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 Appropriations Committee on Health and Human Services
BILL: SB 1084
INTRODUCER: Senator Trumbull
SUBJECT: Long-term Managed Care Program
DATE: April 17, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Brown Brown HP Favorable
2. Gerbrandt Money AHS Pre-meeting
3. FP
I. Summary:
SB 1084 amends s. 409.981, F.S., to create a Medicaid long-term care managed care pilot
program in Miami-Dade County to integrate health care services, long-term care services, and
home and community-based services for persons with developmental disabilities. The pilot
program will be available, on a volunteer basis, to Medicaid eligible individuals on the iBudget
waitlist.
The bill is likely to have a significant negative fiscal impact. The Agency for Health Care
Administration (AHCA), which operates the state’s Medicaid program, has not submitted an
estimate of the bill’s potential fiscal impact. See Section V. of this analysis.
The bill takes effect upon becoming a law.
II. Present Situation:
The Florida Medicaid Program
Florida Medicaid is the health care safety net for low-income Floridians. The national Medicaid
program is a partnership of federal and state governments established to provide coverage for
health services for eligible persons. Florida’s program is financed through state and federal
funds.
1
The Agency for Health Care Administration (AHCA) is the single state agency responsible for
the administration of the Florida Medicaid program, authorized under Title XIX of the Social
Security Act (SSA). This authority includes establishing and maintaining a Medicaid state plan
approved by the federal Centers for Medicare & Medicaid Services (CMS) and maintaining any
1
Section 20.42, F.S.
REVISED: BILL: SB 1084 Page 2
Medicaid waivers needed to operate the Florida Medicaid program as directed by Florida
Statute,
2
the General Appropriations Act (GAA), and other legislation accompanying the GAA.
A Medicaid state plan is an agreement between a state and the federal government describing
how that 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. State Medicaid
programs may request from CMS a formal waiver of the requirements codified in the SSA,
which provides states flexibility in providing services not afforded through their Medicaid state
plan.
Statewide Medicaid Managed Care
In Florida, a large majority of Medicaid recipients receive their services through a managed care
plan contracted with the AHCA under the Statewide Medicaid Managed Care (SMMC)
program.
3
Other recipients who are not eligible for managed care, are not subject to mandatory
managed care enrollment, or are not yet enrolled in a plan, are provided services directly from
health care practitioners or facilities, and in those cases, providers are paid on a fee-for-service
basis.
SMMC has three components:
Managed Medical Assistance (MMA), under which the AHCA makes payments for primary
and acute medical treatments and related services using a managed care model;
Long-term Care Managed Care (LTCMC), under which the AHCA makes payments for
long-term care, including home and community-based services, using a managed care model;
and
The Medicaid Prepaid Dental Health Program (Prepaid Dental), under which the AHCA
makes payments for dental services for children and adults using a managed care model.
SMMC benefits are authorized through federal waivers and are specifically required by the
Florida Legislature in ss. 409.973 and 409.98, F.S. SMMC benefits cover primary, acute,
preventive, behavioral health, prescribed drugs, long-term care, and dental services. Section
409.973, F.S., specifies the minimum services that must be provided by managed care plans:
Managed Care Plan Benefits
4
Advanced practice registered nurse services Medical supplies, equipment, prostheses, and
orthoses
Ambulatory surgical treatment center services Mental health services
Birthing center services Nursing care
Chiropractic services Optical services and supplies
Donor human milk bank services Optometrist services
2
See parts III and IV of ch. 409, F.S.
3
As of January 31, 2023, Florida Medicaid’s total enrollment comprised 5,696,638 persons. Eighty-seven percent were
enrolled in a Medicaid managed care plan. See:
https://ahca.myflorida.com/medicaid/Finance/data_analytics/enrollment_report/docs/ENR_202301.xls (last visited March 9,
2023).
4
Section 409.973, F.S. BILL: SB 1084 Page 3
Early periodic screening diagnosis and
treatment services for recipients under age 21
Physical, occupational, respiratory, and
speech therapy services
Emergency services Physician services, including physician
assistant services
Family planning services and supplies.
Pursuant to 42 C.F.R. s. 438.102, plans may
elect to not provide these services due to an
objection on moral or religious grounds, and
must notify the agency of that election when
submitting a reply to an invitation to negotiate
Podiatric services
Healthy start services, except as provided in s.
