Bill Text: FL S0704 | 2015 | Regular Session | Enrolled
Bill Title: Florida Statutes
Spectrum: Partisan Bill (Republican 1-0)
Status: (Passed) 2015-03-19 - Chapter No. 2015-3 [S0704 Detail]
Download: Florida-2015-S0704-Enrolled.html
ENROLLED 2015 Legislature SB 704 2015704er 1 2 An act relating to the Florida Statutes; repealing ss. 3 88.7011, 120.745, 163.336, 218.077(5), 220.33(7), 4 253.01(2)(b), 288.106(4)(f), 339.08(1)(n), 381.0407, 5 403.709(1)(f), 409.911(10), 409.91211, 430.04(15), 6 430.502(10)-(12), 443.131(5), 624.351, 624.352, and 7 626.2815(7), F.S., and amending ss. 110.123, 339.135, 8 409.912, 409.9122, 576.061, 828.27, and 1002.32, F.S., 9 to delete provisions which have become inoperative by 10 noncurrent repeal or expiration and, pursuant to s. 11 11.242(5)(b) and (i), F.S., may be omitted from the 12 2015 Florida Statutes only through a reviser’s bill 13 duly enacted by the Legislature; amending ss. 14 409.91195, 409.91196, 409.962, 636.0145, 641.19, 15 641.225, and 641.386, F.S., to conform cross 16 references; providing an effective date. 17 18 Be It Enacted by the Legislature of the State of Florida: 19 20 Section 1. Section 88.7011, Florida Statutes, is repealed. 21 Reviser’s note.—Repealed to conform to s. 58, ch. 2011-92, Laws 22 of Florida, which repealed s. 88.7011 effective on a date 23 contingent upon the provisions of s. 81, ch. 2011-92. 24 Section 81, ch. 2011-92, provides that “[e]xcept as 25 otherwise expressly provided in this act, this act shall 26 take effect upon the earlier of 90 days following Congress 27 amending 42 U.S.C. s. 666(f) to allow or require states to 28 adopt the 2008 version of the Uniform Interstate Family 29 Support Act, or 90 days following the state obtaining a 30 waiver of its state plan requirement under Title IV-D of 31 the Social Security Act.” Public Law No. 113-183 was signed 32 by the President on September 29, 2014; a portion of that 33 law requires that the 2008 version of the Uniform 34 Interstate Family Support Act is required. 35 Section 2. Paragraph (g) of subsection (3) of section 36 110.123, Florida Statutes, is amended to read: 37 110.123 State group insurance program.— 38 (3) STATE GROUP INSURANCE PROGRAM.— 39 (g) Participation by individuals in the program is 40 available to all state officers, full-time state employees, and 41 part-time state employees and is voluntary. Participation in the 42 program is also available to retired state officers and 43 employees who elect at the time of retirement to continue 44 coverage under the program, but may elect to continue all or 45 only part of the coverage they had at the time of retirement. A 46 surviving spouse may elect to continue coverage only under a 47 state group health insurance plan, a TRICARE supplemental 48 insurance plan, or a health maintenance organization plan. 491. Full-time state employees described in subparagraph50(2)(c)1. are eligible for health insurance coverage in calendar51year 2014 as long as they remain employed by an employer52participating in the state group insurance program during the53year. This subparagraph expires December 31, 2014.542. Employees paid from other-personal-services (OPS) funds55are not eligible for coverage before January 1, 2014.56 Reviser’s note.—Amended to delete subparagraph (3)(g)1., which 57 expired pursuant to its own terms, effective December 31, 58 2014, and to delete subparagraph (3)(g)2. to repeal a 59 provision that has served its purpose. 60 Section 3. Section 120.745, Florida Statutes, is repealed. 61 Reviser’s note.—The cited section, which relates to legislative 62 review of agency rules in effect on or before November 16, 63 2010, was repealed pursuant to its own terms, effective 64 July 1, 2014. 65 Section 4. Section 163.336, Florida Statutes, is repealed. 66 Reviser’s note.—The cited section, which relates to the coastal 67 resort area redevelopment pilot project, expired pursuant 68 to its own terms, effective December 31, 2014. 69 Section 5. Subsection (5) of section 218.077, Florida 70 Statutes, is repealed. 71 Reviser’s note.—The cited subsection, which relates to the 72 Employer-Sponsored Benefits Study Task Force, was repealed 73 pursuant to its own terms, effective June 30, 2014. 74 Section 6. Subsection (7) of section 220.33, Florida 75 Statutes, is repealed. 76 Reviser’s note.—The cited subsection, which relates to payment 77 of estimated tax due no later than Sunday, June 30, 2013, 78 by June 28, 2013, expired pursuant to its own terms, 79 effective July 1, 2014. 80 Section 7. Paragraph (b) of subsection (2) of section 81 253.01, Florida Statutes, is repealed. 82 Reviser’s note.—The cited paragraph, which relates to transfer 83 of moneys, for the 2013-2014 fiscal year only, from the 84 Internal Improvement Trust Fund to the Save Our Everglades 85 Trust Fund for Everglades restoration pursuant to s. 86 216.181(12), expired pursuant to its own terms, effective 87 July 1, 2014. 88 Section 8. Paragraph (f) of subsection (4) of section 89 288.106, Florida Statutes, is repealed. 90 Reviser’s note.—The cited paragraph, which permits reduction of 91 local financial support requirements of s. 288.106 by one 92 half for a qualified target industry business located in 93 one of a specified list of counties under certain 94 circumstances, expired pursuant to its own terms, effective 95 June 30, 2014. 96 Section 9. Paragraph (n) of subsection (1) of section 97 339.08, Florida Statutes, is repealed. 98 Reviser’s note.—The cited paragraph, which relates to 99 expenditure of funds to pay administrative expenses 100 incurred in accordance with applicable laws by the 101 multicounty transportation authority created under chapter 102 343 where jurisdiction for the authority includes a portion 103 of the State Highway System and the expenses are in 104 furtherance of the provisions of chapter 2012-174, Laws of 105 Florida, to provide a financial analysis of the cost 106 savings to be achieved by the consolidation of transit 107 authorities within the region, expired pursuant to its own 108 terms, effective July 1, 2014. 109 Section 10. Paragraph (a) of subsection (4) of section 110 339.135, Florida Statutes, is amended to read: 111 339.135 Work program; legislative budget request; 112 definitions; preparation, adoption, execution, and amendment.— 113 (4) FUNDING AND DEVELOPING A TENTATIVE WORK PROGRAM.— 114 (a)1. To assure that no district or county is penalized for 115 local efforts to improve the State Highway System, the 116 department shall, for the purpose of developing a tentative work 117 program, allocate funds for new construction to the districts, 118 except for the turnpike enterprise, based on equal parts of 119 population and motor fuel tax collections. Funds for 120 resurfacing, bridge repair and rehabilitation, bridge fender 121 system construction or repair, public transit projects except 122 public transit block grants as provided in s. 341.052, and other 123 programs with quantitative needs assessments shall be allocated 124 based on the results of these assessments. The department may 125 not transfer any funds allocated to a district under this 126 paragraph to any other district except as provided in subsection 127 (7). Funds for public transit block grants shall be allocated to 128 the districts pursuant to s. 341.052. Funds for the intercity 129 bus program provided for under s. 5311(f) of the federal 130 nonurbanized area formula program shall be administered and 131 allocated directly to eligible bus carriers as defined in s. 132 341.031(12) at the state level rather than the district. In 133 order to provide state funding to support the intercity bus 134 program provided for under provisions of the federal 5311(f) 135 program, the department shall allocate an amount equal to the 136 federal share of the 5311(f) program from amounts calculated 137 pursuant to s. 206.46(3). 138 2. Notwithstanding the provisions of subparagraph 1., the 139 department shall allocate at least 50 percent of any new 140 discretionary highway capacity funds to the Florida Strategic 141 Intermodal System created pursuant to s. 339.61. Any remaining 142 new discretionary highway capacity funds shall be allocated to 143 the districts for new construction as provided in subparagraph 144 1. For the purposes of this subparagraph, the term “new 145 discretionary highway capacity funds” means any funds available 146 to the department above the prior year funding level for 147 capacity improvements, which the department has the discretion 148 to allocate to highway projects. 1493. Notwithstanding subparagraphs 1. and 2. and ss.150206.46(3) and 334.044(26), and for fiscal years 2009-2010151through 2013-2014 only, the department shall annually allocate152up to $15 million of the first proceeds of the increased153revenues estimated by the November 2009 Revenue Estimating154Conference to be deposited into the State Transportation Trust155Fund to provide for the portion of the transfer of funds156included in s. 343.58(4)(a)1.a. or 2.a., as applicable. The157transfer of funds included in s. 343.58(4) shall not negatively158impact projects included in fiscal years 2009-2010 through 20131592014 of the work program as of July 1, 2009, as amended pursuant160to subsection (7). This subparagraph expires July 1, 2014.161 Reviser’s note.—Amended to delete subparagraph (4)(a)3., which 162 expired pursuant to its own terms, effective July 1, 2014. 163 Section 11. Section 381.0407, Florida Statutes, is 164 repealed. 165 Reviser’s note.—The cited section, the Managed Care and Publicly 166 Funded Primary Care Program Coordination Act, was repealed 167 by s. 51, ch. 2012-184, effective October 1, 2014. Since 168 the section was not repealed by a “current session” of the 169 Legislature, it may be omitted from the 2015 Florida 170 Statutes only through a reviser’s bill duly enacted by the 171 Legislature. See s. 11.242(5)(b) and (i). 172 Section 12. Paragraph (f) of subsection (1) of section 173 403.709, Florida Statutes, is repealed. 174 Reviser’s note.—The cited paragraph, which relates to transfer 175 of moneys, for the 2013-2014 fiscal year only, from the 176 Solid Waste Management Trust Fund to the Save Our 177 Everglades Trust Fund for Everglades restoration pursuant 178 to s. 216.181(12), expired pursuant to its own terms, 179 effective July 1, 2014. 180 Section 13. Subsection (10) of section 409.911, Florida 181 Statutes, is repealed. 182 Reviser’s note.—The cited subsection, which relates to the 183 Medicaid Low-Income Pool Council, expired pursuant to its 184 own terms, effective October 1, 2014. 185 Section 14. Section 409.912, Florida Statutes, is amended 186 to read: 187 409.912 Cost-effective purchasing of health care.—The 188 agency shall purchase goods and services for Medicaid recipients 189 in the most cost-effective manner consistent with the delivery 190 of quality medical care. To ensure that medical services are 191 effectively utilized, the agency may, in any case, require a 192 confirmation or second physician’s opinion of the correct 193 diagnosis for purposes of authorizing future services under the 194 Medicaid program. This section does not restrict access to 195 emergency services or poststabilization care services as defined 196 in 42 C.F.R. s. 438.114. Such confirmation or second opinion 197 shall be rendered in a manner approved by the agency. The agency 198 shall maximize the use of prepaid per capita and prepaid 199 aggregate fixed-sum basis services when appropriate and other 200 alternative service delivery and reimbursement methodologies, 201 including competitive bidding pursuant to s. 287.057, designed 202 to facilitate the cost-effective purchase of a case-managed 203 continuum of care. The agency shall also require providers to 204 minimize the exposure of recipients to the need for acute 205 inpatient, custodial, and other institutional care and the 206 inappropriate or unnecessary use of high-cost services. The 207 agency shall contract with a vendor to monitor and evaluate the 208 clinical practice patterns of providers in order to identify 209 trends that are outside the normal practice patterns of a 210 provider’s professional peers or the national guidelines of a 211 provider’s professional association. The vendor must be able to 212 provide information and counseling to a provider whose practice 213 patterns are outside the norms, in consultation with the agency, 214 to improve patient care and reduce inappropriate utilization. 215 The agency may mandate prior authorization, drug therapy 216 management, or disease management participation for certain 217 populations of Medicaid beneficiaries, certain drug classes, or 218 particular drugs to prevent fraud, abuse, overuse, and possible 219 dangerous drug interactions. The Pharmaceutical and Therapeutics 220 Committee shall make recommendations to the agency on drugs for 221 which prior authorization is required. The agency shall inform 222 the Pharmaceutical and Therapeutics Committee of its decisions 223 regarding drugs subject to prior authorization. The agency is 224 authorized to limit the entities it contracts with or enrolls as 225 Medicaid providers by developing a provider network through 226 provider credentialing. The agency may competitively bid single 227 source-provider contracts if procurement of goods or services 228 results in demonstrated cost savings to the state without 229 limiting access to care. The agency may limit its network based 230 on the assessment of beneficiary access to care, provider 231 availability, provider quality standards, time and distance 232 standards for access to care, the cultural competence of the 233 provider network, demographic characteristics of Medicaid 234 beneficiaries, practice and provider-to-beneficiary standards, 235 appointment wait times, beneficiary use of services, provider 236 turnover, provider profiling, provider licensure history, 237 previous program integrity investigations and findings, peer 238 review, provider Medicaid policy and billing compliance records, 239 clinical and medical record audits, and other factors. Providers 240 are not entitled to enrollment in the Medicaid provider network. 241 The agency shall determine instances in which allowing Medicaid 242 beneficiaries to purchase durable medical equipment and other 243 goods is less expensive to the Medicaid program than long-term 244 rental of the equipment or goods. The agency may establish rules 245 to facilitate purchases in lieu of long-term rentals in order to 246 protect against fraud and abuse in the Medicaid program as 247 defined in s. 409.913. The agency may seek federal waivers 248 necessary to administer these policies. 249 (1)The agency shall work with the Department of Children250and Families to ensure access of children and families in the251child protection system to needed and appropriate mental health252and substance abuse services. This subsection expires October 1,2532014.254(2)The agency may enter into agreements with appropriate 255 agents of other state agencies or of any agency of the Federal 256 Government and accept such duties in respect to social welfare 257 or public aid as may be necessary to implement the provisions of 258 Title XIX of the Social Security Act and ss. 409.901-409.920. 259 This subsection expires October 1, 2016. 260(3)The agency may contract with health maintenance261organizations certified pursuant to part I of chapter 641 for262the provision of services to recipients. This subsection expires263October 1, 2014.264 (2)(4)The agency may contract with:265(a)An entity that provides no prepaid health care services266other than Medicaid services under contract with the agency and267which is owned and operated by a county, county health268department, or county-owned and operated hospital to provide269health care services on a prepaid or fixed-sum basis to270recipients, which entity may provide such prepaid services271either directly or through arrangements with other providers.272Such prepaid health care services entities must be licensed273under parts I and III of chapter 641. An entity recognized under274this paragraph which demonstrates to the satisfaction of the275Office of Insurance Regulation of the Financial Services276Commission that it is backed by the full faith and credit of the277county in which it is located may be exempted from s. 641.225.278This paragraph expires October 1, 2014.279(b)An entity that is providing comprehensive behavioral280health care services to certain Medicaid recipients through a281capitated, prepaid arrangement pursuant to the federal waiver282provided for by s. 409.905(5). Such entity must be licensed283under chapter 624, chapter 636, or chapter 641, or authorized284under paragraph (c) or paragraph (d), and must possess the285clinical systems and operational competence to manage risk and286provide comprehensive behavioral health care to Medicaid287recipients. As used in this paragraph, the term “comprehensive288behavioral health care services” means covered mental health and289substance abuse treatment services that are available to290Medicaid recipients. The secretary of the Department of Children291and Families shall approve provisions of procurements related to292children in the department’s care or custody before enrolling293such children in a prepaid behavioral health plan. Any contract294awarded under this paragraph must be competitively procured. In295developing the behavioral health care prepaid plan procurement296document, the agency shall ensure that the procurement document297requires the contractor to develop and implement a plan to298ensure compliance with s. 394.4574 related to services provided299to residents of licensed assisted living facilities that hold a300limited mental health license. Except as provided in301subparagraph 5., and except in counties where the Medicaid302managed care pilot program is authorized pursuant to s.303409.91211, the agency shall seek federal approval to contract304with a single entity meeting these requirements to provide305comprehensive behavioral health care services to all Medicaid306recipients not enrolled in a Medicaid managed care plan307authorized under s. 409.91211, a provider service network308authorized under paragraph (d), or a Medicaid health maintenance309organization in an AHCA area. In an AHCA area where the Medicaid310managed care pilot program is authorized pursuant to s.311409.91211 in one or more counties, the agency may procure a312contract with a single entity to serve the remaining counties as313an AHCA area or the remaining counties may be included with an314adjacent AHCA area and are subject to this paragraph. Each315entity must offer a sufficient choice of providers in its316network to ensure recipient access to care and the opportunity317to select a provider with whom they are satisfied. The network318shall include all public mental health hospitals. To ensure319unimpaired access to behavioral health care services by Medicaid320recipients, all