FL
Florida House Bill H1085

Florida 2025 Regular Session

Florida House Bill H1085 Compare Versions

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1010 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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1414 A bill to be entitled 1
1515 An act relating to the Children's Medical Services 2
1616 program; transferring operation of the Children's 3
1717 Medical Services Managed Care Plan from the Department 4
1818 of Health to the Agency for Health Care 5
1919 Administration, effective on a specified date; 6
2020 providing construction as to judicial and 7
2121 administrative actions pending as of a specified date 8
2222 and time; requiring the department's Children's 9
2323 Medical Services (CMS) program to collaborate with the 10
2424 agency in the care of children and youth with special 11
2525 health care needs; requiring the CMS program to 12
2626 conduct certain clinical eligibility screenings and 13
2727 provide ongoing consultation to the agency for a 14
28-specified purpose; amending s. 409.974, F.S.; 15
29-requiring the CMS program to transfer operation of 16
30-certain managed care contr acts from the department to 17
31-the agency effective on a specified date; requiring 18
32-the CMS program to conduct clinical eligibility 19
33-screening for certain children and youth with special 20
34-health care needs; requiring the program to provide 21
35-ongoing consultation t o the agency for a specified 22
36-purpose; requiring the agency to establish specific 23
37-measures for evaluation of services provided to 24
38-children and youth with special health care needs; 25
28+specified purpose; amending s. 409.906, F.S.; 15
29+conforming a cross-reference; amending s. 409.974, 16
30+F.S.; requiring the CMS pr ogram to transfer operation 17
31+of certain managed care contracts from the department 18
32+to the agency effective on a specified date; requiring 19
33+the CMS program to conduct clinical eligibility 20
34+screening for certain children and youth with special 21
35+health care needs; requiring the program to provide 22
36+ongoing consultation to the agency for a specified 23
37+purpose; requiring the agency to establish specific 24
38+measures for evaluation of services provided to 25
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4747 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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51-requiring the agency to contract with an independent 26
52-evaluator to conduct th e evaluation of services 27
53-provided; specifying requirements for the evaluation; 28
54-requiring the agency to submit the results of the 29
55-evaluation to the Governor and the Legislature by a 30
56-specified date; amending s. 391.016, F.S.; revising 31
57-the purposes and functi ons of the CMS program; 32
58-amending s. 391.021, F.S.; revising definitions; 33
59-amending s. 391.025, F.S.; revising the scope of the 34
60-CMS program; amending s. 391.026, F.S.; revising the 35
61-powers and duties of the department to conform to 36
62-changes made by the act; pr oviding for the future 37
63-repeal of s. 391.026(8) through (11), F.S., relating 38
64-to the department's oversight and administration of 39
65-the CMS program; repealing s. 391.028, F.S., relating 40
66-to administration of the program; amending s. 391.029, 41
67-F.S.; revising program eligibility requirements; 42
68-conforming provisions to changes made by the act; 43
69-amending s. 391.0315, F.S.; conforming provisions to 44
70-changes made by the act; providing for future repeal 45
71-of specified provisions; repealing ss. 391.035, 46
72-391.037, 391.045, 391. 047, 391.055, and 391.071, F.S., 47
73-relating to provider qualifications, physicians and 48
74-private sector services, provider reimbursements, 49
75-third-party payments, service delivery systems under 50
51+children and youth with special health care needs; 26
52+requiring the agency to contract with an independent 27
53+evaluator to conduct the evaluation of services 28
54+provided; specifying requirements for the evaluation; 29
55+requiring the agency to submit the results of the 30
56+evaluation to the Governor and the Legislature by a 31
57+specified date; amending s. 391.016, F.S.; revising 32
58+the purposes and functions of the CMS program; 33
59+amending s. 391.021, F.S.; revising definitions; 34
60+amending s. 391.025, F.S.; revising the scope of the 35
61+CMS program; amending s. 391.026, F.S.; revising the 36
62+powers and duties of the department to conform to 37
63+changes made by the act; providing for the future 38
64+repeal of s. 391.026(8) through (11), F.S., relating 39
65+to the department's oversight and administration of 40
66+the CMS program; repealing s. 391.028, F.S., relating 41
67+to administration of the program; amending s. 391.029, 42
68+F.S.; revising program eligibility requirements; 43
69+conforming provisions to changes made by the act; 44
70+amending s. 391.0315, F.S.; conforming provisions to 45
71+changes made by the act; providing for future repeal 46
72+of specified provisions; repealing ss. 391.035, 47
73+391.037, 391.045, 391.047, 391.055, and 391.071, F.S., 48
74+relating to provider qualifications, physicians and 49
75+private sector services, provider reimbursements, 50
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8484 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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88-the program, and quality of care requirements, 51
89-respectively; amendin g s. 391.097, F.S.; conforming a 52
90-provision to changes made by the act; repealing part 53
91-II of ch. 391, F.S., consisting of ss. 391.221 and 54
92-391.223, F.S., relating to Children's Medical Services 55
93-councils and panels; amending ss. 409.166, 409.811, 56
94-409.813, 409.8134, 409.814, 409.815, 409.8177, 57
95-409.818, 409.912, 409.9126, 409.9131, 409.920, and 58
96-409.962, F.S.; conforming provisions to changes made 59
97-by the act; requiring the Agency for Health Care 60
98-Administration to develop a comprehensive plan to 61
99-redesign the Florida Medicaid Model Waiver for home 62
100-and community-based services to include children who 63
101-receive private duty nursing services; providing 64
102-requirements for the redesign of waiver program; 65
103-requiring the Agency for Health Care Administration to 66
104-submit a report to the Governor, the President of the 67
105-Senate, and the Speaker of the House of 68
106-Representatives by a specified date; providing 69
107-effective dates. 70
108- 71
109-Be It Enacted by the Legislature of the State of Florida: 72
110- 73
111- Section 1. Transfer of operation of the Childr en's Medical 74
112-Services Managed Care Plan. — 75
88+third-party payments, service delivery systems under 51
89+the program, and quality of care requirements, 52
90+respectively; amending s. 391.097, F.S.; conforming a 53
91+provision to changes made by the act; repealing part 54
92+II of ch. 391, F.S., consisting of ss. 391.221 and 55
93+391.223, F.S., relating to Children's Medical Services 56
94+councils and panels; amending ss. 409.166, 409.811, 57
95+409.813, 409.8134, 409.814, 409.815, 409.8177, 58
96+409.818, 409.912, 409.9126, 409.9131, 409.920, 59
97+409.962, 409.968, and 409.972, F.S.; conforming 60
98+provisions to changes made by the act; requiring the 61
99+Agency for Health Care Administration to develop a 62
100+comprehensive plan to redesign the Florida Medicaid 63
101+Model Waiver for home and community -based services to 64
102+include children who receive private duty nursing 65
103+services; providing requirements for the redesign of 66
104+waiver program; requiring the Agency for Health Care 67
105+Administration to submit a report to the Governor, the 68
106+President of the Senate, and the Speaker of the House 69
107+of Representatives by a specified date; providing 70
108+effective dates. 71
109+ 72
110+Be It Enacted by the Legislature o f the State of Florida: 73
111+ 74
112+ Section 1. Transfer of operation of the Children's Medical 75
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121121 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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125- (1) Effective July 1, 2025, all statutory powers, duties, 76
126-functions, records, personnel, pending issues, existing 77
127-contracts, administrative authority, administrative rules, and 78
128-unexpended balances of appropriatio ns, allocations, and other 79
129-funds for the operation of the Department of Health's Children's 80
130-Medical Services Managed Care Plan are transferred to the Agency 81
131-for Health Care Administration. 82
132- (2) The transfer of operations of the Children's Medical 83
133-Services Managed Care Plan does not affect the validity of any 84
134-judicial or administrative action pending as of 11:59 p.m. on 85
135-the day before the effective date of the transfer to which the 86
136-Department of Health's Children's Medical Services Managed Care 87
137-Plan is at that time a party, and the Agency for Health Care 88
138-Administration shall be substituted as a party in interest in 89
139-any such action. 90
140- (3) The Department of Health's Children's Medical Services 91
141-program shall collaborate with the Agency for Health Care 92
142-Administration in the care of children and youth with special 93
143-health care needs. The Department of Health's Children's Medical 94
144-Services program shall do all of the following: 95
145- (a) Conduct clinical eligibility screening for children 96
146-and youth with special health ca re needs who are eligible for or 97
147-enrolled in Medicaid or the Children's Health Insurance Program. 98
148- (b) Provide ongoing consultation to the Agency for Health 99
149-Care Administration to ensure high -quality, family-centered, 100
125+Services Managed Care Plan. — 76
126+ (1) Effective July 1, 2025, all statutory powers, duties, 77
127+functions, records, personnel, pending issues, existing 78
128+contracts, administrati ve authority, administrative rules, and 79
129+unexpended balances of appropriations, allocations, and other 80
130+funds for the operation of the Department of Health's Children's 81
131+Medical Services Managed Care Plan are transferred to the Agency 82
132+for Health Care Administ ration. 83
133+ (2) The transfer of operations of the Children's Medical 84
134+Services Managed Care Plan does not affect the validity of any 85
135+judicial or administrative action pending as of 11:59 p.m. on 86
136+the day before the effective date of the transfer to which the 87
137+Department of Health's Children's Medical Services Managed Care 88
138+Plan is at that time a party, and the Agency for Health Care 89
139+Administration shall be substituted as a party in interest in 90
140+any such action. 91
141+ (3) The Department of Health's Children's Medical S ervices 92
142+program shall collaborate with the Agency for Health Care 93
143+Administration in the care of children and youth with special 94