409.975(4)
Prescription drugs
Hearing services Renal dialysis services
Home health agency services Respiratory equipment and supplies
Hospice services Rural health clinic services
Hospital inpatient services Substance abuse treatment services
Hospital outpatient services Transportation to access covered services
Laboratory and imaging services
Florida Medicaid does not cover all low-income Floridians. Current eligibility prioritizes low-
income children, disabled persons, and elders, and sets income eligibility by reference to the
annual federal poverty level. For some groups, clinical eligibility provisions apply, as well.
The Florida Medicaid program covers:
5
More than 5.5 million low-income individuals, including approximately 2.5 million children,
or 54 percent of the children in Florida;
More than 54 percent of the births occurring in Florida in calendar year 2020; and
More than 60 percent of the nursing home days in Florida.
Types of Comprehensive Medicaid Managed Care Plans
Comprehensive services in SMMC are managed by two types of managed care plans: traditional
managed care organizations and provider service networks (PSNs). Traditional managed care
organizations are usually health insurers or health maintenance organizations (HMOs). PSNs are
managed care plans that are owned or are majority-controlled by health care providers, such as
physician groups or hospitals.
All managed care plans in SMMC, including PSNs, are reimbursed as prepaid plans. That is,
they are paid capitated rates (prospective, per-member, per-month payments) by the AHCA in
advance for any particular month and are expected to provide medically necessary services to
their respective members during that month, using the dollars within that month’s capitation.
Medically necessary services are required to be provided regardless of whether the capitation
includes all the dollars necessary to provide those services.
6
5
Agency for Health Care Administration, Presentation to the Senate Health Policy Committee, Jan. 23, 2023.
6
See s. 409.968(1) and (2), F.S. BILL: SB 1084 Page 4
The AHCA contracts with managed care plans on a statewide and regional basis, in sufficient
numbers to ensure choice. The cyclical Medicaid procurement process ensures plans offer
competitive benefit designs and prices. In addition, plans compete for consumer choice. That is,
while Medicaid requires a basic benefit package, and regulates the adequacy of plans’ provider
networks, plans can add to their benefit packages and offer provider networks attractive to
Medicaid recipients when choosing a plan.
The AHCA began the next procurement process in 2022 for implementation in the 2025 plan
year and released the re-procurement solicitation documents on April 11, 2023.
7
Medicaid Long-Term Care
Federal Medicaid law establishes coverage for institutional care, such as nursing home care and
residential institutions for people with developmental disabilities, but does not allow federal
dollars to be spent on alternatives to such care. Those alternatives include home and community-
based services designed to keep people in their homes and communities instead of going into an
institution when they need higher levels of care. This federal spending limitation creates a bias
toward institutional care, and toward acute care, rather than allowing the non-acute supports that
prevent institutionalization.
Florida obtained federal waivers to allow the state Medicaid program to cover other kinds of
long-term care services for elders and people with disabilities, to prevent admission into a
nursing home. The Medicaid Long-term Care Waiver provides services to eligible individuals
age 18 or older who need long-term services and supports, including individuals over the age of
18 with a diagnosis of cystic fibrosis, AIDS, or a traumatic brain or spinal cord injury. The Long-
term Care Waiver is designed to delay or prevent institutionalization and allow waiver recipients
to maintain stable health while receiving services at home and in the community. Individuals in
the program may also be served in a nursing facility setting. The Long-Term Care Waiver is a
capitated, managed care program.
Section 409.98, F.S., specifies the non-institutional, often non-acute, long-term care benefits that
must be provided by the long-term care managed care program:
7
Agency for Health Care Administration, Presentation to the Senate Health Policy Committee, Jan. 23, 2023. BILL: SB 1084 Page 5
SMMC Long-Term Care Mandatory Benefits
Services provided in an ALF Physical therapy
Hospice services Intermittent and skilled nursing
Adult day care Medication administration
Personal care Medication management
Home accessibility adaption Nutritional assessment and risk reduction
Behavior management Caregiver training
Home-delivered meals Respite care
Case management Personal emergency response system
Occupational therapy Transportation
Speech therapy Medical equipment and supplies
Respiratory therapy Nursing Facility Care Services
Medicaid Home and Community-Based Waiver for Persons with Developmental
Disabilities
Under federal law, fee-for-service Medicaid provides coverage for health care services to cure or
ameliorate diseases. Generally, Medicaid does not cover services that will not cure or mitigate a
medical diagnosis. However, people with developmental disabilities, while certainly requiring
traditional medical services, need other kinds of services to maintain their independence and
avoid institutionalization. Home and community-based services (HCBS) can be provided to
assist people with developmental disabilities with activities of daily living which enables them to
live in their homes or communities, rather than moving to a facility for care.