contracts issued pursuant to this paragraph must321require 80 percent of the capitation paid to the managed care322plan, including health maintenance organizations and capitated323provider service networks, to be expended for the provision of324behavioral health care services. If the managed care plan325expends less than 80 percent of the capitation paid for the326provision of behavioral health care services, the difference327shall be returned to the agency. The agency shall provide the328plan with a certification letter indicating the amount of329capitation paid during each calendar year for behavioral health330care services pursuant to this section. The agency may reimburse331for substance abuse treatment services on a fee-for-service332basis until the agency finds that adequate funds are available333for capitated, prepaid arrangements.3341. The agency shall modify the contracts with the entities335providing comprehensive inpatient and outpatient mental health336care services to Medicaid recipients in Hillsborough, Highlands,337Hardee, Manatee, and Polk Counties, to include substance abuse338treatment services.3392. Except as provided in subparagraph 5., the agency and340the Department of Children and Families shall contract with341managed care entities in each AHCA area except area 6 or arrange342to provide comprehensive inpatient and outpatient mental health343and substance abuse services through capitated prepaid344arrangements to all Medicaid recipients who are eligible to345participate in such plans under federal law and regulation. In346AHCA areas where eligible individuals number less than 150,000,347the agency shall contract with a single managed care plan to348provide comprehensive behavioral health services to all349recipients who are not enrolled in a Medicaid health maintenance350organization, a provider service network authorized under351paragraph (d), or a Medicaid capitated managed care plan352authorized under s. 409.91211. The agency may contract with more353than one comprehensive behavioral health provider to provide354care to recipients who are not enrolled in a Medicaid capitated355managed care plan authorized under s. 409.91211, a provider356service network authorized under paragraph (d), or a Medicaid357health maintenance organization in AHCA areas where the eligible358population exceeds 150,000. In an AHCA area where the Medicaid359managed care pilot program is authorized pursuant to s.360409.91211 in one or more counties, the agency may procure a361contract with a single entity to serve the remaining counties as362an AHCA area or the remaining counties may be included with an363adjacent AHCA area and shall be subject to this paragraph.364Contracts for comprehensive behavioral health providers awarded365pursuant to this section shall be competitively procured. Both366for-profit and not-for-profit corporations are eligible to367compete. Managed care plans contracting with the agency under368subsection (3) or paragraph (d) shall provide and receive369payment for the same comprehensive behavioral health benefits as370provided in AHCA rules, including handbooks incorporated by371reference. In AHCA area 11, the agency shall contract with at372least two comprehensive behavioral health care providers to373provide behavioral health care to recipients in that area who374are enrolled in, or assigned to, the MediPass program. One of375the behavioral health care contracts must be with the existing376provider service network pilot project, as described in377paragraph (d), for the purpose of demonstrating the cost378effectiveness of the provision of quality mental health services379through a public hospital-operated managed care model. Payment380shall be at an agreed-upon capitated rate to ensure cost381savings. Of the recipients in area 11 who are assigned to382MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those383MediPass-enrolled recipients shall be assigned to the existing384provider service network in area 11 for their behavioral care.3853. Children residing in a statewide inpatient psychiatric386program, or in a Department of Juvenile Justice or a Department387of Children and Families residential program approved as a388Medicaid behavioral health overlay services provider may not be389included in a behavioral health care prepaid health plan or any390other Medicaid managed care plan pursuant to this paragraph.3914. Traditional community mental health providers under392contract with the Department of Children and Families pursuant393to part IV of chapter 394, child welfare providers under394contract with the Department of Children and Families in areas 1395and 6, and inpatient mental health providers licensed pursuant396to chapter 395 must be offered an opportunity to accept or397decline a contract to participate in any provider network for398prepaid behavioral health services.3995. All Medicaid-eligible children, except children in area4001 and children in Highlands County, Hardee County, Polk County,401or Manatee County of area 6, which are open for child welfare402services in the statewide automated child welfare information403system, shall receive their behavioral health care services404through a specialty prepaid plan operated by community-based405lead agencies through a single agency or formal agreements among406several agencies. The agency shall work with the specialty plan407to develop clinically effective, evidence-based alternatives as408a downward substitution for the statewide inpatient psychiatric409program and similar residential care and institutional services.410The specialty prepaid plan must result in savings to the state411comparable to savings achieved in other Medicaid managed care412and prepaid programs. Such plan must provide mechanisms to413maximize state and local revenues. The specialty prepaid plan414shall be developed by the agency and the Department of Children415and Families. The agency may seek federal waivers to implement416this initiative. Medicaid-eligible children whose cases are open417for child welfare services in the statewide automated child418welfare information system and who reside in AHCA area 10 shall419be enrolled in a capitated provider service network or other420capitated managed care plan, which, in coordination with421available community-based care providers specified in s.422409.987, shall provide sufficient medical, developmental, and423behavioral health services to meet the needs of these children.424 425Effective July 1, 2012, in order to ensure continuity of care,426the agency is authorized to extend or modify current contracts427based on current service areas or on a regional basis, as428determined appropriate by the agency, with comprehensive429behavioral health care providers as described in this paragraph430during the period prior to its expiration. This paragraph431expires October 1, 2014.432(c) A federally qualified health center or an entity owned433by one or more federally qualified health centers or an entity434owned by other migrant and community health centers receiving435non-Medicaid financial support from the Federal Government to436provide health care services on a prepaid or fixed-sum basis to437recipients. A federally qualified health center or an entity438that is owned by one or more federally qualified health centers439and is reimbursed by the agency on a prepaid basis is exempt440from parts I and III of chapter 641, but must comply with the441solvency requirements in s. 641.2261(2) and meet the appropriate442requirements governing financial reserve, quality assurance, and443patients’ rights established by the agency. This paragraph444expires October 1, 2014.445(d)1.a provider service network, which may be reimbursed 446 on a fee-for-service or prepaid basis. Prepaid provider service 447 networks shall receive per-member, per-month payments. A 448 provider service network that does not choose to be a prepaid 449 plan shall receive fee-for-service rates with a shared savings 450 settlement. The fee-for-service option shall be available to a 451 provider service network only for the first 2 years of the 452 plan’s operation or until the contract year beginning September 453 1, 2014, whichever is later. The agency shall annually conduct 454 cost reconciliations to determine the amount of cost savings 455 achieved by fee-for-service provider service networks for the 456 dates of service in the period being reconciled. Only payments 457 for covered services for dates of service within the 458 reconciliation period and paid within 6 months after the last 459 date of service in the reconciliation period shall be included. 460 The agency shall perform the necessary adjustments for the 461 inclusion of claims incurred but not reported within the 462 reconciliation for claims that could be received and paid by the 463 agency after the 6-month claims processing time lag. The agency 464 shall provide the results of the reconciliations to the fee-for 465 service provider service networks within 45 days after the end 466 of the reconciliation period. The fee-for-service provider 467 service networks shall review and provide written comments or a 468 letter of concurrence to the agency within 45 days after receipt 469 of the reconciliation results. This reconciliation shall be 470 considered final. 471 (a)2.A provider service network which is reimbursed by the 472 agency on a prepaid basis shall be exempt from parts I and III 473 of chapter 641, but must comply with the solvency requirements 474 in s. 641.2261(2) and meet appropriate financial reserve, 475 quality assurance, and patient rights requirements as 476 established by the agency. 4773.Medicaid recipients assigned to a provider service478network shall be chosen equally from those who would otherwise479have been assigned to prepaid plans and MediPass. The agency is480authorized to seek federal Medicaid waivers as necessary to481implement the provisions of this section. This subparagraph482expires October 1, 2014.483 (b)4.A provider service network is a network established 484 or organized and operated by a health care provider, or group of 485 affiliated health care providers,including minority physician486networks and emergency room diversion programs that meet the487requirements of s. 409.91211,which provides a substantial 488 proportion of the health care items and services under a 489 contract directly through the provider or affiliated group of 490 providers and may make arrangements with physicians or other 491 health care professionals, health care institutions, or any 492 combination of such individuals or institutions to assume all or 493 part of the financial risk on a prospective basis for the 494 provision of basic health services by the physicians, by other 495 health professionals, or through the institutions. The health 496 care providers must have a controlling interest in the governing 497 body of the provider service network organization. 498(e) An entity that provides only comprehensive behavioral499health care services to certain Medicaid recipients through an500administrative services organization agreement. Such an entity501must possess the clinical systems and operational competence to502provide comprehensive health care to Medicaid recipients. As503used in this paragraph, the term “comprehensive behavioral504health care services” means covered mental health and substance505abuse treatment services that are available to Medicaid506recipients. Any contract awarded under this paragraph must be507competitively procured. The agency must ensure that Medicaid508recipients have available the choice of at least two managed509care plans for their behavioral health care services. This510paragraph expires October 1, 2014.511(f) An entity authorized in s. 430.205 to contract with the512agency and the Department of Elderly Affairs to provide health513care and social services on a prepaid or fixed-sum basis to514elderly recipients. Such prepaid health care services entities515are exempt from the provisions of part I of chapter 641 for the516first 3 years of operation. An entity recognized under this517paragraph that demonstrates to the satisfaction of the Office of518Insurance Regulation that it is backed by the full faith and519credit of one or more counties in which it operates may be520exempted from s. 641.225. This paragraph expires October 1,5212013.522(g) A Children’s Medical Services Network, as defined in s.523391.021. This paragraph expires October 1, 2014.524(5) The agency may contract with any public or private525entity otherwise authorized by this section on a prepaid or526fixed-sum basis for the provision of health care services to527recipients. An entity may provide prepaid services to528recipients, either directly or through arrangements with other529entities, if each entity involved in providing services:530(a) Is organized primarily for the purpose of providing531health care or other services of the type regularly offered to532Medicaid recipients;533(b) Ensures that services meet the standards set by the534agency for quality, appropriateness, and timeliness;535(c) Makes provisions satisfactory to the agency for536insolvency protection and ensures that neither enrolled Medicaid537recipients nor the agency will be liable for the debts of the538entity;539(d) Submits to the agency, if a private entity, a financial540plan that the agency finds to be fiscally sound and that541provides for working capital in the form of cash or equivalent542liquid assets excluding revenues from Medicaid premium payments543equal to at least the first 3 months of operating expenses or544$200,000, whichever is greater;545(e) Furnishes evidence satisfactory to the agency of546adequate liability insurance coverage or an adequate plan of547self-insurance to respond to claims for injuries arising out of548the furnishing of health care;549(f) Provides, through contract or otherwise, for periodic550review of its medical facilities and services, as required by551the agency; and552(g) Provides organizational, operational, financial, and553other information required by the agency.554 555This subsection expires October 1, 2014.556(6) The agency may contract on a prepaid or fixed-sum basis557with any health insurer that:558(a) Pays for health care services provided to enrolled559Medicaid recipients in exchange for a premium payment paid by560the agency;561(b) Assumes the underwriting risk; and562(c) Is organized and licensed under applicable provisions563of the Florida Insurance Code and is currently in good standing564with the Office of Insurance Regulation.565 566This subsection expires October 1, 2014.567(7) The agency may contract on a prepaid or fixed-sum basis568with an exclusive provider organization to provide health care569services to Medicaid recipients provided that the exclusive570provider organization meets applicable managed care plan571requirements in this section, ss. 409.9122, 409.9123, 409.9128,572and 627.6472, and other applicable provisions of law. This573subsection expires October 1, 2014.574(8) The Agency for Health Care Administration may provide575cost-effective purchasing of chiropractic services on a fee-for576service basis to Medicaid recipients through arrangements with a577statewide chiropractic preferred provider organization578incorporated in this state as a not-for-profit corporation. The579agency shall ensure that the benefit limits and prior580authorization requirements in the current Medicaid program shall581apply to the services provided by the chiropractic preferred582provider organization. This subsection expires October 1, 2014.583(9) The agency shall not contract on a prepaid or fixed-sum584basis for Medicaid services with an entity which knows or585reasonably should know that any officer, director, agent,586managing employee, or owner of stock or beneficial interest in587excess of 5 percent common or preferred stock, or the entity588itself, has been found guilty of, regardless of adjudication, or589entered a plea of nolo contendere, or guilty, to:590(a) Fraud;591(b) Violation of federal or state antitrust statutes,592including those proscribing price fixing between competitors and593the allocation of customers among competitors;594(c) Commission of a felony involving embezzlement, theft,595forgery, income tax evasion, bribery, falsification or596destruction of records, making false statements, receiving597stolen property, making false claims, or obstruction of justice;598or599(d) Any crime in any jurisdiction which directly relates to600the provision of health services on a prepaid or fixed-sum601basis.602 603This subsection expires October 1, 2014.604 (3)(10)The agency, after notifying the Legislature, may 605 apply for waivers of applicable federal laws and regulations as 606 necessary to implement more appropriate systems of health care 607 for Medicaid recipients and reduce the cost of the Medicaid 608 program to the state and federal governments and shall implement 609 such programs, after legislative approval, within a reasonable 610 period of time after federal approval. These programs must be 611 designed primarily to reduce the need for inpatient care, 612 custodial care and other long-term or institutional care, and 613 other high-cost services. Prior to seeking legislative approval 614 of such a waiver as authorized by this subsection, the agency 615 shall provide notice and an opportunity for public comment. 616 Notice shall be provided to all persons who have made requests 617 of the agency for advance notice and shall be published in the 618 Florida Administrative Register not less than 28 days prior to 619 the intended action. This subsection expires October 1, 2016. 