144+health care needs. The Department of Health's Children's Medical 95
145+Services program shall do all of the following: 96
146+ (a) Conduct clinical eligibility screening for children 97
147+and youth with special health care needs who are eligible for or 98
148+enrolled in Medicaid or the Children's Health Insurance Program. 99
149+ (b) Provide ongoing consultation to the Agency for Health 100
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158158 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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162-coordinated health services within an effective system of care 101
163-for children and youth with special health care needs. 102
164- Section 2. Subsection (4) of section 409.974, Florida 103
165-Statutes, is amended to read: 104
166- 409.974 Eligible plans. — 105
167- (4) CHILDREN'S MEDICAL SERVICES NETWORK.— 106
168- (a) The Department of Health's Children's Medical Services 107
169-program shall do all of the following: 108
170- 1. Effective July 1, 2025, transfer to the agency the 109
171-operation of managed care contracts procured by the department 110
172-for Medicaid and Children's Health Insurance Program services 111
173-provided to children and youth with special health care needs 112
174-who are enrolled in the Children's Medical Services Managed Care 113
175-Plan. 114
176- 2. Conduct clinical eligibility screening for children and 115
177-youth with special health care needs who are eligible for or are 116
178-enrolled in Medicaid or the Children's Health Insurance Program. 117
179- 3. Provide ongoing consultation to the agency to ensure 118
180-high-quality, family-centered, coordinated health services are 119
181-provided within an effective system of care for children and 120
182-youth with special health care needs. 121
183- (b) The agency shall establish specific measures of 122
184-access, quality, and costs of providing health care services to 123
185-children and youth with special health care needs. The agency 124
186-shall contract with an independent evaluator to conduct an 125
162+Care Administration to ensure high-quality, family-centered, 101
163+coordinated health services within an effective system of care 102
164+for children and youth with special health care needs. 103
165+ Section 2. Paragraph (d) of subsection (13) of section 104
166+409.906, Florida Statutes, is amended to read: 105
167+ 409.906 Optional Medicaid services. —Subject to specific 106
168+appropriations, the agency may make payments for services which 107
169+are optional to the state under Title XIX of the Social Security 108
170+Act and are furnished by Medicaid providers to recipients who 109
171+are determined to be eligible on the dates on which the services 110
172+were provided. Any optional service that is provided shall be 111
173+provided only when medically necessary and in accordance with 112
174+state and federal law. Optional services rendered by providers 113
175+in mobile units to Medicaid recipients may be restricted or 114
176+prohibited by the agency. Nothing in this section shall be 115
177+construed to prevent or limit the agency from adjusting fees, 116
178+reimbursement rates, lengths of stay, number of visits, or 117
179+number of services, o r making any other adjustments necessary to 118
180+comply with the availability of moneys and any limitations or 119
181+directions provided for in the General Appropriations Act or 120
182+chapter 216. If necessary to safeguard the state's systems of 121
183+providing services to elder ly and disabled persons and subject 122
184+to the notice and review provisions of s. 216.177, the Governor 123
185+may direct the Agency for Health Care Administration to amend 124
186+the Medicaid state plan to delete the optional Medicaid service 125
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195195 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199-evaluation of services provided. The evaluation must include, 126
200-but need not be limited to, all of the following: 127
201- 1. A performance comparison of plans contracted to provide 128
202-services to children and youth with special health care ne eds as 129
203-well as plans contracted to serve a broader population of 130
204-Managed Medical Assistance enrollees. The performance comparison 131
205-must be based on the measures established by the agency and 132
206-differentiated based on the age and medical condition or 133
207-diagnosis of patients receiving services under each plan. 134
208- 2. For each plan, an assessment of cost savings, patient 135
209-choice, access to services, coordination of care, person -136
210-centered planning, health and quality -of-life outcomes, patient 137
211-and provider satisfaction, and provider networks and quality of 138
212-care. 139
213- 140
214-The agency shall submit the results of the evaluation to the 141
215-Governor, the President of the Senate, and the Speaker of the 142
216-House of Representatives by January 15, 2028 Participation by 143
217-the Children's Medical Serv ices Network shall be pursuant to a 144
218-single, statewide contract with the agency that is not subject 145
219-to the procurement requirements or regional plan number limits 146
220-of this section. The Children's Medical Services Network must 147
221-meet all other plan requirements for the managed medical 148
222-assistance program. 149
223- Section 3. Subsection (1) of section 391.016, Florida 150
199+known as "Intermediate Care Fa cilities for the Developmentally 126
200+Disabled." Optional services may include: 127
201+ (13) HOME AND COMMUNITY -BASED SERVICES.— 128
202+ (d) The agency shall seek federal approval to pay for 129
203+flexible services for persons with severe mental illness or 130
204+substance use disorder s, including, but not limited to, 131
205+temporary housing assistance. Payments may be made as enhanced 132
206+capitation rates or incentive payments to managed care plans 133
207+that meet the requirements of s. 409.968(3) s. 409.968(4). 134
208+ Section 3. Subsection (4) of sectio n 409.974, Florida 135
209+Statutes, is amended to read: 136
210+ 409.974 Eligible plans. — 137
211+ (4) CHILDREN'S MEDICAL SERVICES NETWORK.— 138
212+ (a) The Department of Health's Children's Medical Services 139
213+program shall do all of the following: 140
214+ 1. Effective July 1, 2025, transfer to the agency the 141
215+operation of managed care contracts procured by the department 142
216+for Medicaid and Children's Health Insurance Program services 143
217+provided to children and youth with special health care needs 144
218+who are enrolled in the Children's Medical Services Managed Care 145
219+Plan. 146
220+ 2. Conduct clinical eligibility screening for children and 147
221+youth with special health care needs who are eligible for or are 148
222+enrolled in Medicaid or the Children's Health Insurance Program. 149
223+ 3. Provide ongoing consultation to the agency to ensure 150
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232232 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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236-Statutes, is amended to read: 151
237- 391.016 Purposes and functions. —The Children's Medical 152
238-Services program is established for the following purposes and 153
239-authorized to perform the following functions: 154
240- (1) Provide to children and youth with special health care 155
241-needs a family-centered, comprehensive, and coordinated 156
242-statewide managed system of care that links community -based 157
243-health care with multidisciplinary, regional, and tertiary 158
244-pediatric specialty care. The program shall coordinate and 159
245-maintain a consistent medical home for participating children. 160
246- Section 4. Subsections (1), (2), and (4) of section 161
247-391.021, Florida Statutes, are amended to read: 162
248- 391.021 Definitions.—When used in this act, the term: 163
249- (2)(1) "Children's Medical Services Managed Care Plan 164
250-network" or "plan network" means a statewide managed care 165
251-service system that includes health care providers, as defined 166
252-in this section. 167
253- (1)(2) "Children and youth with special health care needs" 168
254-means those children and youth younger than 21 years of age who 169
255-have chronic and serious physical, developmental, behavioral, or 170
256-emotional conditions and who require health care and related 171
257-services of a type or amount beyond that which is generally 172
258-required by children and youth. 173
259- (4) "Eligible individual" means a child or youth with a 174
260-special health care need or a female with a high -risk pregnancy, 175
236+high-quality, family-centered, coordinated health services are 151
237+provided within an effective system of care for children and 152
238+youth with special health care needs. 153
239+ (b) The agency shall establish specific measures of 154
240+access, quality, and costs of providing health care services to 155
241+children and youth with special health care needs. The agency 156
242+shall contract with an independent evaluator to conduct an 157
243+evaluation of services provided. The evaluation must include, 158
244+but need not be limited to, all of the following: 159
245+ 1. A performance comparison of plans contracted to provide 160
246+services to children and youth with special health care needs as 161
247+well as plans contracted to serve a broader population of 162
248+Managed Medical Assistance enrollees. The perform ance comparison 163
249+must be based on the measures established by the agency and 164
250+differentiated based on the age and medical condition or 165
251+diagnosis of patients receiving services under each plan. 166
252+ 2. For each plan, an assessment of cost savings, patient 167
253+choice, access to services, coordination of care, person -168
254+centered planning, health and quality -of-life outcomes, patient 169
255+and provider satisfaction, and provider networks and quality of 170
256+care. 171
257+ 172
258+The agency shall submit the results of the evaluation to the 173
259+Governor, the President of the Senate, and the Speaker of the 174
260+House of Representatives by January 15, 2028 Participation by 175
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269269 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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273-who meets the financial and medical eligibility standards 176
274-established in s. 391.029. 177
275- Section 5. Subsection (1) of section 391.025, Florida 178
276-Statutes, is amended to read: 179
277- 391.025 Applicability and scope. — 180
278- (1) The Children's Medical Services program consists of 181
279-the following components: 182
280- (a) The newborn scr eening program established in s. 383.14 183
281-and the newborn, infant, and toddler hearing screening program 184
282-established in s. 383.145 . 185
283- (b) The regional perinatal intensive care centers program 186
284-established in ss. 383.15 -383.19. 187
