Senate Bill sb0792er

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  1                                 

  2         An act relating to the Agency for Health Care

  3         Administration; amending s. 409.904, F.S.;

  4         providing for the agency to pay for health

  5         insurance premiums for certain

  6         Medicaid-eligible persons; providing for the

  7         agency to pay for specified cancer treatment;

  8         providing Medicaid eligibility for certain

  9         disabled persons under a Medicaid buy-in

10         program, subject to specific federal

11         authorization; directing the Agency for Health

12         Care Administration to seek a federal grant,

13         demonstration project, or waiver for

14         establishment of such buy-in program, subject

15         to a specific appropriation; amending s.

16         409.905, F.S.; prescribing conditions upon

17         which an adjustment in a hospital's inpatient

18         per diem rate may be based; prescribing

19         additional limitations that may be placed on

20         hospital inpatient services under Medicaid;

21         amending s. 409.906, F.S.; providing for

22         reimbursement and use-management reforms with

23         respect to community mental health services;

24         revising standards for payable intermediate

25         care services; authorizing the agency to pay

26         for assistive-care services; amending s.

27         409.908, F.S.; prohibiting nursing home

28         reimbursement rate increases associated with

29         changes in ownership; modifying requirements

30         for nursing home cost reporting; requiring a

31         report; revising standards, guidelines, and


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  1         limitations relating to reimbursement of

  2         Medicaid providers; amending s. 409.911, F.S.;

  3         updating data requirements and share rates for

  4         disproportionate share distributions; amending

  5         s. 409.9116, F.S.; modifying the formula for

  6         disproportionate share/financial assistance

  7         distribution to rural hospitals; amending s.

  8         409.91195, F.S.; requiring the Medicaid

  9         Pharmaceutical and Therapeutics Committee to

10         recommend a preferred drug formulary; revising

11         the membership of the Medicaid Pharmaceutical

12         and Therapeutics Committee; providing for

13         committee responsibilities; requiring the

14         agency to publish the preferred drug formulary;

15         providing for a hearing process; amending s.

16         409.912, F.S.; authorizing the agency to

17         establish requirements for prior authorization

18         for certain populations, drug classes, or

19         particular drugs; specifying conditions under

20         which the agency may enter certain contracts

21         with exclusive provider organizations; revising

22         components of the agency's spending-control

23         program; prescribing additional services that

24         the agency may provide through competitive

25         bidding; authorizing the agency to establish,

26         and make exceptions to, a restricted-drug

27         formulary; directing the agency to establish a

28         demonstration project in Miami-Dade County to

29         provide minority health care; amending s.

30         409.9122, F.S.; providing for disproportionate

31         assignment of certain Medicaid-eligible


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  1         children to children's clinic networks;

  2         providing for assignment of certain Medicaid

  3         recipients to managed-care plans; amending s.

  4         409.915, F.S.; exempting counties from

  5         contributing toward the increased cost of

  6         hospital inpatient services due to elimination

  7         of Medicaid ceilings on certain types of

  8         hospitals and for special Medicaid

  9         reimbursement to hospitals; revising the level

10         of county participation; providing for

11         distribution of funds under the

12         disproportionate share program for specified

13         hospitals for the 2001 federal fiscal year;

14         providing for the distribution of County Health

15         Department Trust Funds; requiring the

16         certificate-of-need workgroup to review and

17         make recommendations regarding specified

18         regulations; providing for a temporary rate

19         reduction; providing for an exemption from

20         review for transfer of certain beds and

21         services to a satellite facility; providing for

22         future repeal; providing an appropriation;

23         amending s. 408.036, F.S.; exempting specified

24         projects from required review by the Agency for

25         Health Care Administration; providing that the

26         act fulfills an important state interest;

27         amending ss. 240.4075, 240.4076, F.S.;

28         including nursing homes, family practice

29         teaching hospitals and specialty children's

30         hospitals as facilities eligible under the

31         program; exempting such hospitals from the


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  1         fund-matching requirements of the program;

  2         transferring the program from the Board of

  3         Regents to the Department of Health; providing

  4         effective dates.

  5  

  6  Be It Enacted by the Legislature of the State of Florida:

  7  

  8         Section 1.  Subsections (9), (10), and (11) are added

  9  to section 409.904, Florida Statutes, to read:

10         409.904  Optional payments for eligible persons.--The

11  agency may make payments for medical assistance and related

12  services on behalf of the following persons who are determined

13  to be eligible subject to the income, assets, and categorical

14  eligibility tests set forth in federal and state law. Payment

15  on behalf of these Medicaid eligible persons is subject to the

16  availability of moneys and any limitations established by the

17  General Appropriations Act or chapter 216.

18         (9)  A Medicaid-eligible individual for the

19  individual's health insurance premiums, if the agency

20  determines that such payments are cost-effective.

21         (10)  Eligible women with incomes below 200 percent of

22  the federal poverty level and under age 65, for cancer

23  treatment pursuant to the federal Breast and Cervical Cancer

24  Prevention and Treatment Act of 2000, screened through the

25  National Breast and Cervical Cancer Early Detection program.

26         (11)  Subject to specific federal authorization, a

27  person who, but for earnings in excess of the limit

28  established under s. 1905(q)(2)(B) of the Social Security Act,

29  would be considered for receiving supplemental security

30  income, who is at least 16 but less than 65 years of age, and

31  whose assets, resources, and earned or unearned income, or


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  1  both, do not exceed 250 percent of the most current federal

  2  poverty level. Such persons may be eligible for Medicaid

  3  services as part of a Medicaid buy-in established under s.

  4  409.914(2) specifically designed to accommodate those persons

  5  made eligible for such a buy-in by Title II of Pub. L. No.

  6  106-170. Such buy-in shall include income-related premiums and

  7  cost sharing.

  8         Section 2.  Subject to a specific appropriation, the

  9  Agency for Health Care Administration is directed to seek a

10  federal grant, demonstration project, or waiver, as may be

11  authorized by the United States Department of Health and Human

12  Services, for purposes of establishing a Medicaid buy-in

13  program or other programs to assist individuals with

14  disabilities in gaining employment. The services to be

15  provided are those required to enable such individuals to gain

16  or keep employment. The grant, demonstration project, or

17  waiver shall be submitted to the Secretary of Health and Human

18  Services at such time, in such manner, and containing such

19  information as the secretary shall require, as authorized

20  under Title II of Pub. L. No. 106-170, the "Ticket to Work and

21  Work Incentives Act of 1999."

22         Section 3.  Subsection (5) of section 409.905, Florida

23  Statutes, is amended to read:

24         409.905  Mandatory Medicaid services.--The agency may

25  make payments for the following services, which are required

26  of the state by Title XIX of the Social Security Act,

27  furnished by Medicaid providers to recipients who are

28  determined to be eligible on the dates on which the services

29  were provided.  Any service under this section shall be

30  provided only when medically necessary and in accordance with

31  state and federal law. Nothing in this section shall be


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  1  construed to prevent or limit the agency from adjusting fees,

  2  reimbursement rates, lengths of stay, number of visits, number

  3  of services, or any other adjustments necessary to comply with

  4  the availability of moneys and any limitations or directions

  5  provided for in the General Appropriations Act or chapter 216.

  6         (5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay

  7  for all covered services provided for the medical care and

  8  treatment of a recipient who is admitted as an inpatient by a

  9  licensed physician or dentist to a hospital licensed under

10  part I of chapter 395.  However, the agency shall limit the

11  payment for inpatient hospital services for a Medicaid

12  recipient 21 years of age or older to 45 days or the number of

13  days necessary to comply with the General Appropriations Act.

14         (a)  The agency is authorized to implement

15  reimbursement and utilization management reforms in order to

16  comply with any limitations or directions in the General

17  Appropriations Act, which may include, but are not limited to:

18  prior authorization for inpatient psychiatric days; prior

19  authorization for nonemergency hospital inpatient admissions

20  for individuals 21 years of age and older; authorization of

21  emergency and urgent-care admissions within 24 hours after

22  admission; enhanced utilization and concurrent review programs

23  for highly utilized services; reduction or elimination of

24  covered days of service; adjusting reimbursement ceilings for

25  variable costs; adjusting reimbursement ceilings for fixed and

26  property costs; and implementing target rates of increase. The

27  agency may limit prior authorization for hospital inpatient

28  services to selected diagnosis-related groups, based on an

29  analysis of the cost and potential for unnecessary

30  hospitalizations represented by certain diagnoses. Admissions

31  for normal delivery and newborns are exempt from requirements


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  1  for prior authorization. In implementing the provisions of

  2  this section related to prior authorization, the agency shall

  3  ensure that the process for authorization is accessible 24

  4  hours per day, 7 days per week and authorization is

  5  automatically granted when not denied within 4 hours after the

  6  request. Authorization procedures must include steps for

  7  review of denials. Upon implementing the prior authorization

  8  program for hospital inpatient services, the agency shall

  9  discontinue its hospital retrospective review program.

10         (b)  A licensed hospital maintained primarily for the

11  care and treatment of patients having mental disorders or

12  mental diseases is not eligible to participate in the hospital

13  inpatient portion of the Medicaid program except as provided

14  in federal law.  However, the department shall apply for a

15  waiver, within 9 months after June 5, 1991, designed to

16  provide hospitalization services for mental health reasons to

17  children and adults in the most cost-effective and lowest cost

18  setting possible.  Such waiver shall include a request for the

19  opportunity to pay for care in hospitals known under federal

20  law as "institutions for mental disease" or "IMD's."  The

21  waiver proposal shall propose no additional aggregate cost to

22  the state or Federal Government, and shall be conducted in

23  Hillsborough County, Highlands County, Hardee County, Manatee

24  County, and Polk County.  The waiver proposal may incorporate

25  competitive bidding for hospital services, comprehensive

26  brokering, prepaid capitated arrangements, or other mechanisms

27  deemed by the department to show promise in reducing the cost

28  of acute care and increasing the effectiveness of preventive

29  care.  When developing the waiver proposal, the department

30  shall take into account price, quality, accessibility,

31  linkages of the hospital to community services and family


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  1  support programs, plans of the hospital to ensure the earliest

  2  discharge possible, and the comprehensiveness of the mental

  3  health and other health care services offered by participating

  4  providers.

  5         (c)  Agency for Health Care Administration shall adjust

  6  a hospital's current inpatient per diem rate to reflect the

  7  cost of serving the Medicaid population at that institution

  8  if:

  9         1.  The hospital experiences an increase in Medicaid

10  caseload by more than 25 percent in any year, primarily

11  resulting from the closure of a hospital in the same service

12  area occurring after July 1, 1995; or

13         2.  The hospital's Medicaid per diem rate is at least

14  25 percent below the Medicaid per patient cost for that year.

15  

16  No later than November 1, 2001 2000, the agency must provide

17  estimated costs for any adjustment in a hospital inpatient per

18  diem pursuant to this paragraph to the Executive Office of the

19  Governor, the House of Representatives General Appropriations

20  Committee, and the Senate Appropriations Budget Committee.

21  Before the agency implements a change in a hospital's

22  inpatient per diem rate pursuant to this paragraph, the

23  Legislature must have specifically appropriated sufficient

24  funds in the 2001-2002 General Appropriations Act to support

25  the increase in cost as estimated by the agency. This

26  paragraph is repealed on July 1, 2001.

27         Section 4.  Subsection (8) of section 409.906, Florida

28  Statutes, is amended, and subsection (25) is added to that

29  section, to read:

30         409.906  Optional Medicaid services.--Subject to

31  specific appropriations, the agency may make payments for


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  1  services which are optional to the state under Title XIX of

  2  the Social Security Act and are furnished by Medicaid

  3  providers to recipients who are determined to be eligible on

  4  the dates on which the services were provided.  Any optional

  5  service that is provided shall be provided only when medically

  6  necessary and in accordance with state and federal law.

  7  Nothing in this section shall be construed to prevent or limit

  8  the agency from adjusting fees, reimbursement rates, lengths

  9  of stay, number of visits, or number of services, or making

10  any other adjustments necessary to comply with the

11  availability of moneys and any limitations or directions

12  provided for in the General Appropriations Act or chapter 216.

