inpatient psychiatric
  353  program, or in a Department of Juvenile Justice or a Department
  354  of Children and Family Services residential program approved as
  355  a Medicaid behavioral health overlay services provider may not
  356  be included in a behavioral health care prepaid health plan or
  357  any other Medicaid managed care plan pursuant to this paragraph.
  358         6. In converting to a prepaid system of delivery, the
  359  agency shall in its procurement document require an entity
  360  providing only comprehensive behavioral health care services to
  361  prevent the displacement of indigent care patients by enrollees
  362  in the Medicaid prepaid health plan providing behavioral health
  363  care services from facilities receiving state funding to provide
  364  indigent behavioral health care, to facilities licensed under
  365  chapter 395 which do not receive state funding for indigent
  366  behavioral health care, or reimburse the unsubsidized facility
  367  for the cost of behavioral health care provided to the displaced
  368  indigent care patient.
  369         7. Traditional community mental health providers under
  370  contract with the Department of Children and Family Services
  371  pursuant to part IV of chapter 394, child welfare providers
  372  under contract with the Department of Children and Family
  373  Services in areas 1 and 6, and inpatient mental health providers
  374  licensed pursuant to chapter 395 must be offered an opportunity
  375  to accept or decline a contract to participate in any provider
  376  network for prepaid behavioral health services.
  377         8. All Medicaid-eligible children, except children in area
  378  1 and children in Highlands County, Hardee County, Polk County,
  379  or Manatee County of area 6, that are open for child welfare
  380  services in the HomeSafeNet system, shall receive their
  381  behavioral health care services through a specialty prepaid plan
  382  operated by community-based lead agencies through a single
  383  agency or formal agreements among several agencies. The
  384  specialty prepaid plan must result in savings to the state
  385  comparable to savings achieved in other Medicaid managed care
  386  and prepaid programs. Such plan must provide mechanisms to
  387  maximize state and local revenues. The specialty prepaid plan
  388  shall be developed by the agency and the Department of Children
  389  and Family Services. The agency may seek federal waivers to
  390  implement this initiative. Medicaid-eligible children whose
  391  cases are open for child welfare services in the HomeSafeNet
  392  system and who reside in AHCA area 10 are exempt from the
  393  specialty prepaid plan upon the development of a service
  394  delivery mechanism for children who reside in area 10 as
  395  specified in s. 409.91211(3)(dd).
  396         (d) A provider service network may be reimbursed on a fee
  397  for-service or prepaid basis. A provider service network which
  398  is reimbursed by the agency on a prepaid basis shall be exempt
  399  from parts I and III of chapter 641, but must comply with the
  400  solvency requirements in s. 641.2261(2) and meet appropriate
  401  financial reserve, quality assurance, and patient rights
  402  requirements as established by the agency. Medicaid recipients
  403  assigned to a provider service network shall be chosen equally
  404  from those who would otherwise have been assigned to prepaid
  405  plans and MediPass. The agency is authorized to seek federal
  406  Medicaid waivers as necessary to implement the provisions of
  407  this section. Any contract previously awarded to a provider
  408  service network operated by a hospital pursuant to this
  409  subsection shall remain in effect for a period of 3 years
  410  following the current contract expiration date, regardless of
  411  any contractual provisions to the contrary. A provider service
  412  network is a network established or organized and operated by a
  413  health care provider, or group of affiliated health care
  414  providers, including minority physician networks and emergency
  415  room diversion programs that meet the requirements of s.
  416  409.91211, which provides a substantial proportion of the health
  417  care items and services under a contract directly through the
  418  provider or affiliated group of providers and may make
  419  arrangements with physicians or other health care professionals,
  420  health care institutions, or any combination of such individuals
  421  or institutions to assume all or part of the financial risk on a
  422  prospective basis for the provision of basic health services by
  423  the physicians, by other health professionals, or through the
  424  institutions. The health care providers must have a controlling
  425  interest in the governing body of the provider service network
  426  organization.
  427         (21) Any entity contracting with the agency pursuant to
  428  this section to provide health care services to Medicaid
  429  recipients is prohibited from engaging in any of the following
  430  practices or activities:
  431         (a) Practices that are discriminatory, including, but not
  432  limited to, attempts to discourage participation on the basis of
  433  actual or perceived health status.
  434         (b) Activities that could mislead or confuse recipients, or
  435  misrepresent the organization, its marketing representatives, or
  436  the agency. Violations of this paragraph include, but are not
  437  limited to:
  438         1. False or misleading claims that marketing
  439  representatives are employees or representatives of the state or
  440  county, or of anyone other than the entity or the organization
  441  by whom they are reimbursed.
  442         2. False or misleading claims that the entity is
  443  recommended or endorsed by any state or county agency, or by any
  444  other organization which has not certified its endorsement in
  445  writing to the entity.
  446         3. False or misleading claims that the state or county
  447  recommends that a Medicaid recipient enroll with an entity.
  448         4. Claims that a Medicaid recipient will lose benefits
  449  under the Medicaid program, or any other health or welfare
  450  benefits to which the recipient is legally entitled, if the
  451  recipient does not enroll with the entity.
  452         (c) Granting or offering of any monetary or other valuable
  453  consideration for enrollment, except as authorized by subsection
  454  (25) (24).
  455         (d) Door-to-door solicitation of recipients who have not
  456  contacted the entity or who have not invited the entity to make
  457  a presentation.
  458         (e) Solicitation of Medicaid recipients by marketing
  459  representatives stationed in state offices unless approved and
  460  supervised by the agency or its agent and approved by the
  461  affected state agency when solicitation occurs in an office of
  462  the state agency. The agency shall ensure that marketing
  463  representatives stationed in state offices shall market their
  464  managed care plans to Medicaid recipients only in designated
  465  areas and in such a way as to not interfere with the recipients’
  466  activities in the state office.
  467         (f) Enrollment of Medicaid recipients.
  468         (22) The agency shall may impose a fine for a violation of
  469  this section or the contract with the agency by a person or
  470  entity that is under contract with the agency. With respect to
  471  any nonwillful violation, such fine shall not exceed $2,500 per
  472  violation. In no event shall such fine exceed an aggregate
  473  amount of $10,000 for all nonwillful violations arising out of
  474  the same action. With respect to any knowing and willful
  475  violation of this section or the contract with the agency, the
  476  agency may impose a fine upon the entity in an amount not to
  477  exceed $20,000 for each such violation. In no event shall such
  478  fine exceed an aggregate amount of $100,000 for all knowing and
  479  willful violations arising out of the same action.
  480         (23)Any entity that contracts with the agency on a prepaid
  481  or fixed-sum basis as a managed care plan as defined in s.
  482  409.9122(2)(f) or s. 409.91211 shall post a surety bond with the
  483  agency in an amount that is equivalent to a 1-year guaranteed
  484  savings amount as specified in the contract. In lieu of a surety
  485  bond, the agency may establish an irrevocable account in which
  486  the vendor funds an equivalent amount over a 6-month period. The
  487  purpose of the surety bond or account is to protect the agency
  488  if the entity terminates its contract with the agency before the
  489  scheduled end date for the contract. If the contract is
  490  terminated by the vendor for any reason, the agency shall pursue
  491  a claim against the surety bond or account for an early
  492  termination fee. The early termination fee must be equal to
  493  administrative costs incurred by the state due to the early
  494  termination and the differential of the guaranteed savings based
  495  on the original contract term and the corresponding termination
  496  date. The agency shall terminate a vendor who does not reimburse
  497  the state within 30 days after any early termination involving
  498  administrative costs and requiring reimbursement of lost savings
  499  from the Medicaid program.
