The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: CS/CS/SB 1950
INTRODUCER: Appropriations Committee (Recommended by Appropriations Subcommittee on Health
and Human Services); Health Policy Committee; and Senator Brodeur
SUBJECT: Statewide Medicaid Managed Care Program
DATE: March 2, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Fav/CS
2. McKnight Money AHS Recommend: Fav/CS
3. McKnight Sadberry AP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 1950 makes changes to the Statewide Medicaid Managed Care (SMMC) program in
anticipation of the next competitive procurement for the 2025 plan year. The bill:
Requires provider service networks (PSNs) to be reimbursed on a prepaid basis.
Authorizes the Agency for Health Care Administration (AHCA) to select eligible managed
care plans to provide services through a single statewide procurement and deletes the
requirement that the AHCA conduct separate and simultaneous procurements for each
Medicaid region.
Authorizes the AHCA to award contracts to managed care plans on a regional or statewide
basis.
Outlines a new regional structure for plan selection under the SMMC program’s Managed
Medical Assistance (MMA) and Long-Term Care (LTC) programs with a minimum and
maximum number of plans designated for each region. The bill provides for nine regions
named by letters (Regions A-I), rather than the 11 regions named by numbers (Regions 1-11)
in current law.
Requires the AHCA to award a contract to at least one PSN in each of the nine regions under
the MMA program and under the LTC program.
Requires managed care plans to contract with Florida cancer hospitals that meet specified
federal criteria in their networks as essential providers, and provides a payment rate for
services provided without a contract.
REVISED: BILL: CS/CS/SB 1950 Page 2
Revises MMA plan healthy behaviors program requirements to include tobacco cessation
programs, rather than smoking cessation programs, and to clarify that substance abuse
programs must include opioid abuse recovery.
Authorizes an MMA Child Welfare Specialty Plan to serve a child in a permanent
guardianship situation whose parents receive payments through the Guardianship Assistance
Program.
Deletes obsolete language.
The bill has a significant negative fiscal impact to the Florida Medicaid program. See Section V
of this analysis.
The bill takes effect on July 1, 2022.
II. Present Situation:
Florida Medicaid Program
The Medicaid program is a joint federal-state program that finances health coverage for
individuals, including eligible low-income adults, children, pregnant women, elderly adults, and
persons with disabilities.
1
The Centers for Medicare & Medicaid Services (CMS) within the U.S.
Department of Health and Human Services (HHS) is responsible for administering the federal
Medicaid program. Florida Medicaid is the health care safety net for low-income Floridians.
Florida’s program is administered by the Agency for Health Care Administration (AHCA) and
financed through state and federal funds.
2
A Medicaid state plan is an agreement between a state and the federal government describing
how the state administers its Medicaid programs. The state plan establishes groups of individuals
covered under the Medicaid program, services that are provided, payment methodologies, and
other administrative and organizational requirements.
In order to participate in Medicaid, federal law requires states to cover certain population groups
(mandatory eligibility groups) and gives states the flexibility to cover other population groups
(optional eligibility groups).
States set individual eligibility criteria within federal minimum
standards. The AHCA may seek an amendment to the state plan as necessary to comply with
federal or state laws or to implement program changes. States send state plan amendments to the
federal CMS for review and approval.
3
Medicaid enrollees generally receive benefits through one of two service-delivery systems: fee-
for-service or managed care. Under fee-for-service, health care providers are paid by the state
Medicaid program for each service provided to a Medicaid enrollee. Under managed care, the
state contracts with private managed care plans for the coordination and payment of services for
Medicaid enrollees. The state pays the managed care plans a capitation payment, or fixed
monthly payment, per recipient enrolled in the managed care plan.
1
Medicaid.gov, Medicaid, available at https://www.medicaid.gov/medicaid/index.html (last visited Jan. 23, 2022).
2
Section 20.42, F.S.
3
Medicaid.gov, Medicaid State Plan Amendments, available at https://www.medicaid.gov/medicaid/medicaid-state-plan-
amendments/index.html (last visited Jan. 23, 2022). BILL: CS/CS/SB 1950 Page 3
Statewide Medicaid Managed Care (SMMC) Program
In 2011, the Legislature established the Medicaid program as a statewide, integrated managed
care program for all covered services, and directed the AHCA to create the Statewide Medicaid
Managed Care (SMMC) program and contract with managed care plans on a regional basis to
provide services to eligible recipients.
