HB 1811

CHAMBER ACTION

The Committee on Appropriations recommends the following:

Committee Substitute

Remove the entire bill and insert:

A bill to be entitled

An act relating to Medicaid; amending s. 16.56, F.S.;

adding certain criminal violations to the list of

specified crimes within the jurisdiction of the Office of

Statewide Prosecution; amending s. 400.408, F.S.;

including the Medicaid Fraud Control Unit in the Agency

for Health Care Administration's local coordinating

workgroups for identifying unlicensed assisted living

facilities; amending s. 400.434, F.S.; giving the Medicaid

Fraud Control Unit of the Department of Legal Affairs the

authority to enter and inspect certain facilities;

creating s. 409.9021, F.S.; requiring a Medicaid applicant

to agree to forfeiture of all entitlements under the

Medicaid program upon a judicial or administrative finding

of fraud within a specified period; amending s. 409.912,

F.S.; authorizing the Agency for Health Care

Administration to require a confirmation or second

physician's opinion of the correct diagnosis for purposes

of authorizing future services under the Medicaid program;

authorizing the agency to impose mandatory enrollment in

drug-therapy-management or disease-management programs for

certain categories of recipients; requiring that the

agency and the Drug Utilization Review Board consult with

the Department of Health; allowing termination of certain

practitioners from the Medicaid program; providing that

Medicaid recipients may be required to participate in a

provider lock-in program for a specified time; requiring

the agency to seek a federal waiver to terminate

eligibility; requiring the agency to conduct a study of

electronic verification systems; authorizing the agency to

use credentialing criteria for the purpose of including

providers in the Medicaid program; amending s. 409.913,

F.S.; providing specified conditions for providers to meet

in order to submit claims to the Medicaid program;

providing that claims may be denied if not properly

submitted; providing that the agency may seek any remedy

under law if a provider submits specified false or

erroneous claims; providing that suspension or termination

precludes participation in the Medicaid program; providing

that the agency is required to report administrative

sanctions to licensing authorities for certain violations;

providing that the agency may withhold payment to a

provider under certain circumstances; providing that the

agency may deny payments to terminated or suspended

providers; authorizing the agency to implement amnesty

programs for providers to voluntarily repay overpayments;

authorizing the agency to adopt rules; providing for

limiting, restricting, or suspending Medicaid eligibility

of Medicaid recipients convicted of certain crimes or

offenses; authorizing the agency and the Medicaid Fraud

Control Unit of the Department of Legal Affairs to review

non-Medicaid-related records in order to determine

reconciliation of a provider's records; authorizing the

agency head or designee to limit, restrict, or suspend

Medicaid eligibility under certain circumstances;

authorizing the agency to limit the number of certain

types of prescription claims submitted by pharmacy

providers; requiring the agency to limit the allowable

amount of certain types of prescriptions under specified

circumstances; amending s. 409.9131, F.S.; requiring that

the Office of Program Policy Analysis and Government

Accountability report to the Legislature on the agency's

fraud and abuse prevention, deterrence, detection, and

recovery efforts; revising a definition; requiring an

additional statement on Medicaid cost reports certifying

that Medicaid providers are familiar with the laws and

regulations regarding the provision of health care

services under the Medicaid program; amending s. 409.920,

F.S.; providing and revising definitions; creating s.

409.9201, F.S.; providing definitions; providing that a

person who knowingly sells or attempts to sell legend

drugs obtained through the Medicaid program commits a

felony; providing that a person who knowingly purchases or

attempts to purchase legend drugs obtained through the

Medicaid program and intended for the use of another

commits a felony; providing that a person who knowingly

makes or conspires to make false representations for the

purpose of obtaining goods or services from the Medicaid

program commits a felony; providing specified criminal

penalties depending on the value of the legend drugs or

goods or services obtained from the Medicaid program;

amending s. 456.072, F.S.; providing an additional ground

under which a health care practitioner who prescribes

medicinal drugs or controlled substances may be subject to

discipline by the Department of Health or the appropriate

board having jurisdiction over the health care

practitioner; authorizing the Department of Health to

initiate a disciplinary investigation of prescribing

practitioners under specified circumstances; amending s.

465.188, F.S.; removing the requirement that the agency

give pharmacists at least 1 week's notice prior to an

audit; specifying an effective date for certain audit

criteria; providing that specified Medicaid audit

procedures not apply to any investigative audit conducted

by the agency when the agency has reliable evidence that

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the claim that is the subject of the audit involves fraud,

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willful misrepresentation, or abuse under the Medicaid

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program; prohibiting the accounting practice of

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extrapolation for calculating penalties for Medicaid

104

audits; creating s. 812.0191, F.S.; providing definitions;

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providing that a person who traffics in property paid for

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in whole or in part by the Medicaid program, or who

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knowingly finances, directs, or traffics in such property,

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commits a felony; providing specified criminal penalties

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depending on the value of the property; amending s.

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895.02, F.S.; revising a definition; amending s. 905.34,

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F.S.; adding any criminal violation of s. 409.920 or s.

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409.9201, F.S., to the list of crimes within the

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jurisdiction of the statewide grand jury; amending s.

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932.701, F.S.; revising a definition; amending s.

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932.7055, F.S.; requiring that proceeds collected under

116

the Florida Contraband Forfeiture Act be deposited in the

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Department of Legal Affairs' Grants and Donations Trust

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Fund; amending ss. 394.9082, 400.0077, 409.9065, 409.9071,

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409.908, 409.91196, 409.9122, 409.9131, 430.608, 636.0145,

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641.225, and 641.386, F.S.; correcting cross-references;

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reenacting s. 921.0022(3)(g), F.S., relating to the

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offense severity ranking chart of the Criminal Punishment

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Code, to incorporate the amendment to s. 409.920, F.S., in

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a reference thereto; reenacting ss. 705.101(6) and

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932.703(4), F.S., relating to unclaimed evidence and

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forfeiture of contraband articles, respectively, to

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incorporate the amendment to s. 932.701, F.S., in

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references thereto; requiring a report to the Legislature

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on the feasibility of creating a database of valid

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prescriber information; providing an appropriation and

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authorizing positions; providing an effective date.

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

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Section 1. Subsection (1) of section 16.56, Florida

136

Statutes, is amended to read:

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16.56 Office of Statewide Prosecution.--

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(1) There is created in the Department of Legal Affairs an

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Office of Statewide Prosecution. The office shall be a separate

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"budget entity" as that term is defined in chapter 216. The

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office may:

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(a) Investigate and prosecute the offenses of:

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1. Bribery, burglary, criminal usury, extortion, gambling,

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kidnapping, larceny, murder, prostitution, perjury, robbery,

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carjacking, and home-invasion robbery;

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2. Any crime involving narcotic or other dangerous drugs;

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3. Any violation of the provisions of the Florida RICO

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(Racketeer Influenced and Corrupt Organization) Act, including

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any offense listed in the definition of racketeering activity in

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s. 895.02(1)(a), providing such listed offense is investigated

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in connection with a violation of s. 895.03 and is charged in a

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separate count of an information or indictment containing a

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count charging a violation of s. 895.03, the prosecution of

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which listed offense may continue independently if the

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prosecution of the violation of s. 895.03 is terminated for any

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reason;

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4. Any violation of the provisions of the Florida Anti-

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Fencing Act;

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5. Any violation of the provisions of the Florida

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Antitrust Act of 1980, as amended;

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6. Any crime involving, or resulting in, fraud or deceit

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upon any person;

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7. Any violation of s. 847.0135, relating to computer

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pornography and child exploitation prevention, or any offense

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related to a violation of s. 847.0135;

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8. Any violation of the provisions of chapter 815; or

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9. Any criminal violation of part I of chapter 499; or

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10. Any criminal violation of s. 409.920 or s. 409.9201;

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or any attempt, solicitation, or conspiracy to commit any of the

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crimes specifically enumerated above. The office shall have such

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power only when any such offense is occurring, or has occurred,

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in two or more judicial circuits as part of a related

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transaction, or when any such offense is connected with an

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organized criminal conspiracy affecting two or more judicial

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circuits.

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(b) Upon request, cooperate with and assist state

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attorneys and state and local law enforcement officials in their

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efforts against organized crimes.

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board, bureau, commission, or other agency of the state, or of

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any political subdivision thereof, cooperation and assistance in

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the performance of its duties.

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Section 2. Paragraph (i) of subsection (1) of section

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400.408, Florida Statutes, is amended to read:

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400.408 Unlicensed facilities; referral of person for

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residency to unlicensed facility; penalties; verification of

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licensure status.--

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(1)

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(i) Each field office of the Agency for Health Care

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Administration shall establish a local coordinating workgroup

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which includes representatives of local law enforcement

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agencies, state attorneys, the Medicaid Fraud Control Unit of

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the Department of Legal Affairs, local fire authorities, the

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Department of Children and Family Services, the district long-

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term care ombudsman council, and the district human rights

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advocacy committee to assist in identifying the operation of

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unlicensed facilities and to develop and implement a plan to

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ensure effective enforcement of state laws relating to such

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facilities. The workgroup shall report its findings, actions,

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and recommendations semiannually to the Director of Health

202

Facility Regulation of the agency.

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Section 3. Section 400.434, Florida Statutes, is amended

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to read:

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400.434 Right of entry and inspection.--Any duly

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designated officer or employee of the department, the Department

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of Children and Family Services, the agency, the Medicaid Fraud

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Control Unit of the Department of Legal Affairs, the state or

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local fire marshal, or a member of the state or local long-term

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care ombudsman council shall have the right to enter unannounced

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upon and into the premises of any facility licensed pursuant to

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this part in order to determine the state of compliance with the

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provisions of this part and of rules or standards in force

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pursuant thereto. The right of entry and inspection shall also

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extend to any premises which the agency has reason to believe is

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being operated or maintained as a facility without a license;

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but no such entry or inspection of any premises may be made

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without the permission of the owner or person in charge thereof,

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unless a warrant is first obtained from the circuit court

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authorizing such entry. The warrant requirement shall extend

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only to a facility which the agency has reason to believe is

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being operated or maintained as a facility without a license.

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Any application for a license or renewal thereof made pursuant

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to this part shall constitute permission for, and complete

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acquiescence in, any entry or inspection of the premises for

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which the license is sought, in order to facilitate verification

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of the information submitted on or in connection with the

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application; to discover, investigate, and determine the

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existence of abuse or neglect; or to elicit, receive, respond

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to, and resolve complaints. Any current valid license shall

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constitute unconditional permission for, and complete

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acquiescence in, any entry or inspection of the premises by

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authorized personnel. The agency shall retain the right of entry

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and inspection of facilities that have had a license revoked or

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suspended within the previous 24 months, to ensure that the

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facility is not operating unlawfully. However, before entering

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the facility, a statement of probable cause must be filed with

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the director of the agency, who must approve or disapprove the

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action within 48 hours. Probable cause shall include, but is not

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limited to, evidence that the facility holds itself out to the

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public as a provider of personal care services or the receipt of

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a complaint by the long-term care ombudsman council about the

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facility. Data collected by the state or local long-term care

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ombudsman councils or the state or local advocacy councils may

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be used by the agency in investigations involving violations of

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regulatory standards.

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Section 4. Section 409.9021, Florida Statutes, is created

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to read:

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409.9021 Forfeiture of eligibility agreement.--As a

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condition of Medicaid eligibility, subject to federal approval,

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a Medicaid applicant shall agree in writing to forfeit all

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entitlements to any goods or services provided through the

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Medicaid program if he or she is found to have committed fraud,

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through judicial or administrative determination, two times in a

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period of 5 years. This provision applies only to the Medicaid

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recipient found to have committed or participated in the fraud

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and does not apply to any family member of the recipient that

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was not involved in the fraud.

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Section 5. Section 409.912, Florida Statutes, is amended

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to read:

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

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agency shall purchase goods and services for Medicaid recipients

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in the most cost-effective manner consistent with the delivery

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of quality medical care. To ensure that medical services are

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effectively utilized, the agency may, in any case, require a

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confirmation or second physician's opinion of the correct

267

diagnosis for purposes of authorizing future services under the

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Medicaid program. This section does not restrict access to

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emergency services or poststabilization care services as defined

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in 42 C.F.R. s. 438.114. Such confirmation or second opinion

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shall be rendered in a manner approved by the agency. The agency

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shall maximize the use of prepaid per capita and prepaid

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aggregate fixed-sum basis services when appropriate and other

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alternative service delivery and reimbursement methodologies,

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including competitive bidding pursuant to s. 287.057, designed

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

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continuum of care. The agency shall also require providers to

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minimize the exposure of recipients to the need for acute

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inpatient, custodial, and other institutional care and the

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inappropriate or unnecessary use of high-cost services. The

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agency may mandate ~~establish~~ prior authorization, drug therapy

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management, or disease management participation ~~requirements~~ for

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certain populations of Medicaid beneficiaries, certain drug

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

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and possible dangerous drug interactions. The Pharmaceutical and

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Therapeutics Committee shall make recommendations to the agency

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on drugs for which prior authorization is required. The agency

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shall inform the Pharmaceutical and Therapeutics Committee of

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its decisions regarding drugs subject to prior authorization.

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(1) The agency shall work with the Department of Children

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and Family Services to ensure access of children and families in

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the child protection system to needed and appropriate mental

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health and substance abuse services.

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(2) The agency may enter into agreements with appropriate

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agents of other state agencies or of any agency of the Federal

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Government and accept such duties in respect to social welfare

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or public aid as may be necessary to implement the provisions of

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Title XIX of the Social Security Act and ss. 409.901-409.920.

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(3) The agency may contract with health maintenance

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organizations certified pursuant to part I of chapter 641 for

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the provision of services to recipients.

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(4) The agency may contract with:

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(a) An entity that provides no prepaid health care

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services other than Medicaid services under contract with the

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

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health department, or county-owned and operated hospital to

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

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recipients, which entity may provide such prepaid services

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either directly or through arrangements with other providers.

