August 07, 2020
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Bill No. 0700
Amendment No. 381609
Senate House

1Representative Cantens offered the following:
3     Amendment (with directory and title amendments)
4     On page 44, between lines 29 and 30, insert:
5     Section 14.  Paragraph (b) of subsection (4) of section
6409.912, Florida Statutes, is amended to read:
7     409.912  Cost-effective purchasing of health care.--The
8agency shall purchase goods and services for Medicaid recipients
9in the most cost-effective manner consistent with the delivery
10of quality medical care. The agency shall maximize the use of
11prepaid per capita and prepaid aggregate fixed-sum basis
12services when appropriate and other alternative service delivery
13and reimbursement methodologies, including competitive bidding
14pursuant to s. 287.057, designed to facilitate the cost-
15effective purchase of a case-managed continuum of care. The
16agency shall also require providers to minimize the exposure of
17recipients to the need for acute inpatient, custodial, and other
18institutional care and the inappropriate or unnecessary use of
19high-cost services. The agency may establish prior authorization
20requirements for certain populations of Medicaid beneficiaries,
21certain drug classes, or particular drugs to prevent fraud,
22abuse, overuse, and possible dangerous drug interactions. The
23Pharmaceutical and Therapeutics Committee shall make
24recommendations to the agency on drugs for which prior
25authorization is required. The agency shall inform the
26Pharmaceutical and Therapeutics Committee of its decisions
27regarding drugs subject to prior authorization.
28     (4)  The agency may contract with:
29     (b)  An entity that is providing comprehensive behavioral
30health care services to certain Medicaid recipients through a
31capitated, prepaid arrangement pursuant to the federal waiver
32provided for by s. 409.905(5). Such an entity must be licensed
33under chapter 624, chapter 636, or chapter 641 and must possess
34the clinical systems and operational competence to manage risk
35and provide comprehensive behavioral health care to Medicaid
36recipients. As used in this paragraph, the term "comprehensive
37behavioral health care services" means covered mental health and
38substance abuse treatment services that are available to
39Medicaid recipients. The secretary of the Department of Children
40and Family Services shall approve provisions of procurements
41related to children in the department's care or custody prior to
42enrolling such children in a prepaid behavioral health plan. Any
43contract awarded under this paragraph must be competitively
44procured. In developing the behavioral health care prepaid plan
45procurement document, the agency shall ensure that the
46procurement document requires the contractor to develop and
47implement a plan to ensure compliance with s. 394.4574 related
48to services provided to residents of licensed assisted living
49facilities that hold a limited mental health license. The agency
50shall seek federal approval to contract with a single entity
51meeting these requirements to provide comprehensive behavioral
52health care services to all Medicaid recipients in an AHCA area.
53Each entity must offer sufficient choice of providers in its
54network to ensure recipient access to care and the opportunity
55to select a provider with whom they are satisfied. The network
56shall include all public mental health hospitals. To ensure
57unimpaired access to behavioral health care services by Medicaid
58recipients, all contracts issued pursuant to this paragraph
59shall require 80 percent of the capitation paid to the managed
60care plan, including health maintenance organizations, to be
61expended for the provision of behavioral health care services.
62In the event the managed care plan expends less than 80 percent
63of the capitation paid pursuant to this paragraph for the
64provision of behavioral health care services, the difference
65shall be returned to the agency. The agency shall provide the
66managed care plan with a certification letter indicating the
67amount of capitation paid during each calendar year for the
68provision of behavioral health care services pursuant to this
69section. The agency may reimburse for substance abuse treatment
70services on a fee-for-service basis until the agency finds that
71adequate funds are available for capitated, prepaid
73     1.  By January 1, 2001, the agency shall modify the
74contracts with the entities providing comprehensive inpatient
75and outpatient mental health care services to Medicaid
76recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
77Counties, to include substance abuse treatment services.
78     2.  By July 1, 2003, the agency and the Department of
79Children and Family Services shall execute a written agreement
80that requires collaboration and joint development of all policy,
81budgets, procurement documents, contracts, and monitoring plans
82that have an impact on the state and Medicaid community mental
83health and targeted case management programs.
