Bill Text: FL S0694 | 2017 | Regular Session | Comm Sub
Bill Title: Consolidation of Medicaid Waiver Programs
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Failed) 2017-05-05 - Died in Appropriations Subcommittee on Health and Human Services, companion bill(s) passed, see SB 2514 (Ch. 2017-129) [S0694 Detail]
Download: Florida-2017-S0694-Comm_Sub.html
Florida Senate - 2017 CS for SB 694 By the Committee on Health Policy; and Senators Hutson and Passidomo 588-02954-17 2017694c1 1 A bill to be entitled 2 An act relating to consolidation of Medicaid waiver 3 programs; amending s. 409.904, F.S.; authorizing any 4 state agency or department involved in providing 5 health, social, or human services to make payments for 6 medical assistance for certain persons diagnosed with 7 Acquired Immune Deficiency Syndrome (AIDS); amending 8 s. 409.906, F.S.; removing the Agency for Health Care 9 Administration’s ability to consolidate certain home 10 and community-based services; amending s. 409.912, 11 F.S.; deleting the requirement that the agency 12 implement a Medicaid prescription drug management 13 system; amending s. 409.979, F.S.; requiring that 14 Medicaid recipients enrolled in certain home and 15 community-based service Medicaid waivers be 16 transitioned into the long-term care managed care 17 program by January 1, 2018; requiring the agency to 18 seek federal approval to terminate certain waiver 19 programs once all eligible Medicaid recipients have 20 transitioned into the long-term care managed care 21 program; amending ss. 393.0661 and 409.968, F.S.; 22 conforming cross-references; providing an effective 23 date. 24 25 Be It Enacted by the Legislature of the State of Florida: 26 27 Section 1. Subsection (11) is added to section 409.904, 28 Florida Statutes, to read: 29 409.904 Optional payments for eligible persons.—The agency 30 may make payments for medical assistance and related services on 31 behalf of the following persons who are determined to be 32 eligible subject to the income, assets, and categorical 33 eligibility tests set forth in federal and state law. Payment on 34 behalf of these Medicaid eligible persons is subject to the 35 availability of moneys and any limitations established by the 36 General Appropriations Act or chapter 216. 37 (11) Subject to federal waiver approval, a person diagnosed 38 with Acquired Immune Deficiency Syndrome (AIDS), who has an 39 AIDS-related opportunistic infection, who is at risk of 40 hospitalization as determined by the agency or its designee, and 41 whose income is at, or below, 300 percent of the federal benefit 42 rate. 43 Section 2. Paragraph (b) of subsection (13) of section 44 409.906, Florida Statutes, is amended to read: 45 409.906 Optional Medicaid services.—Subject to specific 46 appropriations, the agency may make payments for services which 47 are optional to the state under Title XIX of the Social Security 48 Act and are furnished by Medicaid providers to recipients who 49 are determined to be eligible on the dates on which the services 50 were provided. Any optional service that is provided shall be 51 provided only when medically necessary and in accordance with 52 state and federal law. Optional services rendered by providers 53 in mobile units to Medicaid recipients may be restricted or 54 prohibited by the agency. Nothing in this section shall be 55 construed to prevent or limit the agency from adjusting fees, 56 reimbursement rates, lengths of stay, number of visits, or 57 number of services, or making any other adjustments necessary to 58 comply with the availability of moneys and any limitations or 59 directions provided for in the General Appropriations Act or 60 chapter 216. If necessary to safeguard the state’s systems of 61 providing services to elderly and disabled persons and subject 62 to the notice and review provisions of s. 216.177, the Governor 63 may direct the Agency for Health Care Administration to amend 64 the Medicaid state plan to delete the optional Medicaid service 65 known as “Intermediate Care Facilities for the Developmentally 66 Disabled.” Optional services may include: 67 (13) HOME AND COMMUNITY-BASED SERVICES.— 68(b) The agency may consolidate types of services offered in69the Aged and Disabled Waiver, the Channeling Waiver, the Project70AIDS Care Waiver, and the Traumatic Brain and Spinal Cord Injury71Waiver programs in order to group similar services under a72single service, or continue a service upon evidence of the need73for including a particular service type in a particular waiver.74The agency is authorized to seek a Medicaid state plan amendment75or federal waiver approval to implement this policy.76 Section 3. Paragraph (a) of subsection (8) of section 77 409.912, Florida Statutes, is amended to read: 78 409.912 Cost-effective purchasing of health care.