620(11) The agency shall establish a postpayment utilization621control program designed to identify recipients who may622inappropriately overuse or underuse Medicaid services and shall623provide methods to correct such misuse. This subsection expires624October 1, 2014.625(12) The agency shall develop and provide coordinated626systems of care for Medicaid recipients and may contract with627public or private entities to develop and administer such628systems of care among public and private health care providers629in a given geographic area. This subsection expires October 1,6302014.631(13) The agency shall operate or contract for the operation632of utilization management and incentive systems designed to633encourage cost-effective use of services and to eliminate634services that are medically unnecessary. The agency shall track635Medicaid provider prescription and billing patterns and evaluate636them against Medicaid medical necessity criteria and coverage637and limitation guidelines adopted by rule. Medical necessity638determination requires that service be consistent with symptoms639or confirmed diagnosis of illness or injury under treatment and640not in excess of the patient’s needs. The agency shall conduct641reviews of provider exceptions to peer group norms and shall,642using statistical methodologies, provider profiling, and643analysis of billing patterns, detect and investigate abnormal or644unusual increases in billing or payment of claims for Medicaid645services and medically unnecessary provision of services.646Providers that demonstrate a pattern of submitting claims for647medically unnecessary services shall be referred to the Medicaid648program integrity unit for investigation. In its annual report,649required in s. 409.913, the agency shall report on its efforts650to control overutilization as described in this subsection. This651subsection expires October 1, 2014.652(14)(a) The agency shall operate the Comprehensive653Assessment and Review for Long-Term Care Services (CARES)654nursing facility preadmission screening program to ensure that655Medicaid payment for nursing facility care is made only for656individuals whose conditions require such care and to ensure657that long-term care services are provided in the setting most658appropriate to the needs of the person and in the most659economical manner possible. The CARES program shall also ensure660that individuals participating in Medicaid home and community661based waiver programs meet criteria for those programs,662consistent with approved federal waivers.663(b) The agency shall operate the CARES program through an664interagency agreement with the Department of Elderly Affairs.665The agency, in consultation with the Department of Elderly666Affairs, may contract for any function or activity of the CARES667program, including any function or activity required by 42668C.F.R. s. 483.20, relating to preadmission screening and669resident review.670(c) Prior to making payment for nursing facility services671for a Medicaid recipient, the agency must verify that the672nursing facility preadmission screening program has determined673that the individual requires nursing facility care and that the674individual cannot be safely served in community-based programs.675The nursing facility preadmission screening program shall refer676a Medicaid recipient to a community-based program if the677individual could be safely served at a lower cost and the678recipient chooses to participate in such program. For679individuals whose nursing home stay is initially funded by680Medicare and Medicare coverage is being terminated for lack of681progress towards rehabilitation, CARES staff shall consult with682the person making the determination of progress toward683rehabilitation to ensure that the recipient is not being684inappropriately disqualified from Medicare coverage. If, in685their professional judgment, CARES staff believes that a686Medicare beneficiary is still making progress toward687rehabilitation, they may assist the Medicare beneficiary with an688appeal of the disqualification from Medicare coverage. The use689of CARES teams to review Medicare denials for coverage under690this section is authorized only if it is determined that such691reviews qualify for federal matching funds through Medicaid. The692agency shall seek or amend federal waivers as necessary to693implement this section.694(d) For the purpose of initiating immediate prescreening695and diversion assistance for individuals residing in nursing696homes and in order to make families aware of alternative long697term care resources so that they may choose a more cost698effective setting for long-term placement, CARES staff shall699conduct an assessment and review of a sample of individuals700whose nursing home stay is expected to exceed 20 days,701regardless of the initial funding source for the nursing home702placement. CARES staff shall provide counseling and referral703services to these individuals regarding choosing appropriate704long-term care alternatives. This paragraph does not apply to705continuing care facilities licensed under chapter 651 or to706retirement communities that provide a combination of nursing707home, independent living, and other long-term care services.708(e) By January 15 of each year, the agency shall submit a709report to the Legislature describing the operations of the CARES710program. The report must describe:7111. Rate of diversion to community alternative programs;7122. CARES program staffing needs to achieve additional713diversions;7143. Reasons the program is unable to place individuals in715less restrictive settings when such individuals desired such716services and could have been served in such settings;7174. Barriers to appropriate placement, including barriers718due to policies or operations of other agencies or state-funded719programs; and7205. Statutory changes necessary to ensure that individuals721in need of long-term care services receive care in the least722restrictive environment.723(f) The Department of Elderly Affairs shall track724individuals over time who are assessed under the CARES program725and who are diverted from nursing home placement. By January 15726of each year, the department shall submit to the Legislature a727longitudinal study of the individuals who are diverted from728nursing home placement. The study must include:7291. The demographic characteristics of the individuals730assessed and diverted from nursing home placement, including,731but not limited to, age, race, gender, frailty, caregiver732status, living arrangements, and geographic location;7332. A summary of community services provided to individuals734for 1 year after assessment and diversion;7353. A summary of inpatient hospital admissions for736individuals who have been diverted; and7374. A summary of the length of time between diversion and738subsequent entry into a nursing home or death.739 740This subsection expires October 1, 2013.741(15)(a) The agency shall identify health care utilization742and price patterns within the Medicaid program which are not743cost-effective or medically appropriate and assess the744effectiveness of new or alternate methods of providing and745monitoring service, and may implement such methods as it746considers appropriate. Such methods may include disease747management initiatives, an integrated and systematic approach748for managing the health care needs of recipients who are at risk749of or diagnosed with a specific disease by using best practices,750prevention strategies, clinical-practice improvement, clinical751interventions and protocols, outcomes research, information752technology, and other tools and resources to reduce overall753costs and improve measurable outcomes.754(b) The responsibility of the agency under this subsection755includes the development of capabilities to identify actual and756optimal practice patterns; patient and provider educational757initiatives; methods for determining patient compliance with758prescribed treatments; fraud, waste, and abuse prevention and759detection programs; and beneficiary case management programs.7601. The practice pattern identification program shall761evaluate practitioner prescribing patterns based on national and762regional practice guidelines, comparing practitioners to their763peer groups. The agency and its Drug Utilization Review Board764shall consult with the Department of Health and a panel of765practicing health care professionals consisting of the766following: the Speaker of the House of Representatives and the767President of the Senate shall each appoint three physicians768licensed under chapter 458 or chapter 459, and the Governor769shall appoint two pharmacists licensed under chapter 465 and one770dentist licensed under chapter 466 who is an oral surgeon. Terms771of the panel members shall expire at the discretion of the772appointing official. The advisory panel shall be responsible for773evaluating treatment guidelines and recommending ways to774incorporate their use in the practice pattern identification775program. Practitioners who are prescribing inappropriately or776inefficiently, as determined by the agency, may have their777prescribing of certain drugs subject to prior authorization or778may be terminated from all participation in the Medicaid779program.7802. The agency shall also develop educational interventions781designed to promote the proper use of medications by providers782and beneficiaries.7833. The agency shall implement a pharmacy fraud, waste, and784abuse initiative that may include a surety bond or letter of785credit requirement for participating pharmacies, enhanced786provider auditing practices, the use of additional fraud and787abuse software, recipient management programs for beneficiaries788inappropriately using their benefits, and other steps that789eliminate provider and recipient fraud, waste, and abuse. The790initiative shall address enforcement efforts to reduce the791number and use of counterfeit prescriptions.7924. The agency may contract with an entity in the state to793provide Medicaid providers with electronic access to Medicaid794prescription refill data and information relating to the795Medicaid preferred drug list. The initiative shall be designed796to enhance the agency’s efforts to reduce fraud, abuse, and797errors in the prescription drug benefit program and to otherwise798further the intent of this paragraph.7995. The agency shall contract with an entity to design a800database of clinical utilization information or electronic801medical records for Medicaid providers. The database must be802web-based and allow providers to review on a real-time basis the803utilization of Medicaid services, including, but not limited to,804physician office visits, inpatient and outpatient805hospitalizations, laboratory and pathology services,806radiological and other imaging services, dental care, and807patterns of dispensing prescription drugs in order to coordinate808care and identify potential fraud and abuse.8096. The agency may apply for any federal waivers needed to810administer this paragraph.811 812This subsection expires October 1, 2014.813(16) An entity contracting on a prepaid or fixed-sum basis814shall meet the surplus requirements of s. 641.225. If an815entity’s surplus falls below an amount equal to the surplus816requirements of s. 641.225, the agency shall prohibit the entity817from engaging in marketing and preenrollment activities, shall818cease to process new enrollments, and may not renew the entity’s819contract until the required balance is achieved. The820requirements of this subsection do not apply:821(a) Where a public entity agrees to fund any deficit822incurred by the contracting entity; or823(b) Where the entity’s performance and obligations are824guaranteed in writing by a guaranteeing organization which:8251. Has been in operation for at least 5 years and has826assets in excess of $50 million; or8272. Submits a written guarantee acceptable to the agency828which is irrevocable during the term of the contracting entity’s829contract with the agency and, upon termination of the contract,830until the agency receives proof of satisfaction of all831outstanding obligations incurred under the contract.832 833This subsection expires October 1, 2014.834 (4)(17)(a) The agency may require an entity contracting on 835 a prepaid or fixed-sum basis to establish a restricted 836 insolvency protection account with a federally guaranteed 837 financial institution licensed to do business in this state. The 838 entity shall deposit into that account 5 percent of the 839 capitation payments made by the agency each month until a 840 maximum total of 2 percent of the total current contract amount 841 is reached. The restricted insolvency protection account may be 842 drawn upon with the authorized signatures of two persons 843 designated by the entity and two representatives of the agency. 844 If the agency finds that the entity is insolvent, the agency may 845 draw upon the account solely with the two authorized signatures 846 of representatives of the agency, and the funds may be disbursed 847 to meet financial obligations incurred by the entity under the 848 prepaid contract. If the contract is terminated, expired, or not 849 continued, the account balance must be released by the agency to 850 the entity upon receipt of proof of satisfaction of all 851 outstanding obligations incurred under this contract. 852 (b) The agency may waive the insolvency protection account 853 requirement in writing when evidence is on file with the agency 854 of adequate insolvency insurance and reinsurance that will 855 protect enrollees if the entity becomes unable to meet its 856 obligations. 857(18) An entity that contracts with the agency on a prepaid858or fixed-sum basis for the provision of Medicaid services shall859reimburse any hospital or physician that is outside the entity’s860authorized geographic service area as specified in its contract861with the agency, and that provides services authorized by the862entity to its members, at a rate negotiated with the hospital or863physician for the provision of services or according to the864lesser of the following:865(a) The usual and customary charges made to the general866public by the hospital or physician; or867(b) The Florida Medicaid reimbursement rate established for868the hospital or physician.869 870This subsection expires October 1, 2014.871(19) When a merger or acquisition of a Medicaid prepaid872contractor has been approved by the Office of Insurance873Regulation pursuant to s. 628.4615, the agency shall approve the874assignment or transfer of the appropriate Medicaid prepaid875contract upon request of the surviving entity of the merger or876acquisition if the contractor and the other entity have been in877good standing with the agency for the most recent 12-month878period, unless the agency determines that the assignment or879transfer would be detrimental to the Medicaid recipients or the880Medicaid program. To be in good standing, an entity must not881have failed accreditation or committed any material violation of882the requirements of s. 641.52 and must meet the Medicaid883contract requirements. For purposes of this section, a merger or884acquisition means a change in controlling interest of an entity,885including an asset or stock purchase. This subsection expires886October 1, 2014.887 (5)(20)Any entity contracting with the agency pursuant to 888 this section to provide health care services to Medicaid 889 recipients is prohibited from engaging in any of the following 890 practices or activities: 891 (a) Practices that are discriminatory, including, but not 892 limited to, attempts to discourage participation on the basis of 893 actual or perceived health status. 894 (b) Activities that could mislead or confuse recipients, or 895 misrepresent the organization, its marketing representatives, or 896 the agency. Violations of this paragraph include, but are not 897 limited to: 898 1. False or misleading claims that marketing 899 representatives are employees or representatives of the state or 900 county, or of anyone other than the entity or the organization 901 by whom they are reimbursed. 902 2. False or misleading claims that the entity is 903 recommended or endorsed by any state or county agency, or by any 904 other organization which has not certified its endorsement in 905 writing to the entity. 906 3. False or misleading claims that the state or county 907 recommends that a Medicaid recipient enroll with an entity. 908 4. Claims that a Medicaid recipient will lose benefits 909 under the Medicaid program, or any other health or welfare 910 benefits to which the recipient is legally entitled, if the 911 recipient does not enroll with the entity. 912 (c) Granting or offering of any monetary or other valuable 913 consideration for enrollment, except as authorized by subsection914(23). 915 (d) Door-to-door solicitation of recipients who have not 916 contacted the entity or who have not invited the entity to make 917 a presentation. 918 (e) Solicitation of Medicaid recipients by marketing 919 representatives stationed in state offices unless approved and 920 supervised by the agency or its agent and approved by the 921 affected state agency when solicitation occurs in an office of 922 the state agency. The agency shall ensure that marketing 923 representatives stationed in state offices shall market their 924 managed care plans to Medicaid recipients only in designated 925 areas and in such a way as to not interfere with the recipients’ 926 activities in the state office. 927 (f) Enrollment of Medicaid recipients. 928 (6)(21)The agency may impose a fine for a violation of 929 this section or the contract with the agency by a person or 930 entity that is under contract with the agency. With respect to 931 any nonwillful violation, such fine shall not exceed $2,500 per 932 violation. In no event shall such fine exceed an aggregate 933 amount of $10,000 for all nonwillful violations arising out of 934 the same action. With respect to any knowing and willful 935 violation of this section or the contract with the agency, the 936 agency may impose a fine upon the entity in an amount not to 937 exceed $20,000 for each such violation. In no event shall such 938 fine exceed an aggregate amount of $100,000 for all knowing and 939 willful violations arising out of the same action. 940(22) A health maintenance organization or a person or941entity exempt from chapter 641 that is under contract with the942agency for the provision of health care services to Medicaid943recipients may not use or distribute marketing materials used to944solicit Medicaid recipients, unless such materials have been945approved by the agency. The provisions of this subsection do not946apply to general advertising and marketing materials used by a947health maintenance organization to solicit both non-Medicaid948subscribers and Medicaid recipients. This subsection expires949October 1, 2014.950(23) Upon approval by the agency, health maintenance951organizations and persons or entities exempt from chapter 641952that are under contract with the agency for the provision of953health care services to Medicaid recipients may be permitted954within the capitation rate to provide additional health benefits955that the agency has found are of high quality, are practicably956available, provide reasonable value to the recipient, and are957provided at no additional cost to the state. This subsection958expires October 1, 2014.959(24) The agency shall utilize the statewide health960maintenance organization complaint hotline for the purpose of961investigating and resolving Medicaid and prepaid health plan962complaints, maintaining a record of complaints and confirmed963problems, and receiving disenrollment requests made by964recipients. This subsection expires October 1, 2014.965(25) The agency shall require the publication of the health966maintenance organization’s and the prepaid health plan’s967consumer services telephone numbers and the “800” telephone968number of the statewide health maintenance organization969complaint hotline on each Medicaid identification card issued by970a health maintenance organization or prepaid health plan971contracting with the agency to serve Medicaid recipients and on972each subscriber handbook issued to a Medicaid recipient. This973subsection expires October 1, 2014.974 (7)(26)The agency shall establish a health care quality 975 improvement system for those entities contracting with the 976 agency pursuant to this section, incorporating all the standards 977 and guidelines developed by the Centers for Medicare and 978 Medicaid ServicesBureau of the Health Care Financing979Administrationas a part of the quality assurance reform 980 initiative. The system shall include, but need not be limited 981 to, the following: 982 (a) Guidelines for internal quality assurance programs, 983 including standards for: 984 1. Written quality assurance program descriptions. 