Senate Bill sb2678e1
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1 A bill to be entitled
2 An act relating to health care practice
3 parameters; repealing s. 408.02, F.S., relating
4 to practice parameters; amending s. 440.13,
5 F.S.; providing for practice parameters and
6 protocols; amending ss. 440.134, 627.6418,
7 627.6613, F.S., relating to worker's
8 compensation managed care plans and health
9 insurance policy coverage for mammograms;
10 removing references and legislative intent, to
11 conform; providing legislative intent that the
12 statutory requirements conform to certain
13 parameters relating to mammograms; amending s.
14 409.904, F.S.; postponing the effective date of
15 changes to standards for eligibility for
16 certain optional medical assistance, including
17 coverage under the medically needy program;
18 providing appropriations; providing for
19 retroactive application; providing effective
20 dates.
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22 Be It Enacted by the Legislature of the State of Florida:
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24 Section 1. Section 408.02, Florida Statutes, is
25 repealed.
26 Section 2. Subsection (15) of section 440.13, Florida
27 Statutes, is amended to read:
28 440.13 Medical services and supplies; penalty for
29 violations; limitations.--
30 (15) PRACTICE PARAMETERS.--The practice parameters and
31 protocols mandated under this chapter shall be the Workers'
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1 Compensation Utilization Management Standards adopted by the
2 American Accreditation Health Care Commission in effect on
3 January 1, 2003.
4 (a) The Agency for Health Care Administration, in
5 conjunction with the department and appropriate health
6 professional associations and health-related organizations
7 shall develop and may adopt by rule scientifically sound
8 practice parameters for medical procedures relevant to
9 workers' compensation claimants. Practice parameters developed
10 under this section must focus on identifying effective
11 remedial treatments and promoting the appropriate utilization
12 of health care resources. Priority must be given to those
13 procedures that involve the greatest utilization of resources
14 either because they are the most costly or because they are
15 the most frequently performed. Practice parameters for
16 treatment of the 10 top procedures associated with workers'
17 compensation injuries including the remedial treatment of
18 lower-back injuries must be developed by December 31, 1994.
19 (b) The guidelines may be initially based on
20 guidelines prepared by nationally recognized health care
21 institutions and professional organizations but should be
22 tailored to meet the workers' compensation goal of returning
23 employees to full employment as quickly as medically possible,
24 taking into consideration outcomes data collected from managed
25 care providers and any other inpatient and outpatient
26 facilities serving workers' compensation claimants.
27 (c) Procedures must be instituted which provide for
28 the periodic review and revision of practice parameters based
29 on the latest outcomes data, research findings, technological
30 advancements, and clinical experiences, at least once every 3
31 years.
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1 (d) Practice parameters developed under this section
2 must be used by carriers and the agency in evaluating the
3 appropriateness and overutilization of medical services
4 provided to injured employees.
5 Section 3. Subsection (11) of section 440.134, Florida
6 Statutes, is amended to read:
7 440.134 Workers' compensation managed care
8 arrangement.--
9 (11) A description of the use of workers' compensation
10 practice parameters and protocols for treatment for health
11 care services when adopted by the agency.
12 Section 4. Subsection (1) of section 627.6418, Florida
13 Statutes, is amended to read:
14 627.6418 Coverage for mammograms.--
15 (1) An accident or health insurance policy issued,
16 amended, delivered, or renewed in this state must provide
17 coverage for at least the following:
18 (a) A baseline mammogram for any woman who is 35 years
19 of age or older, but younger than 40 years of age.
20 (b) A mammogram every 2 years for any woman who is 40
21 years of age or older, but younger than 50 years of age, or
22 more frequently based on the patient's physician's
23 recommendation.
24 (c) A mammogram every year for any woman who is 50
25 years of age or older.
26 (d) One or more mammograms a year, based upon a
27 physician's recommendation, for any woman who is at risk for
28 breast cancer because of a personal or family history of
29 breast cancer, because of having a history of biopsy-proven
30 benign breast disease, because of having a mother, sister, or
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1 daughter who has or has had breast cancer, or because a woman
2 has not given birth before the age of 30.