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Such prepaid health care services entities must be licensed

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

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

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recognized under this paragraph which demonstrates to the

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satisfaction of the Office of Insurance Regulation of the

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Financial Services Commission that it is backed by the full

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faith and credit of the county in which it is located may be

317

exempted from s. 641.225.

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(b) An entity that is providing comprehensive behavioral

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health care services to certain Medicaid recipients through a

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capitated, prepaid arrangement pursuant to the federal waiver

321

provided for by s. 409.905(5). Such an entity must be licensed

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under chapter 624, chapter 636, or chapter 641 and must possess

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the clinical systems and operational competence to manage risk

324

and provide comprehensive behavioral health care to Medicaid

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recipients. As used in this paragraph, the term "comprehensive

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behavioral health care services" means covered mental health and

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substance abuse treatment services that are available to

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Medicaid recipients. The secretary of the Department of Children

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and Family Services shall approve provisions of procurements

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related to children in the department's care or custody prior to

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enrolling such children in a prepaid behavioral health plan. Any

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contract awarded under this paragraph must be competitively

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procured. In developing the behavioral health care prepaid plan

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procurement document, the agency shall ensure that the

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procurement document requires the contractor to develop and

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implement a plan to ensure compliance with s. 394.4574 related

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to services provided to residents of licensed assisted living

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facilities that hold a limited mental health license. The agency

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shall seek federal approval to contract with a single entity

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meeting these requirements to provide comprehensive behavioral

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health care services to all Medicaid recipients in an AHCA area.

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Each entity must offer sufficient choice of providers in its

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network to ensure recipient access to care and the opportunity

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to select a provider with whom they are satisfied. The network

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shall include all public mental health hospitals. To ensure

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unimpaired access to behavioral health care services by Medicaid

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recipients, all contracts issued pursuant to this paragraph

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shall require 80 percent of the capitation paid to the managed

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care plan, including health maintenance organizations, to be

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expended for the provision of behavioral health care services.

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In the event the managed care plan expends less than 80 percent

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of the capitation paid pursuant to this paragraph for the

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provision of behavioral health care services, the difference

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shall be returned to the agency. The agency shall provide the

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managed care plan with a certification letter indicating the

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amount of capitation paid during each calendar year for the

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provision of behavioral health care services pursuant to this

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section. The agency may reimburse for substance abuse treatment

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services on a fee-for-service basis until the agency finds that

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adequate funds are available for capitated, prepaid

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arrangements.

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

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contracts with the entities providing comprehensive inpatient

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and outpatient mental health care services to Medicaid

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

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Counties, to include substance abuse treatment services.

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2. By July 1, 2003, the agency and the Department of

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Children and Family Services shall execute a written agreement

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that requires collaboration and joint development of all policy,

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budgets, procurement documents, contracts, and monitoring plans

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that have an impact on the state and Medicaid community mental

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health and targeted case management programs.

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3. By July 1, 2006, the agency and the Department of

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Children and Family Services shall contract with managed care

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entities in each AHCA area except area 6 or arrange to provide

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comprehensive inpatient and outpatient mental health and

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substance abuse services through capitated prepaid arrangements

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to all Medicaid recipients who are eligible to participate in

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such plans under federal law and regulation. In AHCA areas where

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eligible individuals number less than 150,000, the agency shall

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contract with a single managed care plan. The agency may

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contract with more than one plan in AHCA areas where the

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eligible population exceeds 150,000. Contracts awarded pursuant

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to this section shall be competitively procured. Both for-profit

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and not-for-profit corporations shall be eligible to compete.

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4. By October 1, 2003, the agency and the department shall

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submit a plan to the Governor, the President of the Senate, and

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the Speaker of the House of Representatives which provides for

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the full implementation of capitated prepaid behavioral health

390

care in all areas of the state. The plan shall include

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provisions which ensure that children and families receiving

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foster care and other related services are appropriately served

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and that these services assist the community-based care lead

394

agencies in meeting the goals and outcomes of the child welfare

395

system. The plan will be developed with the participation of

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community-based lead agencies, community alliances, sheriffs,

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and community providers serving dependent children.

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a. Implementation shall begin in 2003 in those AHCA areas

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of the state where the agency is able to establish sufficient

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capitation rates.

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b. If the agency determines that the proposed capitation

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rate in any area is insufficient to provide appropriate

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services, the agency may adjust the capitation rate to ensure

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that care will be available. The agency and the department may

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use existing general revenue to address any additional required

406

match but may not over-obligate existing funds on an annualized

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basis.

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c. Subject to any limitations provided for in the General

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Appropriations Act, the agency, in compliance with appropriate

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federal authorization, shall develop policies and procedures

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that allow for certification of local and state funds.

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5. Children residing in a statewide inpatient psychiatric

413

program, or in a Department of Juvenile Justice or a Department

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of Children and Family Services residential program approved as

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a Medicaid behavioral health overlay services provider shall not

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be included in a behavioral health care prepaid health plan

417

pursuant to this paragraph.

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6. In converting to a prepaid system of delivery, the

419

agency shall in its procurement document require an entity

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providing comprehensive behavioral health care services to

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prevent the displacement of indigent care patients by enrollees

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in the Medicaid prepaid health plan providing behavioral health

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care services from facilities receiving state funding to provide

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indigent behavioral health care, to facilities licensed under

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chapter 395 which do not receive state funding for indigent

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behavioral health care, or reimburse the unsubsidized facility

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for the cost of behavioral health care provided to the displaced

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indigent care patient.

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7. Traditional community mental health providers under

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contract with the Department of Children and Family Services

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pursuant to part IV of chapter 394, child welfare providers

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under contract with the Department of Children and Family

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Services, and inpatient mental health providers licensed

434

pursuant to chapter 395 must be offered an opportunity to accept

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or decline a contract to participate in any provider network for

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prepaid behavioral health services.

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by one or more federally qualified health centers or an entity

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owned by other migrant and community health centers receiving

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non-Medicaid financial support from the Federal Government to

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

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recipients. Such prepaid health care services entity must be

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licensed under parts I and III of chapter 641, but shall be

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prohibited from serving Medicaid recipients on a prepaid basis,

445

until such licensure has been obtained. However, such an entity

446

is exempt from s. 641.225 if the entity meets the requirements

447

specified in subsections (17) ~~(15)~~ and (18) ~~(16)~~.

448

(d) A provider service network may be reimbursed on a fee-

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for-service or prepaid basis. A provider service network which

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is reimbursed by the agency on a prepaid basis shall be exempt

451

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

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financial reserve, quality assurance, and patient rights

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requirements as established by the agency. The agency shall

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award contracts on a competitive bid basis and shall select

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bidders based upon price and quality of care. Medicaid

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recipients assigned to a demonstration project shall be chosen

457

equally from those who would otherwise have been assigned to

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prepaid plans and MediPass. The agency is authorized to seek

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federal Medicaid waivers as necessary to implement the

460

provisions of this section.

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(e) An entity that provides comprehensive behavioral

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health care services to certain Medicaid recipients through an

463

administrative services organization agreement. Such an entity

464

must possess the clinical systems and operational competence to

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provide comprehensive health care to Medicaid recipients. As

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used in this paragraph, the term "comprehensive behavioral

467

health care services" means covered mental health and substance

468

abuse treatment services that are available to Medicaid

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recipients. Any contract awarded under this paragraph must be

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competitively procured. The agency must ensure that Medicaid

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recipients have available the choice of at least two managed

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care plans for their behavioral health care services.

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(f) An entity that provides in-home physician services to

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test the cost-effectiveness of enhanced home-based medical care

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to Medicaid recipients with degenerative neurological diseases

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and other diseases or disabling conditions associated with high

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costs to Medicaid. The program shall be designed to serve very

478

disabled persons and to reduce Medicaid reimbursed costs for

479

inpatient, outpatient, and emergency department services. The

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agency shall contract with vendors on a risk-sharing basis.

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(g) Children's provider networks that provide care

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coordination and care management for Medicaid-eligible pediatric

483

patients, primary care, authorization of specialty care, and

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other urgent and emergency care through organized providers

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designed to service Medicaid eligibles under age 18 and

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pediatric emergency departments' diversion programs. The

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networks shall provide after-hour operations, including evening

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and weekend hours, to promote, when appropriate, the use of the

489

children's networks rather than hospital emergency departments.

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(h) An entity authorized in s. 430.205 to contract with

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the agency and the Department of Elderly Affairs to provide

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health care and social services on a prepaid or fixed-sum basis

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to elderly recipients. Such prepaid health care services

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entities are exempt from the provisions of part I of chapter 641

495

for the first 3 years of operation. An entity recognized under

496

this paragraph that demonstrates to the satisfaction of the

497

Office of Insurance Regulation that it is backed by the full

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faith and credit of one or more counties in which it operates

499

may be exempted from s. 641.225.

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(i) A Children's Medical Services network, as defined in

501

s. 391.021.

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(5) By October 1, 2003, the agency and the department

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shall, to the extent feasible, develop a plan for implementing

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new Medicaid procedure codes for emergency and crisis care,

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supportive residential services, and other services designed to

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maximize the use of Medicaid funds for Medicaid-eligible

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recipients. The agency shall include in the agreement developed

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pursuant to subsection (4) a provision that ensures that the

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match requirements for these new procedure codes are met by

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certifying eligible general revenue or local funds that are

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currently expended on these services by the department with

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contracted alcohol, drug abuse, and mental health providers. The

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plan must describe specific procedure codes to be implemented, a

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projection of the number of procedures to be delivered during

515

fiscal year 2003-2004, and a financial analysis that describes

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the certified match procedures, and accountability mechanisms,

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projects the earnings associated with these procedures, and

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describes the sources of state match. This plan may not be

519

implemented in any part until approved by the Legislative Budget

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Commission. If such approval has not occurred by December 31,

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2003, the plan shall be submitted for consideration by the 2004

522

Legislature.

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

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entity otherwise authorized by this section on a prepaid or

525

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

526

recipients. An entity may provide prepaid services to

527

recipients, either directly or through arrangements with other

528

entities, if each entity involved in providing services:

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(a) Is organized primarily for the purpose of providing

530

health care or other services of the type regularly offered to

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Medicaid recipients.;

532

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

533

agency for quality, appropriateness, and timeliness.;

534

535

insolvency protection and ensures that neither enrolled Medicaid

536

recipients nor the agency will be liable for the debts of the

537

entity.;

538

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

539

financial plan that the agency finds to be fiscally sound and

540

that provides for working capital in the form of cash or

541

equivalent liquid assets excluding revenues from Medicaid

542

premium payments equal to at least the first 3 months of

543

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

544

(e) Furnishes evidence satisfactory to the agency of

545

adequate liability insurance coverage or an adequate plan of

546

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

547

the furnishing of health care.;

548

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

549

review of its medical facilities and services, as required by

550

the agency.~~; and~~

551

(g) Provides organizational, operational, financial, and

552

other information required by the agency.

553

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

554

basis with any health insurer that:

555

(a) Pays for health care services provided to enrolled

556

Medicaid recipients in exchange for a premium payment paid by

557

the agency.;

558

(b) Assumes the underwriting risk.~~; and~~

559

560

of the Florida Insurance Code and is currently in good standing

561

with the Office of Insurance Regulation.

562

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

563

basis with an exclusive provider organization to provide health

564

care services to Medicaid recipients provided that the exclusive

565

provider organization meets applicable managed care plan

566

requirements in this section, ss. 409.9122, 409.9123, 409.9128,

567

and 627.6472, and other applicable provisions of law.

568

(9) The Agency for Health Care Administration may provide

569

cost-effective purchasing of chiropractic services on a fee-for-

570

service basis to Medicaid recipients through arrangements with a

571

statewide chiropractic preferred provider organization

572

incorporated in this state as a not-for-profit corporation. The

573

agency shall ensure that the benefit limits and prior

574

authorization requirements in the current Medicaid program shall

575

apply to the services provided by the chiropractic preferred

576

provider organization.

577

(10) The agency shall not contract on a prepaid or fixed-

578

sum basis for Medicaid services with an entity which knows or

579

reasonably should know that any officer, director, agent,

580

managing employee, or owner of stock or beneficial interest in

581

excess of 5 percent common or preferred stock, or the entity

582

itself, has been found guilty of, regardless of adjudication, or

583

entered a plea of nolo contendere, or guilty, to:

584

(a) Fraud;

585

(b) Violation of federal or state antitrust statutes,

586

including those proscribing price fixing between competitors and

587

the allocation of customers among competitors;

588

589

forgery, income tax evasion, bribery, falsification or

590

destruction of records, making false statements, receiving

591

stolen property, making false claims, or obstruction of justice;

592

593

(d) Any crime in any jurisdiction which directly relates

594

to the provision of health services on a prepaid or fixed-sum

595

basis.

596

(11) The agency, after notifying the Legislature, may

597

apply for waivers of applicable federal laws and regulations as

598

necessary to implement more appropriate systems of health care

599

for Medicaid recipients and reduce the cost of the Medicaid

600

program to the state and federal governments and shall implement

601

such programs, after legislative approval, within a reasonable

602

period of time after federal approval. These programs must be

603

designed primarily to reduce the need for inpatient care,

604

custodial care and other long-term or institutional care, and

605

other high-cost services.

606

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

607

as authorized by this subsection, the agency shall provide

608

notice and an opportunity for public comment. Notice shall be

609

provided to all persons who have made requests of the agency for

610

advance notice and shall be published in the Florida

611

Administrative Weekly not less than 28 days prior to the

612

intended action.

613

(b) Notwithstanding s. 216.292, funds that are

614

appropriated to the Department of Elderly Affairs for the

615

Assisted Living for the Elderly Medicaid waiver and are not

616

expended shall be transferred to the agency to fund Medicaid-

617

reimbursed nursing home care.

618

(12) The agency shall establish a postpayment utilization

619

control program designed to identify recipients who may

620

inappropriately overuse or underuse Medicaid services and shall

621

provide methods to correct such misuse.