13  If necessary to safeguard the state's systems of providing

14  services to elderly and disabled persons and subject to the

15  notice and review provisions of s. 216.177, the Governor may

16  direct the Agency for Health Care Administration to amend the

17  Medicaid state plan to delete the optional Medicaid service

18  known as "Intermediate Care Facilities for the Developmentally

19  Disabled."  Optional services may include:

20         (8)  COMMUNITY MENTAL HEALTH SERVICES.--

21         (a)  The agency may pay for rehabilitative services

22  provided to a recipient by a mental health or substance abuse

23  provider licensed by the agency and under contract with the

24  agency or the Department of Children and Family Services to

25  provide such services.  Those services which are psychiatric

26  in nature shall be rendered or recommended by a psychiatrist,

27  and those services which are medical in nature shall be

28  rendered or recommended by a physician or psychiatrist. The

29  agency must develop a provider enrollment process for

30  community mental health providers which bases provider

31  enrollment on an assessment of service need. The provider


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  1  enrollment process shall be designed to control costs, prevent

  2  fraud and abuse, consider provider expertise and capacity, and

  3  assess provider success in managing utilization of care and

  4  measuring treatment outcomes. Providers will be selected

  5  through a competitive procurement or selective contracting

  6  process. In addition to other community mental health

  7  providers, the agency shall consider for enrollment mental

  8  health programs licensed under chapter 395 and group practices

  9  licensed under chapter 458, chapter 459, chapter 490, or

10  chapter 491. The agency is also authorized to continue

11  operation of its behavioral health utilization management

12  program and may develop new services if these actions are

13  necessary to ensure savings from the implementation of the

14  utilization management system. The agency shall coordinate the

15  implementation of this enrollment process with the Department

16  of Children and Family Services and the Department of Juvenile

17  Justice. The agency is authorized to utilize diagnostic

18  criteria in setting reimbursement rates, to preauthorize

19  certain high-cost or highly utilized services, to limit or

20  eliminate coverage for certain services, or to make any other

21  adjustments necessary to comply with any limitations or

22  directions provided for in the General Appropriations Act.

23         (b)  The agency is authorized to implement

24  reimbursement and use management reforms in order to comply

25  with any limitations or directions in the General

26  Appropriations Act, which may include, but are not limited to:

27  prior authorization of treatment and service plans; prior

28  authorization of services; enhanced use review programs for

29  highly used services; and limits on services for those

30  determined to be abusing their benefit coverages.

31  


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  1         (25)  ASSISTIVE-CARE SERVICES.--The agency may pay for

  2  assistive-care services provided to recipients with functional

  3  or cognitive impairments residing in assisted living

  4  facilities, adult family-care homes, or residential treatment

  5  facilities. These services may include health support,

  6  assistance with the activities of daily living and the

  7  instrumental acts of daily living, assistance with medication

  8  administration, and arrangements for health care.

  9         Section 5.  Paragraph (a) of subsection (1), paragraph

10  (b) of subsection (2), and subsections (4), (9), (11), (13),

11  (14), and (18) of section 409.908, Florida Statutes, are

12  amended, and subsection (22) is added to that section, to

13  read:

14         409.908  Reimbursement of Medicaid providers.--Subject

15  to specific appropriations, the agency shall reimburse

16  Medicaid providers, in accordance with state and federal law,

17  according to methodologies set forth in the rules of the

18  agency and in policy manuals and handbooks incorporated by

19  reference therein.  These methodologies may include fee

20  schedules, reimbursement methods based on cost reporting,

21  negotiated fees, competitive bidding pursuant to s. 287.057,

22  and other mechanisms the agency considers efficient and

23  effective for purchasing services or goods on behalf of

24  recipients.  Payment for Medicaid compensable services made on

25  behalf of Medicaid eligible persons is subject to the

26  availability of moneys and any limitations or directions

27  provided for in the General Appropriations Act or chapter 216.

28  Further, nothing in this section shall be construed to prevent

29  or limit the agency from adjusting fees, reimbursement rates,

30  lengths of stay, number of visits, or number of services, or

31  making any other adjustments necessary to comply with the


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  1  availability of moneys and any limitations or directions

  2  provided for in the General Appropriations Act, provided the

  3  adjustment is consistent with legislative intent.

  4         (1)  Reimbursement to hospitals licensed under part I

  5  of chapter 395 must be made prospectively or on the basis of

  6  negotiation.

  7         (a)  Reimbursement for inpatient care is limited as

  8  provided for in s. 409.905(5), except for:

  9         1.  The raising of rate reimbursement caps, excluding

10  rural hospitals.

11         2.  Recognition of the costs of graduate medical

12  education.

13         3.  Other methodologies recognized in the General

14  Appropriations Act.

15         4.  Hospital inpatient rates shall be reduced by 6

16  percent effective July 1, 2001 and restored effective April 1,

17  2002.

18  

19  During the years funds are transferred from the Department of

20  Health Board of Regents, any reimbursement supported by such

21  funds shall be subject to certification by the Department of

22  Health Board of Regents that the hospital has complied with s.

23  381.0403. The agency is authorized to receive funds from state

24  entities, including, but not limited to, the Department of

25  Health Board of Regents, local governments, and other local

26  political subdivisions, for the purpose of making special

27  exception payments, including federal matching funds, through

28  the Medicaid inpatient reimbursement methodologies. Funds

29  received from state entities or local governments for this

30  purpose shall be separately accounted for and shall not be

31  commingled with other state or local funds in any manner. The


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  1  agency may certify all local governmental funds used as state

  2  match under Title XIX of the Social Security Act, to the

  3  extent that the identified local health care provider that is

  4  otherwise entitled to and is contracted to receive such local

  5  funds is the benefactor under the state's Medicaid program as

  6  determined under the General Appropriations Act and pursuant

  7  to an agreement between the Agency for Health Care

  8  Administration and the local governmental entity. The local

  9  governmental entity shall use a certification form prescribed

10  by the agency. At a minimum, the certification form shall

11  identify the amount being certified and describe the

12  relationship between the certifying local governmental entity

13  and the local health care provider. The agency shall prepare

14  an annual statement of impact which documents the specific

15  activities undertaken during the previous fiscal year pursuant

16  to this paragraph, to be submitted to the Legislature no later

17  than January 1, annually. Notwithstanding this section and s.

18  409.915, counties are exempt from contributing toward the cost

19  of the special exception reimbursement for hospitals serving a

20  disproportionate share of low-income persons and providing

21  graduate medical education.

22         (2)

23         (b)  Subject to any limitations or directions provided

24  for in the General Appropriations Act, the agency shall

25  establish and implement a Florida Title XIX Long-Term Care

26  Reimbursement Plan (Medicaid) for nursing home care in order

27  to provide care and services in conformance with the

28  applicable state and federal laws, rules, regulations, and

29  quality and safety standards and to ensure that individuals

30  eligible for medical assistance have reasonable geographic

31  access to such care.


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  1         1.  Changes of ownership or of licensed operator do not

  2  qualify for increases in reimbursement rates associated with

  3  the change of ownership or of licensed operator. The agency

  4  shall amend the Title XIX Long Term Care Reimbursement Plan to

  5  provide that the initial nursing home reimbursement rates, for

  6  the operating, patient care, and MAR components, associated

  7  with related and unrelated party changes of ownership or

  8  licensed operator filed on or after September 1, 2001, are

  9  equivalent to the previous owner's reimbursement rate.

10         2.  The agency shall amend the long-term care

11  reimbursement plan and cost reporting system to create direct

12  care and indirect care subcomponents of the patient care

13  component of the per diem rate. These two subcomponents

14  together shall equal the patient care component of the per

15  diem rate. Separate cost-based ceilings shall be calculated

16  for each patient care subcomponent. The direct care

17  subcomponent of the per diem rate shall be limited by the

18  cost-based class ceiling and the indirect care subcomponent

19  shall be limited by the lower of the cost-based class ceiling,

20  by the target rate class ceiling or by the individual provider

21  target. The agency shall adjust the patient care component

22  effective January 1, 2002. The cost to adjust the direct care

23  subcomponent shall be net of the total funds previously

24  allocated for the case mix add-on. The agency shall make the

25  required changes to the nursing home cost reporting forms to

26  implement this requirement effective January 1, 2002.

27         3.  The direct care subcomponent shall include salaries

28  and benefits of direct care staff providing nursing services

29  including registered nurses, licensed practical nurses, and

30  certified nursing assistants who deliver care directly to

31  residents in the nursing home facility. This excludes nursing


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  1  administration, MDS, and care plan coordinators, staff

  2  development, and staffing coordinator.

  3         4.  All other patient care costs shall be included in

  4  the indirect care cost subcomponent of the patient care per

  5  diem rate. There shall be no costs directly or indirectly

  6  allocated to the direct care subcomponent from a home office

  7  or management company.

  8         5.  On July 1 of each year, the agency shall report to

  9  the Legislature direct and indirect care costs, including

10  average direct and indirect care costs per resident per

11  facility and direct care and indirect care salaries and

12  benefits per category of staff member per facility.

13         6.  Under the plan, interim rate adjustments shall not

14  be granted to reflect increases in the cost of general or

15  professional liability insurance for nursing homes unless the

16  following criteria are met: have at least a 65 percent

17  Medicaid utilization in the most recent cost report submitted

18  to the agency, and the increase in general or professional

19  liability costs to the facility for the most recent policy

20  period affects the total Medicaid per diem by at least 5

21  percent. This rate adjustment shall not result in the per diem

22  exceeding the class ceiling. This provision shall apply only

23  to fiscal year 2000-2001 and shall be implemented to the

24  extent existing appropriations are available. The agency shall

25  report to the Governor, the Speaker of the House of

26  Representatives, and the President of the Senate by December

27  31, 2000, on the cost of liability insurance for Florida

28  nursing homes for fiscal years 1999 and 2000 and the extent to

29  which these costs are not being compensated by the Medicaid

30  program. Medicaid-participating nursing homes shall be

31  required to report to the agency information necessary to


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  1  compile this report. Effective no earlier than the

  2  rate-setting period beginning April 1, 1999, the agency shall

  3  establish a case-mix reimbursement methodology for the rate of

  4  payment for long-term care services for nursing home

  5  residents. The agency shall compute a per diem rate for

  6  Medicaid residents, adjusted for case mix, which is based on a

  7  resident classification system that accounts for the relative

  8  resource utilization by different types of residents and which

  9  is based on level-of-care data and other appropriate data. The

10  case-mix methodology developed by the agency shall take into

11  account the medical, behavioral, and cognitive deficits of

12  residents. In developing the reimbursement methodology, the

13  agency shall evaluate and modify other aspects of the

14  reimbursement plan as necessary to improve the overall

15  effectiveness of the plan with respect to the costs of patient

16  care, operating costs, and property costs. In the event

17  adequate data are not available, the agency is authorized to

18  adjust the patient's care component or the per diem rate to

19  more adequately cover the cost of services provided in the

20  patient's care component. The agency shall work with the

21  Department of Elderly Affairs, the Florida Health Care

22  Association, and the Florida Association of Homes for the

23  Aging in developing the methodology.

24  

25  It is the intent of the Legislature that the reimbursement

26  plan achieve the goal of providing access to health care for

27  nursing home residents who require large amounts of care while

28  encouraging diversion services as an alternative to nursing

29  home care for residents who can be served within the

30  community. The agency shall base the establishment of any

31  maximum rate of payment, whether overall or component, on the


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  1  available moneys as provided for in the General Appropriations

  2  Act. The agency may base the maximum rate of payment on the

  3  results of scientifically valid analysis and conclusions

  4  derived from objective statistical data pertinent to the

  5  particular maximum rate of payment.

  6         (4)  Subject to any limitations or directions provided

  7  for in the General Appropriations Act, alternative health

  8  plans, health maintenance organizations, and prepaid health

  9  plans shall be reimbursed a fixed, prepaid amount negotiated,

10  or competitively bid pursuant to s. 287.057, by the agency and

11  prospectively paid to the provider monthly for each Medicaid

12  recipient enrolled.  The amount may not exceed the average

13  amount the agency determines it would have paid, based on

14  claims experience, for recipients in the same or similar

15  category of eligibility.  The agency shall calculate

16  capitation rates on a regional basis and, beginning September

17  1, 1995, shall include age-band differentials in such

18  calculations. Effective July 1, 2001, the cost of exempting

19  statutory teaching hospitals, specialty hospitals, and

20  community hospital education program hospitals from

21  reimbursement ceilings and the cost of special Medicaid

22  payments shall not be included in premiums paid to health

23  maintenance organizations or prepaid health care plans. Each

24  rate semester, the agency shall calculate and publish a

25  Medicaid hospital rate schedule that does not reflect either

26  special Medicaid payments or the elimination of rate

27  reimbursement ceilings, to be used by hospitals and Medicaid

28  health maintenance organizations, in order to determine the

29  Medicaid rate referred to in ss. 409.912(16), 409.9128(5), and

30  641.513(6).

31  


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  1         (9)  A provider of home health care services or of

  2  medical supplies and appliances shall be reimbursed on the

  3  basis of competitive bidding or for the lesser of the amount

  4  billed by the provider or the agency's established maximum

  5  allowable amount, except that, in the case of the rental of

  6  durable medical equipment, the total rental payments may not

  7  exceed the purchase price of the equipment over its expected

  8  useful life or the agency's established maximum allowable

  9  amount, whichever amount is less.

10         (11)  A provider of independent laboratory services

11  shall be reimbursed on the basis of competitive bidding or for

12  the least of the amount billed by the provider, the provider's

13  usual and customary charge, or the Medicaid maximum allowable

14  fee established by the agency.