—The 79 agency shall purchase goods and services for Medicaid recipients 80 in the most cost-effective manner consistent with the delivery 81 of quality medical care. To ensure that medical services are 82 effectively utilized, the agency may, in any case, require a 83 confirmation or second physician’s opinion of the correct 84 diagnosis for purposes of authorizing future services under the 85 Medicaid program. This section does not restrict access to 86 emergency services or poststabilization care services as defined 87 in 42 C.F.R. s. 438.114. Such confirmation or second opinion 88 shall be rendered in a manner approved by the agency. The agency 89 shall maximize the use of prepaid per capita and prepaid 90 aggregate fixed-sum basis services when appropriate and other 91 alternative service delivery and reimbursement methodologies, 92 including competitive bidding pursuant to s. 287.057, designed 93 to facilitate the cost-effective purchase of a case-managed 94 continuum of care. The agency shall also require providers to 95 minimize the exposure of recipients to the need for acute 96 inpatient, custodial, and other institutional care and the 97 inappropriate or unnecessary use of high-cost services. The 98 agency shall contract with a vendor to monitor and evaluate the 99 clinical practice patterns of providers in order to identify 100 trends that are outside the normal practice patterns of a 101 provider’s professional peers or the national guidelines of a 102 provider’s professional association. The vendor must be able to 103 provide information and counseling to a provider whose practice 104 patterns are outside the norms, in consultation with the agency, 105 to improve patient care and reduce inappropriate utilization. 106 The agency may mandate prior authorization, drug therapy 107 management, or disease management participation for certain 108 populations of Medicaid beneficiaries, certain drug classes, or 109 particular drugs to prevent fraud, abuse, overuse, and possible 110 dangerous drug interactions. The Pharmaceutical and Therapeutics 111 Committee shall make recommendations to the agency on drugs for 112 which prior authorization is required. The agency shall inform 113 the Pharmaceutical and Therapeutics Committee of its decisions 114 regarding drugs subject to prior authorization. The agency is 115 authorized to limit the entities it contracts with or enrolls as 116 Medicaid providers by developing a provider network through 117 provider credentialing. The agency may competitively bid single 118 source-provider contracts if procurement of goods or services 119 results in demonstrated cost savings to the state without 120 limiting access to care. The agency may limit its network based 121 on the assessment of beneficiary access to care, provider 122 availability, provider quality standards, time and distance 123 standards for access to care, the cultural competence of the 124 provider network, demographic characteristics of Medicaid 125 beneficiaries, practice and provider-to-beneficiary standards, 126 appointment wait times, beneficiary use of services, provider 127 turnover, provider profiling, provider licensure history, 128 previous program integrity investigations and findings, peer 129 review, provider Medicaid policy and billing compliance records, 130 clinical and medical record audits, and other factors. Providers 131 are not entitled to enrollment in the Medicaid provider network. 132 The agency shall determine instances in which allowing Medicaid 133 beneficiaries to purchase durable medical equipment and other 134 goods is less expensive to the Medicaid program than long-term 135 rental of the equipment or goods. The agency may establish rules 136 to facilitate purchases in lieu of long-term rentals in order to 137 protect against fraud and abuse in the Medicaid program as 138 defined in s. 409.913. The agency may seek federal waivers 139 necessary to administer these policies. 140 (8)(a) The agency shall implement a Medicaid prescribed 141 drug spending-control program that includes the following 142 components: 143 1. A Medicaid preferred drug list, which shall be a listing 144 of cost-effective therapeutic options recommended by the 145 Medicaid Pharmacy and Therapeutics Committee established 146 pursuant to s. 409.91195 and adopted by the agency for each 147 therapeutic class on the preferred drug list. At the discretion 148 of the committee, and when feasible, the preferred drug list 149 should include at least two products in a therapeutic class. The 150 agency may post the preferred drug list and updates to the list 151 on an Internet website without following the rulemaking 152 procedures of chapter 120. Antiretroviral agents are excluded 153 from the preferred drug list. The agency shall also limit the 154 amount of a prescribed drug dispensed to no more than a 34-day 155 supply unless the drug products’ smallest marketed package is 156 greater than a 34-day supply, or the drug is determined by the 157 agency to be a maintenance drug in which case a 100-day maximum 158 supply may be authorized. The agency may seek any federal 159 waivers necessary to implement these