622

(13) The agency shall develop and provide coordinated

623

systems of care for Medicaid recipients and may contract with

624

public or private entities to develop and administer such

625

systems of care among public and private health care providers

626

in a given geographic area.

627

(14) The agency shall operate or contract for the

628

operation of utilization management and incentive systems

629

designed to encourage cost-effective use services.

630

(15)(a) The agency shall operate the Comprehensive

631

Assessment and Review (CARES) nursing facility preadmission

632

screening program to ensure that Medicaid payment for nursing

633

facility care is made only for individuals whose conditions

634

require such care and to ensure that long-term care services are

635

provided in the setting most appropriate to the needs of the

636

person and in the most economical manner possible. The CARES

637

program shall also ensure that individuals participating in

638

Medicaid home and community-based waiver programs meet criteria

639

for those programs, consistent with approved federal waivers.

640

(b) The agency shall operate the CARES program through an

641

interagency agreement with the Department of Elderly Affairs.

642

643

for a Medicaid recipient, the agency must verify that the

644

nursing facility preadmission screening program has determined

645

that the individual requires nursing facility care and that the

646

individual cannot be safely served in community-based programs.

647

The nursing facility preadmission screening program shall refer

648

a Medicaid recipient to a community-based program if the

649

individual could be safely served at a lower cost and the

650

recipient chooses to participate in such program.

651

(d) By January 1 of each year, the agency shall submit a

652

report to the Legislature and the Office of Long-Term-Care

653

Policy describing the operations of the CARES program. The

654

report must describe:

655

1. Rate of diversion to community alternative programs.;

656

2. CARES program staffing needs to achieve additional

657

diversions.;

658

3. Reasons the program is unable to place individuals in

659

less restrictive settings when such individuals desired such

660

services and could have been served in such settings.;

661

4. Barriers to appropriate placement, including barriers

662

due to policies or operations of other agencies or state-funded

663

programs.~~; and~~

664

5. Statutory changes necessary to ensure that individuals

665

in need of long-term care services receive care in the least

666

restrictive environment.

667

(16)(a) The agency shall identify health care utilization

668

and price patterns within the Medicaid program which are not

669

cost-effective or medically appropriate and assess the

670

effectiveness of new or alternate methods of providing and

671

monitoring service, and may implement such methods as it

672

considers appropriate. Such methods may include disease

673

management initiatives, an integrated and systematic approach

674

for managing the health care needs of recipients who are at risk

675

of or diagnosed with a specific disease by using best practices,

676

prevention strategies, clinical-practice improvement, clinical

677

interventions and protocols, outcomes research, information

678

technology, and other tools and resources to reduce overall

679

costs and improve measurable outcomes.

680

(b) The responsibility of the agency under this subsection

681

shall include the development of capabilities to identify actual

682

and optimal practice patterns; patient and provider educational

683

initiatives; methods for determining patient compliance with

684

prescribed treatments; fraud, waste, and abuse prevention and

685

detection programs; and beneficiary case management programs.

686

1. The practice pattern identification program shall

687

evaluate practitioner prescribing patterns based on national and

688

regional practice guidelines, comparing practitioners to their

689

peer groups. The agency and its Drug Utilization Review Board

690

shall consult with the Department of Health and a panel of

691

practicing health care professionals consisting of the

692

following: the Speaker of the House of Representatives and the

693

President of the Senate shall each appoint three physicians

694

licensed under chapter 458 or chapter 459; and the Governor

695

shall appoint two pharmacists licensed under chapter 465 and one

696

dentist licensed under chapter 466 who is an oral surgeon. Terms

697

of the panel members shall expire at the discretion of the

698

appointing official. The panel shall begin its work by August 1,

699

1999, regardless of the number of appointments made by that

700

date. The advisory panel shall be responsible for evaluating

701

treatment guidelines and recommending ways to incorporate their

702

use in the practice pattern identification program.

703

Practitioners who are prescribing inappropriately or

704

inefficiently, as determined by the agency, may have their

705

prescribing of certain drugs subject to prior authorization or

706

may be terminated from all participation in the Medicaid

707

program.

708

2. The agency shall also develop educational interventions

709

designed to promote the proper use of medications by providers

710

and beneficiaries.

711

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

712

abuse initiative that may include a surety bond or letter of

713

credit requirement for participating pharmacies, enhanced

714

provider auditing practices, the use of additional fraud and

715

abuse software, recipient management programs for beneficiaries

716

inappropriately using their benefits, and other steps that will

717

eliminate provider and recipient fraud, waste, and abuse. The

718

initiative shall address enforcement efforts to reduce the

719

number and use of counterfeit prescriptions.

720

4. By September 30, 2002, the agency shall contract with

721

an entity in the state to implement a wireless handheld clinical

722

pharmacology drug information database for practitioners. The

723

initiative shall be designed to enhance the agency's efforts to

724

reduce fraud, abuse, and errors in the prescription drug benefit

725

program and to otherwise further the intent of this paragraph.

726

5. The agency may apply for any federal waivers needed to

727

implement this paragraph.

728

(17) An entity contracting on a prepaid or fixed-sum basis

729

shall, in addition to meeting any applicable statutory surplus

730

requirements, also maintain at all times in the form of cash,

731

investments that mature in less than 180 days allowable as

732

admitted assets by the Office of Insurance Regulation, and

733

restricted funds or deposits controlled by the agency or the

734

Office of Insurance Regulation, a surplus amount equal to one-

735

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

736

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

737

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

738

entity's surplus falls below an amount equal to one-and-one-half

739

times the entity's monthly Medicaid prepaid revenues, the agency

740

shall prohibit the entity from engaging in marketing and

741

preenrollment activities, shall cease to process new

742

enrollments, and shall not renew the entity's contract until the

743

required balance is achieved. The requirements of this

744

subsection do not apply:

745

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

746

incurred by the contracting entity; or

747

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

748

guaranteed in writing by a guaranteeing organization which:

749

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

750

assets in excess of $50 million; or

751

2. Submits a written guarantee acceptable to the agency

752

which is irrevocable during the term of the contracting entity's

753

contract with the agency and, upon termination of the contract,

754

until the agency receives proof of satisfaction of all

755

outstanding obligations incurred under the contract.

756

(18)(a) The agency may require an entity contracting on a

757

prepaid or fixed-sum basis to establish a restricted insolvency

758

protection account with a federally guaranteed financial

759

institution licensed to do business in this state. The entity

760

shall deposit into that account 5 percent of the capitation

761

payments made by the agency each month until a maximum total of

762

2 percent of the total current contract amount is reached. The

763

restricted insolvency protection account may be drawn upon with

764

the authorized signatures of two persons designated by the

765

entity and two representatives of the agency. If the agency

766

finds that the entity is insolvent, the agency may draw upon the

767

account solely with the two authorized signatures of

768

representatives of the agency, and the funds may be disbursed to

769

meet financial obligations incurred by the entity under the

770

prepaid contract. If the contract is terminated, expired, or not

771

continued, the account balance must be released by the agency to

772

the entity upon receipt of proof of satisfaction of all

773

outstanding obligations incurred under this contract.

774

(b) The agency may waive the insolvency protection account

775

requirement in writing when evidence is on file with the agency

776

of adequate insolvency insurance and reinsurance that will

777

protect enrollees if the entity becomes unable to meet its

778

obligations.

779

(19) An entity that contracts with the agency on a prepaid

780

or fixed-sum basis for the provision of Medicaid services shall

781

reimburse any hospital or physician that is outside the entity's

782

authorized geographic service area as specified in its contract

783

with the agency, and that provides services authorized by the

784

entity to its members, at a rate negotiated with the hospital or

785

physician for the provision of services or according to the

786

lesser of the following:

787

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

788

public by the hospital or physician; or

789

(b) The Florida Medicaid reimbursement rate established

790

for the hospital or physician.

791

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

792

contractor has been approved by the Office of Insurance

793

Regulation pursuant to s. 628.4615, the agency shall approve the

794

assignment or transfer of the appropriate Medicaid prepaid

795

contract upon request of the surviving entity of the merger or

796

acquisition if the contractor and the other entity have been in

797

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

798

period, unless the agency determines that the assignment or

799

transfer would be detrimental to the Medicaid recipients or the

800

Medicaid program. To be in good standing, an entity must not

801

have failed accreditation or committed any material violation of

802

the requirements of s. 641.52 and must meet the Medicaid

803

contract requirements. For purposes of this section, a merger or

804

acquisition means a change in controlling interest of an entity,

805

including an asset or stock purchase.

806

(21) Any entity contracting with the agency pursuant to

807

this section to provide health care services to Medicaid

808

recipients is prohibited from engaging in any of the following

809

practices or activities:

810

(a) Practices that are discriminatory, including, but not

811

limited to, attempts to discourage participation on the basis of

812

actual or perceived health status.

813

(b) Activities that could mislead or confuse recipients,

814

or misrepresent the organization, its marketing representatives,

815

or the agency. Violations of this paragraph include, but are not

816

limited to:

817

1. False or misleading claims that marketing

818

representatives are employees or representatives of the state or

819

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

820

by whom they are reimbursed.

821

2. False or misleading claims that the entity is

822

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

823

other organization which has not certified its endorsement in

824

writing to the entity.

825

3. False or misleading claims that the state or county

826

recommends that a Medicaid recipient enroll with an entity.

827

4. Claims that a Medicaid recipient will lose benefits

828

under the Medicaid program, or any other health or welfare

829

benefits to which the recipient is legally entitled, if the

830

recipient does not enroll with the entity.

831

832

consideration for enrollment, except as authorized by subsection

833

(24)~~(22)~~.

834

(d) Door-to-door solicitation of recipients who have not

835

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

836

a presentation.

837

(e) Solicitation of Medicaid recipients by marketing

838

representatives stationed in state offices unless approved and

839

supervised by the agency or its agent and approved by the

840

affected state agency when solicitation occurs in an office of

841

the state agency. The agency shall ensure that marketing

842

representatives stationed in state offices shall market their

843

managed care plans to Medicaid recipients only in designated

844

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

845

activities in the state office.

846

(f) Enrollment of Medicaid recipients.

847

(22) The agency may impose a fine for a violation of this

848

section or the contract with the agency by a person or entity

849

that is under contract with the agency. With respect to any

850

nonwillful violation, such fine shall not exceed $2,500 per

851

violation. In no event shall such fine exceed an aggregate

852

amount of $10,000 for all nonwillful violations arising out of

853

the same action. With respect to any knowing and willful

854

violation of this section or the contract with the agency, the

855

agency may impose a fine upon the entity in an amount not to

856

exceed $20,000 for each such violation. In no event shall such

857

fine exceed an aggregate amount of $100,000 for all knowing and

858

willful violations arising out of the same action.

859

(23) A health maintenance organization or a person or

860

entity exempt from chapter 641 that is under contract with the

861

agency for the provision of health care services to Medicaid

862

recipients may not use or distribute marketing materials used to

863

solicit Medicaid recipients, unless such materials have been

864

approved by the agency. The provisions of this subsection do not

865

apply to general advertising and marketing materials used by a

866

health maintenance organization to solicit both non-Medicaid

867

subscribers and Medicaid recipients.

868

(24) Upon approval by the agency, health maintenance

869

organizations and persons or entities exempt from chapter 641

870

that are under contract with the agency for the provision of

871

health care services to Medicaid recipients may be permitted

872

within the capitation rate to provide additional health benefits

873

that the agency has found are of high quality, are practicably

874

available, provide reasonable value to the recipient, and are

875

provided at no additional cost to the state.

876

(25) The agency shall utilize the statewide health

877

maintenance organization complaint hotline for the purpose of

878

investigating and resolving Medicaid and prepaid health plan

879

complaints, maintaining a record of complaints and confirmed

880

problems, and receiving disenrollment requests made by

881

recipients.

882

(26) The agency shall require the publication of the

883

health maintenance organization's and the prepaid health plan's

884

consumer services telephone numbers and the "800" telephone

885

number of the statewide health maintenance organization

886

complaint hotline on each Medicaid identification card issued by

887

a health maintenance organization or prepaid health plan

888

contracting with the agency to serve Medicaid recipients and on

889

each subscriber handbook issued to a Medicaid recipient.

890

(27) The agency shall establish a health care quality

891

improvement system for those entities contracting with the

892

agency pursuant to this section, incorporating all the standards

893

and guidelines developed by the Medicaid Bureau of the Health

894

Care Financing Administration as a part of the quality assurance

895

reform initiative. The system shall include, but need not be

896

limited to, the following:

897

(a) Guidelines for internal quality assurance programs,

898

including standards for:

899

1. Written quality assurance program descriptions.

900

2. Responsibilities of the governing body for monitoring,

901

evaluating, and making improvements to care.

902

3. An active quality assurance committee.

903

4. Quality assurance program supervision.

904

5. Requiring the program to have adequate resources to

905

effectively carry out its specified activities.

906

6. Provider participation in the quality assurance

907

program.

908

7. Delegation of quality assurance program activities.

909

8. Credentialing and recredentialing.

910

9. Enrollee rights and responsibilities.

911

10. Availability and accessibility to services and care.

912

11. Ambulatory care facilities.

913

12. Accessibility and availability of medical records, as

914

well as proper recordkeeping and process for record review.

915

13. Utilization review.

916

14. A continuity of care system.

917

15. Quality assurance program documentation.

918

16. Coordination of quality assurance activity with other

919

management activity.

920

17. Delivering care to pregnant women and infants; to

921

elderly and disabled recipients, especially those who are at

922

risk of institutional placement; to persons with developmental

923

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

924

conditions.

925

(b) Guidelines which require the entities to conduct

926

quality-of-care studies which:

927

1. Target specific conditions and specific health service

928

delivery issues for focused monitoring and evaluation.

929

2. Use clinical care standards or practice guidelines to

930

objectively evaluate the care the entity delivers or fails to

931

deliver for the targeted clinical conditions and health services

932

delivery issues.

933

3. Use quality indicators derived from the clinical care

934

standards or practice guidelines to screen and monitor care and

935

services delivered.