  500         Section 2. Subsections (1) through (6) of section
  501  409.91211, Florida Statutes, are amended to read:
  502         409.91211 Medicaid managed care pilot program.—
  503         (1)(a) The agency is authorized to seek and implement
  504  experimental, pilot, or demonstration project waivers, pursuant
  505  to s. 1115 of the Social Security Act, to create a statewide
  506  initiative to provide for a more efficient and effective service
  507  delivery system that enhances quality of care and client
  508  outcomes in the Florida Medicaid program pursuant to this
  509  section. Phase one of the demonstration shall be implemented in
  510  two geographic areas. One demonstration site shall include only
  511  Broward County. A second demonstration site shall initially
  512  include Duval County and shall be expanded to include Baker,
  513  Clay, and Nassau Counties within 1 year after the Duval County
  514  program becomes operational. The agency shall implement
  515  expansion of the program to include the remaining counties of
  516  the state and remaining eligibility groups in accordance with
  517  the process specified in the federally approved special terms
  518  and conditions numbered 11-W-00206/4, as approved by the federal
  519  Centers for Medicare and Medicaid Services on October 19, 2005,
  520  with a goal of full statewide implementation by June 30, 2014
  521  2011.
  522         (b) This waiver extension shall authority is contingent
  523  upon federal approval to preserve the low-income pool upper
  524  payment-limit funding mechanism for providers and hospitals,
  525  including a guarantee of a reasonable growth factor, a
  526  methodology to allow the use of a portion of these funds to
  527  serve as a risk pool for demonstration sites, provisions to
  528  preserve the state’s ability to use intergovernmental transfers,
  529  and provisions to protect the disproportionate share program
  530  authorized pursuant to this chapter. Upon completion of the
  531  evaluation conducted under s. 3, ch. 2005-133, Laws of Florida,
  532  The agency shall expand may request statewide expansion of the
  533  demonstration to counties that have two or more plans and that
  534  have capacity to serve the designated population projects. The
  535  agency may expand to additional counties as plan capacity is
  536  developed. Statewide phase-in to additional counties shall be
  537  contingent upon review and approval by the Legislature. Under
  538  the upper-payment-limit program, or the low-income pool as
  539  implemented by the Agency for Health Care Administration
  540  pursuant to federal waiver, the state matching funds required
  541  for the program shall be provided by local governmental entities
  542  through intergovernmental transfers in accordance with published
  543  federal statutes and regulations. The Agency for Health Care
  544  Administration shall distribute upper-payment-limit,
  545  disproportionate share hospital, and low-income pool funds
  546  according to published federal statutes, regulations, and
  547  waivers and the low-income pool methodology approved by the
  548  federal Centers for Medicare and Medicaid Services.
  549         (c) It is the intent of the Legislature that the low-income
  550  pool plan required by the terms and conditions of the Medicaid
  551  reform waiver and submitted to the federal Centers for Medicare
  552  and Medicaid Services propose the distribution of the above
  553  mentioned program funds based on the following objectives:
  554         1. Assure a broad and fair distribution of available funds
  555  based on the access provided by Medicaid participating
  556  hospitals, regardless of their ownership status, through their
  557  delivery of inpatient or outpatient care for Medicaid
  558  beneficiaries and uninsured and underinsured individuals;
  559         2. Assure accessible emergency inpatient and outpatient
  560  care for Medicaid beneficiaries and uninsured and underinsured
  561  individuals;
  562         3. Enhance primary, preventive, and other ambulatory care
  563  coverages for uninsured individuals;
  564         4. Promote teaching and specialty hospital programs;
  565         5. Promote the stability and viability of statutorily
  566  defined rural hospitals and hospitals that serve as sole
  567  community hospitals;
  568         6. Recognize the extent of hospital uncompensated care
  569  costs;
  570         7. Maintain and enhance essential community hospital care;
  571         8. Maintain incentives for local governmental entities to
  572  contribute to the cost of uncompensated care;
  573         9. Promote measures to avoid preventable hospitalizations;
  574         10. Account for hospital efficiency; and
  575         11. Contribute to a community’s overall health system.
  576         (2) The Legislature intends for the capitated managed care
  577  pilot program to:
  578         (a) Provide recipients in Medicaid fee-for-service or the
  579  MediPass program a comprehensive and coordinated capitated
  580  managed care system for all health care services specified in
  581  ss. 409.905 and 409.906.
  582         (b) Stabilize Medicaid expenditures under the pilot program
  583  compared to Medicaid expenditures in the pilot area for the 3
  584  years before implementation of the pilot program, while
  585  ensuring:
  586         1. Consumer education and choice.
  587         2. Access to medically necessary services.
  588         3. Coordination of preventative, acute, and long-term care.
  589         4. Reductions in unnecessary service utilization.
  590         (c) Provide an opportunity to evaluate the feasibility of
  591  statewide implementation of capitated managed care networks as a
  592  replacement for the current Medicaid fee-for-service and
  593  MediPass systems.
  594         (3) The agency shall have the following powers, duties, and
  595  responsibilities with respect to the pilot program:
  596         (a) To implement a system to deliver all mandatory services
  597  specified in s. 409.905 and optional services specified in s.
  598  409.906, as approved by the Centers for Medicare and Medicaid
  599  Services and the Legislature in the waiver pursuant to this
  600  section. Services to recipients under plan benefits shall
  601  include emergency services provided under s. 409.9128.
  602         (b) To implement a pilot program, including Medicaid
  603  eligibility categories specified in ss. 409.903 and 409.904, as
  604  authorized in an approved federal waiver.
  605         (c) To implement the managed care pilot program that
  606  maximizes all available state and federal funds, including those
  607  obtained through intergovernmental transfers, the low-income
  608  pool, supplemental Medicaid payments, and the disproportionate
  609  share program. Within the parameters allowed by federal statute
  610  and rule, the agency may seek options for making direct payments
  611  to hospitals and physicians employed by or under contract with
  612  the state’s medical schools for the costs associated with
  613  graduate medical education under Medicaid reform.
  614         (d) To implement actuarially sound, risk-adjusted
  615  capitation rates for Medicaid recipients in the pilot program
  616  which cover comprehensive care, enhanced services, and
  617  catastrophic care.
  618         (e) To implement policies and guidelines for phasing in
  619  financial risk for approved provider service networks that, for
  620  purposes of this paragraph, include the Children’s Medical
  621  Services Network, over a 5-year period. These policies and
  622  guidelines must include an option for a provider service network
  623  to be paid fee-for-service rates. For any provider service
  624  network established in a managed care pilot area, the option to
  625  be paid fee-for-service rates must include a savings-settlement
  626  mechanism that is consistent with s. 409.912(44). This model
  627  must be converted to a risk-adjusted capitated rate by the
  628  beginning of the sixth year of operation, and may be converted
  629  earlier at the option of the provider service network. Federally
  630  qualified health centers may be offered an opportunity to accept
  631  or decline a contract to participate in any provider network for
  632  prepaid primary care services.
  633         (f) To implement stop-loss requirements and the transfer of
  634  excess cost to catastrophic coverage that accommodates the risks
  635  associated with the development of the pilot program.
  636         (g) To recommend a process to be used by the Social
  637  Services Estimating Conference to determine and validate the
  638  rate of growth of the per-member costs of providing Medicaid
  639  services under the managed care pilot program.