To obtain federal Medicaid funding for HCBS, Florida obtained a Medicaid waiver.
8
This allows
coverage of non-medical services to avoid institutionalization and allows the state to limit the
scope of the program to the number of enrollees deemed affordable by the state. In this way, the
HCBS waiver is not an entitlement; it is a first-come, first-served, slot-limited program.
The HCBS waiver, known as iBudget Florida, serves eligible
9
persons with developmental
disabilities. Eligible diagnoses include disorders or syndromes attributable to intellectual
disability, cerebral palsy, autism, spina bifida, Down syndrome, Phelan-McDermid syndrome, or
Prader-Willi syndrome. The disorder must manifest before the age of 18, and it must constitute a
substantial handicap that can reasonably be expected to continue indefinitely.
10
The Agency for Persons with Disabilities (APD) administers the iBudget program with the stated
purpose of:
Promoting and maintaining the health and welfare of eligible individuals with developmental
disabilities.
Providing medically necessary supports and services to delay or prevent institutionalization.
8
Florida Developmental Disabilities Individual Budgeting Waiver (0867.R02.00), March 4, 2011, authorized under s. 1915b
of the Social Security Act.
9
The HCBS waiver retains the Medicaid requirement that enrollees be low-income, but measures only the developmentally
disabled person’s income; not the income generated by the whole household.
10
Section 393.063(12), F.S. BILL: SB 1084 Page 6
Fostering the principles of self-determination as a foundation for services and supports.
11
Section 393.066 (3), F.S., specifies that community-based services offered through the iBudget
must include the following medically necessary services to prevent institutionalization:
Home and Community-Based Services
12
Adult Day Training Respite Services
Family Care Services Social Services
Guardian Advocate Referral Services Physical, Occupational, Respiratory, and
Speech Therapy
Medical/Dental Services Supported Employment
Parent Training Supported Living
Personal Care Services Behavioral Services
Recreation Transportations
Residential Facility Services Residential Habilitation
Under the broad service categories specified in s. 393.066(3), F.S., the APD offers 26 supports
and services delivered by contracted service providers to assist individuals to live in their own
homes or the community.
13
Currently, HCBS services are not integrated with Medicaid acute medical services, as those
services are administered for iBudget enrollees by the AHCA, usually through the fee-for service
model, not through SMMC. However, every iBudget enrollee receives case management services
from a waiver support coordinator. Waiver support coordinators are responsible for identifying,
coordinating, and accessing supports and services from all available funding sources for iBudget
enrollees, including Medicaid state plan services.
Florida law requires that Medicaid be the payer of last resort for medically necessary supports
and services,
14
and that iBudget enrollees use all available services authorized under the
Medicaid state plan, school-based services, private insurance and other benefits, prior to using
iBudget Waiver funds.
15
Therefore waiver support coordinators must first obtain supports and
services from third party payers, other government or community programs, school-based
programs, and natural supports.
Historically, despite the utilization management tools authorized by law and the entitlement
flexibilities provided by the federal waiver, APD has frequently been unable to manage the
11
Agency for Health Care Administration, Developmental Disabilities Individual Budgeting Waiver Services Coverage and
Limitations Handbook, September 2021.
12
Section 393.006(3), F.S.
13
Supra, note 11.
14
Section 409.910, F.S.
15
393.0662(3), F.S. BILL: SB 1084 Page 7
iBudget program within the budget appropriated by the legislature, resulting in significant
deficits
16
and surpluses.
17
In 2019, the Legislature directed the APD to implement better monitoring and accounting
procedures and to take corrective action when deficits are projected to develop. Additionally,
APD was required to develop a plan to redesign the iBudget program if a deficit were to reoccur
in the 2018-2019 fiscal year.
18
The APD did generate a deficit that year and submitted a plan to
address the budget shortfall that included the following recommendations:
Include the iBudget Waiver in the Social Services Estimating Conference;
Implement a behavioral health Intermediate Care Facility service rate;
Implement individual caps for iBudget clients;
Implement budget transfers from the Medicaid state plan to the iBudget waiver for clients
turning 21;
Expand the Medicaid Assistive Care Services program to include APD group homes;
Centralize the significant additional needs process;
Implement service limitations on Life Skills Development services; and
Restructure support coordination services.