15         (13)  Medicare premiums for persons eligible for both

16  Medicare and Medicaid coverage shall be paid at the rates

17  established by Title XVIII of the Social Security Act.  For

18  Medicare services rendered to Medicaid-eligible persons,

19  Medicaid shall pay Medicare deductibles and coinsurance as

20  follows:

21         (a)  Medicaid shall make no payment toward deductibles

22  and coinsurance for any service that is not covered by

23  Medicaid.

24         (b)  Medicaid's financial obligation for deductibles

25  and coinsurance payments shall be based on Medicare allowable

26  fees, not on a provider's billed charges.

27         (c)  Medicaid will pay no portion of Medicare

28  deductibles and coinsurance when payment that Medicare has

29  made for the service equals or exceeds what Medicaid would

30  have paid if it had been the sole payor.  The combined payment

31  of Medicare and Medicaid shall not exceed the amount Medicaid


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  1  would have paid had it been the sole payor. The Legislature

  2  finds that there has been confusion regarding the

  3  reimbursement for services rendered to dually eligible

  4  Medicare beneficiaries. Accordingly, the Legislature clarifies

  5  that it has always been the intent of the Legislature before

  6  and after 1991 that, in reimbursing in accordance with fees

  7  established by Title XVIII for premiums, deductibles, and

  8  coinsurance for Medicare services rendered by physicians to

  9  Medicaid eligible persons, physicians be reimbursed at the

10  lesser of the amount billed by the physician or the Medicaid

11  maximum allowable fee established by the Agency for Health

12  Care Administration, as is permitted by federal law. It has

13  never been the intent of the Legislature with regard to such

14  services rendered by physicians that Medicaid be required to

15  provide any payment for deductibles, coinsurance, or

16  copayments for Medicare cost sharing, or any expenses incurred

17  relating thereto, in excess of the payment amount provided for

18  under the State Medicaid plan for such service. This payment

19  methodology is applicable even in those situations in which

20  the payment for Medicare cost sharing for a qualified Medicare

21  beneficiary with respect to an item or service is reduced or

22  eliminated. This expression of the Legislature is in

23  clarification of existing law and shall apply to payment for,

24  and with respect to provider agreements with respect to, items

25  or services furnished on or after the effective date of this

26  act. This paragraph applies to payment by Medicaid for items

27  and services furnished before the effective date of this act

28  if such payment is the subject of a lawsuit that is based on

29  the provisions of this section, and that is pending as of, or

30  is initiated after, the effective date of this act.

31  


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  1         (d)  Notwithstanding The following provisions are

  2  exceptions to paragraphs (a)-(c):

  3         1.  Medicaid payments for Nursing Home Medicare part A

  4  coinsurance shall be the lesser of the Medicare coinsurance

  5  amount or the Medicaid nursing home per diem rate.

  6         2.  Medicaid shall pay all deductibles and coinsurance

  7  for Nursing Home Medicare part B services.

  8         2.3.  Medicaid shall pay all deductibles and

  9  coinsurance for Medicare-eligible recipients receiving

10  freestanding end stage renal dialysis center services.

11         4.  Medicaid shall pay all deductibles and coinsurance

12  for hospital outpatient Medicare part B services.

13         3.5.  Medicaid payments for general hospital inpatient

14  services shall be limited to the Medicare deductible per spell

15  of illness.  Medicaid shall make no payment toward coinsurance

16  for Medicare general hospital inpatient services.

17         4.6.  Medicaid shall pay all deductibles and

18  coinsurance for Medicare emergency transportation services

19  provided by ambulances licensed pursuant to chapter 401.

20         (14)  A provider of prescribed drugs shall be

21  reimbursed the least of the amount billed by the provider, the

22  provider's usual and customary charge, or the Medicaid maximum

23  allowable fee established by the agency, plus a dispensing

24  fee. The agency is directed to implement a variable dispensing

25  fee for payments for prescribed medicines while ensuring

26  continued access for Medicaid recipients.  The variable

27  dispensing fee may be based upon, but not limited to, either

28  or both the volume of prescriptions dispensed by a specific

29  pharmacy provider and the volume of prescriptions dispensed to

30  an individual recipient. The agency is authorized to limit

31  reimbursement for prescribed medicine in order to comply with


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  1  any limitations or directions provided for in the General

  2  Appropriations Act, which may include implementing a

  3  prospective or concurrent utilization review program.

  4         (18)  Unless otherwise provided for in the General

  5  Appropriations Act, a provider of transportation services

  6  shall be reimbursed the lesser of the amount billed by the

  7  provider or the Medicaid maximum allowable fee established by

  8  the agency, except when the agency has entered into a direct

  9  contract with the provider, or with a community transportation

10  coordinator, for the provision of an all-inclusive service, or

11  when services are provided pursuant to an agreement negotiated

12  between the agency and the provider.  The agency, as provided

13  for in s. 427.0135, shall purchase transportation services

14  through the community coordinated transportation system, if

15  available, unless the agency determines a more cost-effective

16  method for Medicaid clients. Nothing in this subsection shall

17  be construed to limit or preclude the agency from contracting

18  for services using a prepaid capitation rate or from

19  establishing maximum fee schedules, individualized

20  reimbursement policies by provider type, negotiated fees,

21  prior authorization, competitive bidding, increased use of

22  mass transit, or any other mechanism that the agency considers

23  efficient and effective for the purchase of services on behalf

24  of Medicaid clients, including implementing a transportation

25  eligibility process. The agency shall not be required to

26  contract with any community transportation coordinator or

27  transportation operator that has been determined by the

28  agency, the Department of Legal Affairs Medicaid Fraud Control

29  Unit, or any other state or federal agency to have engaged in

30  any abusive or fraudulent billing activities. The agency is

31  authorized to competitively procure transportation services or


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  1  make other changes necessary to secure approval of federal

  2  waivers needed to permit federal financing of Medicaid

  3  transportation services at the service matching rate rather

  4  than the administrative matching rate.

  5         (22)  The agency may request and implement Medicaid

  6  waivers from the federal Health Care Financing Administration

  7  to advance and treat a portion of the Medicaid nursing home

  8  per diem as capital for creating and operating a

  9  risk-retention group for self-insurance purposes, consistent

10  with federal and state laws and rules.

11         Section 6.  Paragraph (c) of subsection (1), paragraph

12  (b) of subsection (3), and subsection (7) of section 409.911,

13  Florida Statutes, are amended to read:

14         409.911  Disproportionate share program.--Subject to

15  specific allocations established within the General

16  Appropriations Act and any limitations established pursuant to

17  chapter 216, the agency shall distribute, pursuant to this

18  section, moneys to hospitals providing a disproportionate

19  share of Medicaid or charity care services by making quarterly

20  Medicaid payments as required. Notwithstanding the provisions

21  of s. 409.915, counties are exempt from contributing toward

22  the cost of this special reimbursement for hospitals serving a

23  disproportionate share of low-income patients.

24         (1)  Definitions.--As used in this section and s.

25  409.9112:

26         (c)  "Base Medicaid per diem" means the hospital's

27  Medicaid per diem rate initially established by the Agency for

28  Health Care Administration on January 1, 1999 prior to the

29  beginning of each state fiscal year. The base Medicaid per

30  diem rate shall not include any additional per diem increases

31  


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  1  received as a result of the disproportionate share

  2  distribution.

  3         (3)  In computing the disproportionate share rate:

  4         (b)  The agency shall use 1994 the most recent calendar

  5  year audited financial data available at the beginning of each

  6  state fiscal year for the calculation of disproportionate

  7  share payments under this section.

  8         (7)  For fiscal year 1991-1992 and all years other than

  9  1992-1993, The following criteria shall be used in determining

10  the disproportionate share percentage:

11         (a)  If the disproportionate share rate is less than 10

12  percent, the disproportionate share percentage is zero and

13  there is no additional payment.

14         (b)  If the disproportionate share rate is greater than

15  or equal to 10 percent, but less than 20 percent, then the

16  disproportionate share percentage is 1.8478498 2.1544347.

17         (c)  If the disproportionate share rate is greater than

18  or equal to 20 percent, but less than 30 percent, then the

19  disproportionate share percentage is 3.4145488 4.6415888766.

20         (d)  If the disproportionate share rate is greater than

21  or equal to 30 percent, but less than 40 percent, then the

22  disproportionate share percentage is 6.3095734 10.0000001388.

23         (e)  If the disproportionate share rate is greater than

24  or equal to 40 percent, but less than 50 percent, then the

25  disproportionate share percentage is 11.6591440 21.544347299.

26         (f)  If the disproportionate share rate is greater than

27  or equal to 50 percent, but less than 60 percent, then the

28  disproportionate share percentage is 73.5642254 46.41588941.

29         (g)  If the disproportionate share rate is greater than

30  or equal to 60 percent but less than 72.5 percent, then the

31  disproportionate share percentage is 135.9356391 100.


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  1         (h)  If the disproportionate share rate is greater than

  2  or equal to 72.5 percent, then the disproportionate share

  3  percentage is 170.

  4         Section 7.  Subsection (2) of section 409.9116, Florida

  5  Statutes, is amended to read:

  6         409.9116  Disproportionate share/financial assistance

  7  program for rural hospitals.--In addition to the payments made

  8  under s. 409.911, the Agency for Health Care Administration

  9  shall administer a federally matched disproportionate share

10  program and a state-funded financial assistance program for

11  statutory rural hospitals. The agency shall make

12  disproportionate share payments to statutory rural hospitals

13  that qualify for such payments and financial assistance

14  payments to statutory rural hospitals that do not qualify for

15  disproportionate share payments. The disproportionate share

16  program payments shall be limited by and conform with federal

17  requirements. Funds shall be distributed quarterly in each

18  fiscal year for which an appropriation is made.

19  Notwithstanding the provisions of s. 409.915, counties are

20  exempt from contributing toward the cost of this special

21  reimbursement for hospitals serving a disproportionate share

22  of low-income patients.

23         (2)  The agency shall use the following formula for

24  distribution of funds for the disproportionate share/financial

25  assistance program for rural hospitals.

26         (a)  The agency shall first determine a preliminary

27  payment amount for each rural hospital by allocating all

28  available state funds using the following formula:

29  

30                  PDAER = (TAERH x TARH)/STAERH

31  


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  1  Where:

  2         PDAER = preliminary distribution amount for each rural

  3  hospital.

  4         TAERH = total amount earned by each rural hospital.

  5         TARH = total amount appropriated or distributed under

  6  this section.

  7         STAERH = sum of total amount earned by each rural

  8  hospital.

  9         (b)  Federal matching funds for the disproportionate

10  share program shall then be calculated for those hospitals

11  that qualify for disproportionate share in paragraph (a).

12         (c)  The state-funds-only payment amount shall then be

13  calculated for each hospital using the formula:

14  

15         SFOER = Maximum value of (1) SFOL - PDAER or (2) 0

16  

17  Where:

18         SFOER = state-funds-only payment amount for each rural

19  hospital.

20         SFOL = state-funds-only payment level, which is set at

21  4 percent of TARH.

22  

23  In calculating the SFOER, PDAER includes federal matching

24  funds from paragraph (b).

25         (d)  The adjusted total amount allocated to the rural

26  disproportionate share program shall then be calculated using

27  the following formula:

28  

29                     ATARH = (TARH - SSFOER)

30  

31  Where:


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  1         ATARH = adjusted total amount appropriated or

  2  distributed under this section.

  3         SSFOER = sum of the state-funds-only payment amount

  4  calculated under paragraph (c) for all rural hospitals.

  5         (e)  The distribution of the adjusted total amount of

  6  rural disproportionate share hospital funds shall then be

  7  calculated using the following formula:

  8  

  9                 DAERH = [(TAERH x ATARH)/STAERH]

10  

11  Where:

12         DAERH = distribution amount for each rural hospital.

13         (f)  Federal matching funds for the disproportionate

14  share program shall then be calculated for those hospitals

15  that qualify for disproportionate share in paragraph (e).

16         (g)  State-funds-only payment amounts calculated under

17  paragraph (c) and corresponding federal matching funds are

18  then added to the results of paragraph (f) to determine the

19  total distribution amount for each rural hospital.

20         In determining the payment amount for each rural

21  hospital under this section, the agency shall first allocate

22  all available state funds by the following formula:

23  

24                   DAER = (TAERH x TARH)/STAERH

25  

26  Where:

27         DAER = distribution amount for each rural hospital.

28         STAERH = sum of total amount earned by each rural

29  hospital.

30         TAERH = total amount earned by each rural hospital.

31  


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  1         TARH = total amount appropriated or distributed under

  2  this section.

  3  

  4  Federal matching funds for the disproportionate share program

  5  shall then be calculated for those hospitals that qualify for

  6  disproportionate share payments under this section.