cost-control programs and 160 to continue participation in the federal Medicaid rebate 161 program, or alternatively to negotiate state-only manufacturer 162 rebates. The agency may adopt rules to administer this 163 subparagraph. The agency shall continue to provide unlimited 164 contraceptive drugs and items. The agency must establish 165 procedures to ensure that: 166 a. There is a response to a request for prior consultation 167 by telephone or other telecommunication device within 24 hours 168 after receipt of a request for prior consultation; and 169 b. A 72-hour supply of the drug prescribed is provided in 170 an emergency or when the agency does not provide a response 171 within 24 hours as required by sub-subparagraph a. 172 2. Reimbursement to pharmacies for Medicaid prescribed 173 drugs shall be set at the lowest of: the average wholesale price 174 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC) 175 plus 1.5 percent, the federal upper limit (FUL), the state 176 maximum allowable cost (SMAC), or the usual and customary (UAC) 177 charge billed by the provider. 178 3. The agency shall develop and implement a process for 179 managing the drug therapies of Medicaid recipients who are using 180 significant numbers of prescribed drugs each month. The 181 management process may include, but is not limited to, 182 comprehensive, physician-directed medical-record reviews, claims 183 analyses, and case evaluations to determine the medical 184 necessity and appropriateness of a patient’s treatment plan and 185 drug therapies. The agency may contract with a private 186 organization to provide drug-program-management services. The 187 Medicaid drug benefit management program shall include 188 initiatives to manage drug therapies for HIV/AIDS patients, 189 patients using 20 or more unique prescriptions in a 180-day 190 period, and the top 1,000 patients in annual spending. The 191 agency shall enroll any Medicaid recipient in the drug benefit 192 management program if he or she meets the specifications of this 193 provision and is not enrolled in a Medicaid health maintenance 194 organization. 195 4. The agency may limit the size of its pharmacy network 196 based on need, competitive bidding, price negotiations, 197 credentialing, or similar criteria. The agency shall give 198 special consideration to rural areas in determining the size and 199 location of pharmacies included in the Medicaid pharmacy 200 network. A pharmacy credentialing process may include criteria 201 such as a pharmacy’s full-service status, location, size, 202 patient educational programs, patient consultation, disease 203 management services, and other characteristics. The agency may 204 impose a moratorium on Medicaid pharmacy enrollment if it is 205 determined that it has a sufficient number of Medicaid 206 participating providers. The agency must allow dispensing 207 practitioners to participate as a part of the Medicaid pharmacy 208 network regardless of the practitioner’s proximity to any other 209 entity that is dispensing prescription drugs under the Medicaid 210 program. A dispensing practitioner must meet all credentialing 211 requirements applicable to his or her practice, as determined by 212 the agency. 213 5. The agency shall develop and implement a program that 214 requires Medicaid practitioners who prescribe drugs to use a 215 counterfeit-proof prescription pad for Medicaid prescriptions. 216 The agency shall require the use of standardized counterfeit 217 proof prescription pads by Medicaid-participating prescribers or 218 prescribers who write prescriptions for Medicaid recipients. The 219 agency may implement the program in targeted geographic areas or 220 statewide. 221 6. The agency may enter into arrangements that require 222 manufacturers of generic drugs prescribed to Medicaid recipients 223 to provide rebates of at least 15.1 percent of the average 224 manufacturer price for the manufacturer’s generic products. 225 These arrangements shall require that if a generic-drug 226 manufacturer pays federal rebates for Medicaid-reimbursed drugs 227 at a level below 15.1 percent, the manufacturer must provide a 228 supplemental rebate to the state in an amount necessary to 229 achieve a 15.1-percent rebate level. 230 7. The agency may establish a preferred drug list as 231 described in this subsection, and, pursuant to the establishment 232 of such preferred drug list, negotiate supplemental rebates from 233 manufacturers that are in addition to those required by Title 234 XIX of the Social Security Act and at no less than 14 percent of 235 the average manufacturer price as defined in 42 U.S.C. s. 1936 236 on the last day of a quarter unless the federal or supplemental 237 rebate, or both, equals or exceeds 29 percent. There is no upper 238 limit on the supplemental rebates the agency may negotiate. The 239 agency may determine that specific products, brand-name or 240 generic, are competitive at lower rebate percentages. Agreement 241 to pay the minimum supplemental rebate percentage guarantees a 242 manufacturer that the Medicaid Pharmaceutical and Therapeutics 243 Committee will consider a product for inclusion on the preferred 244 drug list. However, a pharmaceutical manufacturer is not 245 guaranteed placement on the preferred drug list by simply paying 246 the minimum supplemental rebate. Agency decisions will be made 247 on the clinical efficacy of a drug and recommendations of the 248 Medicaid Pharmaceutical and Therapeutics Committee, as well as 249 the price of competing products minus federal and state rebates. 