19
In 2020, Senate Bill 82 was passed and addressed some of the recommendations from the APD’s
iBudget waiver redesign plan, specifically the bill:
Centralized the significant additional needs process at APD headquarters; and
Restructured support coordination services.
20
For FY 2022-2023, the Legislature appropriated $1,871,531,214 to APD for the iBudget waiver
program, of which $742,997,892 are state funds.
21
Currently, the program serves over 35,300
enrolled people.
22
iBudget Waiver Waitlist
The APD maintains a waitlist of people who would like to enroll in the iBudget. Currently, the
waitlist includes 22,535 people. About 660 of those receive other, limited, services from APD,
and over 9,000 people on the waitlist are otherwise eligible for, and receive, Medicaid coverage
16
For example, the legislature made retroactive general revenue appropriations to address APD deficits that occurred in
Fiscal Year’s 2017-2018 ($22.0 million), 2018-2019 ($41.2 million), and 2019-2020 ($50.8 million). See, the Fiscal Year
2019-2020 General Appropriations Act, section 30 and the Fiscal Year 2020-2021 General Appropriations Act, sections 29
and 30, respectively.
17
The APD’s historical deficits have been offset by more recent general revenue surpluses of $11.3 million, $1.0 million and
$39.6 million in Fiscal Year’s 2019-2020, 2020-2021, and 2021-2022, respectively. Data was retrieved from the Legislative
Budgeting System.
18
Chapter 2019-116, s. 26, Laws of Fla.
19
Agency for Persons with Disabilities and Agency for Health Care Administration, 2019 iBudget Waiver Redesign, Sept.
30, 2019.
20
Chapter 2020-71, Laws of Florida
21
Chapter 2022-156, Laws of Fla., Specific Appropriation 245.
22
Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities
and Their Costs: First Quarter Fiscal Year 2022-2023, Nov. 15, 2023, available at:
https://apd.myflorida.com/publications/reports/docs/FY%202023%20Quarterly%20Report%201st%20Quarter%20report.pdf
(last viewed Mar. 24, 2023). BILL: SB 1084 Page 8
for medical care. About 13,500 people on the waiver waitlist receive no APD or Medicaid
services.
23
As new funding becomes available, APD enrolls people from the waitlist in a statutory order of
priority in seven categories:
24
Category 1 – Clients deemed to be in crisis.
Category 2 – Specified children from the child welfare system.
25
Category 3 – Includes, but is not limited to, clients:
o Whose caregiver has a documented condition that is expected to render the caregiver
unable to provide care within the next 12 months and for whom a caregiver is required
but no alternate caregiver is available;
o Who are at substantial risk of incarceration or court commitment without supports;
o Whose documented behaviors or physical needs place them or their caregiver at risk of
serious harm and other supports are not currently available to alleviate the situation; or
o Who are identified as ready for discharge within the next year from a state mental health
hospital or skilled nursing facility and who require a caregiver but for whom no caregiver
is available.
Category 4 – Includes, but is not limited to, clients whose caregivers are 70 years of age or
older and for whom a caregiver is required but no alternate caregiver is available;
Category 5 – Includes, but is not limited to, clients who are expected to graduate within the
next 12 months from secondary school and need support to obtain or maintain competitive
employment, or to pursue an accredited program of postsecondary education to which they
have been accepted.
Category 6 – Clients 21 years of age or older who do not meet the criteria for categories 1-5.
Category 7 – Clients younger than 21 years of age who do not meet the criteria for categories
1-4.
26
APD rarely moves beyond Category 1 (individuals experiencing a crisis) in enrolling people off
the wait list. In Fiscal Years 2020-2021 and 2021-2022, for example, APD enrolled a total of
2,646 new enrollees in the waiver program. Of those, 1,841 (70%) were Category 1 enrollees.
27
23
Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities
and Their Costs: First Quarter Fiscal Year 2022-2023, Nov. 15, 2023, available at:
https://apd.myflorida.com/publications/reports/docs/FY%202023%20Quarterly%20Report%201st%20Quarter%20report.pdf
(last viewed Mar. 24, 2023).
24
Section 393.065(5), F.S.
25
See s. 393.065(5)(b), F.S., for specific criteria.