84     3.  By July 1, 2006, the agency and the Department of
85Children and Family Services shall contract with managed care
86entities in each AHCA area except area 6 or arrange to provide
87comprehensive inpatient and outpatient mental health and
88substance abuse services through capitated prepaid arrangements
89to all Medicaid recipients who are eligible to participate in
90such plans under federal law and regulation. In AHCA areas where
91eligible individuals number less than 150,000, the agency shall
92contract with a single managed care plan to provide
93comprehensive behavioral health services to all recipients who
94are not enrolled in a Medicaid health maintenance organization.
95The agency may contract with more than one comprehensive
96behavioral health provider to provide care to recipients who are
97not enrolled in a Medicaid health maintenance organization plan
98in AHCA areas where the eligible population exceeds 150,000. In
99AHCA area 11, the agency shall award a pilot project to a
100provider service network as described in paragraph (4)(d) with a
101minimum of 150,000 lives for purposes of demonstrating the cost
102effectiveness and improvements in the provision of quality
103mental health services through a provider-based managed care
104model. Contracts for comprehensive behavioral health providers
105awarded pursuant to this section shall be competitively
106procured. Both for-profit and not-for-profit corporations shall
107be eligible to compete. Only single managed care plans which are
108contracted to provide comprehensive behavioral health services
109to Medicaid recipients not enrolled in an health maintenance
110organization shall be capitated to provide and receive payment
111for the comprehensive behavioral health benefits as provided in
112agency rules, including handbooks incorporated by reference.
113     4.  By October 1, 2003, the agency and the department shall
114submit a plan to the Governor, the President of the Senate, and
115the Speaker of the House of Representatives which provides for
116the full implementation of capitated prepaid behavioral health
117care in all areas of the state. The plan shall include
118provisions which ensure that children and families receiving
119foster care and other related services are appropriately served
120and that these services assist the community-based care lead
121agencies in meeting the goals and outcomes of the child welfare
122system. The plan will be developed with the participation of
123community-based lead agencies, community alliances, sheriffs,
124and community providers serving dependent children.
125     a.  Implementation shall begin in 2003 in those AHCA areas
126of the state where the agency is able to establish sufficient
127capitation rates.
128     b.  If the agency determines that the proposed capitation
129rate in any area is insufficient to provide appropriate
130services, the agency may adjust the capitation rate to ensure
131that care will be available. The agency and the department may
132use existing general revenue to address any additional required
133match but may not over-obligate existing funds on an annualized
135     c.  Subject to any limitations provided for in the General
136Appropriations Act, the agency, in compliance with appropriate
137federal authorization, shall develop policies and procedures
138that allow for certification of local and state funds.
139     5.  Children residing in a statewide inpatient psychiatric
140program, or in a Department of Juvenile Justice or a Department
141of Children and Family Services residential program approved as
142a Medicaid behavioral health overlay services provider shall not
143be included in a behavioral health care prepaid health plan
144pursuant to this paragraph.
145     6.  In converting to a prepaid system of delivery, the
146agency shall in its procurement document require an entity
147providing comprehensive behavioral health care services to
148prevent the displacement of indigent care patients by enrollees
149in the Medicaid prepaid health plan providing behavioral health
150care services from facilities receiving state funding to provide
151indigent behavioral health care, to facilities licensed under
152chapter 395 which do not receive state funding for indigent
153behavioral health care, or reimburse the unsubsidized facility
154for the cost of behavioral health care provided to the displaced
155indigent care patient.
156     7.  Traditional community mental health providers under
157contract with the Department of Children and Family Services
158pursuant to part IV of chapter 394, child welfare providers
159under contract with the Department of Children and Family
160Services, and inpatient mental health providers licensed
161pursuant to chapter 395 must be offered an opportunity to accept
162or decline a contract to participate in any provider network for
163prepaid behavioral health services.
165================= T I T L E  A M E N D M E N T =================
166     On page 1, remove line 24, and insert:
167severability; legislative intent; amending s. 409.912, F.S.;
168authorizing the agency to contract for certain services;
169providing for funding of trauma; providing effective dates.

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