250 The agency may contract with an outside agency or contractor to 251 conduct negotiations for supplemental rebates. For the purposes 252 of this section, the term “supplemental rebates” means cash 253 rebates. Value-added programs as a substitution for supplemental 254 rebates are prohibited. The agency may seek any federal waivers 255 to implement this initiative. 256 8. The agency shall expand home delivery of pharmacy 257 products. The agency may amend the state plan and issue a 258 procurement, as necessary, in order to implement this program. 259 The procurements must include agreements with a pharmacy or 260 pharmacies located in the state to provide mail order delivery 261 services at no cost to the recipients who elect to receive home 262 delivery of pharmacy products. The procurement must focus on 263 serving recipients with chronic diseases for which pharmacy 264 expenditures represent a significant portion of Medicaid 265 pharmacy expenditures or which impact a significant portion of 266 the Medicaid population. The agency may seek and implement any 267 federal waivers necessary to implement this subparagraph. 268 9. The agency shall limit to one dose per month any drug 269 prescribed to treat erectile dysfunction. 270 10.a. The agency may implement a Medicaid behavioral drug 271 management system. The agency may contract with a vendor that 272 has experience in operating behavioral drug management systems 273 to implement this program. The agency may seek federal waivers 274 to implement this program. 275 b. The agency, in conjunction with the Department of 276 Children and Families, may implement the Medicaid behavioral 277 drug management system that is designed to improve the quality 278 of care and behavioral health prescribing practices based on 279 best practice guidelines, improve patient adherence to 280 medication plans, reduce clinical risk, and lower prescribed 281 drug costs and the rate of inappropriate spending on Medicaid 282 behavioral drugs. The program may include the following 283 elements: 284 (I) Provide for the development and adoption of best 285 practice guidelines for behavioral health-related drugs such as 286 antipsychotics, antidepressants, and medications for treating 287 bipolar disorders and other behavioral conditions; translate 288 them into practice; review behavioral health prescribers and 289 compare their prescribing patterns to a number of indicators 290 that are based on national standards; and determine deviations 291 from best practice guidelines. 292 (II) Implement processes for providing feedback to and 293 educating prescribers using best practice educational materials 294 and peer-to-peer consultation. 295 (III) Assess Medicaid beneficiaries who are outliers in 296 their use of behavioral health drugs with regard to the numbers 297 and types of drugs taken, drug dosages, combination drug 298 therapies, and other indicators of improper use of behavioral 299 health drugs. 300 (IV) Alert prescribers to patients who fail to refill 301 prescriptions in a timely fashion, are prescribed multiple same 302 class behavioral health drugs, and may have other potential 303 medication problems. 304 (V) Track spending trends for behavioral health drugs and 305 deviation from best practice guidelines. 306 (VI) Use educational and technological approaches to 307 promote best practices, educate consumers, and train prescribers 308 in the use of practice guidelines. 309 (VII) Disseminate electronic and published materials. 310 (VIII) Hold statewide and regional conferences. 311 (IX) Implement a disease management program with a model 312 quality-based medication component for severely mentally ill 313 individuals and emotionally disturbed children who are high 314 users of care. 31511. The agency shall implement a Medicaid prescription drug316management system.317a. The agency may contract with a vendor that has318experience in operating prescription drug management systems in319order to implement this system. Any management system that is320implemented in accordance with this subparagraph must rely on321cooperation between physicians and pharmacists to determine322appropriate practice patterns and clinical guidelines to improve323the prescribing, dispensing, and use of drugs in the Medicaid324program. The agency may seek federal waivers to implement this325program.326b. The drug management system must be designed to