  640         (h) To implement program standards and credentialing
  641  requirements for capitated managed care networks to participate
  642  in the pilot program, including those related to fiscal
  643  solvency, quality of care, and adequacy of access to health care
  644  providers. It is the intent of the Legislature that, to the
  645  extent possible, any pilot program authorized by the state under
  646  this section include any federally qualified health center,
  647  federally qualified rural health clinic, county health
  648  department, the Children’s Medical Services Network within the
  649  Department of Health, or other federally, state, or locally
  650  funded entity that serves the geographic areas within the
  651  boundaries of the pilot program that requests to participate.
  652  This paragraph does not relieve an entity that qualifies as a
  653  capitated managed care network under this section from any other
  654  licensure or regulatory requirements contained in state or
  655  federal law which would otherwise apply to the entity. The
  656  standards and credentialing requirements shall be based upon,
  657  but are not limited to:
  658         1. Compliance with the accreditation requirements as
  659  provided in s. 641.512.
  660         2. Compliance with early and periodic screening, diagnosis,
  661  and treatment screening requirements under federal law.
  662         3. The percentage of voluntary disenrollments.
  663         4. Immunization rates.
  664         5. Standards of the National Committee for Quality
  665  Assurance and other approved accrediting bodies.
  666         6. Recommendations of other authoritative bodies.
  667         7. Specific requirements of the Medicaid program, or
  668  standards designed to specifically meet the unique needs of
  669  Medicaid recipients.
  670         8. Compliance with the health quality improvement system as
  671  established by the agency, which incorporates standards and
  672  guidelines developed by the Centers for Medicare and Medicaid
  673  Services as part of the quality assurance reform initiative.
  674         9. The network’s infrastructure capacity to manage
  675  financial transactions, recordkeeping, data collection, and
  676  other administrative functions.
  677         10. The network’s ability to submit any financial,
  678  programmatic, or patient-encounter data or other information
  679  required by the agency to determine the actual services provided
  680  and the cost of administering the plan.
  681         (i) To implement a mechanism for providing information to
  682  Medicaid recipients for the purpose of selecting a capitated
  683  managed care plan. For each plan available to a recipient, the
  684  agency, at a minimum, shall ensure that the recipient is
  685  provided with:
  686         1. A list and description of the benefits provided.
  687         2. Information about cost sharing.
  688         3. A list of providers participating in the plan networks.
  689         4.3. Plan performance data, if available.
  690         4.An explanation of benefit limitations.
  691         5.Contact information, including identification of
  692  providers participating in the network, geographic locations,
  693  and transportation limitations.
  694         6.Any other information the agency determines would
  695  facilitate a recipient’s understanding of the plan or insurance
  696  that would best meet his or her needs.
  697         (j) To implement a system to ensure that there is a record
  698  of recipient acknowledgment that plan choice counseling has been
  699  provided.
  700         (k) To implement a choice counseling system to ensure that
  701  the choice counseling process and related material are designed
  702  to provide counseling through face-to-face interaction, by
  703  telephone or, and in writing and through other forms of relevant
  704  media. Materials shall be written at the fourth-grade reading
  705  level and available in a language other than English when 5
  706  percent of the county speaks a language other than English.
  707  Choice counseling shall also use language lines and other
  708  services for impaired recipients, such as TTD/TTY.
  709         (l) To implement a system that prohibits capitated managed
  710  care plans, their representatives, and providers employed by or
  711  contracted with the capitated managed care plans from recruiting
  712  persons eligible for or enrolled in Medicaid, from providing
  713  inducements to Medicaid recipients to select a particular
  714  capitated managed care plan, and from prejudicing Medicaid
  715  recipients against other capitated managed care plans. The
  716  system shall require the entity performing choice counseling to
  717  determine if the recipient has made a choice of a plan or has
  718  opted out because of duress, threats, payment to the recipient,
  719  or incentives promised to the recipient by a third party. If the
  720  choice counseling entity determines that the decision to choose
  721  a plan was unlawfully influenced or a plan violated any of the
  722  provisions of s. 409.912(21), the choice counseling entity shall
  723  immediately report the violation to the agency’s program
  724  integrity section for investigation. Verification of choice
  725  counseling by the recipient shall include a stipulation that the
  726  recipient acknowledges the provisions of this subsection.
  727         (m) To implement a choice counseling system that promotes
  728  health literacy, uses technology effectively, and provides
  729  information intended aimed to reduce minority health disparities
  730  through outreach activities for Medicaid recipients.
  731         (n) To contract with entities to perform choice counseling.
  732  The agency may establish standards and performance contracts,
  733  including standards requiring the contractor to hire choice
  734  counselors who are representative of the state’s diverse
  735  population and to train choice counselors in working with
  736  culturally diverse populations.
  737         (o) To implement eligibility assignment processes to
  738  facilitate client choice while ensuring pilot programs of
  739  adequate enrollment levels. These processes shall ensure that
  740  pilot sites have sufficient levels of enrollment to conduct a
  741  valid test of the managed care pilot program within a 2-year
  742  timeframe.
  743         (p) To implement standards for plan compliance, including,
  744  but not limited to, standards for quality assurance and
  745  performance improvement, standards for peer or professional
  746  reviews, grievance policies, and policies for maintaining
  747  program integrity. The agency shall develop a data-reporting
  748  system, seek input from managed care plans in order to establish
  749  requirements for patient-encounter reporting, and ensure that
  750  the data reported is accurate and complete.
  751         1. In performing the duties required under this section,
  752  the agency shall work with managed care plans to establish a
  753  uniform system to measure and monitor outcomes for a recipient
  754  of Medicaid services.
  755         2. The system shall use financial, clinical, and other
  756  criteria based on pharmacy, medical services, and other data
  757  that is related to the provision of Medicaid services,
  758  including, but not limited to:
  759         a. The Health Plan Employer Data and Information Set
  760  (HEDIS) or measures that are similar to HEDIS.
  761         b. Member satisfaction.
  762         c. Provider satisfaction.
  763         d. Report cards on plan performance and best practices.
  764         e. Compliance with the requirements for prompt payment of
  765  claims under ss. 627.613, 641.3155, and 641.513.
  766         f. Utilization and quality data for the purpose of ensuring
  767  access to medically necessary services, including
  768  underutilization or inappropriate denial of services.
  769         3. The agency shall require the managed care plans that
  770  have contracted with the agency to establish a quality assurance
  771  system that incorporates the provisions of s. 409.912(27) and
  772  any standards, rules, and guidelines developed by the agency.
  773         4. The agency shall establish an encounter database in
  774  order to compile data on health services rendered by health care
  775  practitioners who provide services to patients enrolled in
  776  managed care plans in the demonstration sites. The encounter
  777  database shall:
  778         a. Collect the following for each type of patient encounter
  779  with a health care practitioner or facility, including:
  780         (I) The demographic characteristics of the patient.
  781         (II) The principal, secondary, and tertiary diagnosis.
  782         (III) The procedure performed.
  783         (IV) The date and location where the procedure was
  784  performed.
  785         (V) The payment for the procedure, if any.
  786         (VI) If applicable, the health care practitioner’s
  787  universal identification number.
  788         (VII) If the health care practitioner rendering the service
  789  is a dependent practitioner, the modifiers appropriate to
  790  indicate that the service was delivered by the dependent
  791  practitioner.
  792         b. Collect appropriate information relating to prescription
  793  drugs for each type of patient encounter.