  7         Section 8.  Section 409.91195, Florida Statutes, is

  8  amended to read:

  9         409.91195  Medicaid Pharmaceutical and Therapeutics

10  Committee.--There is created a Medicaid Pharmaceutical and

11  Therapeutics Committee within the Agency for Health Care

12  Administration for the purpose of developing a preferred drug

13  formulary pursuant to 42 U.S.C. s. 1396r-8. The committee

14  shall develop and implement a voluntary Medicaid preferred

15  prescribed drug designation program. The program shall provide

16  information to Medicaid providers on medically appropriate and

17  cost-efficient prescription drug therapies through the

18  development and publication of a voluntary Medicaid preferred

19  prescribed-drug list.

20         (1)  The Medicaid Pharmaceutical and Therapeutics

21  Committee shall be comprised as specified in 42 U.S.C. s.

22  1396r-8 and consist of eleven members appointed by the

23  Governor. Four members shall be physicians, licensed under

24  chapter 458; one member licensed under chapter 459; five

25  members shall be pharmacists licensed under chapter 465; and

26  one member shall be a consumer representative. of nine members

27  appointed as follows:  one practicing physician licensed under

28  chapter 458, appointed by the Speaker of the House of

29  Representatives from a list of recommendations from the

30  Florida Medical Association; one practicing physician licensed

31  under chapter 459, appointed by the Speaker of the House of


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  1  Representatives from a list of recommendations from the

  2  Florida Osteopathic Medical Association; one practicing

  3  physician licensed under chapter 458, appointed by the

  4  President of the Senate from a list of recommendations from

  5  the Florida Academy of Family Physicians; one practicing

  6  podiatric physician licensed under chapter 461, appointed by

  7  the President of the Senate from a list of recommendations

  8  from the Florida Podiatric Medical Association; one trauma

  9  surgeon licensed under chapter 458, appointed by the Speaker

10  of the House of Representatives from a list of recommendations

11  from the American College of Surgeons; one practicing dentist

12  licensed under chapter 466, appointed by the President of the

13  Senate from a list of recommendations from the Florida Dental

14  Association; one practicing pharmacist licensed under chapter

15  465, appointed by the Governor from a list of recommendations

16  from the Florida Pharmacy Association; one practicing

17  pharmacist licensed under chapter 465, appointed by the

18  Governor from a list of recommendations from the Florida

19  Society of Health System Pharmacists; and one health care

20  professional with expertise in clinical pharmacology appointed

21  by the Governor from a list of recommendations from the

22  Pharmaceutical Research and Manufacturers Association. The

23  members shall be appointed to serve for terms of 2 years from

24  the date of their appointment. Members may be appointed to

25  more than one term. The Agency for Health Care Administration

26  shall serve as staff for the committee and assist them with

27  all ministerial duties. The Governor shall ensure that at

28  least some of the members of the Medicaid Pharmaceutical and

29  Therapeutics Committee represent Medicaid participating

30  physicians and pharmacies serving all segments and diversity

31  of the Medicaid population, and have experience in either


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  1  developing or practicing under a preferred drug formulary. At

  2  least one of the members shall represent the interests of

  3  pharmaceutical manufacturers.

  4         (2)  Committee members shall select a chairperson and a

  5  vice chairperson each year from the committee membership.

  6         (3)  The committee shall meet at least quarterly and

  7  may meet at other times at the discretion of the chairperson

  8  and members. The committee shall comply with rules adopted by

  9  the agency, including notice of any meeting of the committee

10  pursuant to the requirements of the Administrative Procedure

11  Act.

12         (4)  Upon recommendation of the Medicaid Pharmaceutical

13  and Therapeutics Committee the agency shall adopt a preferred

14  drug list. To the extent feasible, the committee shall review

15  all drug classes included in the formulary at least every 12

16  months, and may recommend additions to and deletions from the

17  formulary, such that the formulary provides

18         (2)  Upon recommendation by the committee, the Agency

19  for Health Care Administration shall establish the voluntary

20  Medicaid preferred prescribed-drug list. Upon further

21  recommendation by the committee, the agency shall add to,

22  delete from, or modify the list. The committee shall also

23  review requests for additions to, deletions from, or

24  modifications of the list. The list shall be adopted by the

25  committee in consultation with medical specialists, when

26  appropriate, using the following criteria:  use of the list

27  shall be voluntary by providers and the list must provide for

28  medically appropriate drug therapies for Medicaid patients

29  which achieve cost savings contained in the General

30  Appropriations Act.

31  


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  1         (5)  Except for mental health-related drugs,

  2  anti-retroviral drugs, and drugs for nursing home residents

  3  and other institutional residents, reimbursement of drugs not

  4  included in the formulary is subject to prior authorization in

  5  the Medicaid program.

  6         (6)(3)  The Agency for Health Care Administration shall

  7  publish and disseminate the preferred drug formulary voluntary

  8  Medicaid preferred prescribed drug list to all Medicaid

  9  providers in the state.

10         (7)  The committee shall ensure that pharmaceutical

11  manufacturers agreeing to provide a supplemental rebate as

12  outlined in this chapter have an opportunity to present

13  evidence supporting inclusion of a product on the preferred

14  drug list. Upon timely notice, the agency shall ensure that

15  any drug that has been approved or had any of its particular

16  uses approved by the United States Food and Drug

17  Administration under a priority review classification will be

18  reviewed by the Medicaid Pharmaceutical and Therapeutics

19  Committee at the next regularly scheduled meeting. To the

20  extent possible, upon notice by a manufacturer the agency

21  shall also schedule a product review for any new product at

22  the next regularly scheduled Medicaid Pharmaceutical and

23  Therapeutics Committee.

24         (8)  Until the Medicaid Pharmaceutical and Therapeutics

25  Committee is appointed and a preferred drug list adopted by

26  the agency, the agency shall use the existing voluntary

27  preferred drug list adopted pursuant to Chapter 2000-367,

28  Section 72, Laws of Florida. Drugs not listed on the voluntary

29  preferred drug list will require prior authorization by the

30  agency or its contractor.

31  


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  1         (9)  The Medicaid Pharmaceutical and Therapeutics

  2  Committee shall develop its preferred drug list

  3  recommendations by considering the clinical efficacy, safety,

  4  and cost effectiveness of a product. When the preferred drug

  5  formulary is adopted by the agency, if a product on the

  6  formulary is one of the first four brand-name drugs used by a

  7  recipient in a month the drug shall not require prior

  8  authorization.

  9         (10)  The Medicaid Pharmaceutical and Therapeutics

10  Committee may also make recommendations to the agency

11  regarding the prior authorization of any prescribed drug

12  covered by Medicaid.

13         (11)  Medicaid recipients may appeal agency preferred

14  drug formulary decisions using the Medicaid fair hearing

15  process administered by the Department of Children and Family

16  Services.

17         Section 9.  Section 409.912, Florida Statutes, is

18  amended to read:

19         409.912  Cost-effective purchasing of health care.--The

20  agency shall purchase goods and services for Medicaid

21  recipients in the most cost-effective manner consistent with

22  the delivery of quality medical care.  The agency shall

23  maximize the use of prepaid per capita and prepaid aggregate

24  fixed-sum basis services when appropriate and other

25  alternative service delivery and reimbursement methodologies,

26  including competitive bidding pursuant to s. 287.057, designed

27  to facilitate the cost-effective purchase of a case-managed

28  continuum of care. The agency shall also require providers to

29  minimize the exposure of recipients to the need for acute

30  inpatient, custodial, and other institutional care and the

31  inappropriate or unnecessary use of high-cost services. The


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  1  agency may establish prior authorization requirements for

  2  certain populations of Medicaid beneficiaries, certain drug

  3  classes, or particular drugs to prevent fraud, abuse, overuse,

  4  and possible dangerous drug interactions. The Pharmaceutical

  5  and Therapeutics Committee shall make recommendations to the

  6  agency on drugs for which prior authorization is required. The

  7  agency shall inform the Pharmaceutical and Therapeutics

  8  Committee of its decisions regarding drugs subject to prior

  9  authorization.

10         (1)  The agency may enter into agreements with

11  appropriate agents of other state agencies or of any agency of

12  the Federal Government and accept such duties in respect to

13  social welfare or public aid as may be necessary to implement

14  the provisions of Title XIX of the Social Security Act and ss.

15  409.901-409.920.

16         (2)  The agency may contract with health maintenance

17  organizations certified pursuant to part I of chapter 641 for

18  the provision of services to recipients.

19         (3)  The agency may contract with:

20         (a)  An entity that provides no prepaid health care

21  services other than Medicaid services under contract with the

22  agency and which is owned and operated by a county, county

23  health department, or county-owned and operated hospital to

24  provide health care services on a prepaid or fixed-sum basis

25  to recipients, which entity may provide such prepaid services

26  either directly or through arrangements with other providers.

27  Such prepaid health care services entities must be licensed

28  under parts I and III by January 1, 1998, and until then are

29  exempt from the provisions of part I of chapter 641. An entity

30  recognized under this paragraph which demonstrates to the

31  satisfaction of the Department of Insurance that it is backed


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  1  by the full faith and credit of the county in which it is

  2  located may be exempted from s. 641.225.

  3         (b)  An entity that is providing comprehensive

  4  behavioral health care services to certain Medicaid recipients

  5  through a capitated, prepaid arrangement pursuant to the

  6  federal waiver provided for by s. 409.905(5). Such an entity

  7  must be licensed under chapter 624, chapter 636, or chapter

  8  641 and must possess the clinical systems and operational

  9  competence to manage risk and provide comprehensive behavioral

10  health care to Medicaid recipients. As used in this paragraph,

11  the term "comprehensive behavioral health care services" means

12  covered mental health and substance abuse treatment services

13  that are available to Medicaid recipients. The secretary of

14  the Department of Children and Family Services shall approve

15  provisions of procurements related to children in the

16  department's care or custody prior to enrolling such children

17  in a prepaid behavioral health plan. Any contract awarded

18  under this paragraph must be competitively procured. In

19  developing the behavioral health care prepaid plan procurement

20  document, the agency shall ensure that the procurement

21  document requires the contractor to develop and implement a

22  plan to ensure compliance with s. 394.4574 related to services

23  provided to residents of licensed assisted living facilities

24  that hold a limited mental health license. The agency must

25  ensure that Medicaid recipients have available the choice of

26  at least two managed care plans for their behavioral health

27  care services. The agency may reimburse for

28  substance-abuse-treatment services on a fee-for-service basis

29  until the agency finds that adequate funds are available for

30  capitated, prepaid arrangements.

31  


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  1         1.  By January 1, 2001, the agency shall modify the

  2  contracts with the entities providing comprehensive inpatient

  3  and outpatient mental health care services to Medicaid

  4  recipients in Hillsborough, Highlands, Hardee, Manatee, and

  5  Polk Counties, to include substance-abuse-treatment services.

  6         2.  By December 31, 2001, the agency shall contract

  7  with entities providing comprehensive behavioral health care

  8  services to Medicaid recipients through capitated, prepaid

  9  arrangements in Charlotte, Collier, DeSoto, Escambia, Glades,

10  Hendry, Lee, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota,

11  and Walton Counties. The agency may contract with entities

12  providing comprehensive behavioral health care services to

13  Medicaid recipients through capitated, prepaid arrangements in

14  Alachua County. The agency may determine if Sarasota County

15  shall be included as a separate catchment area or included in

16  any other agency geographic area.

17         3.  Children residing in a Department of Juvenile

18  Justice residential program approved as a Medicaid behavioral

19  health overlay services provider shall not be included in a

20  behavioral health care prepaid health plan pursuant to this

21  paragraph.

22         4.  In converting to a prepaid system of delivery, the

23  agency shall in its procurement document require an entity

24  providing comprehensive behavioral health care services to

25  prevent the displacement of indigent care patients by

26  enrollees in the Medicaid prepaid health plan providing

27  behavioral health care services from facilities receiving

28  state funding to provide indigent behavioral health care, to

29  facilities licensed under chapter 395 which do not receive

30  state funding for indigent behavioral health care, or

31  


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  1  reimburse the unsubsidized facility for the cost of behavioral

  2  health care provided to the displaced indigent care patient.

  3         5.  Traditional community mental health providers under

  4  contract with the Department of Children and Family Services

  5  pursuant to part IV of chapter 394 and inpatient mental health

  6  providers licensed pursuant to chapter 395 must be offered an

  7  opportunity to accept or decline a contract to participate in

  8  any provider network for prepaid behavioral health services.

  9         (c)  A federally qualified health center or an entity

10  owned by one or more federally qualified health centers or an

11  entity owned by other migrant and community health centers

12  receiving non-Medicaid financial support from the Federal

13  Government to provide health care services on a prepaid or

14  fixed-sum basis to recipients.  Such prepaid health care

15  services entity must be licensed under parts I and III of

16  chapter 641, but shall be prohibited from serving Medicaid

17  recipients on a prepaid basis, until such licensure has been

18  obtained.  However, such an entity is exempt from s. 641.225

19  if the entity meets the requirements specified in subsections

20  (14) and (15).

21         (d)  No more than four provider service networks for

22  demonstration projects to test Medicaid direct contracting.