936

937

contractor which require: focused studies of patterns of care;

938

individual care review in specific situations; and followup

939

activities on previous pattern-of-care study findings and

940

individual-care-review findings. In designing the external

941

quality review function and determining how it is to operate as

942

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

943

agency shall construct its external quality review organization

944

and entity contracts to address each of the following:

945

1. Delineating the role of the external quality review

946

organization.

947

2. Length of the external quality review organization

948

contract with the state.

949

3. Participation of the contracting entities in designing

950

external quality review organization review activities.

951

4. Potential variation in the type of clinical conditions

952

and health services delivery issues to be studied at each plan.

953

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

954

studies to be conducted for each plan.

955

6. Methods for implementing focused studies.

956

7. Individual care review.

957

8. Followup activities.

958

(28) In order to ensure that children receive health care

959

services for which an entity has already been compensated, an

960

entity contracting with the agency pursuant to this section

961

shall achieve an annual Early and Periodic Screening, Diagnosis,

962

and Treatment (EPSDT) Service screening rate of at least 60

963

percent for those recipients continuously enrolled for at least

964

8 months. The agency shall develop a method by which the EPSDT

965

screening rate shall be calculated. For any entity which does

966

not achieve the annual 60 percent rate, the entity must submit a

967

corrective action plan for the agency's approval. If the entity

968

does not meet the standard established in the corrective action

969

plan during the specified timeframe, the agency is authorized to

970

impose appropriate contract sanctions. At least annually, the

971

agency shall publicly release the EPSDT Services screening rates

972

of each entity it has contracted with on a prepaid basis to

973

serve Medicaid recipients.

974

(29) The agency shall perform enrollments and

975

disenrollments for Medicaid recipients who are eligible for

976

MediPass or managed care plans. Notwithstanding the prohibition

977

contained in paragraph (21)~~(19)~~(f), managed care plans may

978

perform preenrollments of Medicaid recipients under the

979

supervision of the agency or its agents. For the purposes of

980

this section, "preenrollment" means the provision of marketing

981

and educational materials to a Medicaid recipient and assistance

982

in completing the application forms, but shall not include

983

actual enrollment into a managed care plan. An application for

984

enrollment shall not be deemed complete until the agency or its

985

agent verifies that the recipient made an informed, voluntary

986

choice. The agency, in cooperation with the Department of

987

Children and Family Services, may test new marketing initiatives

988

to inform Medicaid recipients about their managed care options

989

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

990

the effectiveness of such initiatives. The agency may contract

991

with a third party to perform managed care plan and MediPass

992

enrollment and disenrollment services for Medicaid recipients

993

and is authorized to adopt rules to implement such services. The

994

agency may adjust the capitation rate only to cover the costs of

995

a third-party enrollment and disenrollment contract, and for

996

agency supervision and management of the managed care plan

997

enrollment and disenrollment contract.

998

(30) Any lists of providers made available to Medicaid

999

recipients, MediPass enrollees, or managed care plan enrollees

1000

shall be arranged alphabetically showing the provider's name and

1001

specialty and, separately, by specialty in alphabetical order.

1002

(31) The agency shall establish an enhanced managed care

1003

quality assurance oversight function, to include at least the

1004

following components:

1005

(a) At least quarterly analysis and followup, including

1006

sanctions as appropriate, of managed care participant

1007

utilization of services.

1008

(b) At least quarterly analysis and followup, including

1009

sanctions as appropriate, of quality findings of the Medicaid

1010

peer review organization and other external quality assurance

1011

programs.

1012

1013

sanctions as appropriate, of the fiscal viability of managed

1014

care plans.

1015

(d) At least quarterly analysis and followup, including

1016

sanctions as appropriate, of managed care participant

1017

satisfaction and disenrollment surveys.

1018

(e) The agency shall conduct regular and ongoing Medicaid

1019

recipient satisfaction surveys.

1020

1021

The analyses and followup activities conducted by the agency

1022

under its enhanced managed care quality assurance oversight

1023

function shall not duplicate the activities of accreditation

1024

reviewers for entities regulated under part III of chapter 641,

1025

but may include a review of the finding of such reviewers.

1026

(32) Each managed care plan that is under contract with

1027

the agency to provide health care services to Medicaid

1028

recipients shall annually conduct a background check with the

1029

Florida Department of Law Enforcement of all persons with

1030

ownership interest of 5 percent or more or executive management

1031

responsibility for the managed care plan and shall submit to the

1032

agency information concerning any such person who has been found

1033

guilty of, regardless of adjudication, or has entered a plea of

1034

nolo contendere or guilty to, any of the offenses listed in s.

1035

435.03.

1036

(33) The agency shall, by rule, develop a process whereby

1037

a Medicaid managed care plan enrollee who wishes to enter

1038

hospice care may be disenrolled from the managed care plan

1039

within 24 hours after contacting the agency regarding such

1040

request. The agency rule shall include a methodology for the

1041

agency to recoup managed care plan payments on a pro rata basis

1042

if payment has been made for the enrollment month when

1043

disenrollment occurs.

1044

(34) The agency and entities which contract with the

1045

agency to provide health care services to Medicaid recipients

1046

under this section or s. 409.9122 must comply with the

1047

provisions of s. 641.513 in providing emergency services and

1048

care to Medicaid recipients and MediPass recipients.

1049

(35) All entities providing health care services to

1050

Medicaid recipients shall make available, and encourage all

1051

pregnant women and mothers with infants to receive, and provide

1052

documentation in the medical records to reflect, the following:

1053

(a) Healthy Start prenatal or infant screening.

1054

(b) Healthy Start care coordination, when screening or

1055

other factors indicate need.

1056

1057

prenatal or infant screening results.

1058

(d) Immunizations in accordance with recommendations of

1059

the Advisory Committee on Immunization Practices of the United

1060

States Public Health Service and the American Academy of

1061

Pediatrics, as appropriate.

1062

(e) Counseling and services for family planning to all

1063

women and their partners.

1064

(f) A scheduled postpartum visit for the purpose of

1065

voluntary family planning, to include discussion of all methods

1066

of contraception, as appropriate.

1067

(g) Referral to the Special Supplemental Nutrition Program

1068

for Women, Infants, and Children (WIC).

1069

(36) Any entity that provides Medicaid prepaid health plan

1070

services shall ensure the appropriate coordination of health

1071

care services with an assisted living facility in cases where a

1072

Medicaid recipient is both a member of the entity's prepaid

1073

health plan and a resident of the assisted living facility. If

1074

the entity is at risk for Medicaid targeted case management and

1075

behavioral health services, the entity shall inform the assisted

1076

living facility of the procedures to follow should an emergent

1077

condition arise.

1078

(37) The agency may seek and implement federal waivers

1079

necessary to provide for cost-effective purchasing of home

1080

health services, private duty nursing services, transportation,

1081

independent laboratory services, and durable medical equipment

1082

and supplies through competitive bidding pursuant to s. 287.057.

1083

The agency may request appropriate waivers from the federal

1084

Health Care Financing Administration in order to competitively

1085

bid such services. The agency may exclude providers not selected

1086

through the bidding process from the Medicaid provider network.

1087

(38) The Agency for Health Care Administration is directed

1088

to issue a request for proposal or intent to negotiate to

1089

implement on a demonstration basis an outpatient specialty

1090

services pilot project in a rural and urban county in the state.

1091

As used in this subsection, the term "outpatient specialty

1092

services" means clinical laboratory, diagnostic imaging, and

1093

specified home medical services to include durable medical

1094

equipment, prosthetics and orthotics, and infusion therapy.

1095

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

1096

Medicaid managed care outpatient specialty services must, at a

1097

minimum, meet the following criteria:

1098

1. The entity must be licensed by the Office of Insurance

1099

Regulation under part II of chapter 641.

1100

2. The entity must be experienced in providing outpatient

1101

specialty services.

1102

3. The entity must demonstrate to the satisfaction of the

1103

agency that it provides high-quality services to its patients.

1104

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

1105

complaints and grievance process to assist Medicaid recipients

1106

enrolled in the pilot managed care program to resolve complaints

1107

and grievances.

1108

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

1109

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

1110

to determine the cost-effectiveness and effects on utilization,

1111

access, and quality of providing outpatient specialty services

1112

to Medicaid recipients on a prepaid, capitated basis.

1113

1114

the prepaid health clinic each year that the demonstration

1115

program is in effect. The prepaid health clinic is responsible

1116

for all expenses incurred by the agency in conducting a quality

1117

assurance review.

1118

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

1119

outpatient specialty services to Medicaid recipients shall

1120

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

1121

agency, for the purpose of conducting the evaluation required in

1122

paragraph (e).

1123

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

1124

managed care program and report its findings to the Governor and

1125

the Legislature by no later than January 1, 2001.

1126

(39) The agency shall enter into agreements with not-for-

1127

profit organizations based in this state for the purpose of

1128

providing vision screening.

1129

(40)(a) The agency shall implement a Medicaid prescribed-

1130

drug spending-control program that includes the following

1131

components:

1132

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

1133

for adult Medicaid recipients is limited to the dispensing of

1134

four brand-name drugs per month per recipient. Children are

1135

exempt from this restriction. Antiretroviral agents are excluded

1136

from this limitation. No requirements for prior authorization or

1137

other restrictions on medications used to treat mental illnesses

1138

such as schizophrenia, severe depression, or bipolar disorder

1139

may be imposed on Medicaid recipients. Medications that will be

1140

available without restriction for persons with mental illnesses

1141

include atypical antipsychotic medications, conventional

1142

antipsychotic medications, selective serotonin reuptake

1143

inhibitors, and other medications used for the treatment of

1144

serious mental illnesses. The agency shall also limit the amount

1145

of a prescribed drug dispensed to no more than a 34-day supply.

1146

The agency shall continue to provide unlimited generic drugs,

1147

contraceptive drugs and items, and diabetic supplies. Although a

1148

drug may be included on the preferred drug formulary, it would

1149

not be exempt from the four-brand limit. The agency may

1150

authorize exceptions to the brand-name-drug restriction based

1151

upon the treatment needs of the patients, only when such

1152

exceptions are based on prior consultation provided by the

1153

agency or an agency contractor, but the agency must establish

1154

procedures to ensure that:

1155

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

1156

consultation by telephone or other telecommunication device

1157

within 24 hours after receipt of a request for prior

1158

consultation.;

1159

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

1160

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

1161

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

1162

c. Except for the exception for nursing home residents and

1163

other institutionalized adults and except for drugs on the

1164

restricted formulary for which prior authorization may be sought

1165

by an institutional or community pharmacy, prior authorization

1166

for an exception to the brand-name-drug restriction is sought by

1167

the prescriber and not by the pharmacy. When prior authorization

1168

is granted for a patient in an institutional setting beyond the

1169

brand-name-drug restriction, such approval is authorized for 12

1170

months and monthly prior authorization is not required for that

1171

patient.

1172

2. Reimbursement to pharmacies for Medicaid prescribed

1173

drugs shall be set at the average wholesale price less 13.25

1174

percent.

1175

3. The agency shall develop and implement a process for

1176

managing the drug therapies of Medicaid recipients who are using

1177

significant numbers of prescribed drugs each month. The

1178

management process may include, but is not limited to,

1179

comprehensive, physician-directed medical-record reviews, claims

1180

analyses, and case evaluations to determine the medical

1181

necessity and appropriateness of a patient's treatment plan and

1182

drug therapies. The agency may contract with a private

1183

organization to provide drug-program-management services. The

1184

Medicaid drug benefit management program shall include

1185

initiatives to manage drug therapies for HIV/AIDS patients,

1186

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

1187

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

1188

agency shall enroll any Medicaid patient in the drug benefit

1189

management program if he or she meets the specifications of this

1190

provision and is not enrolled in a Medicaid health maintenance

1191

organization.

1192

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

1193

based on need, competitive bidding, price negotiations,

1194

credentialing, or similar criteria. The agency shall give

1195

special consideration to rural areas in determining the size and

1196

location of pharmacies included in the Medicaid pharmacy

1197

network. A pharmacy credentialing process may include criteria

1198

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

1199

patient educational programs, patient consultation, disease-

1200

management services, and other characteristics. The agency may

1201

impose a moratorium on Medicaid pharmacy enrollment when it is

1202

determined that it has a sufficient number of Medicaid-

1203

participating providers.

1204

5. The agency shall develop and implement a program that

1205

requires Medicaid practitioners who prescribe drugs to use a

1206

counterfeit-proof prescription pad for Medicaid prescriptions.

1207

The agency shall require the use of standardized counterfeit-

1208

proof prescription pads by Medicaid-participating prescribers or

1209

prescribers who write prescriptions for Medicaid recipients. The

1210

agency may implement the program in targeted geographic areas or

1211

statewide.

1212

6. The agency may enter into arrangements that require

1213

manufacturers of generic drugs prescribed to Medicaid recipients

1214

to provide rebates of at least 15.1 percent of the average

1215

manufacturer price for the manufacturer's generic products.

1216

These arrangements shall require that if a generic-drug

1217

manufacturer pays federal rebates for Medicaid-reimbursed drugs

1218

at a level below 15.1 percent, the manufacturer must provide a

1219

supplemental rebate to the state in an amount necessary to

1220

achieve a 15.1-percent rebate level.

1221

7. The agency may establish a preferred drug formulary in

1222

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

1223

establishment of such formulary, it is authorized to negotiate

1224

supplemental rebates from manufacturers that are in addition to

1225

those required by Title XIX of the Social Security Act and at no

1226

less than 10 percent of the average manufacturer price as

1227

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

1228

the federal or supplemental rebate, or both, equals or exceeds

1229

25 percent. There is no upper limit on the supplemental rebates

1230

the agency may negotiate. The agency may determine that specific

1231

products, brand-name or generic, are competitive at lower rebate

1232

percentages. Agreement to pay the minimum supplemental rebate

1233

percentage will guarantee a manufacturer that the Medicaid

1234

Pharmaceutical and Therapeutics Committee will consider a

1235

product for inclusion on the preferred drug formulary. However,

1236

a pharmaceutical manufacturer is not guaranteed placement on the

1237

formulary by simply paying the minimum supplemental rebate.