285- (c) The developmental evaluation and intervention program, 188
286-including the Early Steps Program established in ss. 391.301 -189
287-391.308. 190
288- (d) The Children's Medical Services Managed Care Plan 191
289-through the end of June 30, 2025 network. 192
290- (e) The Children's Multidi sciplinary Assessment Team. 193
291- (f) The Medical Foster Care Program. 194
292- (g) The Title V Children and Youth with Special Health 195
293-Care Needs program. 196
294- (h) The Safety Net Program. 197
295- (i) Child Protection Teams and sexual abuse treatment 198
296-programs established under s. 39.303. 199
297- (j) The State Child Abuse Death Review Committee and local 200
273+the Children's Medical Services Network shall be pursuant to a 176
274+single, statewide contract with the agency that is not subject 177
275+to the procurement requirements or regional plan number limits 178
276+of this section. The Children's Medical Services Network must 179
277+meet all other plan requirements for the managed medical 180
278+assistance program. 181
279+ Section 4. Subsection (1) of section 391.016, Florida 182
280+Statutes, is amended to read: 183
281+ 391.016 Purposes and functions. —The Children's Medical 184
282+Services program is established for the following purposes and 185
283+authorized to perform the following functions: 186
284+ (1) Provide to children and youth with special health care 187
285+needs a family-centered, comprehensive, and coordinated 188
286+statewide managed system of care that links community -based 189
287+health care with multidisciplinary, regional, and tertiary 190
288+pediatric specialty care. The program shall coordinate and 191
289+maintain a consistent medical h ome for participating children. 192
290+ Section 5. Subsections (1), (2), and (4) of section 193
291+391.021, Florida Statutes, are amended to read: 194
292+ 391.021 Definitions. —When used in this act, the term: 195
293+ (2)(1) "Children's Medical Services Managed Care Plan 196
294+network" or "plan network" means a statewide managed care 197
295+service system that includes health care providers, as defined 198
296+in this section. 199
297+ (1)(2) "Children and youth with special health care needs" 200
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306306 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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310-child abuse death review committees established in s. 383.402. 201
311- Section 6. Section 391.026, Florida Statutes, is amended 202
312-to read: 203
313- 391.026 Powers and duties of the department. —The 204
314-department shall have the following powers, duties, and 205
315-responsibilities: 206
316- (1) To provide or contract for the provision of health 207
317-services to eligible individuals. 208
318- (2) To provide services to abused and neglected children 209
319-through Child Protection Teams pursuant to s. 39.303. 210
320- (3) To determine the medical and financial eligibility of 211
321-individuals seeking health services from the program. 212
322- (4) To coordinate a comprehensive delivery system for 213
323-eligible individuals to take maximum advantage of all available 214
324-funds. 215
325- (5) To coordinate with programs relating to children's 216
326-medical services in cooperation with other public and private 217
327-agencies. 218
328- (6) To initiate and coordinate applications to federal 219
329-agencies and private organizations for funds, services, or 220
330-commodities relating to children's medical programs. 221
331- (7) To sponsor or promote grants for projects, programs, 222
332-education, or research in the field of children and youth with 223
333-special health care needs, with an emphasis on early diagnosis 224
334-and treatment. 225
310+means those children and youth younger than 21 years of age who 201
311+have chronic and serious physical, developmental, behavioral, or 202
312+emotional conditions and who require health care and related 203
313+services of a type or amount beyond that which is generally 204
314+required by children and youth. 205
315+ (4) "Eligible individual" means a child or youth with a 206
316+special health care need or a female with a high -risk pregnancy, 207
317+who meets the financial and medical eligibility standards 208
318+established in s. 391.029. 209
319+ Section 6. Subsection (1) of section 391.025, Florida 210
320+Statutes, is amended to read: 211
321+ 391.025 Applicability and scope. — 212
322+ (1) The Children's Medical Services program consists of 213
323+the following components: 214
324+ (a) The newborn screening program established in s. 383.14 215
325+and the newborn, infant, and toddler hearing screening program 216
326+established in s. 383.145 . 217
327+ (b) The regional perinatal intensive care centers program 218
328+established in ss. 383.15 -383.19. 219
329+ (c) The developmental evaluation and intervention program, 220
330+including the Early Steps Program established in ss. 391.301-221
331+391.308. 222
332+ (d) The Children's Medical Services Managed Care Plan 223
333+through the end of June 30, 2025 network. 224
334+ (e) The Children's Multidisciplinary Assessment Team. 225
335335
336-CS/CS/HB 1085 2025
336+CS/HB 1085 2025
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338338
339339
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343343 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
344344
345345
346346
347- (8) To oversee and operate the Children's Medical Services 226
348-Managed Care Plan through the end of June 30, 2025 network. 227
349- (9) To establish reimbursement mechanisms for the 228
350-Children's Medical Services network. 229
351- (10) To establish Children's Medical Services netw ork 230
352-standards and credentialing requirements for health care 231
353-providers and health care services. 232
354- (11) To serve as a provider and principal case manager for 233
355-children with special health care needs under Titles XIX and XXI 234
356-of the Social Security Act. 235
357- (9)(12) To monitor the provision of health services in the 236
358-program, including the utilization and quality of health 237
359-services. 238
360- (10)(13) To administer the Children and Youth with Special 239
361-Health Care Needs program in accordance with Title V of the 240
362-Social Security Act. 241
363- (14) To establish and operate a grievance resolution 242
364-process for participants and health care providers. 243
365- (15) To maintain program integrity in the Children's 244
366-Medical Services program. 245
367- (11)(16) To receive and manage health care premiums, 246
368-capitation payments, and funds from federal, state, local, and 247
369-private entities for the program. The department may contract 248
370-with a third-party administrator for processing claims, 249
371-monitoring medical expenses, and other related services 250
347+ (f) The Medical Foster Care Program. 226
348+ (g) The Title V Children and Youth wit h Special Health 227
349+Care Needs program. 228
350+ (h) The Safety Net Program. 229
351+ (i) Child Protection Teams and sexual abuse treatment 230
352+programs established under s. 39.303. 231
353+ (j) The State Child Abuse Death Review Committee and local 232
354+child abuse death review committees established in s. 383.402. 233
355+ Section 7. Section 391.026, Florida Statutes, is amended 234
356+to read: 235
357+ 391.026 Powers and duties of the department. —The 236
358+department shall have the following powers, duties, and 237
359+responsibilities: 238
360+ (1) To provide or con tract for the provision of health 239
361+services to eligible individuals. 240
362+ (2) To provide services to abused and neglected children 241
363+through Child Protection Teams pursuant to s. 39.303. 242
364+ (3) To determine the medical and financial eligibility of 243
365+individuals seeking health services from the program. 244
366+ (4) To coordinate a comprehensive delivery system for 245
367+eligible individuals to take maximum advantage of all available 246
368+funds. 247
369+ (5) To coordinate with programs relating to children's 248
370+medical services in cooperation w ith other public and private 249
371+agencies. 250
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380380 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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384-necessary to the effici ent and cost-effective operation of the 251
385-Children's Medical Services Managed Care Plan through the end of 252
386-June 30, 2025 network. The department is authorized to maintain 253
387-a minimum reserve for the Children's Medical Services network in 254
388-an amount that is the greater of: 255
389- (a) Ten percent of total projected expenditures for Title 256
390-XIX-funded and Title XXI -funded children; or 257
391- (b) Two percent of total annualized payments from the 258
392-Agency for Health Care Administration for Title XIX and Title 259
393-XXI of the Social Sec urity Act. 260
394- (12)(17) To provide or contract for peer review and other 261
395-quality-improvement activities. 262
396- (13)(18) To adopt rules pursuant to ss. 120.536(1) and 263
397-120.54 to administer the Children's Medical Services Act. 264
398- (14)(19) To serve as the lead agency in administering the 265
399-Early Steps Program pursuant to part C of the federal 266
400-Individuals with Disabilities Education Act and part III of this 267
401-chapter. 268
402- (15) To administer the Medical Foster Care Program, 269
403-including all of the following: 270
404- (a) Recruitment, training, assessment, and monitoring for 271
405-the Medical Foster Care Program. 272
406- (b) Monitoring access and facilitating admissions of 273
407-eligible children and youth to the program and designated 274
408-medical foster care homes. 275
384+ (6) To initiate and coordinate applications to federal 251
385+agencies and private organizations for funds, services, or 252
386+commodities relating to children's medical programs. 253
387+ (7) To sponsor or promote grants for projects, programs, 254
388+education, or research in the field of children and youth with 255
389+special health care needs, with an emphasis on early diagnosis 256
390+and treatment. 257
391+ (8) To oversee and operate the Children's Medical Services 258
392+Managed Care Plan through the end of June 3 0, 2025 network. 259
393+ (9) To establish reimbursement mechanisms for the 260
394+Children's Medical Services network. 261
395+ (10) To establish Children's Medical Services network 262
396+standards and credentialing requirements for health care 263
397+providers and health care services. 264
398+ (11) To serve as a provider and principal case manager for 265
399+children with special health care needs under Titles XIX and XXI 266
400+of the Social Security Act. 267
401+ (9)(12) To monitor the provision of health services in the 268
402+program, including the utilization and qua lity of health 269
403+services. 270
404+ (10)(13) To administer the Children and Youth with Special 271