985 2. Responsibilities of the governing body for monitoring, 986 evaluating, and making improvements to care. 987 3. An active quality assurance committee. 988 4. Quality assurance program supervision. 989 5. Requiring the program to have adequate resources to 990 effectively carry out its specified activities. 991 6. Provider participation in the quality assurance program. 992 7. Delegation of quality assurance program activities. 993 8. Credentialing and recredentialing. 994 9. Enrollee rights and responsibilities. 995 10. Availability and accessibility to services and care. 996 11. Ambulatory care facilities. 997 12. Accessibility and availability of medical records, as 998 well as proper recordkeeping and process for record review. 999 13. Utilization review. 1000 14. A continuity of care system. 1001 15. Quality assurance program documentation. 1002 16. Coordination of quality assurance activity with other 1003 management activity. 1004 17. Delivering care to pregnant women and infants; to 1005 elderly and disabled recipients, especially those who are at 1006 risk of institutional placement; to persons with developmental 1007 disabilities; and to adults who have chronic, high-cost medical 1008 conditions. 1009 (b) Guidelines which require the entities to conduct 1010 quality-of-care studies which: 1011 1. Target specific conditions and specific health service 1012 delivery issues for focused monitoring and evaluation. 1013 2. Use clinical care standards or practice guidelines to 1014 objectively evaluate the care the entity delivers or fails to 1015 deliver for the targeted clinical conditions and health services 1016 delivery issues. 1017 3. Use quality indicators derived from the clinical care 1018 standards or practice guidelines to screen and monitor care and 1019 services delivered. 1020 (c) Guidelines for external quality review of each 1021 contractor which require: focused studies of patterns of care; 1022 individual care review in specific situations; and followup 1023 activities on previous pattern-of-care study findings and 1024 individual-care-review findings. In designing the external 1025 quality review function and determining how it is to operate as 1026 part of the state’s overall quality improvement system, the 1027 agency shall construct its external quality review organization 1028 and entity contracts to address each of the following: 1029 1. Delineating the role of the external quality review 1030 organization. 1031 2. Length of the external quality review organization 1032 contract with the state. 1033 3. Participation of the contracting entities in designing 1034 external quality review organization review activities. 1035 4. Potential variation in the type of clinical conditions 1036 and health services delivery issues to be studied at each plan. 1037 5. Determining the number of focused pattern-of-care 1038 studies to be conducted for each plan. 1039 6. Methods for implementing focused studies. 1040 7. Individual care review. 1041 8. Followup activities. 1042 1043 This subsection expires October 1, 2016. 1044(27) In order to ensure that children receive health care1045services for which an entity has already been compensated, an1046entity contracting with the agency pursuant to this section1047shall achieve an annual Early and Periodic Screening, Diagnosis,1048and Treatment (EPSDT) Service screening rate of at least 601049percent for those recipients continuously enrolled for at least10508 months. The agency shall develop a method by which the EPSDT1051screening rate shall be calculated. For any entity which does1052not achieve the annual 60 percent rate, the entity must submit a1053corrective action plan for the agency’s approval. If the entity1054does not meet the standard established in the corrective action1055plan during the specified timeframe, the agency is authorized to1056impose appropriate contract sanctions. At least annually, the1057agency shall publicly release the EPSDT Services screening rates1058of each entity it has contracted with on a prepaid basis to1059serve Medicaid recipients. This subsection expires October 1,10602014.1061(28) The agency shall perform enrollments and1062disenrollments for Medicaid recipients who are eligible for1063MediPass or managed care plans. Notwithstanding the prohibition1064contained in paragraph (20)(f), managed care plans may perform1065preenrollments of Medicaid recipients under the supervision of1066the agency or its agents. For the purposes of this section, the1067term “preenrollment” means the provision of marketing and1068educational materials to a Medicaid recipient and assistance in1069completing the application forms, but does not include actual1070enrollment into a managed care plan. An application for1071enrollment may not be deemed complete until the agency or its1072agent verifies that the recipient made an informed, voluntary1073choice. The agency, in cooperation with the Department of1074Children and Families, may test new marketing initiatives to1075inform Medicaid recipients about their managed care options at1076selected sites. The agency may contract with a third party to1077perform managed care plan and MediPass enrollment and1078disenrollment services for Medicaid recipients and may adopt1079rules to administer such services. The agency may adjust the1080capitation rate only to cover the costs of a third-party1081enrollment and disenrollment contract, and for agency1082supervision and management of the managed care plan enrollment1083and disenrollment contract. This subsection expires October 1,10842014.1085(29) Any lists of providers made available to Medicaid1086recipients, MediPass enrollees, or managed care plan enrollees1087shall be arranged alphabetically showing the provider’s name and1088specialty and, separately, by specialty in alphabetical order.1089This subsection expires October 1, 2014.1090(30) The agency shall establish an enhanced managed care1091quality assurance oversight function, to include at least the1092following components:1093(a) At least quarterly analysis and followup, including1094sanctions as appropriate, of managed care participant1095utilization of services.1096(b) At least quarterly analysis and followup, including1097sanctions as appropriate, of quality findings of the Medicaid1098peer review organization and other external quality assurance1099programs.1100(c) At least quarterly analysis and followup, including1101sanctions as appropriate, of the fiscal viability of managed1102care plans.1103(d) At least quarterly analysis and followup, including1104sanctions as appropriate, of managed care participant1105satisfaction and disenrollment surveys.1106(e) The agency shall conduct regular and ongoing Medicaid1107recipient satisfaction surveys.1108 1109The analyses and followup activities conducted by the agency1110under its enhanced managed care quality assurance oversight1111function shall not duplicate the activities of accreditation1112reviewers for entities regulated under part III of chapter 641,1113but may include a review of the finding of such reviewers. This1114subsection expires October 1, 2014.1115(31) Each managed care plan that is under contract with the1116agency to provide health care services to Medicaid recipients1117shall annually conduct a background check with the Department of1118Law Enforcement of all persons with ownership interest of 51119percent or more or executive management responsibility for the1120managed care plan and shall submit to the agency information1121concerning any such person who has been found guilty of,1122regardless of adjudication, or has entered a plea of nolo1123contendere or guilty to, any of the offenses listed in s.1124435.04. This subsection expires October 1, 2014.1125(32) The agency shall, by rule, develop a process whereby a1126Medicaid managed care plan enrollee who wishes to enter hospice1127care may be disenrolled from the managed care plan within 241128hours after contacting the agency regarding such request. The1129agency rule shall include a methodology for the agency to recoup1130managed care plan payments on a pro rata basis if payment has1131been made for the enrollment month when disenrollment occurs.1132This subsection expires October 1, 2014.1133(33) The agency and entities that contract with the agency1134to provide health care services to Medicaid recipients under1135this section or ss. 409.91211 and 409.9122 must comply with the1136provisions of s. 641.513 in providing emergency services and1137care to Medicaid recipients and MediPass recipients. Where1138feasible, safe, and cost-effective, the agency shall encourage1139hospitals, emergency medical services providers, and other1140public and private health care providers to work together in1141their local communities to enter into agreements or arrangements1142to ensure access to alternatives to emergency services and care1143for those Medicaid recipients who need nonemergent care. The1144agency shall coordinate with hospitals, emergency medical1145services providers, private health plans, capitated managed care1146networks as established in s. 409.91211, and other public and1147private health care providers to implement the provisions of ss.1148395.1041(7), 409.91255(3)(g), 627.6405, and 641.31097 to develop1149and implement emergency department diversion programs for1150Medicaid recipients. This subsection expires October 1, 2014.1151(34) All entities providing health care services to1152Medicaid recipients shall make available, and encourage all1153pregnant women and mothers with infants to receive, and provide1154documentation in the medical records to reflect, the following:1155(a) Healthy Start prenatal or infant screening.1156(b) Healthy Start care coordination, when screening or1157other factors indicate need.1158(c) Healthy Start enhanced services in accordance with the1159prenatal or infant screening results.1160(d) Immunizations in accordance with recommendations of the1161Advisory Committee on Immunization Practices of the United1162States Public Health Service and the American Academy of1163Pediatrics, as appropriate.1164(e) Counseling and services for family planning to all1165women and their partners.1166(f) A scheduled postpartum visit for the purpose of1167voluntary family planning, to include discussion of all methods1168of contraception, as appropriate.1169(g) Referral to the Special Supplemental Nutrition Program1170for Women, Infants, and Children (WIC).1171 1172This subsection expires October 1, 2014.1173(35) Any entity that provides Medicaid prepaid health plan1174services shall ensure the appropriate coordination of health1175care services with an assisted living facility in cases where a1176Medicaid recipient is both a member of the entity’s prepaid1177health plan and a resident of the assisted living facility. If1178the entity is at risk for Medicaid targeted case management and1179behavioral health services, the entity shall inform the assisted1180living facility of the procedures to follow should an emergent1181condition arise. This subsection expires October 1, 2014.1182(36) The agency shall enter into agreements with not-for1183profit organizations based in this state for the purpose of1184providing vision screening. This subsection expires October 1,11852014.1186 (8)(37)(a) The agency shall implement a Medicaid 1187 prescribed-drug spending-control program that includes the 1188 following components: 1189 1. A Medicaid preferred drug list, which shall be a listing 1190 of cost-effective therapeutic options recommended by the 1191 Medicaid Pharmacy and Therapeutics Committee established 1192 pursuant to s. 409.91195 and adopted by the agency for each 1193 therapeutic class on the preferred drug list. At the discretion 1194 of the committee, and when feasible, the preferred drug list 1195 should include at least two products in a therapeutic class. The 1196 agency may post the preferred drug list and updates to the list 1197 on an Internet website without following the rulemaking 1198 procedures of chapter 120. Antiretroviral agents are excluded 1199 from the preferred drug list. The agency shall also limit the 1200 amount of a prescribed drug dispensed to no more than a 34-day 1201 supply unless the drug products’ smallest marketed package is 1202 greater than a 34-day supply, or the drug is determined by the 1203 agency to be a maintenance drug in which case a 100-day maximum 1204 supply may be authorized. The agency may seek any federal 1205 waivers necessary to implement these cost-control programs and 1206 to continue participation in the federal Medicaid rebate 1207 program, or alternatively to negotiate state-only manufacturer 1208 rebates. The agency may adopt rules to administer this 1209 subparagraph. The agency shall continue to provide unlimited 1210 contraceptive drugs and items. The agency must establish 1211 procedures to ensure that: 1212 a. There is a response to a request for prior consultation 1213 by telephone or other telecommunication device within 24 hours 1214 after receipt of a request for prior consultation; and 1215 b. A 72-hour supply of the drug prescribed is provided in 1216 an emergency or when the agency does not provide a response 1217 within 24 hours as required by sub-subparagraph a. 1218 2. Reimbursement to pharmacies for Medicaid prescribed 1219 drugs shall be set at the lowest of: the average wholesale price 1220 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC) 1221 plus 1.5 percent, the federal upper limit (FUL), the state 1222 maximum allowable cost (SMAC), or the usual and customary (UAC) 1223 charge billed by the provider. 1224 3. The agency shall develop and implement a process for 1225 managing the drug therapies of Medicaid recipients who are using 1226 significant numbers of prescribed drugs each month. The 1227 management process may include, but is not limited to, 1228 comprehensive, physician-directed medical-record reviews, claims 1229 analyses, and case evaluations to determine the medical 1230 necessity and appropriateness of a patient’s treatment plan and 1231 drug therapies. The agency may contract with a private 1232 organization to provide drug-program-management services. The 1233 Medicaid drug benefit management program shall include 1234 initiatives to manage drug therapies for HIV/AIDS patients, 1235 patients using 20 or more unique prescriptions in a 180-day 1236 period, and the top 1,000 patients in annual spending. The 1237 agency shall enroll any Medicaid recipient in the drug benefit 1238 management program if he or she meets the specifications of this 1239 provision and is not enrolled in a Medicaid health maintenance 1240 organization. 1241 4. The agency may limit the size of its pharmacy network 1242 based on need, competitive bidding, price negotiations, 1243 credentialing, or similar criteria. The agency shall give 1244 special consideration to rural areas in determining the size and 1245 location of pharmacies included in the Medicaid pharmacy 1246 network. A pharmacy credentialing process may include criteria 1247 such as a pharmacy’s full-service status, location, size, 1248 patient educational programs, patient consultation, disease 1249 management services, and other characteristics. The agency may 1250 impose a moratorium on Medicaid pharmacy enrollment if it is 1251 determined that it has a sufficient number of Medicaid 1252 participating providers. The agency must allow dispensing 1253 practitioners to participate as a part of the Medicaid pharmacy 1254 network regardless of the practitioner’s proximity to any other 1255 entity that is dispensing prescription drugs under the Medicaid 1256 program. A dispensing practitioner must meet all credentialing 1257 requirements applicable to his or her practice, as determined by 1258 the agency. 1259 5. The agency shall develop and implement a program that 1260 requires Medicaid practitioners who prescribe drugs to use a 1261 counterfeit-proof prescription pad for Medicaid prescriptions. 1262 The agency shall require the use of standardized counterfeit 1263 proof prescription pads by Medicaid-participating prescribers or 1264 prescribers who write prescriptions for Medicaid recipients. The 1265 agency may implement the program in targeted geographic areas or 1266 statewide. 1267 6. The agency may enter into arrangements that require 1268 manufacturers of generic drugs prescribed to Medicaid recipients 1269 to provide rebates of at least 15.1 percent of the average 1270 manufacturer price for the manufacturer’s generic products. 1271 These arrangements shall require that if a generic-drug 1272 manufacturer pays federal rebates for Medicaid-reimbursed drugs 1273 at a level below 15.1 percent, the manufacturer must provide a 1274 supplemental rebate to the state in an amount necessary to 1275 achieve a 15.1-percent rebate level. 1276 7. The agency may establish a preferred drug list as 1277 described in this subsection, and, pursuant to the establishment 1278 of such preferred drug list, negotiate supplemental rebates from 1279 manufacturers that are in addition to those required by Title 1280 XIX of the Social Security Act and at no less than 14 percent of 1281 the average manufacturer price as defined in 42 U.S.C. s. 1936 1282 on the last day of a quarter unless the federal or supplemental 1283 rebate, or both, equals or exceeds 29 percent. There is no upper 1284 limit on the supplemental rebates the agency may negotiate. The 1285 agency may determine that specific products, brand-name or 1286 generic, are competitive at lower rebate percentages. Agreement 1287 to pay the minimum supplemental rebate percentage guarantees a 1288 manufacturer that the Medicaid Pharmaceutical and Therapeutics 1289 Committee will consider a product for inclusion on the preferred 1290 drug list. However, a pharmaceutical manufacturer is not 1291 guaranteed placement on the preferred drug list by simply paying 1292 the minimum supplemental rebate. Agency decisions will be made 1293 on the clinical efficacy of a drug and recommendations of the 1294 Medicaid Pharmaceutical and Therapeutics Committee, as well as 1295 the price of competing products minus federal and state rebates. 