1238

Agency decisions will be made on the clinical efficacy of a drug

1239

and recommendations of the Medicaid Pharmaceutical and

1240

Therapeutics Committee, as well as the price of competing

1241

products minus federal and state rebates. The agency is

1242

authorized to contract with an outside agency or contractor to

1243

conduct negotiations for supplemental rebates. For the purposes

1244

of this section, the term "supplemental rebates" may include, at

1245

the agency's discretion, cash rebates and other program benefits

1246

that offset a Medicaid expenditure. Such other program benefits

1247

may include, but are not limited to, disease management

1248

programs, drug product donation programs, drug utilization

1249

control programs, prescriber and beneficiary counseling and

1250

education, fraud and abuse initiatives, and other services or

1251

administrative investments with guaranteed savings to the

1252

Medicaid program in the same year the rebate reduction is

1253

included in the General Appropriations Act. The agency is

1254

authorized to seek any federal waivers to implement this

1255

initiative.

1256

8. The agency shall establish an advisory committee for

1257

the purposes of studying the feasibility of using a restricted

1258

drug formulary for nursing home residents and other

1259

institutionalized adults. The committee shall be comprised of

1260

seven members appointed by the Secretary of Health Care

1261

Administration. The committee members shall include two

1262

physicians licensed under chapter 458 or chapter 459; three

1263

pharmacists licensed under chapter 465 and appointed from a list

1264

of recommendations provided by the Florida Long-Term Care

1265

Pharmacy Alliance; and two pharmacists licensed under chapter

1266

465.

1267

9. The Agency for Health Care Administration shall expand

1268

home delivery of pharmacy products. To assist Medicaid patients

1269

in securing their prescriptions and reduce program costs, the

1270

agency shall expand its current mail-order-pharmacy diabetes-

1271

supply program to include all generic and brand-name drugs used

1272

by Medicaid patients with diabetes. Medicaid recipients in the

1273

current program may obtain nondiabetes drugs on a voluntary

1274

basis. This initiative is limited to the geographic area covered

1275

by the current contract. The agency may seek and implement any

1276

federal waivers necessary to implement this subparagraph.

1277

(b) The agency shall implement this subsection to the

1278

extent that funds are appropriated to administer the Medicaid

1279

prescribed-drug spending-control program. The agency may

1280

contract all or any part of this program to private

1281

organizations.

1282

1283

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

1284

House of Representatives which must include, but need not be

1285

limited to, the progress made in implementing this subsection

1286

and its effect on Medicaid prescribed-drug expenditures.

1287

(41) Notwithstanding the provisions of chapter 287, the

1288

agency may, at its discretion, renew a contract or contracts for

1289

fiscal intermediary services one or more times for such periods

1290

as the agency may decide; however, all such renewals may not

1291

combine to exceed a total period longer than the term of the

1292

original contract.

1293

(42) The agency shall provide for the development of a

1294

demonstration project by establishment in Miami-Dade County of a

1295

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

1296

improve access to health care for a predominantly minority,

1297

medically underserved, and medically complex population and to

1298

evaluate alternatives to nursing home care and general acute

1299

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

1300

health care condominium and colocated with licensed facilities

1301

providing a continuum of care. The establishment of this project

1302

is not subject to the provisions of s. 408.036 or s. 408.039.

1303

The agency shall report its findings to the Governor, the

1304

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

1305

Representatives by January 1, 2003.

1306

(43) The agency shall develop and implement a utilization

1307

management program for Medicaid-eligible recipients for the

1308

management of occupational, physical, respiratory, and speech

1309

therapies. The agency shall establish a utilization program that

1310

may require prior authorization in order to ensure medically

1311

necessary and cost-effective treatments. The program shall be

1312

operated in accordance with a federally approved waiver program

1313

or state plan amendment. The agency may seek a federal waiver or

1314

state plan amendment to implement this program. The agency may

1315

also competitively procure these services from an outside vendor

1316

on a regional or statewide basis.

1317

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

1318

basis with appropriately licensed prepaid dental health plans to

1319

provide dental services.

1320

(45) Subject to the availability of funds, the agency

1321

shall mandate a recipient's participation in a provider lock-in

1322

program, when appropriate, if a recipient is found by the agency

1323

to have used Medicaid goods or services at a frequency or amount

1324

not medically necessary, limiting the receipt of goods or

1325

services to medically necessary providers after the 21-day

1326

appeal process has ended, for a period of time of not less than

1327

1 year. The lock-in programs shall include, but are not limited

1328

to, pharmacies, medical doctors, and infusion clinics. The

1329

limitation does not apply to emergency services and care

1330

provided to the recipient in a hospital emergency department.

1331

The agency shall seek any federal waivers necessary to implement

1332

this subsection. The agency shall adopt any rules necessary to

1333

comply with or administer this subsection.

1334

(46) The agency shall seek a federal waiver for permission

1335

to terminate the eligibility of a Medicaid recipient who is

1336

found to have committed fraud, through judicial or

1337

administrative determination, two times in a period of five

1338

years.

1339

(47) The agency shall conduct a study of available

1340

electronic systems for purposes of verifying identity and

1341

eligibility of a Medicaid recipient. The agency shall recommend

1342

to the Legislature a plan to implement an electronic

1343

verification system for Medicaid recipients by January 31, 2005.

1344

(48) A provider is not entitled to enrollment in the

1345

Medicaid provider network. The agency may implement a Medicaid

1346

fee for service provider network controls, including, but not

1347

limited to, competitive procurement and provider credentialing.

1348

If a credentialing process is used, the agency may limit its

1349

provider network based upon the following considerations:

1350

beneficiary access to care, provider availability, provider

1351

quality standards and quality assurance processes, cultural

1352

competency, demographic characteristics of beneficiaries,

1353

practice standards, service wait times, provider turnover,

1354

provider licensure and accreditation history, program integrity

1355

history, peer review, Medicaid policy and billing compliance

1356

record, clinical and medical record audit findings, and such

1357

other areas as deemed necessary by the agency to ensure the

1358

integrity of the program.

1359

Section 6. Section 409.913, Florida Statutes, is amended

1360

to read:

1361

409.913 Oversight of the integrity of the Medicaid

1362

program.--The agency shall operate a program to oversee the

1363

activities of Florida Medicaid recipients, and providers and

1364

their representatives, to ensure that fraudulent and abusive

1365

behavior and neglect of recipients occur to the minimum extent

1366

possible, and to recover overpayments and impose sanctions as

1367

appropriate. Beginning January 1, 2003, and each year

1368

thereafter, the agency and the Medicaid Fraud Control Unit of

1369

the Department of Legal Affairs shall submit a joint report to

1370

the Legislature documenting the effectiveness of the state's

1371

efforts to control Medicaid fraud and abuse and to recover

1372

Medicaid overpayments during the previous fiscal year. The

1373

report must describe the number of cases opened and investigated

1374

each year; the sources of the cases opened; the disposition of

1375

the cases closed each year; the amount of overpayments alleged

1376

in preliminary and final audit letters; the number and amount of

1377

fines or penalties imposed; any reductions in overpayment

1378

amounts negotiated in settlement agreements or by other means;

1379

the amount of final agency determinations of overpayments; the

1380

amount deducted from federal claiming as a result of

1381

overpayments; the amount of overpayments recovered each year;

1382

the amount of cost of investigation recovered each year; the

1383

average length of time to collect from the time the case was

1384

opened until the overpayment is paid in full; the amount

1385

determined as uncollectible and the portion of the uncollectible

1386

amount subsequently reclaimed from the Federal Government; the

1387

number of providers, by type, that are terminated from

1388

participation in the Medicaid program as a result of fraud and

1389

abuse; and all costs associated with discovering and prosecuting

1390

cases of Medicaid overpayments and making recoveries in such

1391

cases. The report must also document actions taken to prevent

1392

overpayments and the number of providers prevented from

1393

enrolling in or reenrolling in the Medicaid program as a result

1394

of documented Medicaid fraud and abuse and must recommend

1395

changes necessary to prevent or recover overpayments. ~~For the~~

1396

~~2001-2002 fiscal year, the agency shall prepare a report that~~

1397

~~contains as much of this information as is available to it.~~

1398

(1) For the purposes of this section, the term:

1399

(a) "Abuse" means:

1400

1. Provider practices that are inconsistent with generally

1401

accepted business or medical practices and that result in an

1402

unnecessary cost to the Medicaid program or in reimbursement for

1403

goods or services that are not medically necessary or that fail

1404

to meet professionally recognized standards for health care.

1405

2. Recipient practices that result in unnecessary cost to

1406

the Medicaid program.

1407

(b) "Complaint" means an allegation that fraud, abuse, or

1408

an overpayment has occurred.

1409

1410

misrepresentation made by a person with the knowledge that the

1411

deception results in unauthorized benefit to herself or himself

1412

or another person. The term includes any act that constitutes

1413

fraud under applicable federal or state law.

1414

(d) "Medical necessity" or "medically necessary" means any

1415

goods or services necessary to palliate the effects of a

1416

terminal condition, or to prevent, diagnose, correct, cure,

1417

alleviate, or preclude deterioration of a condition that

1418

threatens life, causes pain or suffering, or results in illness

1419

or infirmity, which goods or services are provided in accordance

1420

with generally accepted standards of medical practice. For

1421

purposes of determining Medicaid reimbursement, the agency is

1422

the final arbiter of medical necessity. Determinations of

1423

medical necessity must be made by a licensed physician employed

1424

by or under contract with the agency and must be based upon

1425

information available at the time the goods or services are

1426

provided.

1427

(e) "Overpayment" includes any amount that is not

1428

authorized to be paid by the Medicaid program whether paid as a

1429

result of inaccurate or improper cost reporting, improper

1430

claiming, unacceptable practices, fraud, abuse, or mistake.

1431

(f) "Person" means any natural person, corporation,

1432

partnership, association, clinic, group, or other entity,

1433

whether or not such person is enrolled in the Medicaid program

1434

or is a provider of health care.

1435

(2) The agency shall conduct, or cause to be conducted by

1436

contract or otherwise, reviews, investigations, analyses,

1437

audits, or any combination thereof, to determine possible fraud,

1438

abuse, overpayment, or recipient neglect in the Medicaid program

1439

and shall report the findings of any overpayments in audit

1440

reports as appropriate.

1441

(3) The agency may conduct, or may contract for,

1442

prepayment review of provider claims to ensure cost-effective

1443

purchasing; to ensure that, billing by a provider to the agency

1444

is in accordance with applicable provisions of all Medicaid

1445

rules, regulations, handbooks, and policies and in accordance

1446

with federal, state, and local law;, and to ensure that

1447

appropriate ~~provision of~~ care is rendered to Medicaid

1448

recipients. Such prepayment reviews may be conducted as

1449

determined appropriate by the agency, without any suspicion or

1450

allegation of fraud, abuse, or neglect, and may last up to 1

1451

year. Unless the agency has reliable evidence of fraud,

1452

misrepresentation, abuse, or neglect, claims shall be

1453

adjudicated for denial or payment within 90 days after receipt

1454

of completed documentation by the agency for review. If there is

1455

reliable evidence of fraud, misrepresentation, abuse, or

1456

neglect, claims shall be adjudicated for denial of payment

1457

within 180 days after complete documentation has been received

1458

by the agency for review.

1459

(4) Any suspected criminal violation identified by the

1460

agency must be referred to the Medicaid Fraud Control Unit of

1461

the Office of the Attorney General for investigation. The agency

1462

and the Attorney General shall enter into a memorandum of

1463

understanding, which must include, but need not be limited to, a

1464

protocol for regularly sharing information and coordinating

1465

casework. The protocol must establish a procedure for the

1466

referral by the agency of cases involving suspected Medicaid

1467

fraud to the Medicaid Fraud Control Unit for investigation, and

1468

the return to the agency of those cases where investigation

1469

determines that administrative action by the agency is

1470

appropriate. Offices of the Medicaid program integrity program

1471

and the Medicaid Fraud Control Unit of the Department of Legal

1472

Affairs, shall, to the extent possible, be collocated. The

1473

agency and the Department of Legal Affairs shall periodically

1474

conduct joint training and other joint activities designed to

1475

increase communication and coordination in recovering

1476

overpayments.

1477

(5) A Medicaid provider is subject to having goods and

1478

services that are paid for by the Medicaid program reviewed by

1479

an appropriate peer-review organization designated by the

1480

agency. The written findings of the applicable peer-review

1481

organization are admissible in any court or administrative

1482

proceeding as evidence of medical necessity or the lack thereof.

1483

(6) Any notice required to be given to a provider under

1484

this section is presumed to be sufficient notice if sent to the

1485

address last shown on the provider enrollment file. It is the

1486

responsibility of the provider to furnish and keep the agency

1487

informed of the provider's current address. United States Postal

1488

Service proof of mailing or certified or registered mailing of

1489

such notice to the provider at the address shown on the provider

1490

enrollment file constitutes sufficient proof of notice. Any

1491

notice required to be given to the agency by this section must

1492

be sent to the agency at an address designated by rule.

1493

(7) When presenting a claim for payment under the Medicaid

1494

program, a provider has an affirmative duty to supervise the

1495

provision of, and be responsible for, goods and services claimed

1496

to have been provided, to supervise and be responsible for

1497

preparation and submission of the claim, and to present a claim

1498

that is true and accurate and that is for goods and services

1499

that:

1500

(a) Have actually been furnished to the recipient by the

1501

provider prior to submitting the claim.

1502

(b) Are Medicaid-covered goods or services that are

1503

medically necessary.

1504

1505

general public by the provider's peers.

1506

(d) Have not been billed in whole or in part to a

1507

recipient or a recipient's responsible party, except for such

1508

copayments, coinsurance, or deductibles as are authorized by the

1509

agency.