26
Section 393.065(5), F.S.
27
Of the 2,646 new enrollees, 182 were in Category 2 (children aging out of the child welfare system); the remainder were in
special categories authorized by the legislature to jump the queue (military dependents, people with Phelan-McDermid
Syndrome, and people in ICFs or nursing facilities), see s. 393.064(6), (7), F.S. See, Agency for Persons with Disabilities,
Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs: First Quarter Fiscal
Year 2022-2023, Nov. 15, 2023, available at:
https://apd.myflorida.com/publications/reports/docs/FY%202023%20Quarterly%20Report%201st%20Quarter%20report.pdf
(last viewed Mar. 24, 2023). BILL: SB 1084 Page 9
Medicaid Coverage for iBudget Enrollees
iBudget waiver benefits include Medicaid coverage for medical services, administered by the
AHCA. The vast majority of full-coverage Medicaid recipients receive services through the
SMMC managed care model, in which the recipient can choose from different health plans to
provide their care. However, under current law, using the managed care model is an option for
iBudget enrollees – not a requirement. iBudget participants may opt to use the traditional fee-for-
service model of service delivery.
28
Medical services and HCBS are currently not integrated because they are provided by two
different programs in two different state agencies. .
HCBS and Managed Care Models
Some states use managed care models for HCBS for persons with developmental disabilities, in
varying forms.
Iowa and Kansas use a long-term care managed care model to provide developmental disability
services. These states use a single, risk-bearing, managed care plan to coordinate all services for
this population, including primary care, acute care, behavioral health, and long-term care
services. Tennessee takes a similar approach, but its managed care plans do not bear risk.
29
New York obtained a federal waiver to transition the Medicaid developmental disability
population into managed care based on a phased-in model, beginning with integrated care
coordination under a single, comprehensive plan. In addition, New York operates a service
delivery model that fully integrates with Medicare coverage, for persons eligible for both
programs, offering primary, acute, long-term care, and habilitation services.
30
Using managed care for the developmental disability population requires careful adaptation of
acute care models to address factors that differentiate this population from a typical long-term
care population. These factors include: the longer length of time individuals will require these
services, often for a lifetime; the role of community services and supports and the need to
integrate them into the model; and the unique developmental disability provider community,
composed of smaller organizations exclusively dependent on government funding and
inexperienced at navigating a managed care environment; among other differentiating factors.
31
Florida does not use a risk-based managed care model for HCBS services, and the Medicaid
managed care model is rarely used by iBudget enrollees. Medicaid acute care services and HCBS
services are not integrated, or coordinated, by any single entity for individual enrollees.
28
Section 409.972(1)(e), F.S.
29
National Association of States United for Aging and Disabilities, MLTSS Institute, “MLTSS for People with Intellectual
and Developmental Disabilities: Strategies for Success (2018), available at:
http://www.advancingstates.org/sites/nasuad/files/2018%20MLTSS%20for%20People%20with%20IDD-
%20Strategies%20for%20Success_0.pdf (last viewed Mar. 24, 2023).
30
Center for Health Care Strategies, “Enrolling Individuals in Intellectual/Developmental Disabilities in Managed Care: A
strategy for Strengthening Long-Term Services and Supports”, March 2019, available at:
https://www.chcs.org/media/Integration-Strategy-3-Strengthening-LTSS-Toolkit_032019.pdf (last viewed March 24, 2023).
31
Id. BILL: SB 1084 Page 10
III. Effect of Proposed Changes:
The bill amends the long-term care managed care statutes in s. 409.981, F.S., to create a pilot
program in Miami-Dade County that establishes an integrated managed care model for providing
medical care, long-term care, and home and community-based services to persons with
developmental disabilities.
The bill requires the Agency for Health Care Administration (AHCA) to contract with a long-
term care managed care plan in Miami-Dade County to integrate medical services, long-term
care services and home and community-based services, under the same managed care coverage
umbrella. Integrated services must be provided on an individualized basis and must be updated at
least quarterly or as warranted by changes in an individual’s circumstances.
The pilot program will be available, on a volunteer basis, to Medicaid eligible individuals on the
iBudget waitlist. Participation is limited to the maximum number of enrollees specified in the
GAA, if any.
The pilot program must provide the medical care benefits described in s. 409.973, F.S., long-
term care benefits described in s. 409.98, F.S., and the home and community-based benefits
described in 393.066, F.S.