1296 The agency may contract with an outside agency or contractor to 1297 conduct negotiations for supplemental rebates. For the purposes 1298 of this section, the term “supplemental rebates” means cash 1299 rebates. Value-added programs as a substitution for supplemental 1300 rebates are prohibited. The agency may seek any federal waivers 1301 to implement this initiative. 1302 8. The agency shall expand home delivery of pharmacy 1303 products. The agency may amend the state plan and issue a 1304 procurement, as necessary, in order to implement this program. 1305 The procurements must include agreements with a pharmacy or 1306 pharmacies located in the state to provide mail order delivery 1307 services at no cost to the recipients who elect to receive home 1308 delivery of pharmacy products. The procurement must focus on 1309 serving recipients with chronic diseases for which pharmacy 1310 expenditures represent a significant portion of Medicaid 1311 pharmacy expenditures or which impact a significant portion of 1312 the Medicaid population. The agency may seek and implement any 1313 federal waivers necessary to implement this subparagraph. 1314 9. The agency shall limit to one dose per month any drug 1315 prescribed to treat erectile dysfunction. 1316 10.a. The agency may implement a Medicaid behavioral drug 1317 management system. The agency may contract with a vendor that 1318 has experience in operating behavioral drug management systems 1319 to implement this program. The agency may seek federal waivers 1320 to implement this program. 1321 b. The agency, in conjunction with the Department of 1322 Children and Families, may implement the Medicaid behavioral 1323 drug management system that is designed to improve the quality 1324 of care and behavioral health prescribing practices based on 1325 best practice guidelines, improve patient adherence to 1326 medication plans, reduce clinical risk, and lower prescribed 1327 drug costs and the rate of inappropriate spending on Medicaid 1328 behavioral drugs. The program may include the following 1329 elements: 1330 (I) Provide for the development and adoption of best 1331 practice guidelines for behavioral health-related drugs such as 1332 antipsychotics, antidepressants, and medications for treating 1333 bipolar disorders and other behavioral conditions; translate 1334 them into practice; review behavioral health prescribers and 1335 compare their prescribing patterns to a number of indicators 1336 that are based on national standards; and determine deviations 1337 from best practice guidelines. 1338 (II) Implement processes for providing feedback to and 1339 educating prescribers using best practice educational materials 1340 and peer-to-peer consultation. 1341 (III) Assess Medicaid beneficiaries who are outliers in 1342 their use of behavioral health drugs with regard to the numbers 1343 and types of drugs taken, drug dosages, combination drug 1344 therapies, and other indicators of improper use of behavioral 1345 health drugs. 1346 (IV) Alert prescribers to patients who fail to refill 1347 prescriptions in a timely fashion, are prescribed multiple same 1348 class behavioral health drugs, and may have other potential 1349 medication problems. 1350 (V) Track spending trends for behavioral health drugs and 1351 deviation from best practice guidelines. 1352 (VI) Use educational and technological approaches to 1353 promote best practices, educate consumers, and train prescribers 1354 in the use of practice guidelines. 1355 (VII) Disseminate electronic and published materials. 1356 (VIII) Hold statewide and regional conferences. 1357 (IX) Implement a disease management program with a model 1358 quality-based medication component for severely mentally ill 1359 individuals and emotionally disturbed children who are high 1360 users of care. 1361 11. The agency shall implement a Medicaid prescription drug 1362 management system. 1363 a. The agency may contract with a vendor that has 1364 experience in operating prescription drug management systems in 1365 order to implement this system. Any management system that is 1366 implemented in accordance with this subparagraph must rely on 1367 cooperation between physicians and pharmacists to determine 1368 appropriate practice patterns and clinical guidelines to improve 1369 the prescribing, dispensing, and use of drugs in the Medicaid 1370 program. The agency may seek federal waivers to implement this 1371 program. 1372 b. The drug management system must be designed to improve 1373 the quality of care and prescribing practices based on best 1374 practice guidelines, improve patient adherence to medication 1375 plans, reduce clinical risk, and lower prescribed drug costs and 1376 the rate of inappropriate spending on Medicaid prescription 1377 drugs. The program must: 1378 (I) Provide for the adoption of best practice guidelines 1379 for the prescribing and use of drugs in the Medicaid program, 1380 including translating best practice guidelines into practice; 1381 reviewing prescriber patterns and comparing them to indicators 1382 that are based on national standards and practice patterns of 1383 clinical peers in their community, statewide, and nationally; 1384 and determine deviations from best practice guidelines. 1385 (II) Implement processes for providing feedback to and 1386 educating prescribers using best practice educational materials 1387 and peer-to-peer consultation. 1388 (III) Assess Medicaid recipients who are outliers in their 1389 use of a single or multiple prescription drugs with regard to 1390 the numbers and types of drugs taken, drug dosages, combination 1391 drug therapies, and other indicators of improper use of 1392 prescription drugs. 1393 (IV) Alert prescribers to recipients who fail to refill 1394 prescriptions in a timely fashion, are prescribed multiple drugs 1395 that may be redundant or contraindicated, or may have other 1396 potential medication problems. 1397 12. The agency may contract for drug rebate administration, 1398 including, but not limited to, calculating rebate amounts, 1399 invoicing manufacturers, negotiating disputes with 1400 manufacturers, and maintaining a database of rebate collections. 1401 13. The agency may specify the preferred daily dosing form 1402 or strength for the purpose of promoting best practices with 1403 regard to the prescribing of certain drugs as specified in the 1404 General Appropriations Act and ensuring cost-effective 1405 prescribing practices. 1406 14. The agency may require prior authorization for 1407 Medicaid-covered prescribed drugs. The agency may prior 1408 authorize the use of a product: 1409 a. For an indication not approved in labeling; 1410 b. To comply with certain clinical guidelines; or 1411 c. If the product has the potential for overuse, misuse, or 1412 abuse. 1413 1414 The agency may require the prescribing professional to provide 1415 information about the rationale and supporting medical evidence 1416 for the use of a drug. The agency shall post prior 1417 authorization, step-edit criteria and protocol, and updates to 1418 the list of drugs that are subject to prior authorization on the 1419 agency’s Internet website within 21 days after the prior 1420 authorization and step-edit criteria and protocol and updates 1421 are approved by the agency. For purposes of this subparagraph, 1422 the term “step-edit” means an automatic electronic review of 1423 certain medications subject to prior authorization. 1424 15. The agency, in conjunction with the Pharmaceutical and 1425 Therapeutics Committee, may require age-related prior 1426 authorizations for certain prescribed drugs. The agency may 1427 preauthorize the use of a drug for a recipient who may not meet 1428 the age requirement or may exceed the length of therapy for use 1429 of this product as recommended by the manufacturer and approved 1430 by the Food and Drug Administration. Prior authorization may 1431 require the prescribing professional to provide information 1432 about the rationale and supporting medical evidence for the use 1433 of a drug. 1434 16. The agency shall implement a step-therapy prior 1435 authorization approval process for medications excluded from the 1436 preferred drug list. Medications listed on the preferred drug 1437 list must be used within the previous 12 months before the 1438 alternative medications that are not listed. The step-therapy 1439 prior authorization may require the prescriber to use the 1440 medications of a similar drug class or for a similar medical 1441 indication unless contraindicated in the Food and Drug 1442 Administration labeling. The trial period between the specified 1443 steps may vary according to the medical indication. The step 1444 therapy approval process shall be developed in accordance with 1445 the committee as stated in s. 409.91195(7) and (8). A drug 1446 product may be approved without meeting the step-therapy prior 1447 authorization criteria if the prescribing physician provides the 1448 agency with additional written medical or clinical documentation 1449 that the product is medically necessary because: 1450 a. There is not a drug on the preferred drug list to treat 1451 the disease or medical condition which is an acceptable clinical 1452 alternative; 1453 b. The alternatives have been ineffective in the treatment 1454 of the beneficiary’s disease; or 1455 c. Based on historic evidence and known characteristics of 1456 the patient and the drug, the drug is likely to be ineffective, 1457 or the number of doses have been ineffective. 1458 1459 The agency shall work with the physician to determine the best 1460 alternative for the patient. The agency may adopt rules waiving 1461 the requirements for written clinical documentation for specific 1462 drugs in limited clinical situations. 1463 17. The agency shall implement a return and reuse program 1464 for drugs dispensed by pharmacies to institutional recipients, 1465 which includes payment of a $5 restocking fee for the 1466 implementation and operation of the program. The return and 1467 reuse program shall be implemented electronically and in a 1468 manner that promotes efficiency. The program must permit a 1469 pharmacy to exclude drugs from the program if it is not 1470 practical or cost-effective for the drug to be included and must 1471 provide for the return to inventory of drugs that cannot be 1472 credited or returned in a cost-effective manner. The agency 1473 shall determine if the program has reduced the amount of 1474 Medicaid prescription drugs which are destroyed on an annual 1475 basis and if there are additional ways to ensure more 1476 prescription drugs are not destroyed which could safely be 1477 reused. 1478 (b) The agency shall implement this subsection to the 1479 extent that funds are appropriated to administer the Medicaid 1480 prescribed-drug spending-control program. The agency may 1481 contract all or any part of this program to private 1482 organizations. 1483 (c) The agency shall submit quarterly reports to the 1484 Governor, the President of the Senate, and the Speaker of the 1485 House of Representatives which must include, but need not be 1486 limited to, the progress made in implementing this subsection 1487 and its effect on Medicaid prescribed-drug expenditures. 1488 (9)(38)Notwithstanding the provisions of chapter 287, the 1489 agency may, at its discretion, renew a contract or contracts for 1490 fiscal intermediary services one or more times for such periods 1491 as the agency may decide; however, all such renewals may not 1492 combine to exceed a total period longer than the term of the 1493 original contract. 1494(39) The agency shall establish a demonstration project in1495Miami-Dade County of a long-term-care facility and a psychiatric1496facility licensed pursuant to chapter 395 to improve access to1497health care for a predominantly minority, medically underserved,1498and medically complex population and to evaluate alternatives to1499nursing home care and general acute care for such population.1500Such project is to be located in a health care condominium and1501collocated with licensed facilities providing a continuum of1502care. These projects are not subject to the provisions of s.1503408.036 or s. 408.039. This subsection expires October 1, 2013.1504(40) The agency shall develop and implement a utilization1505management program for Medicaid-eligible recipients for the1506management of occupational, physical, respiratory, and speech1507therapies. The agency shall establish a utilization program that1508may require prior authorization in order to ensure medically1509necessary and cost-effective treatments. The program shall be1510operated in accordance with a federally approved waiver program1511or state plan amendment. The agency may seek a federal waiver or1512state plan amendment to implement this program. The agency may1513also competitively procure these services from an outside vendor1514on a regional or statewide basis. This subsection expires1515October 1, 2014.1516(41)(a) The agency shall contract on a prepaid or fixed-sum1517basis with appropriately licensed prepaid dental health plans to1518provide dental services. This paragraph expires October 1, 2014.1519(b) Notwithstanding paragraph (a) and for the 2012-20131520fiscal year only, the agency is authorized to provide a Medicaid1521prepaid dental health program in Miami-Dade County. For all1522other counties, the agency may not limit dental services to1523prepaid plans and must allow qualified dental providers to1524provide dental services under Medicaid on a fee-for-service1525reimbursement methodology. The agency may seek any necessary1526revisions or amendments to the state plan or federal waivers in1527order to implement this paragraph. The agency shall terminate1528existing contracts as needed to implement this paragraph. This1529paragraph expires July 1, 2013.1530(42) The Agency for Health Care Administration shall ensure1531that any Medicaid managed care plan as defined in s.1532409.9122(2)(f), whether paid on a capitated basis or a shared1533savings basis, is cost-effective. For purposes of this1534subsection, the term “cost-effective” means that a network’s1535per-member, per-month costs to the state, including, but not1536limited to, fee-for-service costs, administrative costs, and1537case-management fees, if any, must be no greater than the1538state’s costs associated with contracts for Medicaid services1539established under subsection (3), which may be adjusted for1540health status. The agency shall conduct actuarially sound1541adjustments for health status in order to ensure such cost1542effectiveness and shall annually publish the results on its1543Internet website. Contracts established pursuant to this1544subsection which are not cost-effective may not be renewed. This1545subsection expires October 1, 2014.1546(43) Subject to the availability of funds, the agency shall1547mandate a recipient’s participation in a provider lock-in1548program, when appropriate, if a recipient is found by the agency1549to have used Medicaid goods or services at a frequency or amount1550not medically necessary, limiting the receipt of goods or1551services to medically necessary providers after the 21-day1552appeal process has ended, for a period of not less than 1 year.1553The lock-in programs shall include, but are not limited to,1554pharmacies, medical doctors, and infusion clinics. The1555limitation does not apply to emergency services and care1556provided to the recipient in a hospital emergency department.1557The agency shall seek any federal waivers necessary to implement1558this subsection. The agency shall adopt any rules necessary to1559comply with or administer this subsection. This subsection1560expires October 1, 2014.1561 (10)(44)The agency shall seek a federal waiver for 1562 permission to terminate the eligibility of a Medicaid recipient 1563 who has been found to have committed fraud, through judicial or 1564 administrative determination, two times in a period of 5 years. 1565 (11)(45)(a) A provider is not entitled to enrollment in the 1566 Medicaid provider network. The agency may implement a Medicaid 1567 fee-for-service provider network controls, including, but not 1568 limited to, competitive procurement and provider credentialing. 1569 If a credentialing process is used, the agency may limit its 1570 provider network based upon the following considerations: 1571 beneficiary access to care, provider availability, provider 1572 quality standards and quality assurance processes, cultural 1573 competency, demographic characteristics of beneficiaries, 1574 practice standards, service wait times, provider turnover, 1575 provider licensure and accreditation history, program integrity 1576 history, peer review, Medicaid policy and billing compliance 1577 records, clinical and medical record audit findings, and such 1578 other areas that are considered necessary by the agency to 1579 ensure the integrity of the program. 1580 (b) The agency shall limit its network of durable medical 1581 equipment and medical supply providers. For dates of service 1582 after January 1, 2009, the agency shall limit payment for 1583 durable medical equipment and supplies to providers that meet 1584 all the requirements of this paragraph. 1585 1. Providers must be accredited by a Centers for Medicare 1586 and Medicaid Services deemed accreditation organization for 1587 suppliers of durable medical equipment, prosthetics, orthotics, 1588 and supplies. The provider must maintain accreditation and is 1589 subject to unannounced reviews by the accrediting organization. 1590 2. Providers must provide the services or supplies directly 1591 to the Medicaid recipient or caregiver at the provider location 1592 or recipient’s residence or send the supplies directly to the 1593 recipient’s residence with receipt of mailed delivery. 1594 Subcontracting or consignment of the service or supply to a 1595 third party is prohibited. 1596 3. Notwithstanding subparagraph 2., a durable medical 1597 equipment provider may store nebulizers at a physician’s office 1598 for the purpose of having the physician’s staff issue the 1599 equipment if it meets all of the following conditions: 1600 a. The physician must document the medical necessity and 1601 need to prevent further deterioration of the patient’s 1602 respiratory status by the timely delivery of the nebulizer in 1603 the physician’s office. 1604 b. The durable medical equipment provider must have written 1605 documentation of the competency and training by a Florida 1606 licensed registered respiratory therapist of any durable medical 1607 equipment staff who participate in the training of physician 1608 office staff for the use of nebulizers, including cleaning, 1609 warranty, and special needs of patients. 1610 c. The physician’s office must have documented the training 1611 and competency of any staff member who initiates the delivery of 1612 nebulizers to patients. The durable medical equipment provider 1613 must maintain copies of all physician office training. 