1510

(e) Are provided in accord with applicable provisions of

1511

all Medicaid rules, regulations, handbooks, and policies and in

1512

accordance with federal, state, and local law.

1513

(f) Are documented by records made at the time the goods

1514

or services were provided, demonstrating the medical necessity

1515

for the goods or services rendered. Medicaid goods or services

1516

are excessive or not medically necessary unless both the medical

1517

basis and the specific need for them are fully and properly

1518

documented in the recipient's medical record.

1519

1520

The agency may deny payment or require repayment for goods or

1521

services that are not presented as required in this subsection.

1522

(8) The agency shall not reimburse any person or entity

1523

for any prescription for medications, medical supplies, or

1524

medical services if the prescription was written by a physician

1525

or other prescribing practitioner who is not enrolled in the

1526

Medicaid program. This subsection does not apply:

1527

(a) In instances involving bona fide emergency medical

1528

conditions as determined by the agency;

1529

(b) To a provider of medical services to a patient in a

1530

hospital emergency department, hospital inpatient or hospital

1531

outpatient setting, or nursing home;

1532

1533

Medicaid providers as determined by the agency;

1534

(d) To prescribing physicians who are board-certified

1535

specialists treating Medicaid recipients referred for treatment

1536

by a treating physician who is enrolled in the Medicaid program;

1537

(e) To prescriptions written for dually eligible Medicare

1538

beneficiaries by an authorized Medicare provider who is not

1539

enrolled in the Medicaid program;

1540

(f) To other physicians who are not enrolled in the

1541

Medicaid program but who provide a medically necessary service

1542

or prescription not otherwise reasonably available from a

1543

Medicaid-enrolled physician; or

1544

(g) In instances where the agency cannot practically

1545

notify a pharmacy at the point of sale that a prescription will

1546

be approved for processing under paragraphs (a)-(f). This

1547

paragraph shall expire July 1, 2005.

1548

(9)~~(8)~~ A Medicaid provider shall retain medical,

1549

professional, financial, and business records pertaining to

1550

services and goods furnished to a Medicaid recipient and billed

1551

to Medicaid for a period of 5 years after the date of furnishing

1552

such services or goods. The agency may investigate, review, or

1553

analyze such records, which must be made available during normal

1554

business hours. However, 24-hour notice must be provided if

1555

patient treatment would be disrupted. The provider is

1556

responsible for furnishing to the agency, and keeping the agency

1557

informed of the location of, the provider's Medicaid-related

1558

records. The authority of the agency to obtain Medicaid-related

1559

records from a provider is neither curtailed nor limited during

1560

a period of litigation between the agency and the provider.

1561

(10)~~(9)~~ Payments for the services of billing agents or

1562

persons participating in the preparation of a Medicaid claim

1563

shall not be based on amounts for which they bill nor based on

1564

the amount a provider receives from the Medicaid program.

1565

(11)~~(10)~~ The agency may deny payment or require repayment

1566

for inappropriate, medically unnecessary, or excessive goods or

1567

services from the person furnishing them, the person under whose

1568

supervision they were furnished, or the person causing them to

1569

be furnished.

1570

(12)~~(11)~~ The complaint and all information obtained

1571

pursuant to an investigation of a Medicaid provider, or the

1572

authorized representative or agent of a provider, relating to an

1573

allegation of fraud, abuse, or neglect are confidential and

1574

exempt from the provisions of s. 119.07(1):

1575

(a) Until the agency takes final agency action with

1576

respect to the provider and requires repayment of any

1577

overpayment, or imposes an administrative sanction;

1578

(b) Until the Attorney General refers the case for

1579

criminal prosecution;

1580

1581

without merit; or

1582

(d) At all times if the complaint or information is

1583

otherwise protected by law.

1584

(13)~~(12)~~ The agency may terminate participation of a

1585

Medicaid provider in the Medicaid program and may seek civil

1586

remedies or impose other administrative sanctions against a

1587

Medicaid provider, if the provider has been:

1588

(a) Convicted of a criminal offense related to the

1589

delivery of any health care goods or services, including the

1590

performance of management or administrative functions relating

1591

to the delivery of health care goods or services;

1592

(b) Convicted of a criminal offense under federal law or

1593

the law of any state relating to the practice of the provider's

1594

profession; or

1595

1596

neglected or physically abused a patient in connection with the

1597

delivery of health care goods or services.

1598

(14)~~(13)~~ If the provider has been suspended or terminated

1599

from participation in the Medicaid program or the Medicare

1600

program by the Federal Government or any state, the agency must

1601

immediately suspend or terminate, as appropriate, the provider's

1602

participation in the Florida Medicaid program for a period no

1603

less than that imposed by the Federal Government or any other

1604

state, and may not enroll such provider in the Florida Medicaid

1605

program while such foreign suspension or termination remains in

1606

effect. This sanction is in addition to all other remedies

1607

provided by law.

1608

(15)~~(14)~~ The agency may seek any remedy provided by law,

1609

including, but not limited to, the remedies provided in

1610

subsections (13) ~~(12)~~ and (16) ~~(15)~~ and s. 812.035, if:

1611

(a) The provider's license has not been renewed, or has

1612

been revoked, suspended, or terminated, for cause, by the

1613

licensing agency of any state;

1614

(b) The provider has failed to make available or has

1615

refused access to Medicaid-related records to an auditor,

1616

investigator, or other authorized employee or agent of the

1617

agency, the Attorney General, a state attorney, or the Federal

1618

Government;

1619

1620

available such Medicaid-related records as the agency has found

1621

necessary to determine whether Medicaid payments are or were due

1622

and the amounts thereof;

1623

(d) The provider has failed to maintain medical records

1624

made at the time of service, or prior to service if prior

1625

authorization is required, demonstrating the necessity and

1626

appropriateness of the goods or services rendered;

1627

(e) The provider is not in compliance with provisions of

1628

Medicaid provider publications that have been adopted by

1629

reference as rules in the Florida Administrative Code; with

1630

provisions of state or federal laws, rules, or regulations; with

1631

provisions of the provider agreement between the agency and the

1632

provider; or with certifications found on claim forms or on

1633

transmittal forms for electronically submitted claims that are

1634

submitted by the provider or authorized representative, as such

1635

provisions apply to the Medicaid program;

1636

(f) The provider or person who ordered or prescribed the

1637

care, services, or supplies has furnished, or ordered the

1638

furnishing of, goods or services to a recipient which are

1639

inappropriate, unnecessary, excessive, or harmful to the

1640

recipient or are of inferior quality;

1641

(g) The provider has demonstrated a pattern of failure to

1642

provide goods or services that are medically necessary;

1643

(h) The provider or an authorized representative of the

1644

provider, or a person who ordered or prescribed the goods or

1645

services, has submitted or caused to be submitted false or a

1646

pattern of erroneous Medicaid claims ~~that have resulted in~~

1647

~~overpayments to a provider or that exceed those to which the~~

1648

~~provider was entitled under the Medicaid program~~;

1649

(i) The provider or an authorized representative of the

1650

provider, or a person who has ordered or prescribed the goods or

1651

services, has submitted or caused to be submitted a Medicaid

1652

provider enrollment application, a request for prior

1653

authorization for Medicaid services, a drug exception request,

1654

or a Medicaid cost report that contains materially false or

1655

incorrect information;

1656

(j) The provider or an authorized representative of the

1657

provider has collected from or billed a recipient or a

1658

recipient's responsible party improperly for amounts that should

1659

not have been so collected or billed by reason of the provider's

1660

billing the Medicaid program for the same service;

1661

(k) The provider or an authorized representative of the

1662

provider has included in a cost report costs that are not

1663

allowable under a Florida Title XIX reimbursement plan, after

1664

the provider or authorized representative had been advised in an

1665

audit exit conference or audit report that the costs were not

1666

allowable;

1667

(l) The provider is charged by information or indictment

1668

with fraudulent billing practices. The sanction applied for this

1669

reason is limited to suspension of the provider's participation

1670

in the Medicaid program for the duration of the indictment

1671

unless the provider is found guilty pursuant to the information

1672

or indictment;

1673

(m) The provider or a person who has ordered, or

1674

prescribed the goods or services is found liable for negligent

1675

practice resulting in death or injury to the provider's patient;

1676

(n) The provider fails to demonstrate that it had

1677

available during a specific audit or review period sufficient

1678

quantities of goods, or sufficient time in the case of services,

1679

to support the provider's billings to the Medicaid program;

1680

(o) The provider has failed to comply with the notice and

1681

reporting requirements of s. 409.907;

1682

(p) The agency has received reliable information of

1683

patient abuse or neglect or of any act prohibited by s. 409.920;

1684

1685

(q) The provider has failed to comply with an agreed-upon

1686

repayment schedule.

1687

(16)~~(15)~~ The agency shall impose any of the following

1688

sanctions or disincentives on a provider or a person for any of

1689

the acts described in subsection (15) ~~(14)~~:

1690

(a) Suspension for a specific period of time of not more

1691

than 1 year. Suspension shall preclude participation in the

1692

Medicaid program, which includes any action that results in a

1693

claim for payment to the Medicaid program as a result of

1694

furnishing, supervising a person who is furnishing, or causing a

1695

person to furnish goods or services.

1696

(b) Termination for a specific period of time of from more

1697

than 1 year to 20 years. Termination shall preclude

1698

participation in the Medicaid program, which includes any action

1699

that results in a claim for payment to the Medicaid program as a

1700

result of furnishing, supervising a person who is furnishing, or

1701

causing a person to furnish goods or services.

1702

1703

violation. Each day that an ongoing violation continues, such as

1704

refusing to furnish Medicaid-related records or refusing access

1705

to records, is considered, for the purposes of this section, to

1706

be a separate violation. Each instance of improper billing of a

1707

Medicaid recipient; each instance of including an unallowable

1708

cost on a hospital or nursing home Medicaid cost report after

1709

the provider or authorized representative has been advised in an

1710

audit exit conference or previous audit report of the cost

1711

unallowability; each instance of furnishing a Medicaid recipient

1712

goods or professional services that are inappropriate or of

1713

inferior quality as determined by competent peer judgment; each

1714

instance of knowingly submitting a materially false or erroneous

1715

Medicaid provider enrollment application, request for prior

1716

authorization for Medicaid services, drug exception request, or

1717

cost report; each instance of inappropriate prescribing of drugs

1718

for a Medicaid recipient as determined by competent peer

1719

judgment; and each false or erroneous Medicaid claim leading to

1720

an overpayment to a provider is considered, for the purposes of

1721

this section, to be a separate violation.

1722

(d) Immediate suspension, if the agency has received

1723

information of patient abuse or neglect or of any act prohibited

1724

by s. 409.920. Upon suspension, the agency must issue an

1725

immediate final order under s. 120.569(2)(n).

1726

(e) A fine, not to exceed $10,000, for a violation of

1727

paragraph (15)~~(14)~~(i).

1728

(f) Imposition of liens against provider assets,

1729

including, but not limited to, financial assets and real

1730

property, not to exceed the amount of fines or recoveries

1731

sought, upon entry of an order determining that such moneys are

1732

due or recoverable.

1733

(g) Prepayment reviews of claims for a specified period of

1734

time.

1735

(h) Comprehensive followup reviews of providers every 6

1736

months to ensure that they are billing Medicaid correctly.

1737

(i) Corrective-action plans that would remain in effect

1738

for providers for up to 3 years and that would be monitored by

1739

the agency every 6 months while in effect.

1740

(j) Other remedies as permitted by law to effect the

1741

recovery of a fine or overpayment.

1742

1743

The Secretary of Health Care Administration may make a

1744

determination that imposition of a sanction or disincentive is

1745

not in the best interest of the Medicaid program, in which case

1746

a sanction or disincentive shall not be imposed.

1747

(17)~~(16)~~ In determining the appropriate administrative

1748

sanction to be applied, or the duration of any suspension or

1749

termination, the agency shall consider:

1750

(a) The seriousness and extent of the violation or

1751

violations.

1752

(b) Any prior history of violations by the provider

1753

relating to the delivery of health care programs which resulted

1754

in either a criminal conviction or in administrative sanction or

1755

penalty.

1756

1757

management control of Medicaid statutes, rules, regulations, or

1758

policies after written notification to the provider of improper

1759

practice or instance of violation.

1760

(d) The effect, if any, on the quality of medical care

1761

provided to Medicaid recipients as a result of the acts of the

1762

provider.

1763

(e) Any action by a licensing agency respecting the

1764

provider in any state in which the provider operates or has

1765

operated.

1766

(f) The apparent impact on access by recipients to

1767

Medicaid services if the provider is suspended or terminated, in

1768

the best judgment of the agency.

1769

1770

The agency shall document the basis for all sanctioning actions

1771

and recommendations.

1772

(18)~~(17)~~ The agency may take action to sanction, suspend,

1773

or terminate a particular provider working for a group provider,

1774

and may suspend or terminate Medicaid participation at a

1775

specific location, rather than or in addition to taking action

1776

against an entire group.

1777

(19)~~(18)~~ The agency shall establish a process for

1778

conducting followup reviews of a sampling of providers who have

1779

a history of overpayment under the Medicaid program. This

1780

process must consider the magnitude of previous fraud or abuse

1781

and the potential effect of continued fraud or abuse on Medicaid

1782

costs.

1783

(20)~~(19)~~ In making a determination of overpayment to a

1784

provider, the agency must use accepted and valid auditing,

1785

accounting, analytical, statistical, or peer-review methods, or

1786

combinations thereof. Appropriate statistical methods may

1787

include, but are not limited to, sampling and extension to the

1788

population, parametric and nonparametric statistics, tests of

1789

hypotheses, and other generally accepted statistical methods.

1790

Appropriate analytical methods may include, but are not limited

1791

to, reviews to determine variances between the quantities of

1792

products that a provider had on hand and available to be

1793

purveyed to Medicaid recipients during the review period and the

1794

quantities of the same products paid for by the Medicaid program

1795

for the same period, taking into appropriate consideration sales

1796

of the same products to non-Medicaid customers during the same

1797

period. In meeting its burden of proof in any administrative or

1798

court proceeding, the agency may introduce the results of such

1799

statistical methods as evidence of overpayment.