improve327the quality of care and prescribing practices based on best328practice guidelines, improve patient adherence to medication329plans, reduce clinical risk, and lower prescribed drug costs and330the rate of inappropriate spending on Medicaid prescription331drugs. The program must:332(I) Provide for the adoption of best practice guidelines333for the prescribing and use of drugs in the Medicaid program,334including translating best practice guidelines into practice;335reviewing prescriber patterns and comparing them to indicators336that are based on national standards and practice patterns of337clinical peers in their community, statewide, and nationally;338and determine deviations from best practice guidelines.339(II) Implement processes for providing feedback to and340educating prescribers using best practice educational materials341and peer-to-peer consultation.342(III) Assess Medicaid recipients who are outliers in their343use of a single or multiple prescription drugs with regard to344the numbers and types of drugs taken, drug dosages, combination345drug therapies, and other indicators of improper use of346prescription drugs.347(IV) Alert prescribers to recipients who fail to refill348prescriptions in a timely fashion, are prescribed multiple drugs349that may be redundant or contraindicated, or may have other350potential medication problems.351 11.12.The agency may contract for drug rebate 352 administration, including, but not limited to, calculating 353 rebate amounts, invoicing manufacturers, negotiating disputes 354 with manufacturers, and maintaining a database of rebate 355 collections. 356 12.13.The agency may specify the preferred daily dosing 357 form or strength for the purpose of promoting best practices 358 with regard to the prescribing of certain drugs as specified in 359 the General Appropriations Act and ensuring cost-effective 360 prescribing practices. 361 13.14.The agency may require prior authorization for 362 Medicaid-covered prescribed drugs. The agency may prior 363 authorize the use of a product: 364 a. For an indication not approved in labeling; 365 b. To comply with certain clinical guidelines; or 366 c. If the product has the potential for overuse, misuse, or 367 abuse. 368 369 The agency may require the prescribing professional to provide 370 information about the rationale and supporting medical evidence 371 for the use of a drug. The agency shall post prior 372 authorization, step-edit criteria and protocol, and updates to 373 the list of drugs that are subject to prior authorization on the 374 agency’s Internet website within 21 days after the prior 375 authorization and step-edit criteria and protocol and updates 376 are approved by the agency. For purposes of this subparagraph, 377 the term “step-edit” means an automatic electronic review of 378 certain medications subject to prior authorization. 379 14.15.The agency, in conjunction with the Pharmaceutical 380 and Therapeutics Committee, may require age-related prior 381 authorizations for certain prescribed drugs. The agency may 382 preauthorize the use of a drug for a recipient who may not meet 383 the age requirement or may exceed the length of therapy for use 384 of this product as recommended by the manufacturer and approved 385 by the Food and Drug Administration. Prior authorization may 386 require the prescribing professional to provide information 387 about the rationale and supporting medical evidence for the use 388 of a drug. 389 15.16.The agency shall implement a step-therapy prior 390 authorization approval process for medications excluded from the 391 preferred drug list. Medications listed on the preferred drug 392 list must be used within the previous 12 months before the 393 alternative medications that are not listed. The step-therapy 394 prior authorization may require the prescriber to use the 395 medications of a similar drug class or for a similar medical 396 indication unless contraindicated in the Food and Drug 397 Administration labeling. The trial period between the specified 398 steps may vary according to the medical indication. The step 399 therapy approval process shall be developed in accordance with 400 the committee as stated in s. 409.91195(7) and (8). A drug 401 product may be approved without meeting the step-therapy prior 402 authorization criteria if the prescribing physician provides the 403 agency with additional written medical or clinical documentation 404 that the product is medically necessary because: 405 a. There is not a drug on the preferred drug list to treat 406 the disease or medical condition which is an acceptable clinical 407 alternative; 408 b. The alternatives have been ineffective in the treatment 409 of the beneficiary’s disease; or 410 c. Based on historic evidence and known characteristics of 411 the patient and the drug, the drug is likely to be ineffective, 412 or the number of doses have been ineffective. 