405+Health Care Needs program in accordance with Title V of the 272
406+Social Security Act. 273
407+ (14) To establish and operate a grievance resolution 274
408+process for participants and healt h care providers. 275
409409
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417417 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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421- (c) Coordination with the Department of C hildren and 276
422-Families and the Agency for Health Care Administration or their 277
423-designees. 278
424- Section 7. Effective July, 1, 2025, subsections (8) 279
425-through (11) of section 391.026, Florida Statutes, as amended by 280
426-this act, are repealed. 281
427- Section 8. Effective July 1, 2025, section 391.028, 282
428-Florida Statutes, is repealed. 283
429- Section 9. Subsections (2) and (3) of section 391.029, 284
430-Florida Statutes, are amended to read: 285
431- 391.029 Program eligibility. — 286
432- (2) The following individuals are eligible to receive 287
433-services through the program: 288
434- (a) Related to the regional perinatal intensive care 289
435-centers, a high-risk pregnant female who is enrolled in 290
436-Medicaid. 291
437- (b) Children and youth with serious special health care 292
438-needs from birth to 21 years of age who are enr olled in 293
439-Medicaid. 294
440- (c) Children and youth with serious special health care 295
441-needs from birth to 19 years of age who are enrolled in a 296
442-program under Title XXI of the Social Security Act. 297
443- (3) Subject to the availability of funds, the following 298
444-individuals may receive services through the Children's Medical 299
445-Services Safety Net program: 300
421+ (15) To maintain program integrity in the Children's 276
422+Medical Services program. 277
423+ (11)(16) To receive and manage health care premiums, 278
424+capitation payments, and funds from federal, state, local, and 279
425+private entities for the program. The d epartment may contract 280
426+with a third-party administrator for processing claims, 281
427+monitoring medical expenses, and other related services 282
428+necessary to the efficient and cost -effective operation of the 283
429+Children's Medical Services Managed Care Plan through the end of 284
430+June 30, 2025 network. The department is authorized to maintain 285
431+a minimum reserve for the Children's Medical Services network in 286
432+an amount that is the greater of: 287
433+ (a) Ten percent of total projected expenditures for Title 288
434+XIX-funded and Title XXI -funded children; or 289
435+ (b) Two percent of total annualized payments from the 290
436+Agency for Health Care Administration for Title XIX and Title 291
437+XXI of the Social Security Act . 292
438+ (12)(17) To provide or contract for peer review and other 293
439+quality-improvement activities. 294
440+ (13)(18) To adopt rules pursuant to ss. 120.536(1) and 295
441+120.54 to administer the Children's Medical Services Act. 296
442+ (14)(19) To serve as the lead agency in administering the 297
443+Early Steps Program pursuant to part C of the federal 298
444+Individuals with Disab ilities Education Act and part III of this 299
445+chapter. 300
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454454 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
455455
456456
457457
458- (a) Children and youth with serious special health care 301
459-needs from birth to 21 years of age who do not qualify for 302
460-Medicaid or Title XXI of the Social Security Act but who are 303
461-unable to access, due to lack of providers or lack of financial 304
462-resources, specialized services that are medically necessary or 305
463-essential family support services. Families shall participate 306
464-financially in the cost of care based on a sliding fee scale 307
465-established by the department. 308
466- (b) Children and youth with special health care needs from 309
467-birth to 21 years of age, as provided in Title V of the Social 310
468-Security Act. 311
469- (c) An infant who receives an award of compensation under 312
470-s. 766.31(1). The Florida Birth-Related Neurological Injury 313
471-Compensation Association shall reimburse the Children's Medical 314
472-Services Network the state's share of funding, which must 315
473-thereafter be used to obtain matching federal funds under Title 316
474-XXI of the Social Security Act. 317
475- Section 10. Section 391.0315, Florida Statutes, is amended 318
476-to read: 319
477- 391.0315 Benefits.—Benefits provided under the Children's 320
478-Medical Services Managed Care Plan program for children with 321
479-special health care needs shall be equivalent to benefits 322
480-provided to children as specified in ss. 409.905 and 409.906. 323
481-The department may offer additional benefits through Children's 324
482-Medical Services programs for early intervention services, 325
458+ (15) To administer the Medical Foster Care Program, 301
459+including all of the following: 302
460+ (a) Recruitment, training, assessment, and monitoring for 303
461+the Medical Foster Care Program. 304
462+ (b) Monitoring access a nd facilitating admissions of 305
463+eligible children and youth to the program and designated 306
464+medical foster care homes. 307
465+ (c) Coordination with the Department of Children and 308
466+Families and the Agency for Health Care Administration or their 309
467+designees. 310
468+ Section 8. Effective July, 1, 2025, subsections (8) 311
469+through (11) of section 391.026, Florida Statutes, as amended by 312
470+this act, are repealed. 313
471+ Section 9. Effective July 1, 2025, section 391.028, 314
472+Florida Statutes, is repealed. 315
473+ Section 10. Subsections (2) and (3) of section 391.029, 316
474+Florida Statutes, are amended to read: 317
475+ 391.029 Program eligibility. — 318
476+ (2) The following individuals are eligible to receive 319
477+services through the program: 320
478+ (a) Related to the regional perinatal intensive care 321
479+centers, a high-risk pregnant female who is enrolled in 322
480+Medicaid. 323
481+ (b) Children and youth with serious special health care 324
482+needs from birth to 21 years of age who are enrolled in 325
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491491 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
492492
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495-respite services, genetic testing, genetic and nutritional 326
496-counseling, and parent support services, if such services are 327
497-determined to be medically necessary. This section is repealed 328
498-on January 1, 2026. 329
499- Section 11. Section 391.035, Florida Statutes, is 330
500-repealed. 331
501- Section 12. Effective January 1, 2026, section 391.037, 332
502-Florida Statutes, is repealed. 333
503- Section 13. Section 391.045, Florida Statutes, is 334
504-repealed. 335
505- Section 14. Effective January 1, 2026, section 391.047, 336
506-Florida Statutes, is repealed. 337
507- Section 15. Effective January 1, 2026, section 391.055, 338
508-Florida Statutes, is repealed. 339
509- Section 16. Effective January 1, 2026, section 391.071, 340
510-Florida Statutes, is repealed. 341
511- Section 17. Section 391.097, Florida Statutes, is amended 342
512-to read: 343
513- 391.097 Research and evaluation. — 344
514- (1) The department may initiate, fund, and co nduct 345
515-research and evaluation projects to improve the delivery of 346
516-children's medical services. The department may cooperate with 347
517-public and private agencies engaged in work of a similar nature. 348
518- (2) The Children's Medical Services network shall be 349
519-included in any evaluation conducted in accordance with the 350
495+Medicaid. 326
496+ (c) Children and youth with serious special health care 327
497+needs from birth to 19 year s of age who are enrolled in a 328
498+program under Title XXI of the Social Security Act. 329
499+ (3) Subject to the availability of funds, the following 330
500+individuals may receive services through the Children's Medical 331
501+Services Safety Net program: 332
502+ (a) Children and youth with serious special health care 333
503+needs from birth to 21 years of age who do not qualify for 334
504+Medicaid or Title XXI of the Social Security Act but who are 335
505+unable to access, due to lack of providers or lack of financial 336
506+resources, specialized services that are medically necessary or 337
507+essential family support services. Families shall participate 338
508+financially in the cost of care based on a sliding fee scale 339
509+established by the department. 340
510+ (b) Children and youth with special health care needs from 341
511+birth to 21 years of age, as provided in Title V of the Social 342
512+Security Act. 343
513+ (c) An infant who receives an award of compensation under 344
514+s. 766.31(1). The Florida Birth-Related Neurological Injury 345
515+Compensation Association shall reimburse the Children's Medical 346
516+Services Network the state's share of funding, which must 347
517+thereafter be used to obtain matching federal funds under Title 348
518+XXI of the Social Security Act. 349
519+ Section 11. Section 391.0315, Florida Statutes, is amended 350
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528528 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
529529
530530
531531
532-provisions of Title XXI of the Social Security Act as enacted by 351
533-the Legislature. 352
534- Section 18. Part II of chapter 391, Florida Statutes, 353
535-consisting of ss. 391.221 and 391.223, Florida Statutes, is 354
536-repealed, and part III of that chapter is redesignated as part 355
537-II. 356
538- Section 19. Effective July 1, 2025, paragraph (b) of 357
539-subsection (5) of section 409.166, Florida Statutes, is amended 358
540-to read: 359
541- 409.166 Children within the child welfare system; adoption 360
542-assistance program.— 361
543- (5) ELIGIBILITY FOR SERVICES. — 362
544- (b) A child who is handicapped at the time of adoption is 363
545-shall be eligible for services through a plan under contract 364
546-with the agency to serve children and youth with special heath 365
547-care needs the Children's Medical Services network established 366
548-under part I of chapter 391 if the child was eligible for such 367
549-services before prior to the adoption. 368
550- Section 20. Effective July 1, 2025, subsection (7) of 369
551-section 409.811, Florida Statutes, is amended to read: 370
552- 409.811 Definitions relating to Florida Kidcare Act. —As 371
553-used in ss. 409.810-409.821, the term: 372
554- (7) "Children's Medical Services Network" or "network" 373
555-means a statewide managed care service system as defined in s. 374
556-391.021(1). 375
532+to read: 351
533+ 391.0315 Benefits.—Benefits provided under the Children's 352
534+Medical Services Managed Care Plan program for children with 353
535+special health care needs shall be equivalent to benefits 354
536+provided to children as specified in ss. 409.905 and 409.906. 355
537+The department may offer additional benefits through Children's 356