  794         c. Collect appropriate information related to health care
  795  costs and utilization from managed care plans participating in
  796  the demonstration sites.
  797         5. To the extent practicable, when collecting the data the
  798  agency shall use a standardized claim form or electronic
  799  transfer system that is used by health care practitioners,
  800  facilities, and payors.
  801         6. Health care practitioners and facilities in the
  802  demonstration sites shall electronically submit, and managed
  803  care plans participating in the demonstration sites shall
  804  electronically receive, information concerning claims payments
  805  and any other information reasonably related to the encounter
  806  database using a standard format as required by the agency.
  807         7. The agency shall establish reasonable deadlines for
  808  phasing in the electronic transmittal of full encounter data.
  809         8. The system must ensure that the data reported is
  810  accurate and complete.
  811         (q) To implement a grievance resolution process for
  812  Medicaid recipients enrolled in a capitated managed care network
  813  under the pilot program modeled after the subscriber assistance
  814  panel, as created in s. 408.7056. This process shall include a
  815  mechanism for an expedited review of no greater than 24 hours
  816  after notification of a grievance if the life of a Medicaid
  817  recipient is in imminent and emergent jeopardy.
  818         (r) To implement a grievance resolution process for health
  819  care providers employed by or contracted with a capitated
  820  managed care network under the pilot program in order to settle
  821  disputes among the provider and the managed care network or the
  822  provider and the agency.
  823         (s) To implement criteria in an approved federal waiver to
  824  designate health care providers as eligible to participate in
  825  the pilot program. These criteria must include at a minimum
  826  those criteria specified in s. 409.907.
  827         (t) To use health care provider agreements for
  828  participation in the pilot program.
  829         (u) To require that all health care providers under
  830  contract with the pilot program be duly licensed in the state,
  831  if such licensure is available, and meet other criteria as may
  832  be established by the agency. These criteria shall include at a
  833  minimum those criteria specified in s. 409.907.
  834         (v) To ensure that managed care organizations work
  835  collaboratively with other state or local governmental programs
  836  or institutions for the coordination of health care to eligible
  837  individuals receiving services from such programs or
  838  institutions.
  839         (w) To implement procedures to minimize the risk of
  840  Medicaid fraud and abuse in all plans operating in the Medicaid
  841  managed care pilot program authorized in this section.
  842         1. The agency shall ensure that applicable provisions of
  843  this chapter and chapters 414, 626, 641, and 932 which relate to
  844  Medicaid fraud and abuse are applied and enforced at the
  845  demonstration project sites.
  846         2. Providers must have the certification, license, and
  847  credentials that are required by law and waiver requirements.
  848         3. The agency shall ensure that the plan is in compliance
  849  with s. 409.912(21) and (22).
  850         4. The agency shall require that each plan establish
  851  functions and activities governing program integrity in order to
  852  reduce the incidence of fraud and abuse. Plans must report
  853  instances of fraud and abuse pursuant to chapter 641.
  854         5. The plan shall have written administrative and
  855  management arrangements or procedures, including a mandatory
  856  compliance plan, which are designed to guard against fraud and
  857  abuse. The plan shall designate a compliance officer who has
  858  sufficient experience in health care.
  859         6.a. The agency shall require all managed care plan
  860  contractors in the pilot program to report all instances of
  861  suspected fraud and abuse. A failure to report instances of
  862  suspected fraud and abuse is a violation of law and subject to
  863  the penalties provided by law.
  864         b. An instance of fraud and abuse in the managed care plan,
  865  including, but not limited to, defrauding the state health care
  866  benefit program by misrepresentation of fact in reports, claims,
  867  certifications, enrollment claims, demographic statistics, or
  868  patient-encounter data; misrepresentation of the qualifications
  869  of persons rendering health care and ancillary services; bribery
  870  and false statements relating to the delivery of health care;
  871  unfair and deceptive marketing practices; and false claims
  872  actions in the provision of managed care, is a violation of law
  873  and subject to the penalties provided by law.
  874         c. The agency shall require that all contractors make all
  875  files and relevant billing and claims data accessible to state
  876  regulators and investigators and that all such data is linked
  877  into a unified system to ensure consistent reviews and
  878  investigations.
  879         (x) To develop and provide actuarial and benefit design
  880  analyses that indicate the effect on capitation rates and
  881  benefits offered in the pilot program over a prospective 5-year
  882  period based on the following assumptions:
  883         1. Growth in capitation rates which is limited to the
  884  estimated growth rate in general revenue.
  885         2. Growth in capitation rates which is limited to the
  886  average growth rate over the last 3 years in per-recipient
  887  Medicaid expenditures.
  888         3. Growth in capitation rates which is limited to the
  889  growth rate of aggregate Medicaid expenditures between the 2003
  890  2004 fiscal year and the 2004-2005 fiscal year.
  891         (y) To develop a mechanism to require capitated managed
  892  care plans to reimburse qualified emergency service providers,
  893  including, but not limited to, ambulance services, in accordance
  894  with ss. 409.908 and 409.9128. The pilot program must include a
  895  provision for continuing fee-for-service payments for emergency
  896  services, including, but not limited to, individuals who access
  897  ambulance services or emergency departments and who are
  898  subsequently determined to be eligible for Medicaid services.
  899         (z) To ensure that school districts participating in the
  900  certified school match program pursuant to ss. 409.908(21) and
  901  1011.70 shall be reimbursed by Medicaid, subject to the
  902  limitations of s. 1011.70(1), for a Medicaid-eligible child
  903  participating in the services as authorized in s. 1011.70, as
  904  provided for in s. 409.9071, regardless of whether the child is
  905  enrolled in a capitated managed care network. Capitated managed
  906  care networks must make a good faith effort to execute
  907  agreements with school districts regarding the coordinated
  908  provision of services authorized under s. 1011.70. County health
  909  departments and federally qualified health centers delivering
  910  school-based services pursuant to ss. 381.0056 and 381.0057 must
  911  be reimbursed by Medicaid for the federal share for a Medicaid
  912  eligible child who receives Medicaid-covered services in a
  913  school setting, regardless of whether the child is enrolled in a
  914  capitated managed care network. Capitated managed care networks
  915  must make a good faith effort to execute agreements with county
  916  health departments and federally qualified health centers
  917  regarding the coordinated provision of services to a Medicaid
  918  eligible child. To ensure continuity of care for Medicaid
  919  patients, the agency, the Department of Health, and the
  920  Department of Education shall develop procedures for ensuring
  921  that a student’s capitated managed care network provider
  922  receives information relating to services provided in accordance
  923  with ss. 381.0056, 381.0057, 409.9071, and 1011.70.
  924         (aa) To implement a mechanism whereby Medicaid recipients
  925  who are already enrolled in a managed care plan or the MediPass
  926  program in the pilot areas shall be offered the opportunity to
  927  change to capitated managed care plans on a staggered basis, as
  928  defined by the agency. All Medicaid recipients shall have 30
  929  days in which to make a choice of capitated managed care plans.
  930  Those Medicaid recipients who do not make a choice shall be
  931  assigned to a capitated managed care plan in accordance with
  932  paragraph (4)(a) and shall be exempt from s. 409.9122. To
  933  facilitate continuity of care for a Medicaid recipient who is
  934  also a recipient of Supplemental Security Income (SSI), prior to
  935  assigning the SSI recipient to a capitated managed care plan,
  936  the agency shall determine whether the SSI recipient has an
  937  ongoing relationship with a provider or capitated managed care
  938  plan, and, if so, the agency shall assign the SSI recipient to
  939  that provider or capitated managed care plan where feasible.