23  The demonstration projects may be reimbursed on a

24  fee-for-service or prepaid basis.  A provider service network

25  which is reimbursed by the agency on a prepaid basis shall be

26  exempt from parts I and III of chapter 641, but must meet

27  appropriate financial reserve, quality assurance, and patient

28  rights requirements as established by the agency.  The agency

29  shall award contracts on a competitive bid basis and shall

30  select bidders based upon price and quality of care. Medicaid

31  recipients assigned to a demonstration project shall be chosen


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  1  equally from those who would otherwise have been assigned to

  2  prepaid plans and MediPass.  The agency is authorized to seek

  3  federal Medicaid waivers as necessary to implement the

  4  provisions of this section.  A demonstration project awarded

  5  pursuant to this paragraph shall be for 4 2 years from the

  6  date of implementation.

  7         (e)  An entity that provides comprehensive behavioral

  8  health care services to certain Medicaid recipients through an

  9  administrative services organization agreement. Such an entity

10  must possess the clinical systems and operational competence

11  to provide comprehensive health care to Medicaid recipients.

12  As used in this paragraph, the term "comprehensive behavioral

13  health care services" means covered mental health and

14  substance abuse treatment services that are available to

15  Medicaid recipients. Any contract awarded under this paragraph

16  must be competitively procured. The agency must ensure that

17  Medicaid recipients have available the choice of at least two

18  managed care plans for their behavioral health care services.

19         (f)  An entity in Pasco County or Pinellas County that

20  provides in-home physician services to Medicaid recipients

21  with degenerative neurological diseases in order to test the

22  cost-effectiveness of enhanced home-based medical care. The

23  entity providing the services shall be reimbursed on a

24  fee-for-service basis at a rate not less than comparable

25  Medicare reimbursement rates. The agency may apply for waivers

26  of federal regulations necessary to implement such program.

27  This paragraph shall be repealed on July 1, 2002.

28         (g)  Children's provider networks that provide care

29  coordination and care management for Medicaid-eligible

30  pediatric patients, primary care, authorization of specialty

31  care, and other urgent and emergency care through organized


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  1  providers designed to service Medicaid eligibles under age 18.

  2  The networks shall provide after-hour operations, including

  3  evening and weekend hours, to promote, when appropriate, the

  4  use of the children's networks rather than hospital emergency

  5  departments.

  6         (4)  The agency may contract with any public or private

  7  entity otherwise authorized by this section on a prepaid or

  8  fixed-sum basis for the provision of health care services to

  9  recipients. An entity may provide prepaid services to

10  recipients, either directly or through arrangements with other

11  entities, if each entity involved in providing services:

12         (a)  Is organized primarily for the purpose of

13  providing health care or other services of the type regularly

14  offered to Medicaid recipients;

15         (b)  Ensures that services meet the standards set by

16  the agency for quality, appropriateness, and timeliness;

17         (c)  Makes provisions satisfactory to the agency for

18  insolvency protection and ensures that neither enrolled

19  Medicaid recipients nor the agency will be liable for the

20  debts of the entity;

21         (d)  Submits to the agency, if a private entity, a

22  financial plan that the agency finds to be fiscally sound and

23  that provides for working capital in the form of cash or

24  equivalent liquid assets excluding revenues from Medicaid

25  premium payments equal to at least the first 3 months of

26  operating expenses or $200,000, whichever is greater;

27         (e)  Furnishes evidence satisfactory to the agency of

28  adequate liability insurance coverage or an adequate plan of

29  self-insurance to respond to claims for injuries arising out

30  of the furnishing of health care;

31  


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  1         (f)  Provides, through contract or otherwise, for

  2  periodic review of its medical facilities and services, as

  3  required by the agency; and

  4         (g)  Provides organizational, operational, financial,

  5  and other information required by the agency.

  6         (5)  The agency may contract on a prepaid or fixed-sum

  7  basis with any health insurer that:

  8         (a)  Pays for health care services provided to enrolled

  9  Medicaid recipients in exchange for a premium payment paid by

10  the agency;

11         (b)  Assumes the underwriting risk; and

12         (c)  Is organized and licensed under applicable

13  provisions of the Florida Insurance Code and is currently in

14  good standing with the Department of Insurance.

15         (6)  The agency may contract on a prepaid or fixed-sum

16  basis with an exclusive provider organization to provide

17  health care services to Medicaid recipients provided that the

18  contract does not cost more than a managed care plan contract

19  in the same agency region and that the exclusive provider

20  organization meets applicable managed care plan requirements

21  in this section, ss. 409.9122, 409.9123, 409.9128, and

22  627.6472, and other applicable provisions of law.

23         (7)  The Agency for Health Care Administration may

24  provide cost-effective purchasing of chiropractic services on

25  a fee-for-service basis to Medicaid recipients through

26  arrangements with a statewide chiropractic preferred provider

27  organization incorporated in this state as a not-for-profit

28  corporation.  The agency shall ensure that the benefit limits

29  and prior authorization requirements in the current Medicaid

30  program shall apply to the services provided by the

31  chiropractic preferred provider organization.


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  1         (8)  The agency shall not contract on a prepaid or

  2  fixed-sum basis for Medicaid services with an entity which

  3  knows or reasonably should know that any officer, director,

  4  agent, managing employee, or owner of stock or beneficial

  5  interest in excess of 5 percent common or preferred stock, or

  6  the entity itself, has been found guilty of, regardless of

  7  adjudication, or entered a plea of nolo contendere, or guilty,

  8  to:

  9         (a)  Fraud;

10         (b)  Violation of federal or state antitrust statutes,

11  including those proscribing price fixing between competitors

12  and the allocation of customers among competitors;

13         (c)  Commission of a felony involving embezzlement,

14  theft, forgery, income tax evasion, bribery, falsification or

15  destruction of records, making false statements, receiving

16  stolen property, making false claims, or obstruction of

17  justice; or

18         (d)  Any crime in any jurisdiction which directly

19  relates to the provision of health services on a prepaid or

20  fixed-sum basis.

21         (9)  The agency, after notifying the Legislature, may

22  apply for waivers of applicable federal laws and regulations

23  as necessary to implement more appropriate systems of health

24  care for Medicaid recipients and reduce the cost of the

25  Medicaid program to the state and federal governments and

26  shall implement such programs, after legislative approval,

27  within a reasonable period of time after federal approval.

28  These programs must be designed primarily to reduce the need

29  for inpatient care, custodial care and other long-term or

30  institutional care, and other high-cost services.

31  


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  1         (a)  Prior to seeking legislative approval of such a

  2  waiver as authorized by this subsection, the agency shall

  3  provide notice and an opportunity for public comment.  Notice

  4  shall be provided to all persons who have made requests of the

  5  agency for advance notice and shall be published in the

  6  Florida Administrative Weekly not less than 28 days prior to

  7  the intended action.

  8         (b)  Notwithstanding s. 216.292, funds that are

  9  appropriated to the Department of Elderly Affairs for the

10  Assisted Living for the Elderly Medicaid waiver and are not

11  expended shall be transferred to the agency to fund

12  Medicaid-reimbursed nursing home care.

13         (10)  The agency shall establish a postpayment

14  utilization control program designed to identify recipients

15  who may inappropriately overuse or underuse Medicaid services

16  and shall provide methods to correct such misuse.

17         (11)  The agency shall develop and provide coordinated

18  systems of care for Medicaid recipients and may contract with

19  public or private entities to develop and administer such

20  systems of care among public and private health care providers

21  in a given geographic area.

22         (12)  The agency shall operate or contract for the

23  operation of utilization management and incentive systems

24  designed to encourage cost-effective use services.

25         (13)(a)  The agency shall identify health care

26  utilization and price patterns within the Medicaid program

27  which are not cost-effective or medically appropriate and

28  assess the effectiveness of new or alternate methods of

29  providing and monitoring service, and may implement such

30  methods as it considers appropriate. Such methods may include

31  disease management initiatives, an integrated and systematic


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  1  approach for managing the health care needs of recipients who

  2  are at risk of or diagnosed with a specific disease by using

  3  best practices, prevention strategies, clinical-practice

  4  improvement, clinical interventions and protocols, outcomes

  5  research, information technology, and other tools and

  6  resources to reduce overall costs and improve measurable

  7  outcomes.

  8         (b)  The responsibility of the agency under this

  9  subsection shall include the development of capabilities to

10  identify actual and optimal practice patterns; patient and

11  provider educational initiatives; methods for determining

12  patient compliance with prescribed treatments; fraud, waste,

13  and abuse prevention and detection programs; and beneficiary

14  case management programs.

15         1.  The practice pattern identification program shall

16  evaluate practitioner prescribing patterns based on national

17  and regional practice guidelines, comparing practitioners to

18  their peer groups. The agency and its Drug Utilization Review

19  Board shall consult with a panel of practicing health care

20  professionals consisting of the following: the Speaker of the

21  House of Representatives and the President of the Senate shall

22  each appoint three physicians licensed under chapter 458 or

23  chapter 459; and the Governor shall appoint two pharmacists

24  licensed under chapter 465 and one dentist licensed under

25  chapter 466 who is an oral surgeon. Terms of the panel members

26  shall expire at the discretion of the appointing official. The

27  panel shall begin its work by August 1, 1999, regardless of

28  the number of appointments made by that date. The advisory

29  panel shall be responsible for evaluating treatment guidelines

30  and recommending ways to incorporate their use in the practice

31  pattern identification program. Practitioners who are


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  1  prescribing inappropriately or inefficiently, as determined by

  2  the agency, may have their prescribing of certain drugs

  3  subject to prior authorization.

  4         2.  The agency shall also develop educational

  5  interventions designed to promote the proper use of

  6  medications by providers and beneficiaries.

  7         3.  The agency shall implement a pharmacy fraud, waste,

  8  and abuse initiative that may include a surety bond or letter

  9  of credit requirement for participating pharmacies, enhanced

10  provider auditing practices, the use of additional fraud and

11  abuse software, recipient management programs for

12  beneficiaries inappropriately using their benefits, and other

13  steps that will eliminate provider and recipient fraud, waste,

14  and abuse. The initiative shall address enforcement efforts to

15  reduce the number and use of counterfeit prescriptions.

16         4.  The agency may apply for any federal waivers needed

17  to implement this paragraph.

18         (14)  An entity contracting on a prepaid or fixed-sum

19  basis shall, in addition to meeting any applicable statutory

20  surplus requirements, also maintain at all times in the form

21  of cash, investments that mature in less than 180 days

22  allowable as admitted assets by the Department of Insurance,

23  and restricted funds or deposits controlled by the agency or

24  the Department of Insurance, a surplus amount equal to

25  one-and-one-half times the entity's monthly Medicaid prepaid

26  revenues. As used in this subsection, the term "surplus" means

27  the entity's total assets minus total liabilities. If an

28  entity's surplus falls below an amount equal to

29  one-and-one-half times the entity's monthly Medicaid prepaid

30  revenues, the agency shall prohibit the entity from engaging

31  in marketing and preenrollment activities, shall cease to


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  1  process new enrollments, and shall not renew the entity's

  2  contract until the required balance is achieved.  The

  3  requirements of this subsection do not apply:

  4         (a)  Where a public entity agrees to fund any deficit

  5  incurred by the contracting entity; or

  6         (b)  Where the entity's performance and obligations are

  7  guaranteed in writing by a guaranteeing organization which:

  8         1.  Has been in operation for at least 5 years and has

  9  assets in excess of $50 million; or

10         2.  Submits a written guarantee acceptable to the

11  agency which is irrevocable during the term of the contracting

12  entity's contract with the agency and, upon termination of the

13  contract, until the agency receives proof of satisfaction of

14  all outstanding obligations incurred under the contract.

15         (15)(a)  The agency may require an entity contracting

16  on a prepaid or fixed-sum basis to establish a restricted

17  insolvency protection account with a federally guaranteed

18  financial institution licensed to do business in this state.

19  The entity shall deposit into that account 5 percent of the

20  capitation payments made by the agency each month until a

21  maximum total of 2 percent of the total current contract

22  amount is reached. The restricted insolvency protection

23  account may be drawn upon with the authorized signatures of

24  two persons designated by the entity and two representatives

25  of the agency. If the agency finds that the entity is

26  insolvent, the agency may draw upon the account solely with

27  the two authorized signatures of representatives of the

28  agency, and the funds may be disbursed to meet financial

29  obligations incurred by the entity under the prepaid contract.

30  If the contract is terminated, expired, or not continued, the

31  account balance must be released by the agency to the entity


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  1  upon receipt of proof of satisfaction of all outstanding

  2  obligations incurred under this contract.

  3         (b)  The agency may waive the insolvency protection

  4  account requirement in writing when evidence is on file with

  5  the agency of adequate insolvency insurance and reinsurance

  6  that will protect enrollees if the entity becomes unable to

  7  meet its obligations.