538+Medical Services programs for early intervention services, 357
539+respite services, genetic testing, genetic and nutritional 358
540+counseling, and parent support services, if such services are 359
541+determined to be medically necessary. This section is repealed 360
542+on January 1, 2026. 361
543+ Section 12. Section 391.035, Florida Statutes, is 362
544+repealed. 363
545+ Section 13. Effective January 1, 2026, section 391.037, 364
546+Florida Statutes, is repealed. 365
547+ Section 14. Section 391.045, Florida Statutes, is 366
548+repealed. 367
549+ Section 15. Effective January 1, 2026, section 391.047, 368
550+Florida Statutes, is repealed. 369
551+ Section 16. Effective January 1, 2026, section 391.055, 370
552+Florida Statutes, is repealed. 371
553+ Section 17. Effective January 1, 2026, section 391.071, 372
554+Florida Statutes, is repealed. 373
555+ Section 18. Section 391.097, Florida Statutes, is amended 374
556+to read: 375
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565565 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
566566
567567
568568
569- Section 21. Effective July 1, 2025, subsection (1) of 376
570-section 409.813, Florida Statutes, is amended to read: 377
571- 409.813 Health benefits coverage; program components; 378
572-entitlement and nonentitlement. — 379
573- (1) The Florida Kidcare program includes health benefits 380
574-coverage provided to children through the following program 381
575-components, which shall be marketed as the Florida Kidcare 382
576-program: 383
577- (a) Medicaid; 384
578- (b) Medikids as created in s. 409.8132; 385
579- (c) The Florida Healthy Kids Corporation as created in s. 386
580-624.91; 387
581- (d) Employer-sponsored group health insurance plans 388
582-approved under ss. 409.810 -409.821; and 389
583- (e) Plans under contract with the agency to serve children 390
584-and youth with special health care needs The Children's Medical 391
585-Services network established in chapter 391 . 392
586- Section 22. Effective July 1, 2025, subsection (3) of 393
587-section 409.8134, Florida Statutes, is amended to read: 394
588- 409.8134 Program expenditure ceiling; enrollment. — 395
589- (3) Upon determination by the Social Services Estimating 396
590-Conference that there are insuffi cient funds to finance the 397
591-current enrollment in the Florida Kidcare program within current 398
592-appropriations, the program shall initiate disenrollment 399
593-procedures to remove enrollees, except those children enrolled 400
569+ 391.097 Research and evaluation. — 376
570+ (1) The department may initiate, fund, and conduct 377
571+research and evaluation projects to improve the delivery of 378
572+children's medical services. The depar tment may cooperate with 379
573+public and private agencies engaged in work of a similar nature. 380
574+ (2) The Children's Medical Services network shall be 381
575+included in any evaluation conducted in accordance with the 382
576+provisions of Title XXI of the Social Security Act as enacted by 383
577+the Legislature. 384
578+ Section 19. Part II of chapter 391, Florida Statutes, 385
579+consisting of ss. 391.221 and 391.223, Florida Statutes, is 386
580+repealed, and part III of that chapter is redesignated as part 387
581+II. 388
582+ Section 20. Effective July 1, 2025, paragraph (b) of 389
583+subsection (5) of section 409.166, Florida Statutes, is amended 390
584+to read: 391
585+ 409.166 Children within the child welfare system; adoption 392
586+assistance program.— 393
587+ (5) ELIGIBILITY FOR SERVICES. — 394
588+ (b) A child who is handicapped at the time of ado ption is 395
589+shall be eligible for services through a plan under contract 396
590+with the agency to serve children and youth with special heath 397
591+care needs the Children's Medical Services network established 398
592+under part I of chapter 391 if the child was eligible for such 399
593+services before prior to the adoption. 400
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602602 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
603603
604604
605605
606-in a plan under contract with the agency to serve children with 401
607-special health care needs the Children's Medical Services 402
608-Network, on a last-in, first-out basis until the expenditure and 403
609-appropriation levels are balanced. 404
610- Section 23. Subsection (3) and paragraph (c) of subsection 405
611-(10) of section 409.814, Florida Statutes, are amended to read: 406
612- 409.814 Eligibility. —A child who has not reached 19 years 407
613-of age whose family income is equal to or below 300 percent of 408
614-the federal poverty level is eligible for the Florida Kidcare 409
615-program as provided in this section. If an enrolled individual 410
616-is determined to be ineligible for coverage, he or she must be 411
617-immediately disenrolled from the respective Florida Kidcare 412
618-program component. 413
619- (3) A Title XXI-funded child who is eligible for the 414
620-Florida Kidcare program who is a child with special health care 415
621-needs, as determined through a medical or behavioral screening 416
622-instrument, is eligible for health benefits coverage from and 417
623-shall be assigned to and may opt out of a plan under contract 418
624-with the agency to serv e children with special health care needs 419
625-the Children's Medical Services Network . 420
626- (10) In determining the eligibility of a child, an assets 421
627-test is not required. If eligibility for the Florida Kidcare 422
628-program cannot be verified using reliable data sourc es in 423
629-accordance with federal requirements, each applicant shall 424
630-provide documentation during the application process and the 425
606+ Section 21. Effective July 1, 2025, subsection (7) of 401
607+section 409.811, Florida Statutes, is amended to read: 402
608+ 409.811 Definitions relating to Florida Kidcare Act. —As 403
609+used in ss. 409.810-409.821, the term: 404
610+ (7) "Children's Medical Services Network" or "network" 405
611+means a statewide managed care service system as defined in s. 406
612+391.021(1). 407
613+ Section 22. Effective July 1, 2025, subsection (1) of 408
614+section 409.813, Florida Statutes, is amended to read: 409
615+ 409.813 Health benefits coverage; program components; 410
616+entitlement and nonentitlement. — 411
617+ (1) The Florida Kidcare program includes health benefits 412
618+coverage provided to children through the following program 413
619+components, which shall be m arketed as the Florida Kidcare 414
620+program: 415
621+ (a) Medicaid; 416
622+ (b) Medikids as created in s. 409.8132; 417
623+ (c) The Florida Healthy Kids Corporation as created in s. 418
624+624.91; 419
625+ (d) Employer-sponsored group health insurance plans 420
626+approved under ss. 409.810 -409.821; and 421
627+ (e) Plans under contract with the agency to serve children 422
628+and youth with special health care needs The Children's Medical 423
629+Services network established in chapter 391 . 424
630+ Section 23. Effective July 1, 2025, subsection (3) of 425
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639639 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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643-redetermination process, including, but not limited to, the 426
644-following: 427
645- (c) To enroll in a plan under contract with the agency to 428
646-service children with special health care needs the Children's 429
647-Medical Services Network , a completed application, including a 430
648-Children's Medical Services clinical screening. 431
649- Section 24. Effective July 1, 2025, paragraph (t) of 432
650-subsection (2) of sectio n 409.815, Florida Statutes, is amended 433
651-to read: 434
652- 409.815 Health benefits coverage; limitations. — 435
653- (2) BENCHMARK BENEFITS. —In order for health benefits 436
654-coverage to qualify for premium assistance payments for an 437
655-eligible child under ss. 409.810 -409.821, the health benefits 438
656-coverage, except for coverage under Medicaid and Medikids, must 439
657-include the following minimum benefits, as medically necessary. 440
658- (t) Enhancements to minimum requirements. — 441
659- 1. This section sets the minimum benefits that must be 442
660-included in any health benefits coverage, other than Medicaid or 443
661-Medikids coverage, offered under ss. 409.810 -409.821. Health 444
662-benefits coverage may include additional benefits not included 445
663-under this subsection, but may not include benefits excluded 446
664-under paragraph (r). 447
665- 2. Health benefits coverage may extend any limitations 448
666-beyond the minimum benefits described in this section. 449
667- 450
643+section 409.8134, Florid a Statutes, is amended to read: 426
644+ 409.8134 Program expenditure ceiling; enrollment. — 427
645+ (3) Upon determination by the Social Services Estimating 428
646+Conference that there are insufficient funds to finance the 429
647+current enrollment in the Florida Kidcare program wi thin current 430
648+appropriations, the program shall initiate disenrollment 431
649+procedures to remove enrollees, except those children enrolled 432
650+in a plan under contract with the agency to serve children with 433
651+special health care needs the Children's Medical Services 434
652+Network, on a last-in, first-out basis until the expenditure and 435
653+appropriation levels are balanced. 436
654+ Section 24. Subsection (3) and paragraph (c) of subsection 437
655+(10) of section 409.814, Florida Statutes, are amended to read: 438
656+ 409.814 Eligibility. —A child who has not reached 19 years 439
657+of age whose family income is equal to or below 300 percent of 440
658+the federal poverty level is eligible for the Florida Kidcare 441
659+program as provided in this section. If an enrolled individual 442
660+is determined to be ineligible for cov erage, he or she must be 443
661+immediately disenrolled from the respective Florida Kidcare 444
662+program component. 445
663+ (3) A Title XXI-funded child who is eligible for the 446
664+Florida Kidcare program who is a child with special health care 447
665+needs, as determined through a me dical or behavioral screening 448
666+instrument, is eligible for health benefits coverage from and 449
667+shall be assigned to and may opt out of a plan under contract 450
668668
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676676 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
677677
678678
679679
680-Except for a plan under contract with the agency to serve 451
681-children with special health care needs the Children's Medical 452
682-Services Network, the agency may not increase the premium 453
683-assistance payment for either additional benefits provided 454
684-beyond the minimum benefits described in this section or the 455
685-imposition of less restrictive service limitations. 456
686- Section 25. Effective July 1, 2025, paragraph (i) of 457
687-subsection (1) of section 409.8177, Florida Statutes, is amended 458
