Florida Senate - 2012                          SENATOR AMENDMENT
       Bill No. SB 2002
                                Barcode 913706                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                Floor: 1/AD/2R         .                                
             02/23/2012 03:47 PM       .                                

       Senator Hays moved the following:
    1         Senate Amendment (with title amendment)
    3         Between lines 301 and 302
    4  insert:
    5         Section 10. In order to implement Specific Appropriation
    6  208 of the 2012-2013 General Appropriations Act, subsection (41)
    7  of section 409.912, Florida Statutes, is amended to read:
    8         409.912 Cost-effective purchasing of health care.—The
    9  agency shall purchase goods and services for Medicaid recipients
   10  in the most cost-effective manner consistent with the delivery
   11  of quality medical care. To ensure that medical services are
   12  effectively utilized, the agency may, in any case, require a
   13  confirmation or second physician’s opinion of the correct
   14  diagnosis for purposes of authorizing future services under the
   15  Medicaid program. This section does not restrict access to
   16  emergency services or poststabilization care services as defined
   17  in 42 C.F.R. part 438.114. Such confirmation or second opinion
   18  shall be rendered in a manner approved by the agency. The agency
   19  shall maximize the use of prepaid per capita and prepaid
   20  aggregate fixed-sum basis services when appropriate and other
   21  alternative service delivery and reimbursement methodologies,
   22  including competitive bidding pursuant to s. 287.057, designed
   23  to facilitate the cost-effective purchase of a case-managed
   24  continuum of care. The agency shall also require providers to
   25  minimize the exposure of recipients to the need for acute
   26  inpatient, custodial, and other institutional care and the
   27  inappropriate or unnecessary use of high-cost services. The
   28  agency shall contract with a vendor to monitor and evaluate the
   29  clinical practice patterns of providers in order to identify
   30  trends that are outside the normal practice patterns of a
   31  provider’s professional peers or the national guidelines of a
   32  provider’s professional association. The vendor must be able to
   33  provide information and counseling to a provider whose practice
   34  patterns are outside the norms, in consultation with the agency,
   35  to improve patient care and reduce inappropriate utilization.
   36  The agency may mandate prior authorization, drug therapy
   37  management, or disease management participation for certain
   38  populations of Medicaid beneficiaries, certain drug classes, or
   39  particular drugs to prevent fraud, abuse, overuse, and possible
   40  dangerous drug interactions. The Pharmaceutical and Therapeutics
   41  Committee shall make recommendations to the agency on drugs for
   42  which prior authorization is required. The agency shall inform
   43  the Pharmaceutical and Therapeutics Committee of its decisions
   44  regarding drugs subject to prior authorization. The agency is
   45  authorized to limit the entities it contracts with or enrolls as
   46  Medicaid providers by developing a provider network through
   47  provider credentialing. The agency may competitively bid single
   48  source-provider contracts if procurement of goods or services
   49  results in demonstrated cost savings to the state without
   50  limiting access to care. The agency may limit its network based
   51  on the assessment of beneficiary access to care, provider
   52  availability, provider quality standards, time and distance
   53  standards for access to care, the cultural competence of the
   54  provider network, demographic characteristics of Medicaid
   55  beneficiaries, practice and provider-to-beneficiary standards,
   56  appointment wait times, beneficiary use of services, provider
   57  turnover, provider profiling, provider licensure history,
   58  previous program integrity investigations and findings, peer
   59  review, provider Medicaid policy and billing compliance records,
   60  clinical and medical record audits, and other factors. Providers
   61  are not entitled to enrollment in the Medicaid provider network.
   62  The agency shall determine instances in which allowing Medicaid
   63  beneficiaries to purchase durable medical equipment and other
   64  goods is less expensive to the Medicaid program than long-term
   65  rental of the equipment or goods. The agency may establish rules
   66  to facilitate purchases in lieu of long-term rentals in order to
   67  protect against fraud and abuse in the Medicaid program as
   68  defined in s. 409.913. The agency may seek federal waivers
   69  necessary to administer these policies.
   70         (41)(a) The agency shall contract on a prepaid or fixed-sum
   71  basis with appropriately licensed prepaid dental health plans to
   72  provide dental services. This subsection expires October 1,
   73  2014.
   74         (b) Notwithstanding paragraph (a) and for the 2012-2013
   75  fiscal year only, the agency is authorized to provide a Medicaid
   76  prepaid dental health program in Miami-Dade County. For all
   77  other counties, the agency may not limit dental services to
   78  prepaid plans and must allow qualified dental providers to
   79  provide dental services under Medicaid on a fee-for-service
   80  reimbursement methodology. The agency may seek any necessary
   81  revisions or amendments to the state plan or federal waivers in
   82  order to implement this paragraph. The agency shall terminate
   83  existing contracts as needed to implement this paragraph. This
   84  paragraph expires July 1, 2013.
   86  ================= T I T L E  A M E N D M E N T ================
   87         And the title is amended as follows:
   88         Delete line 26
   89  and insert:
   90         services are spent; amending s. 409.912, F.S.;
   91         authorizing the Agency for Health Care Administration
   92         to provide a Medicaid prepaid dental health program in
   93         Miami-Dade County; authorizing the agency to seek
   94         revisions or amendments to the state plan or federal
   95         waivers in order to implement the program; requiring
   96         that the agency terminate existing contracts as
   97         necessary to implement the program; requiring certain
   98         budget