4
The SMMC minimum benefits are authorized by federal
authority and are specifically required in s. 409.973, F.S., for Managed Medical Assistance
(MMA) plans and s. 409.98, F.S., for Long-Term Care (LTC) plans. W alt o n
H o lmes
W aku lla
M ad iso nL eo n
Gad sd en
Jackso n
B ay
L ib ert y
Gu lfF ran klin
T aylo r
L af ayet t e
H amilt o n
B aker
N assau
D u v al
F lag ler
Pu t n am
C lay
D ixie Alach u a
L ev y
M ario n
Vo lu sia
C it ru s
L ake
Oran g e
Semin o le
Osceo la
Po lk
Pasco
M an at ee
H ard ee
H ig h lan d s
St . L u cie
Saraso t a
D e So t o
C h arlo t t e
Glad es
M art in
L ee
H en d ry
Palm B each
C o llier
B ro ward
D ad e
H ern an d o
Re gi on 4
Re gi on 2
Re gi on 1
Re gi on 5
Re gi on 3
Re gi on 7
Re gi on 11
Re gi on 9
Re gi on 10
Re gi on 6
Re gi on 8
Re gi on 1: E s cambia, Ok aloos a, S anta Ros a, and Walt on
Re gi on 2:B ay , Calhoun, Frank lin, Gadsden, Gulf, Holmes , Jac k son, Jeffers on, Leon,
Libert y , Madis on, Tay lor, Wak ulla, and Was hingt on
Re gi on 3:A lac hua, B radford, Cit rus, Columbia, Dix ie, Gilchris t, Hamilton, Hernando,
Lafay et t e, Lak e, Levy , Marion, P utnam, S umter, S uwannee, and Union
Re gi on 4:B ak er, Clay , Duval, Flagler, Nas sau, S t. Johns , and V olusia
Re gi on 5:P as c o and P inellas
Re gi on 6:Hardee, Highlands , Hills borough, Manat ee, and P olk
Re gi on 7:B revard, Orange, Os c eola, and S eminole
Re gi on 8: Charlot t e, Collier, DeSot o, Glades , Hendry , Lee, and S aras ot a
Re gi on 9:Indian River, Mart in, Ok eec hobee, P alm B each, and S t . Lucie
Re gi on 10: B roward
Re gi on 11: Miami-Dade and Monroe
Today, the majority of Florida Medicaid recipients receive their services through a managed care
plan contracted with the AHCA under the SMMC program. The SMMC program has three
components:
MMA: provides Medicaid covered medical services like doctor visits, hospital care,
prescribed drugs, mental health care, and transportation to these services.
5
LTC: provides Medicaid LTC services like care in a nursing facility, assisted living, or at
home. To get LTC you must be at least 18 years old and meet nursing home level of care (or
meet hospital level of care if you have Cystic Fibrosis).
6
Dental: provides all Medicaid dental services for children and adults. All individuals on
Medicaid must enroll in a dental plan.
7
4
Chapter 2011-134, Laws of Fla.
5
Agency for Health Care Administration, Statewide Medicaid Managed Care, Health Plans and Programs, available at
https://www.flmedicaidmanagedcare.com/health/comparehealthplans (last visited Feb. 9, 2022).
6
Id.
7
Id. BILL: CS/CS/SB 1950 Page 4
Eligible Plan Selection
The SMMC program was fully implemented in August 2014. During the initial SMMC
procurement, the AHCA awarded contracts to 18 plans, including seven provider service
networks (PSNs). By the end of the first contract period, due to various mergers, acquisitions,
and conversions to HMO status, only one PSN remained.
8
During the second procurement, beginning December 2018 and ending in December 2023, the
AHCA awarded contracts to 16 plans, including five PSNs, but only three of the PSNs currently
remain in the program due to mergers and acquisitions with a total of 10 health plans.
9
In 2020,
the Legislature extended the allowable term of the SMMC contracts from five to six years.
10
As a
result, the AHCA’s current contracts will end in December 2024. The AHCA will conduct its
next procurement in Fiscal Year 2022-2023 for implementation in the 2025 plan year.