  8         (16)  An entity that contracts with the agency on a

  9  prepaid or fixed-sum basis for the provision of Medicaid

10  services shall reimburse any hospital or physician that is

11  outside the entity's authorized geographic service area as

12  specified in its contract with the agency, and that provides

13  services authorized by the entity to its members, at a rate

14  negotiated with the hospital or physician for the provision of

15  services or according to the lesser of the following:

16         (a)  The usual and customary charges made to the

17  general public by the hospital or physician; or

18         (b)  The Florida Medicaid reimbursement rate

19  established for the hospital or physician.

20         (17)  When a merger or acquisition of a Medicaid

21  prepaid contractor has been approved by the Department of

22  Insurance pursuant to s. 628.4615, the agency shall approve

23  the assignment or transfer of the appropriate Medicaid prepaid

24  contract upon request of the surviving entity of the merger or

25  acquisition if the contractor and the other entity have been

26  in good standing with the agency for the most recent 12-month

27  period, unless the agency determines that the assignment or

28  transfer would be detrimental to the Medicaid recipients or

29  the Medicaid program.  To be in good standing, an entity must

30  not have failed accreditation or committed any material

31  violation of the requirements of s. 641.52 and must meet the


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  1  Medicaid contract requirements.  For purposes of this section,

  2  a merger or acquisition means a change in controlling interest

  3  of an entity, including an asset or stock purchase.

  4         (18)  Any entity contracting with the agency pursuant

  5  to this section to provide health care services to Medicaid

  6  recipients is prohibited from engaging in any of the following

  7  practices or activities:

  8         (a)  Practices that are discriminatory, including, but

  9  not limited to, attempts to discourage participation on the

10  basis of actual or perceived health status.

11         (b)  Activities that could mislead or confuse

12  recipients, or misrepresent the organization, its marketing

13  representatives, or the agency. Violations of this paragraph

14  include, but are not limited to:

15         1.  False or misleading claims that marketing

16  representatives are employees or representatives of the state

17  or county, or of anyone other than the entity or the

18  organization by whom they are reimbursed.

19         2.  False or misleading claims that the entity is

20  recommended or endorsed by any state or county agency, or by

21  any other organization which has not certified its endorsement

22  in writing to the entity.

23         3.  False or misleading claims that the state or county

24  recommends that a Medicaid recipient enroll with an entity.

25         4.  Claims that a Medicaid recipient will lose benefits

26  under the Medicaid program, or any other health or welfare

27  benefits to which the recipient is legally entitled, if the

28  recipient does not enroll with the entity.

29         (c)  Granting or offering of any monetary or other

30  valuable consideration for enrollment, except as authorized by

31  subsection (21).


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  1         (d)  Door-to-door solicitation of recipients who have

  2  not contacted the entity or who have not invited the entity to

  3  make a presentation.

  4         (e)  Solicitation of Medicaid recipients by marketing

  5  representatives stationed in state offices unless approved and

  6  supervised by the agency or its agent and approved by the

  7  affected state agency when solicitation occurs in an office of

  8  the state agency.  The agency shall ensure that marketing

  9  representatives stationed in state offices shall market their

10  managed care plans to Medicaid recipients only in designated

11  areas and in such a way as to not interfere with the

12  recipients' activities in the state office.

13         (f)  Enrollment of Medicaid recipients.

14         (19)  The agency may impose a fine for a violation of

15  this section or the contract with the agency by a person or

16  entity that is under contract with the agency.  With respect

17  to any nonwillful violation, such fine shall not exceed $2,500

18  per violation.  In no event shall such fine exceed an

19  aggregate amount of $10,000 for all nonwillful violations

20  arising out of the same action.  With respect to any knowing

21  and willful violation of this section or the contract with the

22  agency, the agency may impose a fine upon the entity in an

23  amount not to exceed $20,000 for each such violation.  In no

24  event shall such fine exceed an aggregate amount of $100,000

25  for all knowing and willful violations arising out of the same

26  action.

27         (20)  A health maintenance organization or a person or

28  entity exempt from chapter 641 that is under contract with the

29  agency for the provision of health care services to Medicaid

30  recipients may not use or distribute marketing materials used

31  to solicit Medicaid recipients, unless such materials have


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  1  been approved by the agency. The provisions of this subsection

  2  do not apply to general advertising and marketing materials

  3  used by a health maintenance organization to solicit both

  4  non-Medicaid subscribers and Medicaid recipients.

  5         (21)  Upon approval by the agency, health maintenance

  6  organizations and persons or entities exempt from chapter 641

  7  that are under contract with the agency for the provision of

  8  health care services to Medicaid recipients may be permitted

  9  within the capitation rate to provide additional health

10  benefits that the agency has found are of high quality, are

11  practicably available, provide reasonable value to the

12  recipient, and are provided at no additional cost to the

13  state.

14         (22)  The agency shall utilize the statewide health

15  maintenance organization complaint hotline for the purpose of

16  investigating and resolving Medicaid and prepaid health plan

17  complaints, maintaining a record of complaints and confirmed

18  problems, and receiving disenrollment requests made by

19  recipients.

20         (23)  The agency shall require the publication of the

21  health maintenance organization's and the prepaid health

22  plan's consumer services telephone numbers and the "800"

23  telephone number of the statewide health maintenance

24  organization complaint hotline on each Medicaid identification

25  card issued by a health maintenance organization or prepaid

26  health plan contracting with the agency to serve Medicaid

27  recipients and on each subscriber handbook issued to a

28  Medicaid recipient.

29         (24)  The agency shall establish a health care quality

30  improvement system for those entities contracting with the

31  agency pursuant to this section, incorporating all the


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  1  standards and guidelines developed by the Medicaid Bureau of

  2  the Health Care Financing Administration as a part of the

  3  quality assurance reform initiative.  The system shall

  4  include, but need not be limited to, the following:

  5         (a)  Guidelines for internal quality assurance

  6  programs, including standards for:

  7         1.  Written quality assurance program descriptions.

  8         2.  Responsibilities of the governing body for

  9  monitoring, evaluating, and making improvements to care.

10         3.  An active quality assurance committee.

11         4.  Quality assurance program supervision.

12         5.  Requiring the program to have adequate resources to

13  effectively carry out its specified activities.

14         6.  Provider participation in the quality assurance

15  program.

16         7.  Delegation of quality assurance program activities.

17         8.  Credentialing and recredentialing.

18         9.  Enrollee rights and responsibilities.

19         10.  Availability and accessibility to services and

20  care.

21         11.  Ambulatory care facilities.

22         12.  Accessibility and availability of medical records,

23  as well as proper recordkeeping and process for record review.

24         13.  Utilization review.

25         14.  A continuity of care system.

26         15.  Quality assurance program documentation.

27         16.  Coordination of quality assurance activity with

28  other management activity.

29         17.  Delivering care to pregnant women and infants; to

30  elderly and disabled recipients, especially those who are at

31  risk of institutional placement; to persons with developmental


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  1  disabilities; and to adults who have chronic, high-cost

  2  medical conditions.

  3         (b)  Guidelines which require the entities to conduct

  4  quality-of-care studies which:

  5         1.  Target specific conditions and specific health

  6  service delivery issues for focused monitoring and evaluation.

  7         2.  Use clinical care standards or practice guidelines

  8  to objectively evaluate the care the entity delivers or fails

  9  to deliver for the targeted clinical conditions and health

10  services delivery issues.

11         3.  Use quality indicators derived from the clinical

12  care standards or practice guidelines to screen and monitor

13  care and services delivered.

14         (c)  Guidelines for external quality review of each

15  contractor which require: focused studies of patterns of care;

16  individual care review in specific situations; and followup

17  activities on previous pattern-of-care study findings and

18  individual-care-review findings.  In designing the external

19  quality review function and determining how it is to operate

20  as part of the state's overall quality improvement system, the

21  agency shall construct its external quality review

22  organization and entity contracts to address each of the

23  following:

24         1.  Delineating the role of the external quality review

25  organization.

26         2.  Length of the external quality review organization

27  contract with the state.

28         3.  Participation of the contracting entities in

29  designing external quality review organization review

30  activities.

31  


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  1         4.  Potential variation in the type of clinical

  2  conditions and health services delivery issues to be studied

  3  at each plan.

  4         5.  Determining the number of focused pattern-of-care

  5  studies to be conducted for each plan.

  6         6.  Methods for implementing focused studies.

  7         7.  Individual care review.

  8         8.  Followup activities.

  9         (25)  In order to ensure that children receive health

10  care services for which an entity has already been

11  compensated, an entity contracting with the agency pursuant to

12  this section shall achieve an annual Early and Periodic

13  Screening, Diagnosis, and Treatment (EPSDT) Service screening

14  rate of at least 60 percent for those recipients continuously

15  enrolled for at least 8 months.  The agency shall develop a

16  method by which the EPSDT screening rate shall be calculated.

17  For any entity which does not achieve the annual 60 percent

18  rate, the entity must submit a corrective action plan for the

19  agency's approval.  If the entity does not meet the standard

20  established in the corrective action plan during the specified

21  timeframe, the agency is authorized to impose appropriate

22  contract sanctions.  At least annually, the agency shall

23  publicly release the EPSDT Services screening rates of each

24  entity it has contracted with on a prepaid basis to serve

25  Medicaid recipients.

26         (26)  The agency shall perform choice counseling,

27  enrollments, and disenrollments for Medicaid recipients who

28  are eligible for MediPass or managed care plans.

29  Notwithstanding the prohibition contained in paragraph

30  (18)(f), managed care plans may perform preenrollments of

31  Medicaid recipients under the supervision of the agency or its


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  1  agents.  For the purposes of this section, "preenrollment"

  2  means the provision of marketing and educational materials to

  3  a Medicaid recipient and assistance in completing the

  4  application forms, but shall not include actual enrollment

  5  into a managed care plan.  An application for enrollment shall

  6  not be deemed complete until the agency or its agent verifies

  7  that the recipient made an informed, voluntary choice.  The

  8  agency, in cooperation with the Department of Children and

  9  Family Services, may test new marketing initiatives to inform

10  Medicaid recipients about their managed care options at

11  selected sites.  The agency shall report to the Legislature on

12  the effectiveness of such initiatives.  The agency may

13  contract with a third party to perform managed care plan and

14  MediPass choice-counseling, enrollment, and disenrollment

15  services for Medicaid recipients and is authorized to adopt

16  rules to implement such services. The agency may adjust the

17  capitation rate only to cover the costs of a third-party

18  choice-counseling, enrollment, and disenrollment contract, and

19  for agency supervision and management of the managed care plan

20  choice-counseling, enrollment, and disenrollment contract.

21         (27)  Any lists of providers made available to Medicaid

22  recipients, MediPass enrollees, or managed care plan enrollees

23  shall be arranged alphabetically showing the provider's name

24  and specialty and, separately, by specialty in alphabetical

25  order.

26         (28)  The agency shall establish an enhanced managed

27  care quality assurance oversight function, to include at least

28  the following components:

29         (a)  At least quarterly analysis and followup,

30  including sanctions as appropriate, of managed care

31  participant utilization of services.


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  1         (b)  At least quarterly analysis and followup,

  2  including sanctions as appropriate, of quality findings of the

  3  Medicaid peer review organization and other external quality

  4  assurance programs.

  5         (c)  At least quarterly analysis and followup,

  6  including sanctions as appropriate, of the fiscal viability of

  7  managed care plans.

  8         (d)  At least quarterly analysis and followup,

  9  including sanctions as appropriate, of managed care

10  participant satisfaction and disenrollment surveys.

11         (e)  The agency shall conduct regular and ongoing

12  Medicaid recipient satisfaction surveys.

13  

14  The analyses and followup activities conducted by the agency

15  under its enhanced managed care quality assurance oversight

16  function shall not duplicate the activities of accreditation

17  reviewers for entities regulated under part III of chapter

18  641, but may include a review of the finding of such

19  reviewers.

20         (29)  Each managed care plan that is under contract

21  with the agency to provide health care services to Medicaid

22  recipients shall annually conduct a background check with the

23  Florida Department of Law Enforcement of all persons with

24  ownership interest of 5 percent or more or executive

25  management responsibility for the managed care plan and shall

26  submit to the agency information concerning any such person

27  who has been found guilty of, regardless of adjudication, or

28  has entered a plea of nolo contendere or guilty to, any of the

29  offenses listed in s. 435.03.

30         (30)  The agency shall, by rule, develop a process

31  whereby a Medicaid managed care plan enrollee who wishes to


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  1  enter hospice care may be disenrolled from the managed care

  2  plan within 24 hours after contacting the agency regarding

  3  such request. The agency rule shall include a methodology for

  4  the agency to recoup managed care plan payments on a pro rata

  5  basis if payment has been made for the enrollment month when

  6  disenrollment occurs.

  7         (31)  The agency and entities which contract with the

  8  agency to provide health care services to Medicaid recipients

  9  under this section or s. 409.9122 must comply with the

10  provisions of s. 641.513 in providing emergency services and

11  care to Medicaid recipients and MediPass recipients.