1800

(21)~~(20)~~ When making a determination that an overpayment

1801

has occurred, the agency shall prepare and issue an audit report

1802

to the provider showing the calculation of overpayments.

1803

(22)~~(21)~~ The audit report, supported by agency work

1804

papers, showing an overpayment to a provider constitutes

1805

evidence of the overpayment. A provider may not present or

1806

elicit testimony, either on direct examination or cross-

1807

examination in any court or administrative proceeding, regarding

1808

the purchase or acquisition by any means of drugs, goods, or

1809

supplies; sales or divestment by any means of drugs, goods, or

1810

supplies; or inventory of drugs, goods, or supplies, unless such

1811

acquisition, sales, divestment, or inventory is documented by

1812

written invoices, written inventory records, or other competent

1813

written documentary evidence maintained in the normal course of

1814

the provider's business. Notwithstanding the applicable rules of

1815

discovery, all documentation that will be offered as evidence at

1816

an administrative hearing on a Medicaid overpayment must be

1817

exchanged by all parties at least 14 days before the

1818

administrative hearing or must be excluded from consideration.

1819

(23)~~(22)~~(a) In an audit or investigation of a violation

1820

committed by a provider which is conducted pursuant to this

1821

section, the agency is entitled to recover all investigative,

1822

legal, and expert witness costs if the agency's findings were

1823

not contested by the provider or, if contested, the agency

1824

ultimately prevailed.

1825

(b) The agency has the burden of documenting the costs,

1826

which include salaries and employee benefits and out-of-pocket

1827

expenses. The amount of costs that may be recovered must be

1828

reasonable in relation to the seriousness of the violation and

1829

must be set taking into consideration the financial resources,

1830

earning ability, and needs of the provider, who has the burden

1831

of demonstrating such factors.

1832

1833

determined by the agency if the agency determines that an

1834

extreme hardship would result to the provider from immediate

1835

full payment. Any default in payment of costs may be collected

1836

by any means authorized by law.

1837

(24)~~(23)~~ If the agency imposes an administrative sanction

1838

pursuant to subsection (13), subsection (14), or subsection

1839

(15), except paragraphs (15)(e) and (o), ~~under this section~~ upon

1840

any provider or other person who is regulated by another state

1841

entity, the agency shall notify that other entity of the

1842

imposition of the sanction. Such notification must include the

1843

provider's or person's name and license number and the specific

1844

reasons for sanction.

1845

(25)~~(24)~~(a) The agency may withhold Medicaid payments, in

1846

whole or in part, to a provider upon receipt of reliable

1847

evidence that the circumstances giving rise to the need for a

1848

withholding of payments involve fraud, willful

1849

misrepresentation, or abuse under the Medicaid program, or a

1850

crime committed while rendering goods or services to Medicaid

1851

recipients, pending completion of legal proceedings. If it is

1852

determined that fraud, willful misrepresentation, abuse, or a

1853

crime did not occur, the payments withheld must be paid to the

1854

provider within 14 days after such determination with interest

1855

at the rate of 10 percent a year. Any money withheld in

1856

accordance with this paragraph shall be placed in a suspended

1857

account, readily accessible to the agency, so that any payment

1858

ultimately due the provider shall be made within 14 days.

1859

(b) The agency may deny payment or require repayment, if

1860

the goods or services were furnished, supervised, or caused to

1861

be furnished by a person who has been suspended or terminated

1862

from the Medicaid program or Medicare program by the Federal

1863

Government or any state.

1864

(c)~~(b)~~ Overpayments owed to the agency bear interest at

1865

the rate of 10 percent per year from the date of determination

1866

of the overpayment by the agency, and payment arrangements must

1867

be made at the conclusion of legal proceedings. A provider who

1868

does not enter into or adhere to an agreed-upon repayment

1869

schedule may be terminated by the agency for nonpayment or

1870

partial payment.

1871

(d)~~(c)~~ The agency, upon entry of a final agency order, a

1872

judgment or order of a court of competent jurisdiction, or a

1873

stipulation or settlement, may collect the moneys owed by all

1874

means allowable by law, including, but not limited to, notifying

1875

any fiscal intermediary of Medicare benefits that the state has

1876

a superior right of payment. Upon receipt of such written

1877

notification, the Medicare fiscal intermediary shall remit to

1878

the state the sum claimed.

1879

(e) The agency may institute amnesty programs to allow

1880

Medicaid providers the opportunity to voluntarily repay

1881

overpayments. The agency may adopt rules to administer such

1882

programs.

1883

(26)~~(25)~~ The agency may impose administrative sanctions

1884

against a Medicaid recipient, or the agency may seek any other

1885

remedy provided by law, including, but not limited to, the

1886

remedies provided in s. 812.035, if the agency finds that a

1887

recipient has engaged in solicitation in violation of s. 409.920

1888

or that the recipient has otherwise abused the Medicaid program.

1889

(27)~~(26)~~ When the Agency for Health Care Administration

1890

has made a probable cause determination and alleged that an

1891

overpayment to a Medicaid provider has occurred, the agency,

1892

after notice to the provider, may:

1893

(a) Withhold, and continue to withhold during the pendency

1894

of an administrative hearing pursuant to chapter 120, any

1895

medical assistance reimbursement payments until such time as the

1896

overpayment is recovered, unless within 30 days after receiving

1897

notice thereof the provider:

1898

1. Makes repayment in full; or

1899

2. Establishes a repayment plan that is satisfactory to

1900

the Agency for Health Care Administration.

1901

(b) Withhold, and continue to withhold during the pendency

1902

of an administrative hearing pursuant to chapter 120, medical

1903

assistance reimbursement payments if the terms of a repayment

1904

plan are not adhered to by the provider.

1905

(28)~~(27)~~ Venue for all Medicaid program integrity

1906

overpayment cases shall lie in Leon County, at the discretion of

1907

the agency.

1908

(29)~~(28)~~ Notwithstanding other provisions of law, the

1909

agency and the Medicaid Fraud Control Unit of the Department of

1910

Legal Affairs may review a provider's Medicaid-related and non-

1911

Medicaid related records in order to determine the total output

1912

of a provider's practice to reconcile quantities of goods or

1913

services billed to Medicaid with ~~against~~ quantities of goods or

1914

services used in the provider's total practice.

1915

(30)~~(29)~~ The agency may terminate a provider's

1916

participation in the Medicaid program if the provider fails to

1917

reimburse an overpayment that has been determined by final

1918

order, not subject to further appeal, within 35 days after the

1919

date of the final order, unless the provider and the agency have

1920

entered into a repayment agreement.

1921

(31)~~(30)~~ If a provider requests an administrative hearing

1922

pursuant to chapter 120, such hearing must be conducted within

1923

90 days following assignment of an administrative law judge,

1924

absent exceptionally good cause shown as determined by the

1925

administrative law judge or hearing officer. Upon issuance of a

1926

final order, the outstanding balance of the amount determined to

1927

constitute the overpayment shall become due. If a provider fails

1928

to make payments in full, fails to enter into a satisfactory

1929

repayment plan, or fails to comply with the terms of a repayment

1930

plan or settlement agreement, the agency may withhold medical

1931

assistance reimbursement payments until the amount due is paid

1932

in full.

1933

(32)~~(31)~~ Duly authorized agents and employees of the

1934

agency shall have the power to inspect, during normal business

1935

hours, the records of any pharmacy, wholesale establishment, or

1936

manufacturer, or any other place in which drugs and medical

1937

supplies are manufactured, packed, packaged, made, stored, sold,

1938

or kept for sale, for the purpose of verifying the amount of

1939

drugs and medical supplies ordered, delivered, or purchased by a

1940

provider. The agency shall provide at least 2 business days'

1941

prior notice of any such inspection. The notice must identify

1942

the provider whose records will be inspected, and the inspection

1943

shall include only records specifically related to that

1944

provider.

1945

(33) In accordance with federal law, Medicaid recipients

1946

convicted of a crime pursuant to 42 U.S.C. ss. 1320a-7b may be

1947

limited, restricted, or suspended from Medicaid eligibility for

1948

a period not to exceed 1 year, as determined by the agency head

1949

or designee.

1950

(34) To deter fraud and abuse in the Medicaid program, the

1951

agency may limit the number of schedules II and III refill

1952

prescription claims submitted from a pharmacy provider. The

1953

agency shall limit the allowable amount of reimbursement of

1954

prescription refill claims for schedules II and III

1955

pharmaceuticals if the agency or the Medicaid Fraud Control Unit

1956

determines that the specific prescription refill was not

1957

requested by the Medicaid recipient or authorized representative

1958

for whom the refill claim is submitted or was not prescribed by

1959

the recipient's medical provider or physician. Any such refill

1960

request must be consistent with the original prescription.

1961

(35) The Office of Program Policy Analysis and Government

1962

Accountability shall provide a report to the President of the

1963

Senate and the Speaker of the House of Representatives on a

1964

biennial basis, beginning January 31, 2006, on the agency's

1965

efforts to prevent, detect, deter, and recover Medicaid funds

1966

lost to fraud and abuse.

1967

Section 7. Paragraph (d) of subsection (2) and paragraph

1968

(b) of subsection (5) of section 409.9131, Florida Statutes, are

1969

amended, and subsection (6) is added to said section, to read:

1970

409.9131 Special provisions relating to integrity of the

1971

Medicaid program.--

1972

(2) DEFINITIONS.--For purposes of this section, the term:

1973

(d) "Peer review" means an evaluation of the professional

1974

practices of a Medicaid physician provider by a peer or peers in

1975

order to assess the medical necessity, appropriateness, and

1976

quality of care provided, as such care is compared to that

1977

customarily furnished by the physician's peers and to recognized

1978

health care standards, and, in cases involving determination of

1979

medical necessity, to determine whether the documentation in the

1980

physician's records is adequate.

1981

(5) DETERMINATIONS OF OVERPAYMENT.--In making a

1982

determination of overpayment to a physician, the agency must:

1983

(b) Refer all physician service claims for peer review

1984

when the agency's preliminary analysis indicates that an

1985

evaluation of the medical necessity, appropriateness, and

1986

quality of care needs to be undertaken to determine a potential

1987

overpayment, and before any formal proceedings are initiated

1988

against the physician, except as required by s. 409.913.

1989

(6) COST REPORTS.--For any Medicaid provider submitting a

1990

cost report to the agency by any method, and in addition to any

1991

other certification, the following statement must immediately

1992

precede the dated signature of the provider's administrator or

1993

chief financial officer on such cost report:

1994

1995

"I certify that I am familiar with the laws and

1996

regulations regarding the provision of health care

1997

services under the Florida Medicaid program, including

1998

the laws and regulations relating to claims for

1999

Medicaid reimbursements and payments, and that the

2000

services identified in this cost report were provided

2001

in compliance with such laws and regulations."

2002

2003

Section 8. Section 409.920, Florida Statutes, is amended

2004

to read:

2005

409.920 Medicaid provider fraud.--

2006

(1) For the purposes of this section, the term:

2007

(a) "Agency" means the Agency for Health Care

2008

Administration.

2009

(b) "Fiscal agent" means any individual, firm,

2010

corporation, partnership, organization, or other legal entity

2011

that has contracted with the agency to receive, process, and

2012

adjudicate claims under the Medicaid program.

2013

2014

1. Any particular item, device, medical supply, or service

2015

claimed to have been provided to a recipient and listed in an

2016

itemized claim for payment; or

2017

2. In the case of a claim based on costs, any entry in the

2018

cost report, books of account, or other documents supporting

2019

such claim.

2020

(d) "Knowingly" means that the act was done voluntarily

2021

and intentionally and not because of mistake or accident. As

2022

used in this section, the term "knowingly" also includes the

2023

words "willfully" or "willful," which, as used in this section,

2024

means that an act was committed voluntarily and purposely, with

2025

the specific intent to do something that the law forbids, and

2026

that the act was committed with bad purpose, either to disobey

2027

or disregard the law ~~done by a person who is aware or should be~~

2028

~~aware of the nature of his or her conduct and that his or her~~

2029

~~conduct is substantially certain to cause the intended result~~.

2030

(2) It is unlawful to:

2031

(a) Knowingly make, cause to be made, or aid and abet in

2032

the making of any false statement or false representation of a

2033

material fact, by commission or omission, in any claim submitted

2034

to the agency or its fiscal agent for payment.

2035

(b) Knowingly make, cause to be made, or aid and abet in

2036

the making of a claim for items or services that are not

2037

authorized to be reimbursed by the Medicaid program.

2038

2039

of value, other than an authorized copayment from a Medicaid

2040

recipient, from any source in addition to the amount legally

2041

payable for an item or service provided to a Medicaid recipient

2042

under the Medicaid program or knowingly fail to credit the

2043

agency or its fiscal agent for any payment received from a

2044

third-party source.

2045

(d) Knowingly make or in any way cause to be made any

2046

false statement or false representation of a material fact, by

2047

commission or omission, in any document containing items of

2048

income and expense that is or may be used by the agency to

2049

determine a general or specific rate of payment for an item or

2050

service provided by a provider.

2051

(e) Knowingly solicit, offer, pay, or receive any

2052

remuneration, including any kickback, bribe, or rebate, directly

2053

or indirectly, overtly or covertly, in cash or in kind, in

2054

return for referring an individual to a person for the

2055

furnishing or arranging for the furnishing of any item or

2056

service for which payment may be made, in whole or in part,

2057

under the Medicaid program, or in return for obtaining,

2058

purchasing, leasing, ordering, or arranging for or recommending,

2059

obtaining, purchasing, leasing, or ordering any goods, facility,

2060

item, or service, for which payment may be made, in whole or in

2061

part, under the Medicaid program.

2062

(f) Knowingly submit false or misleading information or

2063

statements to the Medicaid program for the purpose of being

2064

accepted as a Medicaid provider.