Various mergers and acquisitions have occurred during the lifecycle of each SMMC contract,
resulting in a situation where a majority of enrollees are receiving services from statewide plans
that operate in all 11 regions. As of October 1, 2021, 40 percent of the SMMC population,
including those enrolled in a specialty plan, were enrolled in a plan operating statewide and 79
percent were enrolled in a plan that operates in at least eight of the 11 regions. The chart below
reflects the current operational SMMC plans in their designated regions as of October 1, 2021:
11
8
Agency for Health Care Administration, 2022 Agency Legislative Bill Analysis for SB 1950, Jan. 19, 2022 (on file with the
Senate Committee on Health Policy).
9
Id.
10
Chapter 2020-156, s. 44, Laws of Fla.
11
Agency for Health Care Administration, Statewide Medicaid Managed Care, available at
https://ahca.myflorida.com/medicaid/statewide_mc/pdf/mma/SMMC_Plans_by_Region.pdf (last visited Feb. 9, 2022). BILL: CS/CS/SB 1950 Page 5
SMMC Health Plans by Region (2018-2024)
1 2 3 4 5 6 7 8 9 10 11
MMA Health Plans
AmeriHealth
Community Care Plan
Simply Healthcare
Vivida Health
Comprehensive Plans (MMA & LTC Combined)
Aetna Better Health
Humana Medical Plan
Molina Healthcare
Simply Healthcare
Sunshine Health
United Healthcare
Specialty Plans
CMS Plan
Clear Health Alliance
Molina SMI Specialty
Sunshine SMI Specialty
Sunshine Child Welfare
Provider Service Networks (PSNs)
A PSN in the Medicaid program is a managed care plan established or organized and operated by
a health care provider, or group of affiliated health care providers, which provides a substantial
proportion of the health care items and services under a contract directly through the provider or
affiliated group of providers and may make arrangements with physicians or other health care
professionals, health care institutions, or any combination of such individuals or institutions to
assume all or part of the financial risk on a prospective basis for the provision of basic health
services by the physicians, by other health professionals, or through the institutions.
12
The health
care providers must have a controlling interest in the governing body of the PSN. The AHCA is
authorized to contract with PSNs under s. 409.912(1), F.S., and may currently reimburse PSNs
on a fee-for-service basis with a shared savings settlement or on a prepaid basis with per-
member, per-month payments. A PSN may be reimbursed on a fee-for-service basis for only the
first two years of the plan’s operation.
13
Specialty Plans
14
An MMA managed care plan can participate in the MMA program as a standard plan or as a
specialty plan. A specialty plan is a managed care plan that serves Medicaid recipients who meet
specified criteria based on age, medical condition, or diagnosis.
15
Under federal Medicaid law
and the SMMC waiver, each recipient has a choice of plans and may select any available plan
12
Section 409.912(1)(b), F.S.
13
Id.
14
Agency for Health Care Administration, Medicaid Managed Medical Assistance Specialty Plans available at
https://ahca.myflorida.com/medicaid/statewide_mc/pdf/mma/Specialty_Plans_110316.pdf (last visited Jan. 23, 2022).
15
Section 409.962(18), F.S. BILL: CS/CS/SB 1950 Page 6
unless that plan is restricted by contract to a specific population that does not include the
recipient.
16
If a specialty plan is available to accommodate a specific condition or diagnosis of a
Medicaid recipient, the AHCA must automatically enroll the recipient in that plan unless the
recipient chooses a different plan.
17
MMA specialty plans cover the same health care services as
the standard MMA plans, and in addition, they must maintain a care coordination program
tailored to the special needs of the plan’s enrollees.
When a recipient is eligible for more than one MMA specialty plan, the AHCA uses a ranking to
determine which MMA specialty plan to assign. Unless the recipient chooses to enroll in another
MMA specialty plan for which he or she is eligible, or in a standard MMA plan offered in his or
her region, the recipient is automatically assigned to the specialty plan listed highest on the
ranking. The AHCA has awarded specialty plan contracts to serve enrollees with specialty
conditions including severe mental illness, HIV/AIDS, as well as children with special health
care needs, and those involved with Florida’s child welfare system.
III. Effect of Proposed Changes:
Section 1 amends s. 409.912(1), F.S., to eliminate fee-for-service (FFS) reimbursement of
provider service networks (PSNs) in conjunction with changes made to s. 409.968(2), F.S., in
section 6 of the bill. Under these changes, PSNs must be reimbursed on a prepaid basis,
receiving a per-member, per-month payment. This section of the bill prohibits the Agency for
Health Care Administration (AHCA) from contracting with a PSN outside of the procurement
process in s. 409.966, F.S., as amended by section 4 of the bill.