413 414 The agency shall work with the physician to determine the best 415 alternative for the patient. The agency may adopt rules waiving 416 the requirements for written clinical documentation for specific 417 drugs in limited clinical situations. 418 16.17.The agency shall implement a return and reuse 419 program for drugs dispensed by pharmacies to institutional 420 recipients, which includes payment of a $5 restocking fee for 421 the implementation and operation of the program. The return and 422 reuse program shall be implemented electronically and in a 423 manner that promotes efficiency. The program must permit a 424 pharmacy to exclude drugs from the program if it is not 425 practical or cost-effective for the drug to be included and must 426 provide for the return to inventory of drugs that cannot be 427 credited or returned in a cost-effective manner. The agency 428 shall determine if the program has reduced the amount of 429 Medicaid prescription drugs thatwhichare destroyed on an 430 annual basis and if there are additional ways to ensure more 431 prescription drugs are not destroyed which could safely be 432 reused. 433 Section 4. Subsections (1) and (2) of section 409.979, 434 Florida Statutes, are amended to read: 435 409.979 Eligibility.— 436 (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid 437 recipients who meet all of the following criteria are eligible 438 to receive long-term care services and must receive long-term 439 care services by participating in the long-term care managed 440 care program. The recipient must be: 441 (a) Sixty-five years of age or older, or age 18 or older 442 and eligible for Medicaid by reason of a disability. 443 (b) Determined by the Comprehensive Assessment Review and 444 Evaluation for Long-Term Care Services (CARES) preadmission 445 screening program to require nursing facility care as defined in 446 s. 409.985(3) or, in the case of individuals diagnosed with 447 cystic fibrosis, determined by the CARES program to require 448 hospital-level of care. 449 (2) ENROLLMENT OFFERS.— 450 (a) Subject to the availability of funds, the Department of 451 Elderly Affairs shall make offers for enrollment to eligible 452 individuals based on a wait-list prioritization. Before making 453 enrollment offers, the agency and the Department of Elderly 454 Affairs shall determine that sufficient funds exist to support 455 additional enrollment into plans. 456 (b) Medicaid recipients enrolled in one of the following 457 home and community-based service Medicaid waivers are eligible 458 to participate in the long-term care managed care program when 459 all eligibility criteria requirements established in paragraph 460 (1) of this subsection are met and shall be transitioned into 461 the long-term care managed care program by January 1, 2018: 462 1. Traumatic Brain and Spinal Cord Injury Waiver. 463 2. Adult Cystic Fibrosis Waiver. 464 3. Project AIDS Care Waiver. 465 466 The agency shall seek federal approval to terminate the 467 Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic 468 Fibrosis Waiver, and the Project AIDS Care Waiver after all 469 eligible Medicaid recipients have transitioned into the long 470 term care managed care program. 471 Section 5. Subsection (7) of section 393.0661, Florida 472 Statutes, is amended to read: 473 393.0661 Home and community-based services delivery system; 474 comprehensive redesign.—The Legislature finds that the home and 475 community-based services delivery system for persons with 476 developmental disabilities and the availability of appropriated 477 funds are two of the critical elements in making services 478 available. Therefore, it is the intent of the Legislature that 479 the Agency for Persons with Disabilities shall develop and 480 implement a comprehensive redesign of the system. 481 (7) The agency shall collect premiums or cost sharing 482 pursuant to s. 409.906(13)(c)s. 409.906(13)(d). 483 Section 6. Paragraph (a) of subsection (4) of section 484 409.968, Florida Statutes, is amended to read: 485 409.968 Managed care plan payments.— 486 (4)(a) Subject to a specific appropriation and federal 487 approval under s. 409.906(13)(d)s. 409.906(13)(e), the agency 488 shall establish a payment methodology to fund managed care plans 489 for flexible services for persons with severe mental illness and 490 substance use disorders, including, but not limited to, 491 temporary housing assistance. A managed care plan eligible for 492 these payments must do all of the following: 493 1. Participate as a specialty plan for severe mental 494 illness or substance use disorders or participate in counties 495 designated by the General Appropriations Act; 496 2. Include providers of behavioral health services pursuant 497 to chapters 394 and 397 in the managed care plan’s provider 498 network; and 499 3. Document a capability to provide housing assistance 500 through agreements with housing providers, relationships with 501 local housing coalitions, and other appropriate arrangements. 502 Section 7. This act shall take effect July 1, 2017.