688-to read: 459
689- 409.8177 Program evaluation. — 460
690- (1) The agency, in consultation with the Department of 461
691-Health, the Department of Children and Families, and the Florida 462
692-Healthy Kids Corporation, shall contract for an evaluation of 463
693-the Florida Kidcare program and shall by January 1 of each year 464
694-submit to the Governor, the President of the Senate, and the 465
695-Speaker of the House of Representatives a report of the program. 466
696-In addition to the items specified under s. 2108 of Title XXI of 467
697-the Social Security Act, the report shall include an assessment 468
698-of crowd-out and access to health care, as well as the 469
699-following: 470
700- (i) An assessment of the effectiveness of the Florida 471
701-Kidcare program, inc luding Medicaid, the Florida Healthy Kids 472
702-program, Medikids, and the plans under contract with the agency 473
703-to serve children with special health care needs Children's 474
704-Medical Services network , and other public and private programs 475
680+with the agency to serve children with special health care needs 451
681+the Children's Medical Services Netwo rk. 452
682+ (10) In determining the eligibility of a child, an assets 453
683+test is not required. If eligibility for the Florida Kidcare 454
684+program cannot be verified using reliable data sources in 455
685+accordance with federal requirements, each applicant shall 456
686+provide documentation during the application process and the 457
687+redetermination process, including, but not limited to, the 458
688+following: 459
689+ (c) To enroll in a plan under contract with the agency to 460
690+service children with special health care needs the Children's 461
691+Medical Services Network, a completed application, including a 462
692+Children's Medical Services clinical screening. 463
693+ Section 25. Effective July 1, 2025, paragraph (t) of 464
694+subsection (2) of section 409.815, Florida Statutes, is amended 465
695+to read: 466
696+ 409.815 Health benefits cove rage; limitations.— 467
697+ (2) BENCHMARK BENEFITS. —In order for health benefits 468
698+coverage to qualify for premium assistance payments for an 469
699+eligible child under ss. 409.810 -409.821, the health benefits 470
700+coverage, except for coverage under Medicaid and Medikids, m ust 471
701+include the following minimum benefits, as medically necessary. 472
702+ (t) Enhancements to minimum requirements. — 473
703+ 1. This section sets the minimum benefits that must be 474
704+included in any health benefits coverage, other than Medicaid or 475
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713713 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
714714
715715
716716
717-in the state in increasing the availability of affordable 476
718-quality health insurance and health care for children. 477
719- Section 26. Effective July 1, 2025, subsection (4) of 478
720-section 409.818, Florida Statutes, is amended to read: 479
721- 409.818 Administration. —In order to implement ss. 409. 810-480
722-409.821, the following agencies shall have the following duties: 481
723- (4) The Office of Insurance Regulation shall certify that 482
724-health benefits coverage plans that seek to provide services 483
725-under the Florida Kidcare program, except those offered through 484
726-the Florida Healthy Kids Corporation or the Children's Medical 485
727-Services Network, meet, exceed, or are actuarially equivalent to 486
728-the benchmark benefit plan and that health insurance plans will 487
729-be offered at an approved rate. In determining actuarial 488
730-equivalence of benefits coverage, the Office of Insurance 489
731-Regulation and health insurance plans must comply with the 490
732-requirements of s. 2103 of Title XXI of the Social Security Act. 491
733-The department shall adopt rules necessary for certifying health 492
734-benefits coverage plans. 493
735- Section 27. Effective July 1, 2025, subsection (11) of 494
736-section 409.912, Florida Statutes, is amended to read: 495
737- 409.912 Cost-effective purchasing of health care. —The 496
738-agency shall purchase goods and services for Medicaid recipients 497
739-in the most cost-effective manner consistent with the delivery 498
740-of quality medical ca re. To ensure that medical services are 499
741-effectively utilized, the agency may, in any case, require a 500
717+Medikids coverage, of fered under ss. 409.810 -409.821. Health 476
718+benefits coverage may include additional benefits not included 477
719+under this subsection, but may not include benefits excluded 478
720+under paragraph (r). 479
721+ 2. Health benefits coverage may extend any limitations 480
722+beyond the minimum benefits described in this section. 481
723+ 482
724+Except for a plan under contract with the agency to serve 483
725+children with special health care needs the Children's Medical 484
726+Services Network, the agency may not increase the premium 485
727+assistance payment for either addit ional benefits provided 486
728+beyond the minimum benefits described in this section or the 487
729+imposition of less restrictive service limitations. 488
730+ Section 26. Effective July 1, 2025, paragraph (i) of 489
731+subsection (1) of section 409.8177, Florida Statutes, is amend ed 490
732+to read: 491
733+ 409.8177 Program evaluation. — 492
734+ (1) The agency, in consultation with the Department of 493
735+Health, the Department of Children and Families, and the Florida 494
736+Healthy Kids Corporation, shall contract for an evaluation of 495
737+the Florida Kidcare program and shall by January 1 of each year 496
738+submit to the Governor, the President of the Senate, and the 497
739+Speaker of the House of Representatives a report of the program. 498
740+In addition to the items specified under s. 2108 of Title XXI of 499
741+the Social Security Act, the report shall include an assessment 500
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750750 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
751751
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753753
754-confirmation or second physician's opinion of the correct 501
755-diagnosis for purposes of authorizing future services under the 502
756-Medicaid program. This section do es not restrict access to 503
757-emergency services or poststabilization care services as defined 504
758-in 42 C.F.R. s. 438.114. Such confirmation or second opinion 505
759-shall be rendered in a manner approved by the agency. The agency 506
760-shall maximize the use of prepaid per c apita and prepaid 507
761-aggregate fixed-sum basis services when appropriate and other 508
762-alternative service delivery and reimbursement methodologies, 509
763-including competitive bidding pursuant to s. 287.057, designed 510
764-to facilitate the cost -effective purchase of a case -managed 511
765-continuum of care. The agency shall also require providers to 512
766-minimize the exposure of recipients to the need for acute 513
767-inpatient, custodial, and other institutional care and the 514
768-inappropriate or unnecessary use of high -cost services. The 515
769-agency shall contract with a vendor to monitor and evaluate the 516
770-clinical practice patterns of providers in order to identify 517
771-trends that are outside the normal practice patterns of a 518
772-provider's professional peers or the national guidelines of a 519
773-provider's professional association. The vendor must be able to 520
774-provide information and counseling to a provider whose practice 521
775-patterns are outside the norms, in consultation with the agency, 522
776-to improve patient care and reduce inappropriate utilization. 523
777-The agency may manda te prior authorization, drug therapy 524
778-management, or disease management participation for certain 525
754+of crowd-out and access to health care, as well as the 501
755+following: 502
756+ (i) An assessment of the effectiveness of the Florida 503
757+Kidcare program, including Medicaid, the Florida Healthy Kids 504
758+program, Medikids, and the plans under contract with the agency 505
759+to serve children with special health care needs Children's 506
760+Medical Services network , and other public and private programs 507
761+in the state in increasing the availability of affordable 508
762+quality health insurance and health care fo r children. 509
763+ Section 27. Effective July 1, 2025, subsection (4) of 510
764+section 409.818, Florida Statutes, is amended to read: 511
765+ 409.818 Administration. —In order to implement ss. 409.810 -512
766+409.821, the following agencies shall have the following duties: 513
767+ (4) The Office of Insurance Regulation shall certify that 514
768+health benefits coverage plans that seek to provide services 515
769+under the Florida Kidcare program, except those offered through 516
770+the Florida Healthy Kids Corporation or the Children's Medical 517
771+Services Network, meet, exceed, or are actuarially equivalent to 518
772+the benchmark benefit plan and that health insurance plans will 519
773+be offered at an approved rate. In determining actuarial 520
774+equivalence of benefits coverage, the Office of Insurance 521
775+Regulation and health insu rance plans must comply with the 522
776+requirements of s. 2103 of Title XXI of the Social Security Act. 523
777+The department shall adopt rules necessary for certifying health 524
778+benefits coverage plans. 525
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787787 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
788788
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790790
791-populations of Medicaid beneficiaries, certain drug classes, or 526
792-particular drugs to prevent fraud, abuse, overuse, and possible 527
793-dangerous drug interactions. Th e Pharmaceutical and Therapeutics 528
794-Committee shall make recommendations to the agency on drugs for 529
795-which prior authorization is required. The agency shall inform 530
796-the Pharmaceutical and Therapeutics Committee of its decisions 531
797-regarding drugs subject to prior authorization. The agency is 532
798-authorized to limit the entities it contracts with or enrolls as 533
799-Medicaid providers by developing a provider network through 534
800-provider credentialing. The agency may competitively bid single -535
801-source-provider contracts if procurem ent of goods or services 536
802-results in demonstrated cost savings to the state without 537
803-limiting access to care. The agency may limit its network based 538
804-on the assessment of beneficiary access to care, provider 539
805-availability, provider quality standards, time and distance 540
806-standards for access to care, the cultural competence of the 541
807-provider network, demographic characteristics of Medicaid 542
808-beneficiaries, practice and provider -to-beneficiary standards, 543
809-appointment wait times, beneficiary use of services, provider 544
810-turnover, provider profiling, provider licensure history, 545
811-previous program integrity investigations and findings, peer 546