Changes to this subsection relocate, but do not substantively change, language exempting PSNs
from parts I and III of ch. 643, F.S.
Section 2 repeals obsolete language in s. 409.9124, F.S., relating to managed care plan
reimbursement.
Section 3 amends s. 409.964, F.S., to eliminate an obsolete requirement that the AHCA provide
public notice and the opportunity for public comment before seeking a waiver to implement the
Statewide Medicaid Managed Care (SMMC) program. This language is obsolete as the public
notice and public meeting requirements were met prior to the AHCA seeking federal authority to
implement the SMMC program in 2011 and 2012.
Section 4 amends s. 409.966(2), F.S., to require the AHCA’s databook consisting of Medicaid
utilization and spending data (which must be published 90 days before issuing an invitation to
negotiate) to include at least the 24 most recent months of data from the Medicaid Encounter
Data System. This removes the requirement that the databook consist of data for the three most
recent contract years.
This section of the bill deletes the requirement for the AHCA to conduct separate and
simultaneous procurements for each Medicaid region and outlines a new structure for regional
16
Section 409.969(1), F.S.
17
Section 409.977(1), F.S. BILL: CS/CS/SB 1950 Page 7
awards. The new structure includes nine regions named by letters (Regions A-I), rather than the
11 regions named by numbers (Regions 1-11) included in the original statute.
The following chart outlines the nine regions proposed in the bill:
18
This section of the bill also deletes obsolete language in s. 409.966(3)(d), F.S., that required the
AHCA to negotiate capitation rates for the first year of the first contract term and in
s. 409.966(3)(e), F.S., that awarded additional contracts to plans who are awarded contracts in
Regions 1 and 2. The AHCA indicates that due to the merger of Regions 1 and 2 into a single
Region A, and because the bill provides for the award of statewide contracts, this provision is no
longer needed.
19
Section 5 amends s. 409.967, F.S., to delete obsolete language relating to plans contracting with
hospital facilities that became licensed and operational before January 1, 2013. This section of
the bill also deletes obsolete language requiring the AHCA to issue a request for information to
determine whether cost savings could be achieved through oversight and management by the end
of the fourth year of the first contract term.
Section 6 amends s. 409.968(2), F.S., to delete language allowing PSNs to receive fee-for-
service rates with a shared savings settlement. In conjunction with changes made to s. 409.912.
F.S., in section 1 of this bill, the bill requires all PSNs to be prepaid plans, receiving a per-
member, per-month payment, and be negotiated pursuant to the procurement process in s.
409.966, F.S.
18
Agency for Health Care Administration, 2022 Agency Legislative Bill Analysis for SB 1950, Jan. 19, 2022 (on file with
the Senate Committee on Health Policy).
19
Agency for Health Care Administration, 2022 Agency Legislative Bill Analysis for SB 1950, Jan. 19, 2022 (on file with
the Senate Committee on Health Policy).
Current Counties Proposed
Region 1 Escambia, Okaloosa, Santa Rosa, and Walton
Region A
Region 2
Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson,
Leon, Liberty, Madison, Taylor, Wakulla, and Washington
Region 3
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton,
Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter,
Suwannee, and Union
Region B
Region 4 Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
Region 5 Pasco and Pinellas Region C
Region 6 Hardee, Highlands, Hillsborough, Manatee, and Polk Region D
Current Counties Proposed
Region 7 Brevard, Orange, Osceola, and Seminole Region E
Region 8 Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota Region F
Region 9 Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie Region G
Region 10 Broward Region H
Region 11 Miami-Dade and Monroe Region I BILL: CS/CS/SB 1950 Page 8
Section 7 amends s. 409.973, F.S., to revise language related to Healthy Behaviors programs
which Managed Medical Assistance (MMA) plans are required to establish to encourage and
reward healthy behaviors. The bill requires each plan to establish a “tobacco cessation program”
rather than a “smoking cessation program” to ensure that each program also includes smokeless
tobacco products. It also requires an MMA plan’s substance abuse recovery program to include
opioid abuse recovery.
This section of the bill also deletes obsolete language in 409.97(4)(b), F.S., relating to the
Primary Care Initiative, which requires the plans to schedule an appointment with a primary care
provider for enrollees who became eligible for Medicaid between January 1, 2014 and December
31, 2015, within 6 months of enrollment in the plan.