  940  Those SSI recipients who do not have such a provider
  941  relationship shall be assigned to a capitated managed care plan
  942  provider in accordance with paragraph (4)(a) and shall be exempt
  943  from s. 409.9122.
  944         (bb) To develop and recommend a service delivery
  945  alternative for children having chronic medical conditions which
  946  establishes a medical home project to provide primary care
  947  services to this population. The project shall provide
  948  community-based primary care services that are integrated with
  949  other subspecialties to meet the medical, developmental, and
  950  emotional needs for children and their families. This project
  951  shall include an evaluation component to determine impacts on
  952  hospitalizations, length of stays, emergency room visits, costs,
  953  and access to care, including specialty care and patient and
  954  family satisfaction.
  955         (cc) To develop and recommend service delivery mechanisms
  956  within capitated managed care plans to provide Medicaid services
  957  as specified in ss. 409.905 and 409.906 to persons with
  958  developmental disabilities sufficient to meet the medical,
  959  developmental, and emotional needs of these persons.
  960         (dd) To implement service delivery mechanisms within a
  961  specialty plan in area 10 capitated managed care plans to
  962  provide behavioral health care services Medicaid services as
  963  specified in ss. 409.905 and 409.906 to Medicaid-eligible
  964  children whose cases are open for child welfare services in the
  965  HomeSafeNet system. These services must be coordinated with
  966  community-based care providers as specified in s. 409.1671,
  967  where available, and be sufficient to meet the medical,
  968  developmental, behavioral, and emotional needs of these
  969  children. Children in area 10 who have an open case in the
  970  HomeSafeNet system shall be enrolled into the specialty plan.
  971  These service delivery mechanisms must be implemented no later
  972  than July 1, 2011 2008, in AHCA area 10 in order for the
  973  children in AHCA area 10 to remain exempt from the statewide
  974  plan under s. 409.912(4)(b)8. An administrative fee may be paid
  975  to the specialty plan for the coordination of services based on
  976  the receipt of the state share of that fee being provided
  977  through intergovernmental transfers.
  978         (4)(a) A Medicaid recipient in the pilot area who is not
  979  currently enrolled in a capitated managed care plan upon
  980  implementation is not eligible for services as specified in ss.
  981  409.905 and 409.906, for the amount of time that the recipient
  982  does not enroll in a capitated managed care network. If a
  983  Medicaid recipient has not enrolled in a capitated managed care
  984  plan within 30 days after eligibility, the agency shall assign
  985  the Medicaid recipient to a capitated managed care plan based on
  986  the assessed needs of the recipient as determined by the agency
  987  and the recipient shall be exempt from s. 409.9122. When making
  988  assignments, the agency shall take into account the following
  989  criteria:
  990         1. A capitated managed care network has sufficient network
  991  capacity to meet the needs of members.
  992         2. The capitated managed care network has previously
  993  enrolled the recipient as a member, or one of the capitated
  994  managed care network’s primary care providers has previously
  995  provided health care to the recipient.
  996         3. The agency has knowledge that the member has previously
  997  expressed a preference for a particular capitated managed care
  998  network as indicated by Medicaid fee-for-service claims data,
  999  but has failed to make a choice.
 1000         4. The capitated managed care network’s primary care
 1001  providers are geographically accessible to the recipient’s
 1002  residence.
 1003         5.Plan performance as designed by the agency.
 1004         (b) When more than one capitated managed care network
 1005  provider meets the criteria specified in paragraph (3)(h), the
 1006  agency shall make recipient assignments consecutively by family
 1007  unit.
 1008         (c) If a recipient is currently enrolled with a Medicaid
 1009  managed care organization that also operates an approved reform
 1010  plan within a demonstration area and the recipient fails to
 1011  choose a plan during the reform enrollment process or during
 1012  redetermination of eligibility, the recipient shall be
 1013  automatically assigned by the agency into the most appropriate
 1014  reform plan operated by the recipient’s current Medicaid managed
 1015  care plan. If the recipient’s current managed care plan does not
 1016  operate a reform plan in the demonstration area which adequately
 1017  meets the needs of the Medicaid recipient, the agency shall use
 1018  the automatic assignment process as prescribed in the special
 1019  terms and conditions numbered 11-W-00206/4. All enrollment and
 1020  choice counseling materials provided by the agency must contain
 1021  an explanation of the provisions of this paragraph for current
 1022  managed care recipients.
 1023         (d) Except for plan performance as provided for in
 1024  paragraph (a), the agency may not engage in practices that are
 1025  designed to favor one capitated managed care plan over another
 1026  or that are designed to influence Medicaid recipients to enroll
 1027  in a particular capitated managed care network in order to
 1028  strengthen its particular fiscal viability.
 1029         (e) After a recipient has made a selection or has been
 1030  enrolled in a capitated managed care network, the recipient
 1031  shall have 90 days in which to voluntarily disenroll and select
 1032  another capitated managed care network. After 90 days, no
 1033  further changes may be made except for cause. Cause shall
 1034  include, but not be limited to, poor quality of care, lack of
 1035  access to necessary specialty services, an unreasonable delay or
 1036  denial of service, inordinate or inappropriate changes of
 1037  primary care providers, service access impairments due to
 1038  significant changes in the geographic location of services, or
 1039  fraudulent enrollment. The agency may require a recipient to use
 1040  the capitated managed care network’s grievance process as
 1041  specified in paragraph (3)(q) prior to the agency’s
 1042  determination of cause, except in cases in which immediate risk
 1043  of permanent damage to the recipient’s health is alleged. The
 1044  grievance process, when used, must be completed in time to
 1045  permit the recipient to disenroll no later than the first day of
 1046  the second month after the month the disenrollment request was
 1047  made. If the capitated managed care network, as a result of the
 1048  grievance process, approves an enrollee’s request to disenroll,
 1049  the agency is not required to make a determination in the case.
 1050  The agency must make a determination and take final action on a
 1051  recipient’s request so that disenrollment occurs no later than
 1052  the first day of the second month after the month the request
 1053  was made. If the agency fails to act within the specified
 1054  timeframe, the recipient’s request to disenroll is deemed to be
 1055  approved as of the date agency action was required. Recipients
 1056  who disagree with the agency’s finding that cause does not exist
 1057  for disenrollment shall be advised of their right to pursue a
 1058  Medicaid fair hearing to dispute the agency’s finding.
 1059         (f) The agency shall apply for federal waivers from the
 1060  Centers for Medicare and Medicaid Services to lock eligible
 1061  Medicaid recipients into a capitated managed care network for 12
 1062  months after an open enrollment period. After 12 months of
 1063  enrollment, a recipient may select another capitated managed
 1064  care network. However, nothing shall prevent a Medicaid
 1065  recipient from changing primary care providers within the
 1066  capitated managed care network during the 12-month period.
 1067         (g) The agency shall apply for federal waivers from the
 1068  Centers for Medicare and Medicaid Services to allow recipients
 1069  to purchase health care coverage through an employer-sponsored
 1070  health insurance plan instead of through a Medicaid-certified
 1071  plan. This provision shall be known as the opt-out option.