812-review, provider Medicaid policy and billing compliance records, 547
813-clinical and medical record audits, and other factors. Providers 548
814-are not entitled to enrollment in the Medicaid provider network. 549
815-The agency shall determine instances in which allowing Medicaid 550
791+ Section 28. Effective July 1, 2025, subsection (11) of 526
792+section 409.912, Florida Statutes, is amended to read: 527
793+ 409.912 Cost-effective purchasing of health care. —The 528
794+agency shall purchase goods and services for Medicaid recipients 529
795+in the most cost-effective manner consistent with the delivery 530
796+of quality medical care. T o ensure that medical services are 531
797+effectively utilized, the agency may, in any case, require a 532
798+confirmation or second physician's opinion of the correct 533
799+diagnosis for purposes of authorizing future services under the 534
800+Medicaid program. This section does no t restrict access to 535
801+emergency services or poststabilization care services as defined 536
802+in 42 C.F.R. s. 438.114. Such confirmation or second opinion 537
803+shall be rendered in a manner approved by the agency. The agency 538
804+shall maximize the use of prepaid per capita and prepaid 539
805+aggregate fixed-sum basis services when appropriate and other 540
806+alternative service delivery and reimbursement methodologies, 541
807+including competitive bidding pursuant to s. 287.057, designed 542
808+to facilitate the cost -effective purchase of a case -managed 543
809+continuum of care. The agency shall also require providers to 544
810+minimize the exposure of recipients to the need for acute 545
811+inpatient, custodial, and other institutional care and the 546
812+inappropriate or unnecessary use of high -cost services. The 547
813+agency shall contract with a vendor to monitor and evaluate the 548
814+clinical practice patterns of providers in order to identify 549
815+trends that are outside the normal practice patterns of a 550
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824824 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
825825
826826
827827
828-beneficiaries to purchase durable medical equipment and other 551
829-goods is less expensive to the Medicaid program than long -term 552
830-rental of the equipment or goods. The agency may establish rules 553
831-to facilitate purchases in lieu of long -term rentals in order to 554
832-protect against fraud and abuse in the Medicaid program as 555
833-defined in s. 409.913. The agency may seek federal waivers 556
834-necessary to adminis ter these policies. 557
835- (11) The agency shall implement a program of all -inclusive 558
836-care for children. The program of all -inclusive care for 559
837-children shall be established to provide in -home hospice-like 560
838-support services to children diagnosed with a life -threatening 561
839-illness and enrolled in the Children's Medical Services network 562
840-to reduce hospitalizations as appropriate. The agency, in 563
841-consultation with the Department of Health, may implement the 564
842-program of all-inclusive care for children after obtaining 565
843-approval from the Centers for Medicare and Medicaid Services. 566
844- Section 28. Effective July 1, 2025, subsection (1) of 567
845-section 409.9126, Florida Statutes, is amended to read: 568
846- 409.9126 Children with special health care needs. — 569
847- (1) Except as provided in subse ction (4), children 570
848-eligible for the Children's Medical Services program who receive 571
849-Medicaid benefits, and other Medicaid -eligible children with 572
850-special health care needs, are shall be exempt from the 573
851-provisions of s. 409.9122 and shall be served through the 574
852-Children's Medical Services network established in chapter 391 . 575
828+provider's professional peers or the national guidelines of a 551
829+provider's professional association. The vendor must be able to 552
830+provide information and counseling to a provider whose practice 553
831+patterns are outside the norms, in consultation with the agency, 554
832+to improve patient care and reduce inappropriate utilization. 555
833+The agency may mandate pr ior authorization, drug therapy 556
834+management, or disease management participation for certain 557
835+populations of Medicaid beneficiaries, certain drug classes, or 558
836+particular drugs to prevent fraud, abuse, overuse, and possible 559
837+dangerous drug interactions. The Pha rmaceutical and Therapeutics 560
838+Committee shall make recommendations to the agency on drugs for 561
839+which prior authorization is required. The agency shall inform 562
840+the Pharmaceutical and Therapeutics Committee of its decisions 563
841+regarding drugs subject to prior auth orization. The agency is 564
842+authorized to limit the entities it contracts with or enrolls as 565
843+Medicaid providers by developing a provider network through 566
844+provider credentialing. The agency may competitively bid single -567
845+source-provider contracts if procurement o f goods or services 568
846+results in demonstrated cost savings to the state without 569
847+limiting access to care. The agency may limit its network based 570
848+on the assessment of beneficiary access to care, provider 571
849+availability, provider quality standards, time and dista nce 572
850+standards for access to care, the cultural competence of the 573
851+provider network, demographic characteristics of Medicaid 574
852+beneficiaries, practice and provider -to-beneficiary standards, 575
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861861 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
862862
863863
864864
865- Section 29. Effective July 1, 2025, paragraph (a) of 576
866-subsection (5) of section 409.9131, Florida Statutes, is amended 577
867-to read: 578
868- 409.9131 Special provisions relating to integrity of the 579
869-Medicaid program.— 580
870- (5) DETERMINATIONS OF OVERPAYMENT. —In making a 581
871-determination of overpayment to a physician, the agency must: 582
872- (a) Use accepted and valid auditing, accounting, 583
873-analytical, statistical, or peer -review methods, or combinations 584
874-thereof. Appropriate statistical methods may include, but are 585
875-not limited to, sampling and extension to the population, 586
876-parametric and nonparametric statistics, tests of hypotheses, 587
877-other generally accepted statistical methods, review of medical 588
878-records, and a consideration of the physician's client case mix. 589
879-Before performing a review of the physician's Medicaid records, 590
880-however, the agency shall make every effort to consider the 591
881-physician's patient case mix, including, but not limited to, 592
882-patient age and whether individual patients are clients of the 593
883-Children's Medical Services Network established in chapter 391 . 594
884-In meeting its burden of proof in any administrative or court 595
885-proceeding, the agency may introduce the results of such 596
886-statistical methods and its othe r audit findings as evidence of 597
887-overpayment. 598
888- Section 30. Effective July 1, 2025, paragraph (e) of 599
889-subsection (1) of section 409.920, Florida Statutes, is amended 600
865+appointment wait times, beneficiary use of services, provider 576
866+turnover, provider profiling, provider licensure history, 577
867+previous program integrity investigations and findings, peer 578
868+review, provider Medicaid policy and billing compliance records, 579
869+clinical and medical record audits, and other factors. Providers 580
870+are not entitled to enrollment in the Medicaid provider network. 581
871+The agency shall determine instances in which allowing Medicaid 582
872+beneficiaries to purchase durable medical equipment and other 583
873+goods is less expensive to the Medicaid program than long -term 584
874+rental of the equipment or goods. The agency may establish rules 585
875+to facilitate purchases in lieu of long -term rentals in order to 586
876+protect against fraud and abuse in the Medicaid program as 587
877+defined in s. 409.913. The agency may seek federal waivers 588
878+necessary to administer t hese policies. 589
879+ (11) The agency shall implement a program of all -inclusive 590
880+care for children. The program of all -inclusive care for 591
881+children shall be established to provide in -home hospice-like 592
882+support services to children diagnosed with a life -threatening 593
883+illness and enrolled in the Children's Medical Services network 594
884+to reduce hospitalizations as appropriate. The agency, in 595
885+consultation with the Department of Health, may implement the 596
886+program of all-inclusive care for children after obtaining 597
887+approval from the Centers for Medicare and Medicaid Services. 598
888+ Section 29. Effective July 1, 2025, subsection (1) of 599
889+section 409.9126, Florida Statutes, is amended to read: 600
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898898 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
899899
900900
901901
902-to read: 601
903- 409.920 Medicaid provider fraud. — 602
904- (1) For the purposes of this section, the t erm: 603
905- (e) "Managed care plans" means a health insurer authorized 604
906-under chapter 624, an exclusive provider organization authorized 605
907-under chapter 627, a health maintenance organization authorized 606
908-under chapter 641, the Children's Medical Services Network 607
909-authorized under chapter 391 , a prepaid health plan authorized 608
910-under this chapter, a provider service network authorized under 609
911-this chapter, a minority physician network authorized under this 610
912-chapter, and an emergency department diversion program 611
913-authorized under this chapter or the General Appropriations Act, 612
914-providing health care services pursuant to a contract with the 613
915-Medicaid program. 614
916- Section 31. Effective July 1, 2025, subsection (7) of 615
917-section 409.962, Florida Statutes, is amended to read: 616
918- 409.962 Definitions.—As used in this part, except as 617
919-otherwise specifically provided, the term: 618
920- (7) "Eligible plan" means a health insurer authorized 619
921-under chapter 624, an exclusive provider organization authorized 620
922-under chapter 627, a health maintenance organ ization authorized 621
923-under chapter 641, or a provider service network authorized 622
924-under s. 409.912(1) or an accountable care organization 623
925-authorized under federal law. For purposes of the managed 624
926-medical assistance program, the term also includes the 625
902+ 409.9126 Children with special health care needs. — 601
903+ (1) Except as provided in subsection (4), children 602
904+eligible for the Children's Medical Services program who receive 603
905+Medicaid benefits, and other Medicaid -eligible children with 604
906+special health care needs, are shall be exempt from the 605
907+provisions of s. 409.9122 and shall be served through the 606