Section 8 amends s. 409.974(1), F.S., to outline the structure for plan selection under the MMA
program. This section authorizes the AHCA to select eligible plans to provide services through a
single statewide procurement and to award contracts to plans on a regional or statewide basis. It
requires the AHCA to award a contract to at least one PSN in each of the 9 regions and to
procure:
3-4 plans for Region A
3-6 plans for Region B
3-5 plans for Region C
4-7 plans for Region D
3-6 plans for Region E
3-4 plans for Region F
3-5 plans for Region G
3-5 plans for Region H
5-10 plans for Region I
This section of the bill also amends s. 409.974(2), F.S., to eliminate the requirement that the
AHCA exercise a preference for plans with a provider network in which over 10 percent of the
providers use electronic health records. It is estimated that 80 percent of providers currently use
electronic health records.
20
Section 9 amends s. 409.975(1)(b), F.S., to expand the list of statewide essential providers to
include Florida cancer hospitals that meet the criteria in 42 U.S.C. s. 1395ww(d)(1)(B)(v).
Currently, Moffitt Cancer Center in Tampa and Sylvester Comprehensive Cancer Center in
Miami meet this criteria. Under the bill, managed care plans would be required to include these
cancer hospitals in their networks as essential providers.
Current law provides for how a children’s hospital that is not in-network with a managed care
plan must be compensated when providing services to a member of that health plan. This section
of the bill also adds Florida’s nationally-certified cancer hospitals, requiring non-participating
cancer center reimbursement rates to be the highest rate the center negotiated with any Medicaid
plan.
20
Email from Legislative Affairs Director, Agency for Health Care Administration, to Senate Committee on Health Policy
Staff (Jan. 24, 2022) (on file with the Senate Committee on Health Policy). BILL: CS/CS/SB 1950 Page 9
Section 10 amends s. 409.977, F.S., to revise and relocate the requirement for the AHCA to
maintain a recipient’s enrollment in a plan if a recipient was enrolled in a plan immediately
before the recipient’s choice period and that plan is still available in the region, unless an
applicable specialty plan is available from subsection (1) to subsection (2).
This section of the bill deletes the obsolete requirement in s. 409.977(4), F.S., for the AHCA to
seek federal approval to develop and implement a process to enable a Medicaid recipient with
access to employer-sponsored health care coverage to opt out of all managed care plans and to
use Medicaid financial assistance to pay for the recipient’s share of the cost in such employer-
sponsored coverage. The AHCA has already obtained federal approval for what has come to be
known as their Health Insurance Premium Payment (HIPP) program
21
and continues to
implement this program.
22
As of August 2021, 53 recipients were participating in the HIPP
program.
23
This section of the bill also amends s. 409.977(5), F.S., to authorize a child welfare specialty
managed care plan under contract with the MMA program to serve a child in a permanent
guardianship situation.
24
Specifically, such a child must continue to be eligible for Medicaid and
must receive guardianship assistance payments under the Guardianship Assistance Program.
Currently, only children in foster care, extended foster care, or subsidized adoption are eligible
for the child welfare specialty plan.
Section 11 amends s. 409.981, F.S., to outline the structure for plan selection under the Long-
Term Care program. Tracking the structure for MMA plan selection above in section 8 of this
bill, except as noted, this section authorizes the AHCA to select eligible plans to provide services
through a single statewide procurement and to award contracts to plans on a regional or
statewide basis. It requires the AHCA to award a contract to at least one PSN in each of the nine
regions and to procure:
3-4 plans for Region A
3-6 plans for Region B
3-5 plans for Region C
4-7 plans for Region D
3-6 plans for Region E
3-4 plans for Region F
3-5 plans for Region G
3-4 plans for Region H
25
21
See Rule 59G-7.007, F.A.C.
22
The Agency for Health Care Administration reports that for the 2020 calendar year, $95,388.79 was spent on premium
reimbursements through the HIPP program. From January to August of 2021, $912,363.87 was spent on premium
reimbursements through the program. Agency for Health Care Administration, 2022 Agency Legislative Bill Analysis for SB
1950, Jan. 19, 2022 (on file with the Senate Committee on Health Policy).
23
Email from Legislative Affairs Director, Agency for Health Care Administration, to Senate Committee on Health Policy
Staff (Jan. 24, 2022) (on file with the Senate Committee on Health Policy).