 1072         1. A recipient who chooses the Medicaid opt-out option
 1073  shall have an opportunity for a specified period of time, as
 1074  authorized under a waiver granted by the Centers for Medicare
 1075  and Medicaid Services, to select and enroll in a Medicaid
 1076  certified plan. If the recipient remains in the employer
 1077  sponsored plan after the specified period, the recipient shall
 1078  remain in the opt-out program for at least 1 year or until the
 1079  recipient no longer has access to employer-sponsored coverage,
 1080  until the employer’s open enrollment period for a person who
 1081  opts out in order to participate in employer-sponsored coverage,
 1082  or until the person is no longer eligible for Medicaid,
 1083  whichever time period is shorter.
 1084         2. Notwithstanding any other provision of this section,
 1085  coverage, cost sharing, and any other component of employer
 1086  sponsored health insurance shall be governed by applicable state
 1087  and federal laws.
 1088         (5) This section authorizes does not authorize the agency
 1089  to seek an extension amendment and to continue operation
 1090  implement any provision of the s. 1115 of the Social Security
 1091  Act experimental, pilot, or demonstration project waiver to
 1092  reform the state Medicaid program in any part of the state other
 1093  than the two geographic areas specified in this section unless
 1094  approved by the Legislature.
 1095         (6) The agency shall develop and submit for approval
 1096  applications for waivers of applicable federal laws and
 1097  regulations as necessary to extend and expand implement the
 1098  managed care pilot project as defined in this section. The
 1099  agency shall seek public input on the waiver and post all waiver
 1100  applications under this section on its Internet website for 30
 1101  days before submitting the applications to the United States
 1102  Centers for Medicare and Medicaid Services. The 30 days shall
 1103  commence with the initial posting and must conclude 30 days
 1104  prior to approval by the United States Centers for Medicare and
 1105  Medicaid Services. All waiver applications shall be provided for
 1106  review and comment to the appropriate committees of the Senate
 1107  and House of Representatives for at least 10 working days prior
 1108  to submission. All waivers submitted to and approved by the
 1109  United States Centers for Medicare and Medicaid Services under
 1110  this section must be approved by the Legislature. Federally
 1111  approved waivers must be submitted to the President of the
 1112  Senate and the Speaker of the House of Representatives for
 1113  referral to the appropriate legislative committees. The
 1114  appropriate committees shall recommend whether to approve the
 1115  implementation of any waivers to the Legislature as a whole. The
 1116  agency shall submit a plan containing a recommended timeline for
 1117  implementation of any waivers and budgetary projections of the
 1118  effect of the pilot program under this section on the total
 1119  Medicaid budget for the 2006-2007 through 2009-2010 state fiscal
 1120  years. This implementation plan shall be submitted to the
 1121  President of the Senate and the Speaker of the House of
 1122  Representatives at the same time any waivers are submitted for
 1123  consideration by the Legislature. The agency may implement the
 1124  waiver and special terms and conditions numbered 11-W-00206/4,
 1125  as approved by the federal Centers for Medicare and Medicaid
 1126  Services. If the agency seeks approval by the Federal Government
 1127  of any modifications to these special terms and conditions, the
 1128  agency must provide written notification of its intent to modify
 1129  these terms and conditions to the President of the Senate and
 1130  the Speaker of the House of Representatives at least 15 days
 1131  before submitting the modifications to the Federal Government
 1132  for consideration. The notification must identify all
 1133  modifications being pursued and the reason the modifications are
 1134  needed. Upon receiving federal approval of any modifications to
 1135  the special terms and conditions, the agency shall provide a
 1136  report to the Legislature describing the federally approved
 1137  modifications to the special terms and conditions within 7 days
 1138  after approval by the Federal Government.
 1139         Section 3. Paragraph (m) is added to subsection (2) of
 1140  section 409.9122, Florida Statutes, to read:
 1141         409.9122 Mandatory Medicaid managed care enrollment;
 1142  programs and procedures.—
 1143         (2)
 1144         (m)1. Time allotted pursuant to this subsection to any
 1145  Medicaid recipient for the selection of, enrollment in, or
 1146  disenrollment from a managed care plan or MediPass is tolled
 1147  throughout any month in which the enrollment broker or choice
 1148  counseling provider, whichever is applicable, has adversely
 1149  affected a beneficiary’s ability to access choice counseling or
 1150  enrollment broker services by its failure to comply with the
 1151  terms and conditions of its contract or has otherwise acted or
 1152  failed to act in a manner that the agency deems likely to
 1153  jeopardize its ability to perform its assigned responsibilities
 1154  as set forth in paragraphs (c) and (d). During any month in
 1155  which time is tolled for a recipient, he or she must be afforded
 1156  uninterrupted access to benefits and services in the same
 1157  delivery system available prior to such tolling.
 1158         2. The agency shall incorporate into all pertinent
 1159  contracts that are executed or renewed on or after July 1, 2010,
 1160  provisions authorizing and requiring the agency to impose
 1161  sanctions or fines against an enrollment broker or choice
 1162  counselor if a recipient is adversely affected due to any action
 1163  or failure to act on the part of the enrollment broker or choice
 1164  counselor.
 1165         Section 4. Section 624.35, Florida Statutes, is created to
 1166  read:
 1167         624.35 Short title.—Sections 624.35-624.352 may be cited as
 1168  the “Medicaid and Public Assistance Fraud Strike Force Act.”
 1169         Section 5. Section 624.351, Florida Statutes, is created to
 1170  read:
 1171         624.351 Medicaid and Public Assistance Fraud Strike Force.—
 1172         (1) LEGISLATIVE FINDINGS.—The Legislature finds that there
 1173  is a need to develop and implement a statewide strategy to
 1174  coordinate state and local agencies, law enforcement entities,
 1175  and investigative units in order to increase the effectiveness
 1176  of programs and initiatives dealing with the prevention,
 1177  detection, and prosecution of Medicaid and public assistance
 1178  fraud.
 1179         (2) ESTABLISHMENT.—The Medicaid and Public Assistance Fraud
 1180  Strike Force is created within the department to oversee and
 1181  coordinate state and local efforts to eliminate Medicaid and
 1182  public assistance fraud and to recover state and federal funds.
 1183  The strike force shall serve in an advisory capacity and provide
 1184  recommendations and policy alternatives to the Chief Financial
 1185  Officer.
 1186         (3) MEMBERSHIP.—The strike force shall consist of the
 1187  following 11 members who may not designate anyone to serve in
 1188  their place:
 1189         (a) The Chief Financial Officer, who shall serve as chair.
 1190         (b) The Attorney General, who shall serve as vice chair.
 1191         (c) The executive director of the Department of Law
 1192  Enforcement.
 1193         (d) The Secretary of Health Care Administration.
 1194         (e) The Secretary of Children and Family Services.
 1195         (f) The State Surgeon General.
 1196         (g) Five members appointed by the Chief Financial Officer,
 1197  consisting of two sheriffs, two chiefs of police, and one state
 1198  attorney. When making these appointments, the Chief Financial
 1199  Officer shall consider representation by geography, population,
 1200  ethnicity, and other relevant factors in order to ensure that
 1201  the membership of the strike force is representative of the
 1202  state as a whole.
 1203         (4) TERMS OF MEMBERSHIP; COMPENSATION; STAFF.—
 1204         (a) The five members appointed by the Chief Financial
 1205  Officer will serve 4-year terms; however, for the purpose of
 1206  providing staggered terms, of the initial appointments, two
 1207  members will be appointed to a 2-year term, two members will be
 1208  appointed to a 3-year term, and one member will be appointed to
 1209  a 4-year term. The remaining members are standing members of the
 1210  strike force and may not serve beyond the time he or she holds
 1211  the position that was the basis for strike force membership. A
 1212  vacancy shall be filled in the same manner as the original
 1213  appointment but only for the unexpired term.