908+Children's Medical Services network established in chapter 391 . 607
909+ Section 30. Effective July 1, 2025, paragraph (a) of 608
910+subsection (5) of section 409.9131, Florida Statutes, is amended 609
911+to read: 610
912+ 409.9131 Special provisions relating to integrity of the 611
913+Medicaid program.— 612
914+ (5) DETERMINATIONS OF OVERPAYMENT. —In making a 613
915+determination of overpayment to a physician, the agency must: 614
916+ (a) Use accepted and valid auditing, accounting, 615
917+analytical, statistical, or peer -review methods, or combinations 616
918+thereof. Appropriate statistical methods may include, but are 617
919+not limited to, sampling and extension to the population, 618
920+parametric and nonparametric statistics, tests of hypotheses, 619
921+other generally accepted statistical methods, review of medical 620
922+records, and a conside ration of the physician's client case mix. 621
923+Before performing a review of the physician's Medicaid records, 622
924+however, the agency shall make every effort to consider the 623
925+physician's patient case mix, including, but not limited to, 624
926+patient age and whether individual patients are clients of the 625
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935935 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
936936
937937
938938
939-Children's Medical Services Network authorized under chapter 391 626
940-and entities qualified under 42 C.F.R. part 422 as Medicare 627
941-Advantage Preferred Provider Organizations, Medicare Advantage 628
942-Provider-sponsored Organizations, Medicare Advantage Health 629
943-Maintenance Organizations, Medicare Advantage Coordinated Care 630
944-Plans, and Medicare Advantage Special Needs Plans, and the 631
945-Program of All-inclusive Care for the Elderly. 632
946- Section 32. The Agency for Health Care Administration 633
947-shall develop a comprehensive plan to redesig n the Florida 634
948-Medicaid Model Waiver for home and community -based services to 635
949-include children who receive private duty nursing services. The 636
950-plan must propose an array of tiered services with the goal of 637
951-ensuring that institutional care is avoided so child ren can 638
952-remain in the home or other community setting. The agency must 639
953-work with stakeholders in developing the plan, including, but 640
954-not limited to, families of children who are in the model waiver 641
955-or receiving private duty nursing, advocates for children, 642
956-providers of services to children receiving private duty 643
957-nursing, and Statewide Medicaid Managed Care plans. The agency 644
958-is authorized to contract with necessary experts to assist in 645
959-developing the plan. The agency must submit a report to the 646
960-Governor, the President of the Senate, and the Speaker of the 647
961-House of Representatives by September 30, 2025, addressing, at a 648
962-minimum, all of the following: 649
963- (1) The purpose, rationale, and expected benefits of the 650
939+Children's Medical Services Network established in chapter 391 . 626
940+In meeting its burden of proof in any administrative or court 627
941+proceeding, the agency may introduce the results of such 628
942+statistical methods and its other audi t findings as evidence of 629
943+overpayment. 630
944+ Section 31. Effective July 1, 2025, paragraph (e) of 631
945+subsection (1) of section 409.920, Florida Statutes, is amended 632
946+to read: 633
947+ 409.920 Medicaid provider fraud. — 634
948+ (1) For the purposes of this section, the term: 635
949+ (e) "Managed care plans" means a health insurer authorized 636
950+under chapter 624, an exclusive provider organization authorized 637
951+under chapter 627, a health maintenance organization authorized 638
952+under chapter 641, the Children's Medical Services Network 639
953+authorized under chapter 391 , a prepaid health plan authorized 640
954+under this chapter, a provider service network authorized under 641
955+this chapter, a minority physician network authorized under this 642
956+chapter, and an emergency department diversion program 643
957+authorized under this chapter or the General Appropriations Act, 644
958+providing health care services pursuant to a contract with the 645
959+Medicaid program. 646
960+ Section 32. Effective July 1, 2025, subsection (7) of 647
961+section 409.962, Florida Statutes, is amended to read: 648
962+ 409.962 Definitions.—As used in this part, except as 649
963+otherwise specifically provided, the term: 650
964964
965-CS/CS/HB 1085 2025
965+CS/HB 1085 2025
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967967
968968
969969 CODING: Words stricken are deletions; words underlined are additions.
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972972 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
973973
974974
975975
976-redesigned waiver plan. 651
977- (2) The proposed eligibili ty criteria for clients and 652
978-service benefit packages to be offered through the redesigned 653
979-waiver plan. Managed care plans participating in the Statewide 654
980-Medicaid Managed Care program must provide services under the 655
981-redesigned waiver plan. 656
982- (3) A proposed implementation plan and timeline, 657
983-including, but not limited to, recommendations for the number of 658
984-clients served by the redesigned waiver plan at initial 659
985-implementation, changes over time, and any per -client benefit 660
986-caps. 661
987- (4) The fiscal impact for the i mplementation year and 662
988-projections for the next 5 years determined on an actuarially 663
989-sound basis. 664
990- (5) An analysis of the availability of services and 665
991-service providers that would be offered under the redesigned 666
992-waiver plan and recommendations to increase availability of such 667
993-services, as applicable. 668
994- (6) A list of all stakeholders, public and private, who 669
995-were consulted or contacted the development of the plan. 670
996- Section 33. Except as otherwise expressly provided in this 671
997-act, this act shall take effect upon becoming a law. 672
976+ (7) "Eligible plan" means a health insurer authorized 651
977+under chapter 624, an exclusive provider organization authorized 652
978+under chapter 627, a health maintenance organizatio n authorized 653
979+under chapter 641, or a provider service network authorized 654
980+under s. 409.912(1) or an accountable care organization 655
981+authorized under federal law. For purposes of the managed 656
982+medical assistance program, the term also includes the 657
983+Children's Medical Services Network authorized under chapter 391 658
984+and entities qualified under 42 C.F.R. part 422 as Medicare 659
985+Advantage Preferred Provider Organizations, Medicare Advantage 660
986+Provider-sponsored Organizations, Medicare Advantage Health 661
987+Maintenance Organizati ons, Medicare Advantage Coordinated Care 662
988+Plans, and Medicare Advantage Special Needs Plans, and the 663
989+Program of All-inclusive Care for the Elderly. 664
990+ Section 33. Subsection (3) of section 409.968, Florida 665
991+Statutes, is amended to read: 666
992+ 409.968 Managed care plan payments.— 667
993+ (3) Reimbursement for prescribed pediatric extended care 668
994+services provided to children enrolled in a managed care plan 669
995+under s. 409.972(1)(g) shall be paid to the prescribed pediatric 670
996+extended care services provider by the agency on a fee-for-671
997+service basis. 672
998+ Section 34. Paragraph (g) of subsection (1) of section 673
999+409.972, Florida Statutes, is amended to read: 674
1000+ 409.972 Mandatory and voluntary enrollment. — 675
1001+
1002+CS/HB 1085 2025
1003+
1004+
1005+
1006+CODING: Words stricken are deletions; words underlined are additions.
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1009+F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
1010+
1011+
1012+
1013+ (1) The following Medicaid -eligible persons are exempt 676
1014+from mandatory managed care enrollment required by s. 409.965, 677
1015+and may voluntarily choose to participate in the managed medical 678
1016+assistance program: 679
1017+ (g) Children receiving services in a prescribed pediatric 680
1018+extended care center. 681
1019+ Section 35. The Agency for Health Care Admini stration 682
1020+shall develop a comprehensive plan to redesign the Florida 683
1021+Medicaid Model Waiver for home and community -based services to 684
1022+include children who receive private duty nursing services. The 685
1023+plan must propose an array of tiered services with the goal o f 686
1024+ensuring that institutional care is avoided so children can 687
1025+remain in the home or other community setting. The agency must 688
1026+work with stakeholders in developing the plan, including, but 689
1027+not limited to, families of children who are in the model waiver 690
1028+or receiving private duty nursing, advocates for children, 691
1029+providers of services to children receiving private duty 692
1030+nursing, and Statewide Medicaid Managed Care plans. The agency 693
1031+is authorized to contract with necessary experts to assist in 694
1032+developing the plan. The agency must submit a report to the 695
1033+Governor, the President of the Senate, and the Speaker of the 696
1034+House of Representatives by September 30, 2025, addressing, at a 697
1035+minimum, all of the following: 698
1036+ (1) The purpose, rationale, and expected benefits of the 699
1037+redesigned waiver plan. 700
1038+
1039+CS/HB 1085 2025
1040+
1041+
1042+
1043+CODING: Words stricken are deletions; words underlined are additions.
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1045+Page 29 of 29
1046+F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
1047+
1048+
1049+
1050+ (2) The proposed eligibility criteria for clients and 701
1051+service benefit packages to be offered through the redesigned 702
1052+waiver plan. Managed care plans participating in the Statewide 703
1053+Medicaid Managed Care program must provide serv ices under the 704
1054+redesigned waiver plan. 705
1055+ (3) A proposed implementation plan and timeline, 706
1056+including, but not limited to, recommendations for the number of 707
1057+clients served by the redesigned waiver plan at initial 708
1058+implementation, changes over time, and any pe r-client benefit 709
1059+caps. 710
1060+ (4) The fiscal impact for the implementation year and 711
1061+projections for the next 5 years determined on an actuarially 712
1062+sound basis. 713
1063+ (5) An analysis of the availability of services and 714
1064+service providers that would be offered under th e redesigned 715
1065+waiver plan and recommendations to increase availability of such 716
1066+services, as applicable. 717
1067+ (6) A list of all stakeholders, public and private, who 718
1068+were consulted or contacted the development of the plan. 719
1069+ Section 36. Except as otherwise ex pressly provided in this 720
1070+act, this act shall take effect upon becoming a law. 721