12         (32)  All entities providing health care services to

13  Medicaid recipients shall make available, and encourage all

14  pregnant women and mothers with infants to receive, and

15  provide documentation in the medical records to reflect, the

16  following:

17         (a)  Healthy Start prenatal or infant screening.

18         (b)  Healthy Start care coordination, when screening or

19  other factors indicate need.

20         (c)  Healthy Start enhanced services in accordance with

21  the prenatal or infant screening results.

22         (d)  Immunizations in accordance with recommendations

23  of the Advisory Committee on Immunization Practices of the

24  United States Public Health Service and the American Academy

25  of Pediatrics, as appropriate.

26         (e)  Counseling and services for family planning to all

27  women and their partners.

28         (f)  A scheduled postpartum visit for the purpose of

29  voluntary family planning, to include discussion of all

30  methods of contraception, as appropriate.

31  


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  1         (g)  Referral to the Special Supplemental Nutrition

  2  Program for Women, Infants, and Children (WIC).

  3         (33)  Any entity that provides Medicaid prepaid health

  4  plan services shall ensure the appropriate coordination of

  5  health care services with an assisted living facility in cases

  6  where a Medicaid recipient is both a member of the entity's

  7  prepaid health plan and a resident of the assisted living

  8  facility. If the entity is at risk for Medicaid targeted case

  9  management and behavioral health services, the entity shall

10  inform the assisted living facility of the procedures to

11  follow should an emergent condition arise.

12         (34)  The agency may seek and implement federal waivers

13  necessary to provide for cost-effective purchasing of home

14  health services, private duty nursing services,

15  transportation, independent laboratory services, and durable

16  medical equipment and supplies through competitive bidding

17  negotiation pursuant to s. 287.057. The agency may request

18  appropriate waivers from the federal Health Care Financing

19  Administration in order to competitively bid such home health

20  services. The agency may exclude providers not selected

21  through the bidding process from the Medicaid provider

22  network.

23         (35)  The Agency for Health Care Administration is

24  directed to issue a request for proposal or intent to

25  negotiate to implement on a demonstration basis an outpatient

26  specialty services pilot project in a rural and urban county

27  in the state.  As used in this subsection, the term

28  "outpatient specialty services" means clinical laboratory,

29  diagnostic imaging, and specified home medical services to

30  include durable medical equipment, prosthetics and orthotics,

31  and infusion therapy.


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  1         (a)  The entity that is awarded the contract to provide

  2  Medicaid managed care outpatient specialty services must, at a

  3  minimum, meet the following criteria:

  4         1.  The entity must be licensed by the Department of

  5  Insurance under part II of chapter 641.

  6         2.  The entity must be experienced in providing

  7  outpatient specialty services.

  8         3.  The entity must demonstrate to the satisfaction of

  9  the agency that it provides high-quality services to its

10  patients.

11         4.  The entity must demonstrate that it has in place a

12  complaints and grievance process to assist Medicaid recipients

13  enrolled in the pilot managed care program to resolve

14  complaints and grievances.

15         (b)  The pilot managed care program shall operate for a

16  period of 3 years.  The objective of the pilot program shall

17  be to determine the cost-effectiveness and effects on

18  utilization, access, and quality of providing outpatient

19  specialty services to Medicaid recipients on a prepaid,

20  capitated basis.

21         (c)  The agency shall conduct a quality assurance

22  review of the prepaid health clinic each year that the

23  demonstration program is in effect. The prepaid health clinic

24  is responsible for all expenses incurred by the agency in

25  conducting a quality assurance review.

26         (d)  The entity that is awarded the contract to provide

27  outpatient specialty services to Medicaid recipients shall

28  report data required by the agency in a format specified by

29  the agency, for the purpose of conducting the evaluation

30  required in paragraph (e).

31  


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  1         (e)  The agency shall conduct an evaluation of the

  2  pilot managed care program and report its findings to the

  3  Governor and the Legislature by no later than January 1, 2001.

  4         (36)  The agency shall enter into agreements with

  5  not-for-profit organizations based in this state for the

  6  purpose of providing vision screening.

  7         (37)(a)  The agency shall implement a Medicaid

  8  prescribed-drug spending-control program that includes the

  9  following components:

10         1.  Medicaid prescribed-drug coverage for brand-name

11  drugs for adult Medicaid recipients not residing in nursing

12  homes or other institutions is limited to the dispensing of

13  four brand-name drugs per month per recipient. Children and

14  institutionalized adults are exempt from this restriction.

15  Antiretroviral agents are excluded from this limitation. No

16  requirements for prior authorization or other restrictions on

17  medications used to treat mental illnesses such as

18  schizophrenia, severe depression, or bipolar disorder may be

19  imposed on Medicaid recipients. Medications that will be

20  available without restriction for persons with mental

21  illnesses include atypical antipsychotic medications,

22  conventional antipsychotic medications, selective serotonin

23  reuptake inhibitors, and other medications used for the

24  treatment of serious mental illnesses. The agency shall also

25  limit the amount of a prescribed drug dispensed to no more

26  than a 34-day supply. The agency shall continue to provide

27  unlimited generic drugs, contraceptive drugs and items, and

28  diabetic supplies. Although a drug may be included on the

29  preferred drug formulary, it would not be exempt from the

30  four-brand limit. The agency may authorize exceptions to the

31  brand-name-drug restriction based upon the treatment needs of


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  1  the patients, only when such exceptions are based on prior

  2  consultation provided by the agency or an agency contractor,

  3  but the agency must establish procedures to ensure that:

  4         a.  There will be a response to a request for prior

  5  consultation by telephone or other telecommunication device

  6  within 24 hours after receipt of a request for prior

  7  consultation; and

  8         b.  A 72-hour supply of the drug prescribed will be

  9  provided in an emergency or when the agency does not provide a

10  response within 24 hours as required by sub-subparagraph a.;

11  and

12         c.  Except for the exception for nursing home residents

13  and other institutionalized adults and except for drugs on the

14  restricted formulary for which prior authorization may be

15  sought by an institutional or community pharmacy, prior

16  authorization for an exception to the brand-name-drug

17  restriction is sought by the prescriber and not by the

18  pharmacy. When prior authorization is granted for a patient in

19  an institutional setting beyond the brand-name-drug

20  restriction, such approval is authorized for 12 months and

21  monthly prior authorization is not required for that patient.

22         2.  Reimbursement to pharmacies for Medicaid prescribed

23  drugs shall be set at the average wholesale price less 13.25

24  percent.

25         3.  The agency shall develop and implement a process

26  for managing the drug therapies of Medicaid recipients who are

27  using significant numbers of prescribed drugs each month. The

28  management process may include, but is not limited to,

29  comprehensive, physician-directed medical-record reviews,

30  claims analyses, and case evaluations to determine the medical

31  necessity and appropriateness of a patient's treatment plan


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  1  and drug therapies. The agency may contract with a private

  2  organization to provide drug-program-management services. The

  3  Medicaid drug benefit management program shall include

  4  initiatives to manage drug therapies for HIV/AIDS patients,

  5  patients using 20 or more unique prescriptions in a 180-day

  6  period, and the top 1,000 patients in annual spending.

  7         4.  The agency may limit the size of its pharmacy

  8  network based on need, competitive bidding, price

  9  negotiations, credentialing, or similar criteria. The agency

10  shall give special consideration to rural areas in determining

11  the size and location of pharmacies included in the Medicaid

12  pharmacy network. A pharmacy credentialing process may include

13  criteria such as a pharmacy's full-service status, location,

14  size, patient educational programs, patient consultation,

15  disease-management services, and other characteristics. The

16  agency may impose a moratorium on Medicaid pharmacy enrollment

17  when it is determined that it has a sufficient number of

18  Medicaid-participating providers.

19         5.  The agency shall develop and implement a program

20  that requires Medicaid practitioners who prescribe drugs to

21  use a counterfeit-proof prescription pad for Medicaid

22  prescriptions. The agency shall require the use of

23  standardized counterfeit-proof prescription pads by

24  Medicaid-participating prescribers or prescribers who write

25  prescriptions for Medicaid recipients. The agency may

26  implement the program in targeted geographic areas or

27  statewide.

28         6.  The agency may enter into arrangements that require

29  manufacturers of generic drugs prescribed to Medicaid

30  recipients to provide rebates of at least 15.1 percent of the

31  average manufacturer price for the manufacturer's generic


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  1  products. These arrangements shall require that if a

  2  generic-drug manufacturer pays federal rebates for

  3  Medicaid-reimbursed drugs at a level below 15.1 percent, the

  4  manufacturer must provide a supplemental rebate to the state

  5  in an amount necessary to achieve a 15.1-percent rebate level.

  6  If a generic-drug manufacturer raises its price in excess of

  7  the Consumer Price Index (Urban), the excess amount shall be

  8  included in the supplemental rebate to the state.

  9         7.  The agency may establish a preferred drug formulary

10  in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the

11  establishment of such formulary, it is authorized to negotiate

12  supplemental rebates from manufacturers that are in addition

13  to those required by Title XIX of the Social Security Act and

14  at no less than 10 percent of the average manufacturer price

15  as defined in 42 U.S.C. s. 1936 on the last day of a quarter

16  unless the federal or supplemental rebate, or both, equals or

17  exceeds 25 percent. There is no upper limit on the

18  supplemental rebates the agency may negotiate. The agency may

19  determine that specific products, brand-name or generic, are

20  competitive at lower rebate percentages. Agreement to pay the

21  minimum supplemental rebate percentage will guarantee a

22  manufacturer that the Medicaid Pharmaceutical and Therapeutics

23  Committee will consider a product for inclusion on the

24  preferred drug formulary. However, a pharmaceutical

25  manufacturer is not guaranteed placement on the formulary by

26  simply paying the minimum supplemental rebate. Agency

27  decisions will be made on the clinical efficacy of a drug and

28  recommendations of the Medicaid Pharmaceutical and

29  Therapeutics Committee, as well as the price of competing

30  products minus federal and state rebates. The agency is

31  authorized to contract with an outside agency or contractor to


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  1  conduct negotiations for supplemental rebates. For the

  2  purposes of this section, the term "supplemental rebates" may

  3  include, at the agency's discretion, cash rebates and other

  4  program benefits that offset a Medicaid expenditure. Such

  5  other program benefits may include, but are not limited to,

  6  disease management programs, drug product donation programs,

  7  drug utilization control programs, prescriber and beneficiary

  8  counseling and education, fraud and abuse initiatives, and

  9  other services or administrative investments with guaranteed

10  savings to the Medicaid program in the same year the rebate

11  reduction is included in the General Appropriations Act. The

12  agency is authorized to seek any federal waivers to implement

13  this initiative.

14         8.  The agency shall establish an advisory committee

15  for the purposes of studying the feasibility of using a

16  restricted drug formulary for nursing home residents and other

17  institutionalized adults. The committee shall be comprised of

18  seven members appointed by the Secretary of Health Care

19  Administration. The committee members shall include two

20  physicians licensed under chapter 458 or chapter 459, Florida

21  Statutes; three pharmacists licensed under chapter 465,

22  Florida Statutes, and appointed from a list of recommendations

23  provided by the Florida Long-Term Care Pharmacy Alliance; and

24  two pharmacists licensed under chapter 465, Florida Statutes.

25         (b)  The agency shall implement this subsection to the

26  extent that funds are appropriated to administer the Medicaid

27  prescribed-drug spending-control program. The agency may

28  contract all or any part of this program to private

29  organizations.

30         (c)  The agency shall submit a report to the Governor,

31  the President of the Senate, and the Speaker of the House of


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  1  Representatives by January 15 of each year. The report must

  2  include, but need not be limited to, the progress made in

  3  implementing Medicaid cost-containment measures and their

  4  effect on Medicaid prescribed-drug expenditures.

  5         (38)  Notwithstanding the provisions of chapter 287,

  6  the agency may, at its discretion, renew a contract or

  7  contracts for fiscal intermediary services one or more times

  8  for such periods as the agency may decide; however, all such

  9  renewals may not combine to exceed a total period longer than

10  the term of the original contract.

11         (39)  The agency shall provide for the development of a

12  demonstration project by establishment in Miami-Dade County of

13  a long-term-care facility licensed pursuant to chapter 395 to

14  improve access to health care for a predominantly minority,

15  medically underserved, and medically complex population and to

16  evaluate alternatives to nursing-home care and general acute

17  care for such population.  Such project is to be located in a

18  health care condominium and colocated with licensed facilities

19  providing a continuum of care.  The establishment of this

20  project is not subject to the provisions of s. 408.036 or s.