 1214         (b) The Legislature finds that the strike force serves a
 1215  legitimate state, county, and municipal purpose and that service
 1216  on the strike force is consistent with a member’s principal
 1217  service in a public office or employment. Therefore membership
 1218  on the strike force does not disqualify a member from holding
 1219  any other public office or from being employed by a public
 1220  entity, except that a member of the Legislature may not serve on
 1221  the strike force.
 1222         (c) Members of the strike force shall serve without
 1223  compensation, but are entitled to reimbursement for per diem and
 1224  travel expenses pursuant to s. 112.061. Reimbursements may be
 1225  paid from appropriations provided to the department by the
 1226  Legislature for the purposes of this section.
 1227         (d) The Chief Financial Officer shall appoint a chief of
 1228  staff for the strike force who must have experience, education,
 1229  and expertise in the fields of law, prosecution, or fraud
 1230  investigations and shall serve at the pleasure of the Chief
 1231  Financial Officer. The department shall provide the strike force
 1232  with staff necessary to assist the strike force in the
 1233  performance of its duties.
 1234         (5) MEETINGS.—The strike force shall hold its
 1235  organizational session by March 1, 2011. Thereafter, the strike
 1236  force shall meet at least four times per year. Additional
 1237  meetings may be held if the chair determines that extraordinary
 1238  circumstances require an additional meeting. Members may appear
 1239  by electronic means. A majority of the members of the strike
 1240  force constitutes a quorum.
 1241         (6) STRIKE FORCE DUTIES.—The strike force shall provide
 1242  advice and make recommendations, as necessary, to the Chief
 1243  Financial Officer.
 1244         (a) The strike force may advise the Chief Financial Officer
 1245  on initiatives that include, but are not limited to:
 1246         1. Conducting a census of local, state, and federal efforts
 1247  to address Medicaid and public assistance fraud in this state,
 1248  including fraud detection, prevention, and prosecution, in order
 1249  to discern overlapping missions, maximize existing resources,
 1250  and strengthen current programs.
 1251         2. Developing a strategic plan for coordinating and
 1252  targeting state and local resources for preventing and
 1253  prosecuting Medicaid and public assistance fraud. The plan must
 1254  identify methods to enhance multiagency efforts that contribute
 1255  to achieving the state’s goal of eliminating Medicaid and public
 1256  assistance fraud.
 1257         3. Identifying methods to implement innovative technology
 1258  and data sharing in order to detect and analyze Medicaid and
 1259  public assistance fraud with speed and efficiency.
 1260         4. Establishing a program to provide grants to state and
 1261  local agencies that develop and implement effective Medicaid and
 1262  public assistance fraud prevention, detection, and investigation
 1263  programs, which are evaluated by the strike force and ranked by
 1264  their potential to contribute to achieving the state’s goal of
 1265  eliminating Medicaid and public assistance fraud. The grant
 1266  program may also provide startup funding for new initiatives by
 1267  local and state law enforcement or administrative agencies to
 1268  combat Medicaid and public assistance fraud.
 1269         5. Developing and promoting crime prevention services and
 1270  educational programs that serve the public, including, but not
 1271  limited to, a well-publicized rewards program for the
 1272  apprehension and conviction of criminals who perpetrate Medicaid
 1273  and public assistance fraud.
 1274         6. Providing grants, contingent upon appropriation, for
 1275  multiagency or state and local Medicaid and public assistance
 1276  fraud efforts, which include, but are not limited to:
 1277         a. Providing for a Medicaid and public assistance fraud
 1278  prosecutor in the Office of the Statewide Prosecutor.
 1279         b. Providing assistance to state attorneys for support
 1280  services or equipment, or for the hiring of assistant state
 1281  attorneys, as needed, to prosecute Medicaid and public
 1282  assistance fraud cases.
 1283         c. Providing assistance to judges for support services or
 1284  for the hiring of senior judges, as needed, so that Medicaid and
 1285  public assistance fraud cases can be heard expeditiously.
 1286         (b) The strike force shall receive periodic reports from
 1287  state agencies, law enforcement officers, investigators,
 1288  prosecutors, and coordinating teams regarding Medicaid and
 1289  public assistance criminal and civil investigations. Such
 1290  reports may include discussions regarding significant factors
 1291  and trends relevant to a statewide Medicaid and public
 1292  assistance fraud strategy.
 1293         (7) REPORTS.—The strike force shall annually prepare and
 1294  submit a report on its activities and recommendations, by
 1295  October 1, to the President of the Senate, the Speaker of the
 1296  House of Representatives, the Governor, and the chairs of the
 1297  House of Representatives and Senate committees that have
 1298  substantive jurisdiction over Medicaid and public assistance
 1299  fraud.
 1300         Section 6. Section 624.352, Florida Statutes, is created to
 1301  read:
 1302         624.352 Interagency agreements to detect and deter Medicaid
 1303  and public assistance fraud.—
 1304         (1) The Chief Financial Officer shall prepare model
 1305  interagency agreements for the coordination of prevention,
 1306  investigation, and prosecution of Medicaid and public assistance
 1307  fraud to be known as “Strike Force” agreements. Parties to such
 1308  agreements may include any agency that is headed by a Cabinet
 1309  officer, the Governor, the Governor and Cabinet, a collegial
 1310  body, or any federal, state, or local law enforcement agency.
 1311         (2) The agreements must include, but are not limited to:
 1312         (a) Establishing the agreement’s purpose, mission,
 1313  authority, organizational structure, procedures, supervision,
 1314  operations, deputations, funding, expenditures, property and
 1315  equipment, reports and records, assets and forfeitures, media
 1316  policy, liability, and duration.
 1317         (b) Requiring that parties to an agreement have appropriate
 1318  powers and authority relative to the purpose and mission of the
 1319  agreement.
 1320         Section 7. Section 16.59, Florida Statutes, is amended to
 1321  read:
 1322         16.59 Medicaid fraud control.—The Medicaid Fraud Control
 1323  Unit There is created in the Department of Legal Affairs to the
 1324  Medicaid Fraud Control Unit, which may investigate all
 1325  violations of s. 409.920 and any criminal violations discovered
 1326  during the course of those investigations. The Medicaid Fraud
 1327  Control Unit may refer any criminal violation so uncovered to
 1328  the appropriate prosecuting authority. The offices of the
 1329  Medicaid Fraud Control Unit, and the offices of the Agency for
 1330  Health Care Administration Medicaid program integrity program,
 1331  and the Divisions of Insurance Fraud and Public Assistance Fraud
 1332  within the Department of Financial Services shall, to the extent
 1333  possible, be collocated; however, positions dedicated to
 1334  Medicaid managed care fraud within the Medicaid Fraud Control
 1335  Unit shall be collocated with the Division of Insurance Fraud.
 1336  The Agency for Health Care Administration, and the Department of
 1337  Legal Affairs, and the Divisions of Insurance Fraud and Public
 1338  Assistance Fraud within the Department of Financial Services
 1339  shall conduct joint training and other joint activities designed
 1340  to increase communication and coordination in recovering
 1341  overpayments.
 1342         Section 8. Paragraph (o) is added to subsection (2) of
 1343  section 20.121, Florida Statutes, to read:
 1344         20.121 Department of Financial Services.—There is created a
 1345  Department of Financial Services.
 1346         (2) DIVISIONS.—The Department of Financial Services shall
 1347  consist of the following divisions:
 1348         (o) The Division of Public Assistance Fraud.