1614 d. The physician’s office must maintain inventory records 1615 of stored nebulizers, including documentation of the durable 1616 medical equipment provider source. 1617 e. A physician contracted with a Medicaid durable medical 1618 equipment provider may not have a financial relationship with 1619 that provider or receive any financial gain from the delivery of 1620 nebulizers to patients. 1621 4. Providers must have a physical business location and a 1622 functional landline business phone. The location must be within 1623 the state or not more than 50 miles from the Florida state line. 1624 The agency may make exceptions for providers of durable medical 1625 equipment or supplies not otherwise available from other 1626 enrolled providers located within the state. 1627 5. Physical business locations must be clearly identified 1628 as a business that furnishes durable medical equipment or 1629 medical supplies by signage that can be read from 20 feet away. 1630 The location must be readily accessible to the public during 1631 normal, posted business hours and must operate at least 5 hours 1632 per day and at least 5 days per week, with the exception of 1633 scheduled and posted holidays. The location may not be located 1634 within or at the same numbered street address as another 1635 enrolled Medicaid durable medical equipment or medical supply 1636 provider or as an enrolled Medicaid pharmacy that is also 1637 enrolled as a durable medical equipment provider. A licensed 1638 orthotist or prosthetist that provides only orthotic or 1639 prosthetic devices as a Medicaid durable medical equipment 1640 provider is exempt from this paragraph. 1641 6. Providers must maintain a stock of durable medical 1642 equipment and medical supplies on site that is readily available 1643 to meet the needs of the durable medical equipment business 1644 location’s customers. 1645 7. Providers must provide a surety bond of $50,000 for each 1646 provider location, up to a maximum of 5 bonds statewide or an 1647 aggregate bond of $250,000 statewide, as identified by Federal 1648 Employer Identification Number. Providers who post a statewide 1649 or an aggregate bond must identify all of their locations in any 1650 Medicaid durable medical equipment and medical supply provider 1651 enrollment application or bond renewal. Each provider location’s 1652 surety bond must be renewed annually and the provider must 1653 submit proof of renewal even if the original bond is a 1654 continuous bond. A licensed orthotist or prosthetist that 1655 provides only orthotic or prosthetic devices as a Medicaid 1656 durable medical equipment provider is exempt from the provisions 1657 in this paragraph. 1658 8. Providers must obtain a level 2 background screening, in 1659 accordance with chapter 435 and s. 408.809, for each provider 1660 employee in direct contact with or providing direct services to 1661 recipients of durable medical equipment and medical supplies in 1662 their homes. This requirement includes, but is not limited to, 1663 repair and service technicians, fitters, and delivery staff. The 1664 provider shall pay for the cost of the background screening. 1665 9. The following providers are exempt from subparagraphs 1. 1666 and 7.: 1667 a. Durable medical equipment providers owned and operated 1668 by a government entity. 1669 b. Durable medical equipment providers that are operating 1670 within a pharmacy that is currently enrolled as a Medicaid 1671 pharmacy provider. 1672 c. Active, Medicaid-enrolled orthopedic physician groups, 1673 primarily owned by physicians, which provide only orthotic and 1674 prosthetic devices. 1675(46) The agency shall contract with established minority1676physician networks that provide services to historically1677underserved minority patients. The networks must provide cost1678effective Medicaid services, comply with the requirements to be1679a MediPass provider, and provide their primary care physicians1680with access to data and other management tools necessary to1681assist them in ensuring the appropriate use of services,1682including inpatient hospital services and pharmaceuticals.1683(a) The agency shall provide for the development and1684expansion of minority physician networks in each service area to1685provide services to Medicaid recipients who are eligible to1686participate under federal law and rules.1687(b) The agency shall reimburse each minority physician1688network as a fee-for-service provider, including the case1689management fee for primary care, if any, or as a capitated rate1690provider for Medicaid services. Any savings shall be shared with1691the minority physician networks pursuant to the contract.1692(c) For purposes of this subsection, the term “cost1693effective” means that a network’s per-member, per-month costs to1694the state, including, but not limited to, fee-for-service costs,1695administrative costs, and case-management fees, if any, must be1696no greater than the state’s costs associated with contracts for1697Medicaid services established under subsection (3), which shall1698be actuarially adjusted for case mix, model, and service area.1699The agency shall conduct actuarially sound audits adjusted for1700case mix and model in order to ensure such cost-effectiveness1701and shall annually publish the audit results on its Internet1702website. Contracts established pursuant to this subsection which1703are not cost-effective may not be renewed.1704(d) The agency may apply for any federal waivers needed to1705implement this subsection.1706 1707This subsection expires October 1, 2014.1708 (12)(47)To the extent permitted by federal law and as 1709 allowed under s. 409.906, the agency shall provide reimbursement 1710 for emergency mental health care services for Medicaid 1711 recipients in crisis stabilization facilities licensed under s. 1712 394.875 as long as those services are less expensive than the 1713 same services provided in a hospital setting. 1714 (13)(48)The agency shall work with the Agency for Persons 1715 with Disabilities to develop a home and community-based waiver 1716 to serve children and adults who are diagnosed with familial 1717 dysautonomia or Riley-Day syndrome caused by a mutation of the 1718 IKBKAP gene on chromosome 9. The agency shall seek federal 1719 waiver approval and implement the approved waiver subject to the 1720 availability of funds and any limitations provided in the 1721 General Appropriations Act. The agency may adopt rules to 1722 implement this waiver program. 1723 (14)(49)The agency shall implement a program of all 1724 inclusive care for children. The program of all-inclusive care 1725 for children shall be established to provide in-home hospice 1726 like support services to children diagnosed with a life 1727 threatening illness and enrolled in the Children’s Medical 1728 Services network to reduce hospitalizations as appropriate. The 1729 agency, in consultation with the Department of Health, may 1730 implement the program of all-inclusive care for children after 1731 obtaining approval from the Centers for Medicare and Medicaid 1732 Services. 1733 (15)(50)Before seeking an amendment to the state plan for 1734 purposes of implementing programs authorized by the Deficit 1735 Reduction Act of 2005, the agency shall notify the Legislature. 1736 (16)(51)The agency may not pay for psychotropic medication 1737 prescribed for a child in the Medicaid program without the 1738 express and informed consent of the child’s parent or legal 1739 guardian. The physician shall document the consent in the 1740 child’s medical record and provide the pharmacy with a signed 1741 attestation of this documentation with the prescription. The 1742 express and informed consent or court authorization for a 1743 prescription of psychotropic medication for a child in the 1744 custody of the Department of Children and Families shall be 1745 obtained pursuant to s. 39.407. 1746 Reviser’s note.—Amended to conform to the repeals of numerous 1747 subunits pursuant to their own terms, effective at various 1748 dates in 2013 and 2014. Material in existing s. 1749 409.912(4)(d)4. referencing s. 409.91211 was deleted to 1750 conform to the repeal of that section effective October 1, 1751 2014, by s. 20, ch. 2011-135, Laws of Florida, and 1752 confirmation of that repeal by this reviser’s bill. The 1753 reference in subsection (26), redesignated here as 1754 subsection (7), to the Medicaid Bureau of the Health Care 1755 Financing Administration was redesignated as the Centers 1756 for Medicare and Medicaid Services to conform to the 1757 renaming of the federal agency. 1758 Section 15. Section 409.91211, Florida Statutes, is 1759 repealed. 1760 Reviser’s note.—The cited section, which relates to the Medicaid 1761 managed care pilot program, was repealed by s. 20, ch. 1762 2011-135, Laws of Florida, effective October 1, 2014. Since 1763 the section was not repealed by a “current session” of the 1764 Legislature, it may be omitted from the 2015 Florida 1765 Statutes only through a reviser’s bill duly enacted by the 1766 Legislature. See s. 11.242(5)(b) and (i). 1767 Section 16. Section 409.9122, Florida Statutes, is amended 1768 to read: 1769 409.9122 Mandatory Medicaid managed care enrollment; 1770 programs and procedures.— 1771 (1)It is the intent of the Legislature that the MediPass1772program be cost-effective, provide quality health care, and1773improve access to health services, and that the program be1774statewide. This subsection expires October 1, 2014.1775(2)(a) The agency shall enroll in a managed care plan or1776MediPass all Medicaid recipients, except those Medicaid1777recipients who are: in an institution; enrolled in the Medicaid1778medically needy program; or eligible for both Medicaid and1779Medicare. Upon enrollment, individuals will be able to change1780their managed care option during the 90-day opt out period1781required by federal Medicaid regulations. The agency is1782authorized to seek the necessary Medicaid state plan amendment1783to implement this policy. However, to the extent permitted by1784federal law, the agency may enroll in a managed care plan or1785MediPass a Medicaid recipient who is exempt from mandatory1786managed care enrollment, provided that:17871. The recipient’s decision to enroll in a managed care1788plan or MediPass is voluntary;17892. If the recipient chooses to enroll in a managed care1790plan, the agency has determined that the managed care plan1791provides specific programs and services which address the1792special health needs of the recipient; and17933. The agency receives any necessary waivers from the1794federal Centers for Medicare and Medicaid Services.1795 1796School districts participating in the certified school match1797program pursuant to ss. 409.908(21) and 1011.70 shall be1798reimbursed by Medicaid, subject to the limitations of s.17991011.70(1), for a Medicaid-eligible child participating in the1800services as authorized in s. 1011.70, as provided for in s.1801409.9071, regardless of whether the child is enrolled in1802MediPass or a managed care plan. Managed care plans shall make a1803good faith effort to execute agreements with school districts1804regarding the coordinated provision of services authorized under1805s. 1011.70. County health departments delivering school-based1806services pursuant to ss. 381.0056 and 381.0057 shall be1807reimbursed by Medicaid for the federal share for a Medicaid1808eligible child who receives Medicaid-covered services in a1809school setting, regardless of whether the child is enrolled in1810MediPass or a managed care plan. Managed care plans shall make a1811good faith effort to execute agreements with county health1812departments regarding the coordinated provision of services to a1813Medicaid-eligible child. To ensure continuity of care for1814Medicaid patients, the agency, the Department of Health, and the1815Department of Education shall develop procedures for ensuring1816that a student’s managed care plan or MediPass provider receives1817information relating to services provided in accordance with ss.1818381.0056, 381.0057, 409.9071, and 1011.70.1819(b) A Medicaid recipient may not be enrolled in or assigned1820to a managed care plan or MediPass unless the managed care plan1821or MediPass has complied with the quality-of-care standards1822specified in paragraphs (4)(a) and (b), respectively.1823(c) Medicaid recipients shall have a choice of managed care1824plans or MediPass. The Agency for Health Care Administration,1825the Department of Health, the Department of Children and1826Families, and the Department of Elderly Affairs shall cooperate1827to ensure that each Medicaid recipient receives clear and easily1828understandable information that meets the following1829requirements:18301. Explains the concept of managed care, including1831MediPass.18322. Provides information on the comparative performance of1833managed care plans and MediPass in the areas of quality,1834credentialing, preventive health programs, network size and1835availability, and patient satisfaction.18363. Explains where additional information on each managed1837care plan and MediPass in the recipient’s area can be obtained.18384. Explains that recipients have the right to choose their1839managed care coverage at the time they first enroll in Medicaid1840and again at regular intervals set by the agency. However, if a1841recipient does not choose a managed care plan or MediPass, the1842agency will assign the recipient to a managed care plan or1843MediPass according to the criteria specified in this section.18445. Explains the recipient’s right to complain, file a1845grievance, or change managed care plans or MediPass providers if1846the recipient is not satisfied with the managed care plan or1847MediPass.1848(d) The agency shall develop a mechanism for providing1849information to Medicaid recipients for the purpose of making a1850managed care plan or MediPass selection. Examples of such1851mechanisms may include, but not be limited to, interactive1852information systems, mailings, and mass marketing materials.1853Managed care plans and MediPass providers are prohibited from1854providing inducements to Medicaid recipients to select their1855plans or from prejudicing Medicaid recipients against other1856managed care plans or MediPass providers.1857(e) Medicaid recipients who are already enrolled in a1858managed care plan or MediPass shall be offered the opportunity1859to change managed care plans or MediPass providers on a1860staggered basis, as defined by the agency. All Medicaid1861recipients shall have 30 days in which to make a choice of1862managed care plans or MediPass providers. Those Medicaid1863recipients who do not make a choice shall be assigned in1864accordance with paragraph (f). To facilitate continuity of care,1865for a Medicaid recipient who is also a recipient of Supplemental1866Security Income (SSI), prior to assigning the SSI recipient to a1867managed care plan or MediPass, the agency shall determine1868whether the SSI recipient has an ongoing relationship with a1869MediPass provider or managed care plan, and if so, the agency1870shall assign the SSI recipient to that MediPass provider or1871managed care plan. Those SSI recipients who do not have such a1872provider relationship shall be assigned to a managed care plan1873or MediPass provider in accordance with paragraph (f).1874(f) If a Medicaid recipient does not choose a managed care1875plan or MediPass provider, the agency shall assign the Medicaid1876recipient to a managed care plan or MediPass provider. Medicaid1877recipients eligible for managed care plan enrollment who are1878subject to mandatory assignment but who fail to make a choice1879shall be assigned to managed care plans until an enrollment of188035 percent in MediPass and 65 percent in managed care plans, of1881all those eligible to choose managed care, is achieved. Once1882this enrollment is achieved, the assignments shall be divided in1883order to maintain an enrollment in MediPass and managed care1884plans which is in a 35 percent and 65 percent proportion,1885respectively. Thereafter, assignment of Medicaid recipients who1886fail to make a choice shall be based proportionally on the1887preferences of recipients who have made a choice in the previous1888period. Such proportions shall be revised at least quarterly to1889reflect an update of the preferences of Medicaid recipients. The1890agency shall disproportionately assign Medicaid-eligible1891recipients who are required to but have failed to make a choice1892of managed care plan or MediPass to the Children’s Medical1893Services Network as defined in s. 391.021, exclusive provider1894organizations, provider service networks, minority physician1895networks, and pediatric emergency department diversion programs1896authorized by this chapter or the General Appropriations Act, in1897such manner as the agency deems appropriate, until the agency1898has determined that the networks and programs have sufficient1899numbers to be operated economically. For purposes of this1900paragraph, when referring to assignment, the term “managed care1901plans” includes health maintenance organizations, exclusive1902provider organizations, provider service networks, minority1903physician networks, Children’s Medical Services Network, and1904pediatric emergency department diversion programs authorized by1905this chapter or the General Appropriations Act. When making1906assignments, the agency shall take into account the following1907criteria:19081. A managed care plan has sufficient network capacity to1909meet the need of members.19102. The managed care plan or MediPass has previously1911enrolled the recipient as a member, or one of the managed care1912plan’s primary care providers or MediPass providers has1913previously provided health care to the recipient.19143. The agency has knowledge that the member has previously1915expressed a preference for a particular managed care plan or1916MediPass provider as indicated by Medicaid fee-for-service1917claims data, but has failed to make a choice.19184. The managed care plan’s or MediPass primary care1919providers are geographically accessible to the recipient’s1920residence.1921(g) When more than one managed care plan or MediPass1922provider meets the criteria specified in paragraph (f), the1923agency shall make recipient assignments consecutively by family1924unit.1925(h) The agency may not engage in practices that are1926designed to favor one managed care plan over another or that are1927designed to influence Medicaid recipients to enroll in MediPass1928rather than in a managed care plan or to enroll in a managed1929care plan rather than in MediPass. This subsection does not1930prohibit the agency from reporting on the performance of1931MediPass or any managed care plan, as measured by performance1932criteria developed by the agency.1933(i) After a recipient has made his or her selection or has1934been enrolled in a managed care plan or MediPass, the recipient1935shall have 90 days to exercise the opportunity to voluntarily1936disenroll