Senate Bill sb1178er

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  2         An act relating to minority health care;

  3         creating s. 381.736, F.S.; providing for the

  4         Department of Health to monitor and report on

  5         Florida's status regarding the Healthy People

  6         2010 goals and objectives currently tracked by

  7         the department; requiring an annual report to

  8         the Legislature; requiring the department to

  9         work with various groups to educate health care

10         professionals on racial and ethnic issues in

11         health, to recruit and train health care

12         professionals from minority backgrounds, and to

13         promote certain research; amending s. 409.901,

14         F.S.; defining the term "minority physician

15         network"; amending s. 409.912, F.S.; requiring

16         the Agency for Health Care Administration to

17         contract with minority physician networks;

18         providing guidelines for the operation of the

19         networks; defining the term "cost-effective";

20         requiring the agency to conduct actuarially

21         sound audits; providing an effective date.

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

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25         Section 1.  Section 381.736, Florida Statutes, is

26  created to read:

27         381.736  Florida Healthy People 2010 Program.--

28         (1)  The Department of Health shall, using existing

29  resources, monitor and report Florida's status on the Healthy

30  People 2010 goals and objectives currently tracked and

31  available to the department. The federal Healthy People 2010


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 1  goals and objectives are designed to measure and help to

 2  improve the health of all Americans by advancing the following

 3  goals:

 4         (a)  Increase the quality and years of healthy life.

 5         (b)  Eliminate health disparities among different

 6  segments of the population.

 7         (2)  The department shall report to the Legislature by

 8  December 31 of each year on the status of disparities in

 9  health among minorities and nonminorities, using health

10  indicators currently available that are consistent with those

11  identified by the federal Healthy People 2010 goals and

12  objectives.

13         (3)  To reduce negative health consequences that result

14  from ignoring racial and ethnic cultures, the department shall

15  work with minority physician networks to develop programs to

16  educate health care professionals about the importance of

17  culture in health status. These programs shall include, but

18  need not be limited to:

19         (a)  The education of health care providers about the

20  prevalence of specific health conditions among certain

21  minority groups.

22         (b)  The training of clinicians to be sensitive to

23  cultural diversity among patients and to recognize that

24  inherent biases can lead to disparate treatments.

25         (c)  The creation of initiatives that educate

26  private-sector health care and managed care organizations

27  about the importance of cross-cultural training of health care

28  professionals and the effect of such training on the

29  professional-patient relationship.

30         (d)  The fostering of increased use of interpreter

31  services in health care settings.


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 1         (4)  The department shall work with and promote the

 2  establishment of public and private partnerships with

 3  charitable organizations, hospitals, and minority physician

 4  networks to increase the proportion of health care

 5  professionals from minority backgrounds.

 6         (5)  The department shall promote research on methods

 7  by which to reduce disparities in health care at colleges and

 8  universities that have historically large minority

 9  enrollments, including centers of excellence in this state

10  identified by the National Center on Minority Health and

11  Health Disparities, by working with those colleges and

12  universities and with community representatives to encourage

13  local minority students to pursue professions in health care.

14         Section 2.  Subsections (23), (24), (25), and (26) of

15  section 409.901, Florida Statutes, are renumbered as

16  subsections (24), (25), (26), and (27), respectively, and a

17  new subsection (23) is added to that section, to read:

18         409.901  Definitions; ss. 409.901-409.920.--As used in

19  ss. 409.901-409.920, except as otherwise specifically

20  provided, the term:

21         (23)  "Minority physician network" means a network of

22  primary care physicians with experience managing Medicaid or

23  Medicare recipients that is predominantly owned by minorities

24  as defined in s. 288.703, which may have a collaborative

25  partnership with a public college or university and a

26  tax-exempt charitable corporation.

27         Section 3.  Subsection (45) is added to section

28  409.912, Florida Statutes, to read:

29         409.912  Cost-effective purchasing of health care.--The

30  agency shall purchase goods and services for Medicaid

31  recipients in the most cost-effective manner consistent with


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 1  the delivery of quality medical care. The agency shall

 2  maximize the use of prepaid per capita and prepaid aggregate

 3  fixed-sum basis services when appropriate and other

 4  alternative service delivery and reimbursement methodologies,

 5  including competitive bidding pursuant to s. 287.057, designed

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

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

 8  minimize the exposure of recipients to the need for acute

 9  inpatient, custodial, and other institutional care and the

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

11  agency may establish prior authorization requirements for

12  certain populations of Medicaid beneficiaries, certain drug

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

14  and possible dangerous drug interactions. The Pharmaceutical

15  and Therapeutics Committee shall make recommendations to the

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

17  agency shall inform the Pharmaceutical and Therapeutics

18  Committee of its decisions regarding drugs subject to prior

19  authorization.

20         (45)  The agency shall contract with established

21  minority physician networks that provide services to

22  historically underserved minority patients. The networks must

23  provide cost-effective Medicaid services, comply with the

24  requirements to be a MediPass provider, and provide their

25  primary care physicians with access to data and other

26  management tools necessary to assist them in ensuring the

27  appropriate use of services, including inpatient hospital

28  services and pharmaceuticals.

29         (a)  The agency shall provide for the development and

30  expansion of minority physician networks in each service area

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 1  to provide services to Medicaid recipients who are eligible to

 2  participate under federal law and rules.

 3         (b)  The agency shall reimburse each minority physician

 4  network as a fee-for-service provider, including the case

 5  management fee for primary care, or as a capitated rate

 6  provider for Medicaid services. Any savings shall be shared

 7  with the minority physician networks pursuant to the contract.

 8         (c)  For purposes of this subsection, the term

 9  "cost-effective" means that a network's per-member, per-month

10  costs to the state, including, but not limited to,

11  fee-for-service costs, administrative costs, and

12  case-management fees, must be no greater than the state's

13  costs associated with contracts for Medicaid services

14  established under subsection (3), which shall be actuarially

15  adjusted for case mix, model, and service area. The agency

16  shall conduct actuarially sound audits adjusted for case mix

17  and model in order to ensure such cost-effectiveness and shall

18  publish the audit results on its Internet website and submit

19  the audit results annually to the Governor, the President of

20  the Senate, and the Speaker of the House of Representatives no

21  later than December 31. Contracts established pursuant to this

22  subsection which are not cost-effective may not be renewed.

23         (d)  The agency may apply for any federal waivers

24  needed to implement this paragraph.

25         Section 4.  This act shall take effect July 1, 2004.

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