 1349         Section 9. Paragraph (b) of subsection (7) of section
 1350  411.01, Florida Statutes, is amended to read:
 1351         411.01 School readiness programs; early learning
 1352  coalitions.—
 1353         (7) PARENTAL CHOICE.—
 1354         (b) If it is determined that a provider has provided any
 1355  cash to the beneficiary in return for receiving the purchase
 1356  order, the early learning coalition or its fiscal agent shall
 1357  refer the matter to the Department of Financial Services
 1358  pursuant to s. 414.411 Division of Public Assistance Fraud for
 1359  investigation.
 1360         Section 10. Subsection (2) of section 414.33, Florida
 1361  Statutes, is amended to read:
 1362         414.33 Violations of food stamp program.—
 1363         (2) In addition, the department shall establish procedures
 1364  for referring to the Department of Law Enforcement any case that
 1365  involves a suspected violation of federal or state law or rules
 1366  governing the administration of the food stamp program to the
 1367  Department of Financial Services pursuant to s. 414.411.
 1368         Section 11. Subsection (9) of section 414.39, Florida
 1369  Statutes, is amended to read:
 1370         414.39 Fraud.—
 1371         (9) All records relating to investigations of public
 1372  assistance fraud in the custody of the department and the Agency
 1373  for Health Care Administration are available for examination by
 1374  the Department of Financial Services Law Enforcement pursuant to
 1375  s. 414.411 943.401 and are admissible into evidence in
 1376  proceedings brought under this section as business records
 1377  within the meaning of s. 90.803(6).
 1378         Section 12. Section 943.401, Florida Statutes, is
 1379  transferred, renumbered as section 414.411, Florida Statutes,
 1380  and amended to read:
 1381         414.411 943.401 Public assistance fraud.—
 1382         (1)(a) The Department of Financial Services Law Enforcement
 1383  shall investigate all public assistance provided to residents of
 1384  the state or provided to others by the state. In the course of
 1385  such investigation the department of Law Enforcement shall
 1386  examine all records, including electronic benefits transfer
 1387  records and make inquiry of all persons who may have knowledge
 1388  as to any irregularity incidental to the disbursement of public
 1389  moneys, food stamps, or other items or benefits authorizations
 1390  to recipients.
 1391         (b) All public assistance recipients, as a condition
 1392  precedent to qualification for public assistance received and as
 1393  defined under the provisions of chapter 409, chapter 411, or
 1394  this chapter 414, must shall first give in writing, to the
 1395  Agency for Health Care Administration, the Department of Health,
 1396  the Agency for Workforce Innovation, and the Department of
 1397  Children and Family Services, as appropriate, and to the
 1398  Department of Financial Services Law Enforcement, consent to
 1399  make inquiry of past or present employers and records, financial
 1400  or otherwise.
 1401         (2) In the conduct of such investigation the Department of
 1402  Financial Services Law Enforcement may employ persons having
 1403  such qualifications as are useful in the performance of this
 1404  duty.
 1405         (3) The results of such investigation shall be reported by
 1406  the Department of Financial Services Law Enforcement to the
 1407  appropriate legislative committees, the Agency for Health Care
 1408  Administration, the Department of Health, the Agency for
 1409  Workforce Innovation, and the Department of Children and Family
 1410  Services, and to such others as the department of Law
 1411  Enforcement may determine.
 1412         (4) The Department of Health and the Department of Children
 1413  and Family Services shall report to the Department of Financial
 1414  Services Law Enforcement the final disposition of all cases
 1415  wherein action has been taken pursuant to s. 414.39, based upon
 1416  information furnished by the Department of Financial Services
 1417  Law Enforcement.
 1418         (5) All lawful fees and expenses of officers and witnesses,
 1419  expenses incident to taking testimony and transcripts of
 1420  testimony and proceedings are a proper charge to the Department
 1421  of Financial Services Law Enforcement.
 1422         (6) The provisions of this section shall be liberally
 1423  construed in order to carry out effectively the purposes of this
 1424  section in the interest of protecting public moneys and other
 1425  public property.
 1426         Section 13. Review of the Medicaid fraud and abuse
 1427  processes.—
 1428         (1) The Auditor General and the Office of Program Policy
 1429  Analysis and Government Accountability shall review and evaluate
 1430  the Agency for Health Care Administration’s Medicaid fraud and
 1431  abuse systems, including the Medicaid program integrity program.
 1432  The reviewers may access Medicaid-related information and data
 1433  from the Attorney General’s Medicaid Fraud Control Unit, the
 1434  Department of Health, the Department of Elderly Affairs, the
 1435  Agency for Persons with Disabilities, and the Department of
 1436  Children and Family Services, as necessary, to conduct the
 1437  review. The review must include, but is not limited to:
 1438         (a) An evaluation of current Medicaid policies and the
 1439  Medicaid fiscal agent;
 1440         (b) An analysis of the Medicaid fraud and abuse prevention
 1441  and detection processes, including agency contracts, Medicaid
 1442  databases, and internal control risk assessments;
 1443         (c) A comprehensive evaluation of the effectiveness of the
 1444  current laws, rules, and contractual requirements that govern
 1445  Medicaid managed care entities;
 1446         (d) An evaluation of the agency’s Medicaid managed care
 1447  oversight processes;
 1448         (e) Recommendations to improve the Medicaid claims
 1449  adjudication process, to increase the overall efficiency of the
 1450  Medicaid program, and to reduce Medicaid overpayments; and
 1451         (f) Operational and legislative recommendations to improve
 1452  the prevention and detection of fraud and abuse in the Medicaid
 1453  managed care program.
 1454         (2) The Auditor General’s Office and the Office of Program
 1455  Policy Analysis and Government Accountability may contract with
 1456  technical consultants to assist in the performance of the
 1457  review. The Auditor General and the Office of Program Policy
 1458  Analysis and Government Accountability shall report to the
 1459  President of the Senate, the Speaker of the House of
 1460  Representatives, and the Governor by December 1, 2011.
 1461         Section 14. Medicaid claims adjudication project.—The
 1462  Agency for Health Care Administration shall issue a competitive
 1463  procurement pursuant to chapter 287, Florida Statutes, with a
 1464  third-party vendor, at no cost to the state, to provide a real
 1465  time, front-end database to augment the Medicaid fiscal agent
 1466  program edits and claims adjudication process. The vendor shall
 1467  provide an interface with the Medicaid fiscal agent to decrease
 1468  inaccurate payment to Medicaid providers and improve the overall
 1469  efficiency of the Medicaid claims-processing system.
 1470         Section 15. All powers, duties, functions, records,
 1471  offices, personnel, property, pending issues and existing
 1472  contracts, administrative authority, administrative rules, and
 1473  unexpended balances of appropriations, allocations, and other
 1474  funds relating to public assistance fraud in the Department of
 1475  Law Enforcement are transferred by a type two transfer, as
 1476  defined in s. 20.06(2), Florida Statutes, to the Division of
 1477  Public Assistance Fraud in the Department of Financial Services.
 1478         Section 16. Except for sections 1, 2, 3, and 13 of this act
 1479  and this section, which shall take effect July 1, 2010, sections
 1480  4, 5, 6, 7, 8, 9, 10, 11, 12, 14, and 15 shall take effect
 1481  January 1, 2011.

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