The AHCA must utilize the “invitation to negotiate” process under s. 287.057(1)(c), F.S., to
procure a single managed care plan for the pilot program. The selected long-term care managed
care plan must:
Be a provider service network (PSN) whose owners include health care providers with
experience serving iBudget waiver clients;
Provide all benefits through a single, integrated model of care;
Document revenues and expenditures related to the pilot program and submit financial
reports; and
Participate in the achieved savings rebate program.
32
The AHCA must contract for an independent evaluation of the selected PSN’s performance
based on specific metrics of access to care, care quality, and cost. The AHCA must submit the
evaluation to the President of the Senate and the Speaker of the House of Representatives by
October 1, 2024.
The bill takes effect upon becoming a law.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
32
The achieved savings rebate program requires plans to share savings with the state, and authorizes plans to retain
statutorily-defined portions of savings, some increments of which are tied to achieving AHCA-defined quality measures.
Section 409.967(3)(f), F.S. BILL: SB 1084 Page 11
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
Persons who enroll in the pilot will experience an increase in home and community-based
services and/or traditional Medicaid benefits.
A provider service network (PSN) awarded a contract under the pilot program will
benefit financially from the bill’s implementation, if that PSN is able to successfully
manage services rendered to the program’s enrollees. The Agency for Health Care
Administration (AHCA) has not provided an analysis of the bill; therefore, the number of
PSNs, if any, who currently meet the bill’s qualifications, or could potentially be created
to meet those qualifications, is unknown.
C. Government Sector Impact:
The bill will have a significant negative fiscal impact on state expenditures. The pilot
program limits participation to the maximum number of enrollees specified in the
General Appropriations Act.
Currently, House Bill 5001, the House proposed General Appropriations Act for Fiscal
Year 2023-2024, provides that AHCA may request budget authority associated with the
enrollment of up to 600 individuals who are currently on the iBudget waiting list and who
voluntarily choose to participate in the pilot program.
The Agency for Persons with Disabilities estimates the average annual cost for a non-
crisis enrollee on the iBudget Waiver is $53,136. Therefore, the estimated cost to provide BILL: SB 1084 Page 12
home and community-based services to 600 individuals who are on the waitlist, and who
are not in crisis, is $31.8 million ($12.9 million GR; $18.9 million TF).
33
The bill will likely have an indeterminate yet negative fiscal impact on the AHCA due to
the bill’s provisions that require the AHCA to contract for an independent evaluation of
the integrated plan.
VI. Technical Deficiencies:
None.
VII. Related Issues:
The bill provides that enrollee participation in the Miami-Dade pilot is voluntary and that
participants “will be selected” from individuals who are on the waitlist for iBudget waiver
services. However, the bill does not specify who will do the selecting.
The bill also provides that participation is limited to the maximum number of enrollees specified
in the General Appropriations Act (GAA), if any. In the event that the number of the volunteers
exceeds the GAA’s maximum number of enrollees, the bill does not provide a process or criteria
to determine which individuals will be selected and which will be excluded. The bill also does
not grant the Agency for Health Care Administration (AHCA) rulemaking authority to develop
selection criteria.
In terms of benefits, it is unclear whether the Provider Service Network (PSN) that wins the
contract under the pilot program will be required to provide coverage for dental services. The bill
requires coverage to include benefits “described in” s. 409.973, F.S. Statewide Medicaid
Managed Care (SMMC) dental services are provided under s. 409.973(5), F.S., but are usually
provided under the Prepaid Dental Health Program, separate from other health care services. The
bill references s. 409.973, F.S., but is silent on whether the AHCA should include dental services
in the pilot’s PSN contract.
It is unclear how quickly the pilot program will be operational. It is not unusual for procurements
conducted via the invitation to negotiate process to take a significant amount of time to be
concluded. For example, as reported earlier in this analysis, the AHCA began the next SMMC
procurement process in 2022 for implementation in the 2025 plan year. It is unclear whether the
bill’s evaluation of the pilot which is required to be submitted by October 1, 2024, will have any
meaningful data or results worthy of being evaluated. The bill does not provide for any
evaluations to be submitted beyond October 1, 2024, in the event the pilot program endures past
that date.
VIII. Statutes Affected:
This bill substantially amends section 409.981 of the Florida Statutes.
33
This estimate excludes medical costs provided to people with developmental disabilities currently covered by Medicaid. BILL: SB 1084 Page 13
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.