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4 It is the intent of the Legislature that, the requirements of
5 this section conform to the practice parameters relating to
6 mammograms as recognized by the United States Agency for
7 Healthcare Research and Quality when practice parameters for
8 the delivery of mammography services are developed pursuant to
9 s. 408.02(7), the Legislature review the requirements of this
10 section and conform to the practice parameters.
11 Section 5. Subsection (1) of section 627.6613, Florida
12 Statutes, is amended to read:
13 627.6613 Coverage for mammograms.--
14 (1) A group, blanket, or franchise accident or health
15 insurance policy issued, amended, delivered, or renewed in
16 this state must provide coverage for at least the following:
17 (a) A baseline mammogram for any woman who is 35 years
18 of age or older, but younger than 40 years of age.
19 (b) A mammogram every 2 years for any woman who is 40
20 years of age or older, but younger than 50 years of age, or
21 more frequently based on the patient's physician's
22 recommendation.
23 (c) A mammogram every year for any woman who is 50
24 years of age or older.
25 (d) One or more mammograms a year, based upon a
26 physician's recommendation, for any woman who is at risk for
27 breast cancer because of a personal or family history of
28 breast cancer, because of having a history of biopsy-proven
29 benign breast disease, because of having a mother, sister, or
30 daughter who has or has had breast cancer, or because a woman
31 has not given birth before the age of 30.
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1
2 It is the intent of the Legislature that the requirements of
3 this section conform to the practice parameters relating to
4 mammograms as recognized by the United States Agency for
5 Healthcare Research and Quality, when practice parameters for
6 the delivery of mammography services are developed pursuant to
7 s. 408.02(7), the Legislature review the requirements of this
8 section and conform to the practice parameters.
9 Section 6. Effective May 1, 2003, subsection (2) of
10 section 409.904, Florida Statutes, is amended to read:
11 409.904 Optional payments for eligible persons.--The
12 agency may make payments for medical assistance and related
13 services on behalf of the following persons who are determined
14 to be eligible subject to the income, assets, and categorical
15 eligibility tests set forth in federal and state law. Payment
16 on behalf of these Medicaid eligible persons is subject to the
17 availability of moneys and any limitations established by the
18 General Appropriations Act or chapter 216.
19 (2) A caretaker relative or parent, a pregnant woman,
20 a child under age 19 who would otherwise qualify for Florida
21 Kidcare Medicaid, a child up to age 21 who would otherwise
22 qualify under s. 409.903(1), a person age 65 or over, or a
23 blind or disabled person, who would otherwise be eligible for
24 Florida Medicaid, except that the income or assets of such
25 family or person exceed established limitations. For a family
26 or person in one of these coverage groups, medical expenses
27 are deductible from income in accordance with federal
28 requirements in order to make a determination of eligibility.
29 Expenses used to meet spend-down liability are not
30 reimbursable by Medicaid. Effective July May 1, 2003, when
31 determining the eligibility of a pregnant woman, a child, or
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1 an aged, blind, or disabled individual, $270 shall be deducted
2 from the countable income of the filing unit. When determining
3 the eligibility of the parent or caretaker relative as defined
4 by Title XIX of the Social Security Act, the additional income
5 disregard of $270 does not apply. A family or person eligible
6 under the coverage known as the "medically needy," is eligible
7 to receive the same services as other Medicaid recipients,
8 with the exception of services in skilled nursing facilities
9 and intermediate care facilities for the developmentally
10 disabled.
11 Section 7. The non-recurring sums of $8,265,777 from
12 the General Revenue Fund, $2,505,224 from the Grants and
13 Donations Trust Fund, and $11,727,287 from the Medical Care
14 Trust Fund are appropriated to the Agency for Health Care
15 Administration to implement section 6 of this act during the
16 2002-2003 fiscal year. This section takes effect May 1, 2003.
17 Section 8. Except as otherwise expressly provided,
18 this act shall take July 1, 2003, but if it becomes a law
19 after May 1, 2003, sections 6 and 7 of this act shall operate
20 retroactively to that date.
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