21  408.039.  The agency shall report its findings to the

22  Governor, the President of the Senate, and the Speaker of the

23  House of Representatives by January 1, 2003.

24         Section 10.  Paragraphs (f) and (k) of subsection (2)

25  of section 409.9122, Florida Statutes, are amended to read:

26         409.9122  Mandatory Medicaid managed care enrollment;

27  programs and procedures.--

28         (2)

29         (f)  When a Medicaid recipient does not choose a

30  managed care plan or MediPass provider, the agency shall

31  assign the Medicaid recipient to a managed care plan or


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  1  MediPass provider. Medicaid recipients who are subject to

  2  mandatory assignment but who fail to make a choice shall be

  3  assigned to managed care plans or provider service networks

  4  until an equal enrollment of 50 percent in MediPass and

  5  provider service networks and 50 percent in managed care plans

  6  is achieved.  Once equal enrollment is achieved, the

  7  assignments shall be divided in order to maintain an equal

  8  enrollment in MediPass and managed care plans for the

  9  1998-1999 fiscal year. Thereafter, assignment of Medicaid

10  recipients who fail to make a choice shall be based

11  proportionally on the preferences of recipients who have made

12  a choice in the previous period. Such proportions shall be

13  revised at least quarterly to reflect an update of the

14  preferences of Medicaid recipients. The agency shall also

15  disproportionately assign Medicaid-eligible children in

16  families who are required to but have failed to make a choice

17  of managed-care plan or MediPass for their child and who are

18  to be assigned to the MediPass program to children's networks

19  as described in s. 409.912(3)(g) and where available. The

20  disproportionate assignment of children to children's networks

21  shall be made until the agency has determined that the

22  children's networks have sufficient numbers to be economically

23  operated. When making assignments, the agency shall take into

24  account the following criteria:

25         1.  A managed care plan has sufficient network capacity

26  to meet the need of members.

27         2.  The managed care plan or MediPass has previously

28  enrolled the recipient as a member, or one of the managed care

29  plan's primary care providers or MediPass providers has

30  previously provided health care to the recipient.

31  


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  1         3.  The agency has knowledge that the member has

  2  previously expressed a preference for a particular managed

  3  care plan or MediPass provider as indicated by Medicaid

  4  fee-for-service claims data, but has failed to make a choice.

  5         4.  The managed care plan's or MediPass primary care

  6  providers are geographically accessible to the recipient's

  7  residence.

  8         (k)1.  Notwithstanding the provisions of paragraph (f),

  9  and for the 2000-2001 fiscal year only, When a Medicaid

10  recipient does not choose a managed care plan or MediPass

11  provider, the agency shall assign the Medicaid recipient to a

12  managed care plan, except in those counties in which there are

13  fewer than two managed care plans accepting Medicaid

14  enrollees, in which case assignment shall be to a managed care

15  plan or a MediPass provider. Medicaid recipients in counties

16  with fewer than two managed care plans accepting Medicaid

17  enrollees who are subject to mandatory assignment but who fail

18  to make a choice shall be assigned to managed care plans until

19  an equal enrollment of 50 percent in MediPass and provider

20  service networks and 50 percent in managed care plans is

21  achieved. Once equal enrollment is achieved, the assignments

22  shall be divided in order to maintain an equal enrollment in

23  MediPass and managed care plans. When making assignments, the

24  agency shall take into account the following criteria:

25         1.a.  A managed care plan has sufficient network

26  capacity to meet the need of members.

27         2.b.  The managed care plan or MediPass has previously

28  enrolled the recipient as a member, or one of the managed care

29  plan's primary care providers or MediPass providers has

30  previously provided health care to the recipient.

31  


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  1         3.c.  The agency has knowledge that the member has

  2  previously expressed a preference for a particular managed

  3  care plan or MediPass provider as indicated by Medicaid

  4  fee-for-service claims data, but has failed to make a choice.

  5         4.d.  The managed care plan's or MediPass primary care

  6  providers are geographically accessible to the recipient's

  7  residence.

  8         5.e.  The agency has authority to make mandatory

  9  assignments based on quality of service and performance of

10  managed care plans.

11         2.  This paragraph is repealed on July 1, 2001.

12         Section 11.  Paragraph (a) of subsection (1) and

13  subsection (7) of section 409.915, Florida Statutes, are

14  amended to read:

15         409.915  County contributions to Medicaid.--Although

16  the state is responsible for the full portion of the state

17  share of the matching funds required for the Medicaid program,

18  in order to acquire a certain portion of these funds, the

19  state shall charge the counties for certain items of care and

20  service as provided in this section.

21         (1)  Each county shall participate in the following

22  items of care and service:

23         (a)  For both health maintenance members and

24  fee-for-service beneficiaries, payments for inpatient

25  hospitalization in excess of 10 12 days, but not in excess of

26  45 days, with the exception of pregnant women and children

27  whose income is in excess of the federal poverty level and who

28  do not participate in the Medicaid medically needy program.

29         (7)  Counties are exempt from contributing toward the

30  cost of new exemptions on inpatient ceilings for statutory

31  teaching hospitals, specialty hospitals, and community


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  1  hospital education program hospitals that came into effect

  2  July 1, 2000, and for special Medicaid payments that came into

  3  effect on or after July 1, 2000. Notwithstanding any provision

  4  of this section to the contrary, counties are exempt from

  5  contributing toward the increased cost of hospital inpatient

  6  services due to the elimination of ceilings on Medicaid

  7  inpatient reimbursement rates paid to teaching hospitals,

  8  specialty hospitals, and community health education program

  9  hospitals and for special Medicaid reimbursements to hospitals

10  for which the Legislature has specifically appropriated funds.

11  This subsection is repealed on July 1, 2001.

12         Section 12.  Effective upon this act becoming a law,

13  and notwithstanding sections 409.911, 409.9113, and 409.9117,

14  Florida Statutes, from the funds made available under the

15  Medicare program, the Medicaid program, and the State

16  Children's Health Insurance Program Benefits Improvement and

17  Protection Act of 2000 for the 2001 federal fiscal year,

18  disproportionate share program funds shall be distributed as

19  follows: $13,937,997 to Jackson Memorial; $285,298 to Mount

20  Sinai Medical Center; $313,748 to Orlando Regional Medical

21  Center; $2,734,019 to Shands - Jacksonville; $1,060,047 to

22  Shands - University of Florida; $1,683,415 to Tampa General

23  Hospital; and $2,231,910 to North Broward Hospital District.

24  Such funds shall be made available in accordance with a budget

25  amendment and the Medicaid plan amendment submitted prior to

26  the close of the 2001 federal fiscal year. This section does

27  not delay implementation of the budget amendment or the

28  Medicaid plan amendment if such is deemed necessary.

29         Section 13.  From the funds in Specific Appropriation

30  1002 of the General Appropriations Act for FY 2001-2002,

31  


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  1  $1,750,000 in non-recurring County Health Department Trust

  2  Funds is provided for the following:

  3  

  4  School Health--Hillsborough County                    $550,000

  5  School Health--Broward County                         $500,000

  6  School Health--Escambia County                        $200,000

  7  School Health--Monroe County                          $200,000

  8  School Health--Dade County                            $300,000

  9         Section 14.  The certificate-of-need workgroup created

10  by section 15 of Chapter 2000-318, Laws of Florida, shall

11  review and make recommendations regarding the appropriateness

12  of current regulations on services provided in ambulatory

13  surgical centers. The recommendations shall be based on

14  consideration of:

15         (1)  The consistency of the regulations with federal

16  law and federal reimbursement policies;

17         (2)  The effectiveness of the regulations in protecting

18  the public health and safety, promoting the quality of

19  services provided by ambulatory surgical centers, and

20  encouraging the participation of ambulatory surgical centers

21  in the delivery of essential community services; and

22         (3)  The impact of any change of the current

23  regulations on the health care market, including:

24         (a)  The number and location of facilities and

25  services, whether provided by an ambulatory surgical center or

26  other licensed health care provider;

27         (b)  The financial condition of safety net providers;

28         (c)  The availability of essential community services,

29  including trauma, emergency care and specialty, tertiary

30  services; and

31  


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  1         (d)  The cost and availability of health care services

  2  to all classes of patients, including insured, uninsured,

  3  underinsured, and Medicare and Medicaid.

  4         Section 15.  Paragraphs (r) and (s) are added to

  5  subsection (3) of section 408.036, Florida Statutes, to read:

  6         408.036  Projects subject to review.--

  7         (3)  EXEMPTIONS.--Upon request, the following projects

  8  are subject to exemption from the provisions of subsection

  9  (1):

10         (r)  For the conversion of hospital-based Medicare and

11  Medicaid certified skilled nursing beds to acute care beds, if

12  the conversion does not involve the construction of new

13  facilities.

14         (s)  For fiscal year 2001-2002 only, for transfer by a

15  health care system of existing services and not more than 100

16  licensed and approved beds from a hospital in district 1,

17  subdistrict 1, to another location within the same subdistrict

18  in order to establish a satellite facility that will improve

19  access to outpatient and inpatient care for residents of the

20  district and subdistrict and that will use new medical

21  technologies, including advanced diagnostics, computer

22  assisted imaging, and telemedicine to improve care. This

23  paragraph is repealed on July 1, 2002.

24         Section 16.  The Legislature determines and declares

25  that this act fulfills an important state interest.

26         Section 17.  It is hereby appropriated for state fiscal

27  year 2001-2002, $713,493 from the General Revenue Fund and

28  $924,837 from the Medical Care Trust Fund to increase the

29  pharmaceutical dispensing fee for prescriptions dispensed to

30  nursing home residents and other institutional residents from

31  $4.23 to $4.73 per prescription.


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  1         Section 18.  From the funds in Specific Appropriation

  2  500 of the General Appropriations Act for FY 2001-2002,

  3  $196,000 in General Revenue is provided for the following:

  4  

  5  Public Guardianship Program - Dade County             $150,000

  6  

  7  Public Guardianship Program - Collier County          $ 38,000

  8  

  9  Public Guardianship Program - Escambia County         $  8,000

10         Section 19.  Subsection (1) and paragraph (a) of

11  subsection (7) of section 240.4075, Florida Statutes, are

12  amended to read:

13         240.4075  Nursing Student Loan Forgiveness Program.--

14         (1)  To encourage qualified personnel to seek

15  employment in areas of this state in which critical nursing

16  shortages exist, there is established the Nursing Student Loan

17  Forgiveness Program.  The primary function of the program is

18  to increase employment and retention of registered nurses and

19  licensed practical nurses in nursing homes and hospitals in

20  the state and in state-operated medical and health care

21  facilities, birth centers, federally sponsored community

22  health centers, and teaching hospitals, family practice

23  teaching hospitals, and specialty children's hospitals by

24  making repayments toward loans received by students from

25  federal or state programs or commercial lending institutions

26  for the support of postsecondary study in accredited or

27  approved nursing programs.

28         (7)(a)  Funds contained in the Nursing Student Loan

29  Forgiveness Trust Fund which are to be used for loan

30  forgiveness for those nurses employed by hospitals, birth

31  centers, and nursing homes must be matched on a


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  1  dollar-for-dollar basis by contributions from the employing

  2  institutions, except that this provision shall not apply to

  3  state-operated medical and health care facilities, county

  4  health departments, federally sponsored community health

  5  centers, or teaching hospitals as defined in s. 408.07, family

  6  practice teaching hospitals as defined in s. 395.805, or

  7  specialty children's hospitals as described in s. 409.9119.

  8  If, in any given fiscal quarter, there are insufficient funds

  9  in the trust fund to grant all eligible applicants' requests,

10  awards must be based on the following priority by employer:

11  county health departments, federally sponsored community

12  health centers, state-operated medical and health care

13  facilities, teaching hospitals as defined in s. 408.07, family

14  practice teaching hospitals as defined in s. 395.805,

15  specialty children's hospitals as described in s. 409.9119,

16  and other hospitals, birthing centers, or nursing homes where

17  the match is required.

18         Section 20.  Paragraph (b) of subsection (4) of section

19  240.4076, Florida Statutes, is amended to read:

20         240.4076  Nursing scholarship program.--

21         (4)  Credit for repayment of a scholarship shall be as

22  follows:

23         (b)  Eligible health care facilities include

24  state-operated medical or health care facilities, county

25  health departments, federally sponsored community health

26  centers, or teaching hospitals as defined in s. 408.07,

27  nursing homes, family practice teaching hospitals as defined

28  in s. 395.805, or specialty children's hospitals as described

29  in s. 409.9119. The recipient shall be encouraged to complete

30  the service obligation at a single employment site.  If

31  continuous employment at the same site is not feasible, the


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  1  recipient may apply to the department for a transfer to

  2  another approved health care facility.

  3         Section 21.  All the statutory powers, duties, and

  4  functions and the records, personnel, property, and unexpended

  5  balances of appropriations, allocations, or other funds of the

  6  Nursing Student Loan Forgiveness Program are transferred from

  7  the Department of Education to the Department of Health by a

  8  type two transfer as defined in section 20.06, Florida

  9  Statutes.

10         Section 22.  Except as otherwise expressly provided in

11  this act, this act shall take effect July 1, 2001.

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  


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