and select another managed care plan or MediPass.1937After 90 days, no further changes may be made except for good1938cause. Good cause includes, but is not limited to, poor quality1939of care, lack of access to necessary specialty services, an1940unreasonable delay or denial of service, or fraudulent1941enrollment. The agency shall develop criteria for good cause1942disenrollment for chronically ill and disabled populations who1943are assigned to managed care plans if more appropriate care is1944available through the MediPass program. The agency must make a1945determination as to whether cause exists. However, the agency1946may require a recipient to use the managed care plan’s or1947MediPass grievance process prior to the agency’s determination1948of cause, except in cases in which immediate risk of permanent1949damage to the recipient’s health is alleged. The grievance1950process, when utilized, must be completed in time to permit the1951recipient to disenroll by the first day of the second month1952after the month the disenrollment request was made. If the1953managed care plan or MediPass, as a result of the grievance1954process, approves an enrollee’s request to disenroll, the agency1955is not required to make a determination in the case. The agency1956must make a determination and take final action on a recipient’s1957request so that disenrollment occurs no later than the first day1958of the second month after the month the request was made. If the1959agency fails to act within the specified timeframe, the1960recipient’s request to disenroll is deemed to be approved as of1961the date agency action was required. Recipients who disagree1962with the agency’s finding that cause does not exist for1963disenrollment shall be advised of their right to pursue a1964Medicaid fair hearing to dispute the agency’s finding.1965(j) The agency shall apply for a federal waiver from the1966Centers for Medicare and Medicaid Services to lock eligible1967Medicaid recipients into a managed care plan or MediPass for 121968months after an open enrollment period. After 12 months’1969enrollment, a recipient may select another managed care plan or1970MediPass provider. However, nothing shall prevent a Medicaid1971recipient from changing primary care providers within the1972managed care plan or MediPass program during the 12-month1973period.1974(k) When a Medicaid recipient does not choose a managed1975care plan or MediPass provider, the agency shall assign the1976Medicaid recipient to a managed care plan, except in those1977counties in which there are fewer than two managed care plans1978accepting Medicaid enrollees, in which case assignment shall be1979to a managed care plan or a MediPass provider. Medicaid1980recipients in counties with fewer than two managed care plans1981accepting Medicaid enrollees who are subject to mandatory1982assignment but who fail to make a choice shall be assigned to1983managed care plans until an enrollment of 35 percent in MediPass1984and 65 percent in managed care plans, of all those eligible to1985choose managed care, is achieved. Once that enrollment is1986achieved, the assignments shall be divided in order to maintain1987an enrollment in MediPass and managed care plans which is in a198835 percent and 65 percent proportion, respectively. For purposes1989of this paragraph, when referring to assignment, the term1990“managed care plans” includes exclusive provider organizations,1991provider service networks, Children’s Medical Services Network,1992minority physician networks, and pediatric emergency department1993diversion programs authorized by this chapter or the General1994Appropriations Act. When making assignments, the agency shall1995take into account the following criteria:19961. A managed care plan has sufficient network capacity to1997meet the need of members.19982. The managed care plan or MediPass has previously1999enrolled the recipient as a member, or one of the managed care2000plan’s primary care providers or MediPass providers has2001previously provided health care to the recipient.20023. The agency has knowledge that the member has previously2003expressed a preference for a particular managed care plan or2004MediPass provider as indicated by Medicaid fee-for-service2005claims data, but has failed to make a choice.20064. The managed care plan’s or MediPass primary care2007providers are geographically accessible to the recipient’s2008residence.20095. The agency has authority to make mandatory assignments2010based on quality of service and performance of managed care2011plans.2012(l) Notwithstanding chapter 287, the agency may renew cost2013effective contracts for choice counseling services once or more2014for such periods as the agency may decide. However, all such2015renewals may not combine to exceed a total period longer than2016the term of the original contract.2017 2018This subsection expires October 1, 2014.2019(3)Notwithstanding s. 409.961, if a Medicaid recipient is 2020 diagnosed with HIV/AIDS, the agency shall assign the recipient 2021 to a managed care plan that is a health maintenance organization 2022 authorized under chapter 641, that is under contract with the 2023 agency as an HIV/AIDS specialty plan as of January 1, 2013, and 2024 that offers a delivery system through a university-based 2025 teaching and research-oriented organization that specializes in 2026 providing health care services and treatment for individuals 2027 diagnosed with HIV/AIDS. This subsection applies to recipients 2028 who are subject to mandatory managed care enrollment and have 2029 failed to choose a managed care option. 2030(4)(a) The agency shall establish quality-of-care standards2031for managed care plans. These standards shall be based upon, but2032are not limited to:20331. Compliance with the accreditation requirements as2034provided in s. 641.512.20352. Compliance with Early and Periodic Screening, Diagnosis,2036and Treatment screening requirements.20373. The percentage of voluntary disenrollments.20384. Immunization rates.20395. Standards of the National Committee for Quality2040Assurance and other approved accrediting bodies.20416. Recommendations of other authoritative bodies.20427. Specific requirements of the Medicaid program, or2043standards designed to specifically assist the unique needs of2044Medicaid recipients.20458. Compliance with the health quality improvement system as2046established by the agency, which incorporates standards and2047guidelines developed by the Medicaid Bureau of the Health Care2048Financing Administration as part of the quality assurance reform2049initiative.2050(b) For the MediPass program, the agency shall establish2051standards which are based upon, but are not limited to:20521. Quality-of-care standards which are comparable to those2053required of managed care plans.20542. Credentialing standards for MediPass providers.20553. Compliance with Early and Periodic Screening, Diagnosis,2056and Treatment screening requirements.20574. Immunization rates.20585. Specific requirements of the Medicaid program, or2059standards designed to specifically assist the unique needs of2060Medicaid recipients.2061 2062This subsection expires October 1, 2014.2063(5)(a) Each female recipient may select as her primary care2064provider an obstetrician/gynecologist who has agreed to2065participate as a MediPass primary care case manager.2066(b) The agency shall establish a complaints and grievance2067process to assist Medicaid recipients enrolled in the MediPass2068program to resolve complaints and grievances. The agency shall2069investigate reports of quality-of-care grievances which remain2070unresolved to the satisfaction of the enrollee.2071 2072This subsection expires October 1, 2014.2073(6)(a) The agency shall work cooperatively with the Social2074Security Administration to identify beneficiaries who are2075jointly eligible for Medicare and Medicaid and shall develop2076cooperative programs to encourage these beneficiaries to enroll2077in a Medicare participating health maintenance organization or2078prepaid health plans.2079(b) The agency shall work cooperatively with the Department2080of Elderly Affairs to assess the potential cost-effectiveness of2081providing MediPass to beneficiaries who are jointly eligible for2082Medicare and Medicaid on a voluntary choice basis. If the agency2083determines that enrollment of these beneficiaries in MediPass2084has the potential for being cost-effective for the state, the2085agency shall offer MediPass to these beneficiaries on a2086voluntary choice basis in the counties where MediPass operates.2087 2088This subsection expires October 1, 2014.2089(7) MediPass enrolled recipients may receive up to 102090visits of reimbursable services by participating Medicaid2091physicians licensed under chapter 460 and up to four visits of2092reimbursable services by participating Medicaid physicians2093licensed under chapter 461. Any further visits must be by prior2094authorization by the MediPass primary care provider. However,2095nothing in this subsection may be construed to increase the2096total number of visits or the total amount of dollars per year2097per person under current Medicaid rules, unless otherwise2098provided for in the General Appropriations Act. This subsection2099expires October 1, 2014.2100(8)(a) The agency shall develop and implement a2101comprehensive plan to ensure that recipients are adequately2102informed of their choices and rights under all Medicaid managed2103care programs and that Medicaid managed care programs meet2104acceptable standards of quality in patient care, patient2105satisfaction, and financial solvency.2106(b) The agency shall provide adequate means for informing2107patients of their choice and rights under a managed care plan at2108the time of eligibility determination.2109(c) The agency shall require managed care plans and2110MediPass providers to demonstrate and document plans and2111activities, as defined by rule, including outreach and followup,2112undertaken to ensure that Medicaid recipients receive the health2113care service to which they are entitled.2114 2115This subsection expires October 1, 2014.2116(9) The agency shall consult with Medicaid consumers and2117their representatives on an ongoing basis regarding measurements2118of patient satisfaction, procedures for resolving patient2119grievances, standards for ensuring quality of care, mechanisms2120for providing patient access to services, and policies affecting2121patient care. This subsection expires October 1, 2014.2122(10) The agency may extend eligibility for Medicaid2123recipients enrolled in licensed and accredited health2124maintenance organizations for the duration of the enrollment2125period or for 6 months, whichever is earlier, provided the2126agency certifies that such an offer will not increase state2127expenditures. This subsection expires October 1, 2013.2128(11) A managed care plan that has a Medicaid contract shall2129at least annually review each primary care physician’s active2130patient load and shall ensure that additional Medicaid2131recipients are not assigned to physicians who have a total2132active patient load of more than 3,000 patients. As used in this2133subsection, the term “active patient” means a patient who is2134seen by the same primary care physician, or by a physician2135assistant or advanced registered nurse practitioner under the2136supervision of the primary care physician, at least three times2137within a calendar year. Each primary care physician shall2138annually certify to the managed care plan whether or not his or2139her patient load exceeds the limits established under this2140subsection and the managed care plan shall accept such2141certification on face value as compliance with this subsection.2142The agency shall accept the managed care plan’s representations2143that it is in compliance with this subsection based on the2144certification of its primary care physicians, unless the agency2145has an objective indication that access to primary care is being2146compromised, such as receiving complaints or grievances relating2147to access to care. If the agency determines that an objective2148indication exists that access to primary care is being2149compromised, it may verify the patient load certifications2150submitted by the managed care plan’s primary care physicians and2151that the managed care plan is not assigning Medicaid recipients2152to primary care physicians who have an active patient load of2153more than 3,000 patients. This subsection expires October 1,21542014.2155(12) Effective July 1, 2003, the agency shall adjust the2156enrollee assignment process of Medicaid managed prepaid health2157plans for those Medicaid managed prepaid plans operating in2158Miami-Dade County which have executed a contract with the agency2159for a minimum of 8 consecutive years in order for the Medicaid2160managed prepaid plan to maintain a minimum enrollment level of216115,000 members per month. When assigning enrollees pursuant to2162this subsection, the agency shall give priority to providers2163that initially qualified under this subsection until such2164providers reach and maintain an enrollment level of 15,0002165members per month. A prepaid health plan that has a statewide2166Medicaid enrollment of 25,000 or more members is not eligible2167for enrollee assignments under this subsection. This subsection2168expires October 1, 2014.2169 (2)(13)The agency shall include in its calculation of the 2170 hospital inpatient component of a Medicaid health maintenance 2171 organization’s capitation rate any special payments, including, 2172 but not limited to, upper payment limit or disproportionate 2173 share hospital payments, made to qualifying hospitals through 2174 the fee-for-service program. The agency may seek federal waiver 2175 approval or state plan amendment as needed to implement this 2176 adjustment. 2177 (3)(14)The agency shall develop a process to enable any 2178 recipient with access to employer-sponsored health care coverage 2179 to opt out of all eligible plans in the Medicaid program and to 2180 use Medicaid financial assistance to pay for the recipient’s 2181 share of cost in any such employer-sponsored coverage. 2182 Contingent on federal approval, the agency shall also enable 2183 recipients with access to other insurance or related products 2184 that provide access to health care services created pursuant to 2185 state law, including any plan or product available pursuant to 2186 the Florida Health Choices Program or any health exchange, to 2187 opt out. The amount of financial assistance provided for each 2188 recipient may not exceed the amount of the Medicaid premium that 2189 would have been paid to a plan for that recipient. 2190 (4)(15)The agency shall maintain and operate the Medicaid 2191 Encounter Data System to collect, process, store, and report on 2192 covered services provided to all Florida Medicaid recipients 2193 enrolled in prepaid managed care plans. 2194 (a) Prepaid managed care plans shall submit encounter data 2195 electronically in a format that complies with the Health 2196 Insurance Portability and Accountability Act provisions for 2197 electronic claims and in accordance with deadlines established 2198 by the agency. Prepaid managed care plans must certify that the 2199 data reported is accurate and complete. 2200 (b) The agency is responsible for validating the data 2201 submitted by the plans. The agency shall develop methods and 2202 protocols for ongoing analysis of the encounter data that 2203 adjusts for differences in characteristics of prepaid plan 2204 enrollees to allow comparison of service utilization among plans 2205 and against expected levels of use. The analysis shall be used 2206 to identify possible cases of systemic underutilization or 2207 denials of claims and inappropriate service utilization such as 2208 higher-than-expected emergency department encounters. The 2209 analysis shall provide periodic feedback to the plans and enable 2210 the agency to establish corrective action plans when necessary. 2211 One of the focus areas for the analysis shall be the use of 2212 prescription drugs. 2213 (5)(16)The agency may establish a per-member, per-month 2214 payment for Medicare Advantage Special Needs members that are 2215 also eligible for Medicaid as a mechanism for meeting the 2216 state’s cost-sharing obligation. The agency may also develop a 2217 per-member, per-month payment only for Medicaid-covered services 2218 for which the state is responsible. The agency shall develop a 2219 mechanism to ensure that such per-member, per-month payment 2220 enhances the value to the state and enrolled members by limiting 2221 cost sharing, enhances the scope of Medicare supplemental 2222 benefits that are equal to or greater than Medicaid coverage for 2223 select services, and improves care coordination. 2224 (6)(17)The agency shall establish, and managed care plans 2225 shall use, a uniform method of accounting for and reporting 2226 medical and nonmedical costs. 2227 (a) Managed care plans shall submit financial data 2228 electronically in a format that complies with the uniform 2229 accounting procedures established by the agency. Managed care 2230 plans must certify that the data reported is accurate and 2231 complete. 2232 (b) The agency is responsible for validating the financial 2233 data submitted by the plans. The agency shall develop methods 2234 and protocols for ongoing analysis of data that adjusts for 2235 differences in characteristics of plan enrollees to allow 2236 comparison among plans and against expected levels of 2237 expenditures. The analysis shall be used to identify possible 2238 cases of overspending on administrative costs or underspending 2239 on medical services. 2240 (7)(18)The agency shall establish and maintain an 2241 information system to make encounter data, financial data, and 2242 other measures of plan performance available to the public and 2243 any interested party. 2244 (a) Information submitted by the managed care plans shall 2245 be available online as well as in other formats. 2246 (b) Periodic agency reports shall be published that include 2247 summary as well as plan specific measures of financial 2248 performance and service utilization. 2249 (c) Any release of the financial and encounter data 2250 submitted by managed care plans shall ensure the confidentiality 2251 of personal health information. 