24
For more information on the Sunshine Health Child Welfare Specialty Plan and the Guardianship Assistance Program, see
Florida Senate Bill Analysis and Fiscal Impact Statement for CS/SB 1080, Jan. 19, 2022 available at
https://www.flsenate.gov/Session/Bill/2022/1080/Analyses/2022s01080.hp.PDF (last visited Jan. 23, 2022). The provisions
of CS/SB 1080 are identical to the changes made to s. 409.977(5), F.S., in this bill.
25
Note that the Agency for Health Care Administration must award 3-5 MMA plans for Region H under bill section 8. BILL: CS/CS/SB 1950 Page 10
5-10 plans for Region I
Section 12 amends s. 409.8132, F.S., to conform a cross-reference to changes made in bill
section 2 which repeals s. 409.9124, F.S.
Section 13 reenacts s. 409.962, F.S., to incorporate changes made by this act to s. 409.912, F.S.,
in bill section 1.
Section 14 reenacts s. 641.19, F.S., to incorporate changes made by this act to s. 409.912, F.S.,
in bill section 1.
Section 15 reenacts s. 430.2053, F.S., to incorporate changes made by this act to s. 409.981, F.S.,
in bill section 11.
Section 16 requires the AHCA to amend existing Statewide Medicaid Managed Care (SMMC)
contracts to implement several provisions of the bill to ss. 409.973, 409.975, and 409.977, F.S.,
and directs the AHCA to implement the procurement-related provisions for the 2025 plan year to
ss. 409.966, 409.974, and 409.981, F.S. The AHCA must amend existing SMMC contracts to
implement provisions of the bill related to the Healthy Behaviors programs, expansion of
essential providers to include Florida’s nationally-certified cancer hospitals, plan enrollment, and
eligibility for the child welfare specialty plan for children in the Guardianship Assistance
Program.
Section 17 provides an effective date of July 1, 2022.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None. BILL: CS/CS/SB 1950 Page 11
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
The capitation rate for children in the Child Welfare Specialty Plan is higher than the
rates for most children in other plans. If children become eligible and receive services
through the Child Welfare Specialty Plan as authorized in the bill, the bill will have a
significant negative fiscal impact to the Florida Medicaid program. The Agency for
Health Care Administration estimates a maximum recurring fiscal impact of $12.2
million ($4.7 million General Revenue) based on a rate year 2020-2021 estimate of 4,120
children who currently would be eligible for the change in plans.
26
The precise fiscal impact of children becoming newly eligible for the Child Welfare
Specialty Plans cannot be calculated without knowing the Medicaid region in which an
eligible child resides and the capitation rate category in which the child is currently
categorized. This is because Medicaid capitation rates vary by region and children could
be in different rate cells based on age, gender, Medicaid eligibility category, and other
characteristics.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 409.912, 409.964,
409.966, 409.967, 409.968, 409.973, 409.974, 409.975, 409.977, 409.981, and 409.8132.
This bill repeals section 409.9124 of the Florida Statutes.
This bill reenacts the following sections of the Florida Statutes: 409.962, 641.19, and 430.2053.
26
Agency for Health Care Administration, 2022 Agency Legislative Bill Analysis for SB 1950, Jan. 19, 2022 (on file with
the Senate Committee on Health Policy). BILL: CS/CS/SB 1950 Page 12
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS/CS by Appropriations on February 28, 2022:
The committee substitute:
Removes the achieved savings rebate provisions from the bill and maintains current
law.
Reinstates the requirement that the databook published by the Agency for Health Care
Administration (AHCA) consisting of Medicaid utilization and spending data,
delineate utilization by age, gender, eligibility group, geographic area, and aggregate
clinical risk score.
Expands the eight proposed regions into nine.
Adjusts the minimum and maximum number of plans with which the AHCA will
contract to provide services to the managed medical assistance (MMA) program and
long-term care (LTC) program enrollees.
Changes the non-participating cancer center reimbursement rate to the highest rate the
center negotiated with any Medicaid plan.
Requires the AHCA to amend existing Statewide Medicaid Managed Care (SMMC)
contracts to implement several provisions of the bill and directs the AHCA to
implement the procurement-related provisions for the 2025 plan year.
CS by Health Policy on January 26, 2022:
The CS corrects a drafting error in the underlying bill that would have inadvertently
deleted the AHCA’s existing authority to implement the HIPP program. The amendment
keeps the HIPP program intact and removes obsolete language from statute regarding
already-obtained federal approval to implement the program.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.