2252 (8)(19)The agency may, on a case-by-case basis, exempt a 2253 recipient from mandatory enrollment in a managed care plan when 2254 the recipient has a unique, time-limited disease or condition 2255 related circumstance and managed care enrollment will interfere 2256 with ongoing care because the recipient’s provider does not 2257 participate in the managed care plans available in the 2258 recipient’s area. 2259(20) The agency shall contract with a single provider2260service network to function as a managing entity for the2261MediPass program in all counties with fewer than two prepaid2262plans. The contractor shall be responsible for implementing2263preauthorization procedures, case management programs, and2264utilization management initiatives in order to improve care2265coordination and patient outcomes while reducing costs. The2266contractor may earn an administrative fee if the fee is less2267than any savings as determined by the reconciliation process2268under s. 409.912(4)(d)1. This subsection expires October 1,22692014, or upon full implementation of the managed medical2270assistance program, whichever is sooner.2271(21) Subject to federal approval, the agency shall contract2272with a single provider service network to function as a third2273party administrator and managing entity for the Medically Needy2274program in all counties. The contractor shall provide care2275coordination and utilization management in order to achieve more2276cost-effective services for Medically Needy enrollees. To2277facilitate the care management functions of the provider service2278network, enrollment in the network shall be for a continuous 62279month period or until the end of the contract between the2280provider service network and the agency, whichever is sooner.2281Beginning the second month after the determination of2282eligibility, the contractor may collect a monthly premium from2283each Medically Needy recipient provided the premium does not2284exceed the enrollee’s share of cost as determined by the2285Department of Children and Families. The contractor must provide2286a 90-day grace period before disenrolling a Medically Needy2287recipient for failure to pay premiums. The contractor may earn2288an administrative fee, if the fee is less than any savings2289determined by the reconciliation process pursuant to s.2290409.912(4)(d)1. Premium revenue collected from the recipients2291shall be deducted from the contractor’s earned savings. This2292subsection expires October 1, 2014, or upon full implementation2293of the managed medical assistance program, whichever is sooner.2294 (9)(22)If required as a condition of a waiver, the agency 2295 may calculate a medical loss ratio for managed care plans. The 2296 calculation shall utilize uniform financial data collected from 2297 all plans and shall be computed for each plan on a statewide 2298 basis. The method for calculating the medical loss ratio shall 2299 meet the following criteria: 2300 (a) Except as provided in paragraphs (b) and (c), 2301 expenditures shall be classified in a manner consistent with 45 2302 C.F.R. part 158. 2303 (b) Funds provided by plans to graduate medical education 2304 institutions to underwrite the costs of residency positions 2305 shall be classified as medical expenditures, provided the 2306 funding is sufficient to sustain the positions for the number of 2307 years necessary to complete the residency requirements and the 2308 residency positions funded by the plans are active providers of 2309 care to Medicaid and uninsured patients. 2310 (c) Prior to final determination of the medical loss ratio 2311 for any period, a plan may contribute to a designated state 2312 trust fund for the purpose of supporting Medicaid and indigent 2313 care and have the contribution counted as a medical expenditure 2314 for the period. 2315 Reviser’s note.—Amended to conform to the repeals of numerous 2316 subunits pursuant to their own terms, effective at various 2317 dates in 2013 and 2014. 2318 Section 17. Subsection (15) of section 430.04, Florida 2319 Statutes, is repealed. 2320 Reviser’s note.—The cited subsection, which relates to 2321 authorization of the Department of Elderly Affairs to 2322 administer all Medicaid waivers and programs relating to 2323 elders and their appropriations, expired pursuant to its 2324 own terms, effective October 1, 2014. 2325 Section 18. Subsections (10), (11), and (12) of section 2326 430.502, Florida Statutes, are repealed. 2327 Reviser’s note.—The cited subsections relate to seeking of a 2328 federal waiver to implement a Medicaid home and community 2329 based waiver targeted to persons with Alzheimer’s disease 2330 to test the effectiveness of Alzheimer’s specific 2331 interventions to delay or to avoid institutional placement. 2332 Subsection (12) provides that authority to continue the 2333 waiver program is automatically eliminated at the close of 2334 the 2010 Regular Session of the Legislature unless further 2335 action is taken to continue it before such time. 2336 Section 19. Subsection (5) of section 443.131, Florida 2337 Statutes, is repealed. 2338 Reviser’s note.—The cited subsection, which relates to an 2339 additional rate for interest on federal advances received 2340 by the Unemployment Compensation Trust Fund, expired 2341 pursuant to its own terms, effective July 1, 2014. 2342 Section 20. Subsection (1) of section 576.061, Florida 2343 Statutes, is amended to read: 2344 576.061 Plant nutrient investigational allowances, 2345 deficiencies, and penalties.— 2346 (1) A commercial fertilizer is deemed deficient if the 2347 analysis of any nutrient is below the guarantee by an amount 2348 exceeding the investigational allowances. The department shall 2349 adopt rules, which shall take effect on July 1, 2014, that 2350 establish the investigational allowances used to determine 2351 whether a fertilizer is deficient in plant food. 2352(a) Effective July 1, 2014, this paragraph and paragraphs2353(b)-(f) are repealed. Until July 1, 2014, investigational2354allowances shall be set as provided in paragraphs (b)-(f).2355(b)Primary plant nutrients; investigational allowances.—2356 2357GuaranteedPercentTotalNitrogenPercentAvailablePhosphatePercentPotashPercent2358 235904 or less0.490.670.412360050.510.670.432361060.520.670.472362070.540.680.532363080.550.680.602364090.570.680.652365100.580.690.702366120.610.690.792367140.630.700.872368160.670.700.942369180.700.711.012370200.730.721.082371220.750.721.152372240.780.731.212373260.810.731.272374280.830.741.332375300.860.751.39237632 or more0.880.761.442377 2378For guarantees not listed, calculate the appropriate value by2379interpolation.2380(c)Nitrogen investigational allowances.—2381 2382Nitrogen BreakdownInvestigational AllowancesPercent2383 2384Nitrate nitrogen0.402385Ammoniacal nitrogen0.402386Water soluble nitrogenor urea nitrogen0.402387Water insoluble nitrogen0.302388 2389 2390In no case may the investigational allowance exceed 50 percent2391of the amount guaranteed.2392(d)Secondary and micro plant nutrients, total or soluble.—2393 2394ElementInvestigational Allowances Percent2395 2396Calcium0.2 unit + 5 percent of guarantee2397Magnesium0.2 unit +5 percent of guarantee2398Sulfur (free and combined)0.2 unit + 5 percent of guarantee2399Boron0.003 unit + 15 percent of guarantee2400Cobalt0.0001 unit + 30 percent of guarantee2401Chlorine0.005 unit + 10 percent of guarantee2402Copper0.005unit + 10 percent of guarantee2403Iron0.005 unit + 10 percent of guarantee2404Manganese0.005 unit + 10 percent of guarantee2405Molybdenum0.0001 unit + 30 percent of guarantee2406Sodium0.005 unit + 10 percent of guarantee2407Zinc0.005 unit +10 percent of guarantee2408 2409 2410The maximum allowance for secondary and minor elements when2411calculated in accordance with this section is 1 unit (12412percent). In no case, however, may the investigational allowance2413exceed 50 percent of the amount guaranteed.2414(e)Liming materials and gypsum.—2415 2416Range PercentInvestigational AllowancesPercent2417 24180-100.302419Over 10-250.402420Over 250.502421 2422(f)Pesticides in fertilizer mixtures.—An investigational2423allowance of 25 percent of the guarantee shall be allowed on all2424pesticides when added to custom blend fertilizers.2425 Reviser’s note.—The cited paragraphs, which relate to 2426 investigational allowances for fertilizer, were repealed 2427 pursuant to their own terms, effective July 1, 2014. 2428 Section 21. Section 624.351, Florida Statutes, is repealed. 2429 Reviser’s note.—The cited section, which relates to the Medicaid 2430 and Public Assistance Fraud Strike Force, was repealed 2431 pursuant to its own terms, effective June 30, 2014. 2432 Section 22. Section 624.352, Florida Statutes, is repealed. 2433 Reviser’s note.—The cited section, which relates to interagency 2434 agreements to detect and deter Medicaid and public 2435 assistance fraud, was repealed pursuant to its own terms, 2436 effective June 30, 2014. 2437 Section 23. Subsection (7) of section 626.2815, Florida 2438 Statutes, is repealed. 2439 Reviser’s note.—The cited subsection, which relates to a 2440 requirement that persons holding a license to solicit or 2441 sell life insurance must complete a minimum of 3 hours in 2442 continuing education on the subject of suitability in 2443 annuity and life insurance transactions, was deleted from 2444 s. 626.2815 by s. 11, ch. 2012-209, Laws of Florida, 2445 effective October 1, 2014. Since the subsection was not 2446 repealed by a “current session” of the Legislature, it may 2447 be omitted from the 2015 Florida Statutes only through a 2448 reviser’s bill duly enacted by the Legislature. See s. 2449 11.242(5)(b) and (i). 2450 Section 24. Paragraph (b) of subsection (4) of section 2451 828.27, Florida Statutes, is amended to read: 2452 828.27 Local animal control or cruelty ordinances; 2453 penalty.— 2454 (4) 2455 (b)1.The governing body of a county or municipality may 2456 impose and collect a surcharge of up to $5 upon each civil 2457 penalty imposed for violation of an ordinance relating to animal 2458 control or cruelty. The proceeds from such surcharges shall be 2459 used to pay the costs of training for animal control officers. 24602. In addition to the uses set forth in subparagraph 1., a2461county, as defined in s. 125.011, may use the proceeds specified2462in that subparagraph and any carryover or fund balance from such2463proceeds for animal shelter operating expenses. This2464subparagraph expires July 1, 2014.2465 Reviser’s note.—Amended to delete subparagraph (4)(b)2., which 2466 expired pursuant to its own terms, effective July 1, 2014. 2467 Section 25. Paragraph (e) of subsection (9) of section 2468 1002.32, Florida Statutes, is amended to read: 2469 1002.32 Developmental research (laboratory) schools.— 2470 (9) FUNDING.—Funding for a lab school, including a charter 2471 lab school, shall be provided as follows: 2472 (e)1.Each lab school shall receive funds for capital 2473 improvement purposes in an amount determined as follows: 2474 multiply the maximum allowable nonvoted discretionary millage 2475 for capital improvements pursuant to s. 1011.71(2) by 96 percent 2476 of the current year’s taxable value for school purposes for the 2477 district in which each lab school is located; divide the result 2478 by the total full-time equivalent membership of the district; 2479 and multiply the result by the full-time equivalent membership 2480 of the lab school. The amount obtained shall be discretionary 2481 capital improvement funds and shall be appropriated from state 2482 funds in the General Appropriations Act to the Lab School 2483 Educational Facility Trust Fund. 24842. Notwithstanding the provisions of subparagraph 1., for2485the 2013-2014 fiscal year, funds appropriated for capital2486improvement purposes shall be divided between lab schools based2487on full-time equivalent student membership. This subparagraph2488expires July 1, 2014.2489 Reviser’s note.—Amended to delete subparagraph (9)(e)2., which 2490 expired pursuant to its own terms, effective July 1, 2014. 2491 Section 26. Subsection (4) of section 409.91195, Florida 2492 Statutes, is amended to read: 2493 409.91195 Medicaid Pharmaceutical and Therapeutics 2494 Committee.—There is created a Medicaid Pharmaceutical and 2495 Therapeutics Committee within the agency for the purpose of 2496 developing a Medicaid preferred drug list. 2497 (4) Upon recommendation of the committee, the agency shall 2498 adopt a preferred drug list as described in s. 409.912(8) 2499409.912(37). To the extent feasible, the committee shall review 2500 all drug classes included on the preferred drug list every 12 2501 months, and may recommend additions to and deletions from the 2502 preferred drug list, such that the preferred drug list provides 2503 for medically appropriate drug therapies for Medicaid patients 2504 which achieve cost savings contained in the General 2505 Appropriations Act. 2506 Reviser’s note.—Amended to conform to the redesignation of 2507 subunits of s. 409.912 by this act. 2508 Section 27. Subsection (1) of section 409.91196, Florida 2509 Statutes, is amended to read: 2510 409.91196 Supplemental rebate agreements; public records 2511 and public meetings exemption.— 2512 (1) The rebate amount, percent of rebate, manufacturer’s 2513 pricing, and supplemental rebate, and other trade secrets as 2514 defined in s. 688.002 that the agency has identified for use in 2515 negotiations, held by the Agency for Health Care Administration 2516 under s. 409.912(8)(a)7.409.912(37)(a)7.are confidential and 2517 exempt from s. 119.07(1) and s. 24(a), Art. I of the State 2518 Constitution. 2519 Reviser’s note.—Amended to conform to the redesignation of 2520 subunits of s. 409.912 by this act. 2521 Section 28. Subsections (1), (6), (12), and (13) of section 2522 409.962, Florida Statutes, are amended to read: 2523 409.962 Definitions.—As used in this part, except as 2524 otherwise specifically provided, the term: 2525 (1) “Accountable care organization” means an entity 2526 qualified as an accountable care organization in accordance with 2527 federal regulations, and which meets the requirements of a 2528 provider service network as described in s. 409.912(2) 2529409.912(4)(d). 2530 (6) “Eligible plan” means a health insurer authorized under 2531 chapter 624, an exclusive provider organization authorized under 2532 chapter 627, a health maintenance organization authorized under 2533 chapter 641, or a provider service network authorized under s. 2534 409.912(2)409.912(4)(d)or an accountable care organization 2535 authorized under federal law. For purposes of the managed 2536 medical assistance program, the term also includes the 2537 Children’s Medical Services Network authorized under chapter 391 2538 and entities qualified under 42 C.F.R. part 422 as Medicare 2539 Advantage Preferred Provider Organizations, Medicare Advantage 2540 Provider-sponsored Organizations, Medicare Advantage Health 2541 Maintenance Organizations, Medicare Advantage Coordinated Care 2542 Plans, and Medicare Advantage Special Needs Plans, and the 2543 Program of All-inclusive Care for the Elderly. 2544 (12) “Prepaid plan” means a managed care plan that is 2545 licensed or certified as a risk-bearing entity, or qualified 2546 pursuant to s. 409.912(2)409.912(4)(d), in the state and is 2547 paid a prospective per-member, per-month payment by the agency. 2548 (13) “Provider service network” means an entity qualified 2549 pursuant to s. 409.912(2)409.912(4)(d)of which a controlling 2550 interest is owned by a health care provider, or group of 2551 affiliated providers, or a public agency or entity that delivers 2552 health services. Health care providers include Florida-licensed 2553 health care professionals or licensed health care facilities, 2554 federally qualified health care centers, and home health care 2555 agencies. 2556 Reviser’s note.—Amended to conform to the redesignation of 2557 subunits of s. 409.912 by this act. 2558 Section 29. Section 636.0145, Florida Statutes, is amended 2559 to read: 2560 636.0145 Certain entities contracting with Medicaid. 2561Notwithstanding the requirements of s. 409.912(4)(b),An entity 2562 that is providing comprehensive inpatient and outpatient mental 2563 health care services to certain Medicaid recipients in 2564 Hillsborough, Highlands, Hardee, Manatee, and Polk Counties 2565 through a capitated, prepaid arrangement pursuant to the federal 2566 waiver provided for in s. 409.905(5) must become licensed under 2567 this chapter by December 31, 1998. Any entity licensed under 2568 this chapter which provides services solely to Medicaid 2569 recipients under a contract with Medicaid is exempt from ss. 2570 636.017, 636.018, 636.022, 636.028, 636.034, and 636.066(1). 2571 Reviser’s note.—Amended to conform to the deletion of s. 2572 409.912(4)(b) by this act to conform to its expiration 2573 pursuant to its own terms, effective October 1, 2014. 2574 Section 30. Subsection (22) of section 641.19, Florida 2575 Statutes, is amended to read: 2576 641.19 Definitions.—As used in this part, the term: 2577 (22) “Provider service network” means a network authorized 2578 under s. 409.912(2)409.912(4)(d), reimbursed on a prepaid 2579 basis, operated by a health care provider or group of affiliated 2580 health care providers, and which directly provides health care 2581 services under a Medicare, Medicaid, or Healthy Kids contract. 2582 Reviser’s note.—Amended to conform to the redesignation of 2583 subunits of s. 409.912 by this act. 2584 Section 31. Subsection (3) of section 641.225, Florida 2585 Statutes, is amended to read: 2586 641.225 Surplus requirements.— 2587(3)(a) An entity providing prepaid capitated services which2588is authorized under s. 409.912(4)(a) and which applies for a2589certificate of authority is subject to the minimum surplus2590requirements set forth in subsection (1), unless the entity is2591backed by the full faith and credit of the county in which it is2592located.2593(b) An entity providing prepaid capitated services which is2594authorized under s. 409.912(4)(b) or (c), and which applies for2595a certificate of authority is subject to the minimum surplus2596requirements set forth in s. 409.912.2597 Reviser’s note.—Amended to conform to the expiration of 2598 paragraphs (4)(a)-(c) of s. 409.912 pursuant to their own 2599 terms, effective October 1, 2014, and confirmation of the 2600 expiration by this act. 2601 Section 32. Subsection (4) of section 641.386, Florida 2602 Statutes, is amended to read: 2603 641.386 Agent licensing and appointment required; 2604 exceptions.— 2605 (4) All agents and health maintenance organizations shall 2606 comply with and be subject to the applicable provisions of ss. 2607 641.309 and 409.912(5)409.912(20), and all companies and 2608 entities appointing agents shall comply with s. 626.451, when 2609 marketing for any health maintenance organization licensed 2610 pursuant to this part, including those organizations under 2611 contract with the Agency for Health Care Administration to 2612 provide health care services to Medicaid recipients or any 2613 private entity providing health care services to Medicaid 2614 recipients pursuant to a prepaid health plan contract with the 2615 Agency for Health Care Administration. 2616 Reviser’s note.—Amended to conform to the redesignation of 2617 subunits of s. 409.912 by this act. 2618 Section 33. This act shall take effect on the 60th day 2619 after adjournment sine die of the session of the Legislature in 2620 which enacted.