2065

(g) Knowingly use or endeavor to use a Medicaid provider's

2066

identification number or a Medicaid recipient's identification

2067

number to make, cause to be made, or aid and abet in the making

2068

of a claim for items or services that are not authorized to be

2069

reimbursed by the Medicaid program.

2070

2071

A person who violates this subsection commits a felony of the

2072

third degree, punishable as provided in s. 775.082, s. 775.083,

2073

or s. 775.084.

2074

(3) The repayment of Medicaid payments wrongfully

2075

obtained, or the offer or endeavor to repay Medicaid funds

2076

wrongfully obtained, does not constitute a defense to, or a

2077

ground for dismissal of, criminal charges brought under this

2078

section.

2079

(4) "Property paid for" includes all property furnished to

2080

or intended to be furnished to any recipient of benefits under

2081

the Medicaid program, regardless of whether reimbursement is

2082

ever actually made by the program.

2083

(5)~~(4)~~ All records in the custody of the agency or its

2084

fiscal agent which relate to Medicaid provider fraud are

2085

business records within the meaning of s. 90.803(6).

2086

(6)~~(5)~~ Proof that a claim was submitted to the agency or

2087

its fiscal agent which contained a false statement or a false

2088

representation of a material fact, by commission or omission,

2089

unless satisfactorily explained, gives rise to an inference that

2090

the person whose signature appears as the provider's authorizing

2091

signature on the claim form, or whose signature appears on an

2092

agency electronic claim submission agreement submitted for

2093

claims made to the fiscal agent by electronic means, had

2094

knowledge of the false statement or false representation. This

2095

subsection applies whether the signature appears on the claim

2096

form or the electronic claim submission agreement by means of

2097

handwriting, typewriting, facsimile signature stamp, computer

2098

impulse, initials, or otherwise.

2099

(7)~~(6)~~ Proof of submission to the agency or its fiscal

2100

agent of a document containing items of income and expense,

2101

which document is used or that may be used by the agency or its

2102

fiscal agent to determine a general or specific rate of payment

2103

and which document contains a false statement or a false

2104

representation of a material fact, by commission or omission,

2105

unless satisfactorily explained, gives rise to the inference

2106

that the person who signed the certification of the document had

2107

knowledge of the false statement or representation. This

2108

subsection applies whether the signature appears on the document

2109

by means of handwriting, typewriting, facsimile signature stamp,

2110

electronic transmission, initials, or otherwise.

2111

(8)~~(7)~~ The Attorney General shall conduct a statewide

2112

program of Medicaid fraud control. To accomplish this purpose,

2113

the Attorney General shall:

2114

(a) Investigate the possible criminal violation of any

2115

applicable state law pertaining to fraud in the administration

2116

of the Medicaid program, in the provision of medical assistance,

2117

or in the activities of providers of health care under the

2118

Medicaid program.

2119

(b) Investigate the alleged abuse or neglect of patients

2120

in health care facilities receiving payments under the Medicaid

2121

program, in coordination with the agency.

2122

2123

private funds in health care facilities receiving payments under

2124

the Medicaid program.

2125

(d) Refer to the Office of Statewide Prosecution or the

2126

appropriate state attorney all violations indicating a

2127

substantial potential for criminal prosecution.

2128

(e) Refer to the agency all suspected abusive activities

2129

not of a criminal or fraudulent nature.

2130

(f) Safeguard the privacy rights of all individuals and

2131

provide safeguards to prevent the use of patient medical records

2132

for any reason beyond the scope of a specific investigation for

2133

fraud or abuse, or both, without the patient's written consent.

2134

(g) Publicize to state employees and the public the

2135

ability of persons to bring suit under the provisions of the

2136

Florida False Claims Act and the potential for the persons

2137

bringing a civil action under the Florida False Claims Act to

2138

obtain a monetary award.

2139

(9)~~(8)~~ In carrying out the duties and responsibilities

2140

under this section, the Attorney General may:

2141

(a) Enter upon the premises of any health care provider,

2142

excluding a physician, participating in the Medicaid program to

2143

examine all accounts and records that may, in any manner, be

2144

relevant in determining the existence of fraud in the Medicaid

2145

program, to investigate alleged abuse or neglect of patients, or

2146

to investigate alleged misappropriation of patients' private

2147

funds. A participating physician is required to make available

2148

any accounts or records that may, in any manner, be relevant in

2149

determining the existence of fraud in the Medicaid program,

2150

alleged abuse or neglect of patients, or alleged

2151

misappropriation of patients' private funds. The accounts or

2152

records of a non-Medicaid patient may not be reviewed by, or

2153

turned over to, the Attorney General without the patient's

2154

written consent.

2155

(b) Subpoena witnesses or materials, including medical

2156

records relating to Medicaid recipients, within or outside the

2157

state and, through any duly designated employee, administer

2158

oaths and affirmations and collect evidence for possible use in

2159

either civil or criminal judicial proceedings.

2160

2161

attorney or law enforcement agency in the investigation and

2162

prosecution of any violation of this section.

2163

(d) Seek any civil remedy provided by law, including, but

2164

not limited to, the remedies provided in ss. 68.081-68.092 and

2165

812.035 and this chapter.

2166

(e) Refer to the agency for collection each instance of

2167

overpayment to a provider of health care under the Medicaid

2168

program which is discovered during the course of an

2169

investigation.

2170

Section 9. Section 409.9201, Florida Statutes, is created

2171

to read:

2172

409.9201 Medicaid fraud.--

2173

(1) As used in this section, the term:

2174

(a) "Legend drug" means any drug, including, but not

2175

limited to, finished dosage forms or active ingredients that are

2176

subject to, defined by, or described by s. 503(b) of the Federal

2177

Food, Drug, and Cosmetic Act or by s. 465.003(8), s.

2178

499.007(12), or s. 499.0122(1)(b) or (c).

2179

(b) "Value" means the amount billed to the Medicaid

2180

program for the property dispensed or the market value of a

2181

legend drug, goods or services at the time and place of the

2182

offense. If the market value cannot be determined, the term

2183

means the replacement cost of the legend drug, goods or services

2184

within a reasonable time after the offense.

2185

(2) Any person who knowingly sells, who knowingly attempts

2186

or conspires to sell, or who knowingly causes any other person

2187

to sell or attempt or conspire to sell a legend drug that was

2188

paid for by the Medicaid program commits a felony.

2189

(a) If the value of the legend drug involved is less than

2190

$20,000, the crime is a felony of the third degree, punishable

2191

as provided in s. 775.082, s. 775.083, or s. 775.084.

2192

(b) If the value of the legend drug involved is $20,000 or

2193

more but less than $100,000, the crime is a felony of the second

2194

degree, punishable as provided in s. 775.082, s. 775.083, or s.

2195

775.084.

2196

2197

or more, the crime is a felony of the first degree, punishable

2198

as provided in s. 775.082, s. 775.083, or s. 775.084.

2199

(3) Any person who knowingly purchases, or who knowingly

2200

attempts or conspires to purchase, a legend drug that was paid

2201

for by the Medicaid program and intended for use by another

2202

person commits a felony.

2203

(a) If the value of the legend drug is less than $20,000,

2204

the crime is a felony of the third degree, punishable as

2205

provided in s. 775.082, s. 775.083, or s. 775.084.

2206

(b) If the value of the legend drug is $20,000 or more but

2207

less than $100,000, the crime is a felony of the second degree,

2208

punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

2209

2210

the crime is a felony of the first degree, punishable as

2211

provided in s. 775.082, s. 775.083, or s. 775.084.

2212

(4) Any person who knowingly makes or causes to be made,

2213

or who attempts or conspires to make, any false statement or

2214

representation to any person for the purpose of obtaining goods

2215

or services from the Medicaid program commits a felony.

2216

(a) If the value of the goods or services is less than

2217

$20,000, the crime is a felony of the third degree, punishable

2218

as provided in s. 775.082, s. 775.083, or s. 775.084.

2219

(b) If the value of the goods or services is $20,000 or

2220

more but less than $100,000, the crime is a felony of the second

2221

degree, punishable as provided in s. 775.082, s. 775.083, or s.

2222

775.084.

2223

2224

$100,000 or more, the crime is a felony of the first degree,

2225

punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

2226

2227

The value of individual items of the legend drugs, goods or

2228

services involved in distinct transactions committed during a

2229

single scheme or course of conduct, whether involving a single

2230

person or several persons, may be aggregated when determining

2231

the punishment for the offense.

2232

Section 10. Paragraph (ff) is added to subsection (1) of

2233

section 456.072, Florida Statutes, to read:

2234

456.072 Grounds for discipline; penalties; enforcement.--

2235

(1) The following acts shall constitute grounds for which

2236

the disciplinary actions specified in subsection (2) may be

2237

taken:

2238

(ff) Engaging in a pattern of practice when prescribing

2239

medicinal drugs or controlled substances which demonstrates a

2240

lack of reasonable skill or safety to patients, a violation of

2241

any provision of this chapter, a violation of the applicable

2242

practice act, or a violation of any rules adopted pursuant to

2243

this chapter or the applicable practice act of the prescribing

2244

practitioner. Notwithstanding s. 456.073(13), the department may

2245

initiate an investigation and establish such a pattern from

2246

billing records, data, or any other information obtained by the

2247

department.

2248

Section 11. Subsection (1) of section 465.188, Florida

2249

Statutes, is amended, and subsection (4) is added to said

2250

section, to read:

2251

465.188 Medicaid audits of pharmacies.--

2252

(1) Notwithstanding any other law, when an audit of the

2253

Medicaid-related records of a pharmacy licensed under chapter

2254

465 is conducted, such audit must be conducted as provided in

2255

this section.

2256

(a) The agency conducting the audit must give the

2257

pharmacist at least 1 week's prior notice of the initial audit

2258

for each audit cycle.

2259

(b) An audit must be conducted by a pharmacist licensed in

2260

this state.

2261

2262

typographical error, scrivener's error, or computer error

2263

regarding a document or record required under the Medicaid

2264

program does not constitute a willful violation and is not

2265

subject to criminal penalties without proof of intent to commit

2266

fraud.

2267

(d) A pharmacist may use the physician's record or other

2268

order for drugs or medicinal supplies written or transmitted by

2269

any means of communication for purposes of validating the

2270

pharmacy record with respect to orders or refills of a legend or

2271

narcotic drug.

2272

(e) A finding of an overpayment or underpayment must be

2273

based on the actual overpayment or underpayment and may not be a

2274

projection based on the number of patients served having a

2275

similar diagnosis or on the number of similar orders or refills

2276

for similar drugs.

2277

(f) Each pharmacy shall be audited under the same

2278

standards and parameters.

2279

(g) A pharmacist must be allowed at least 10 days in which

2280

to produce documentation to address any discrepancy found during

2281

an audit.

2282

(h) The period covered by an audit may not exceed 1

2283

calendar year.

2284

(i) An audit may not be scheduled during the first 5 days

2285

of any month due to the high volume of prescriptions filled

2286

during that time.

2287

(j) The audit report must be delivered to the pharmacist

2288

within 90 days after conclusion of the audit. A final audit

2289

report shall be delivered to the pharmacist within 6 months

2290

after receipt of the preliminary audit report or final appeal,

2291

as provided for in subsection (2), whichever is later.

2292

(k) The audit criteria set forth in this section applies

2293

only to audits of claims submitted for payment subsequent to

2294

July 11, 2003. Notwithstanding any other provisions in this

2295

section, the agency conducting the audit shall not use the

2296

accounting practice of extrapolation in calculating penalties

2297

for Medicaid audits.

2298

(4) This section does not apply to any investigative audit

2299

conducted by the Agency for Health Care Administration when the

2300

agency has reliable evidence that the claim that is the subject

2301

of the audit involves fraud, willful misrepresentation, or abuse

2302

under the Medicaid program.

2303

Section 12. Section 812.0191, Florida Statutes, is created

2304

to read:

2305

812.0191 Property paid for in whole or in part by the

2306

Medicaid program.--

2307

(1) As used in this section, the term:

2308

(a) "Property paid for in whole or in part by the Medicaid

2309

program" means any devices, goods, services, drugs, or other

2310

property furnished or intended to be furnished to a recipient of

2311

benefits under the Medicaid program.

2312

(b) "Value" means the amount billed to Medicaid for the

2313

property dispensed or the market value of the devices, goods,

2314

services, or drugs at the time and place of the offense. If the

2315

market value cannot be determined, the term means the

2316

replacement cost of the devices, goods, services, or drugs

2317

within a reasonable time after the offense.

2318

(2) Any person who traffics in, or endeavors to traffic

2319

in, property that he or she knows or should have known was paid

2320

for in whole or in part by the Medicaid program commits a

2321

felony.

2322

(a) If the value of the property involved is less than

2323

$20,000, the crime is a felony of the third degree, punishable

2324

as provided in s. 775.082, s. 775.083, or s. 775.084.

2325

(b) If the value of the property involved is $20,000 or

2326

more but less than $100,000, the crime is a felony of the second

2327

degree, punishable as provided in s. 775.082, s. 775.083, or s.

2328

775.084.

2329

2330

more, the crime is a felony of the first degree, punishable as

2331

provided in s. 775.082, s. 775.083, or s. 775.084.

2332

2333

The value of individual items of the devices, goods, services,

2334

drugs, or other property involved in distinct transactions

2335

committed during a single scheme or course of conduct, whether

2336

involving a single person or several persons, may be aggregated

2337

when determining the punishment for the offense.

2338

(3) Any person who knowingly initiates, organizes, plans,

2339

finances, directs, manages, or supervises the obtaining of

2340

property paid for in whole or in part by the Medicaid program

2341

and who traffics in, or endeavors to traffic in, such property

2342

commits a felony of the first degree, punishable as provided in

2343

s. 775.082, s. 775.083, or s. 775.084.

2344

Section 13. Paragraph (a) of subsection (1) of section

2345

895.02, Florida Statutes, is amended to read:

2346

895.02 Definitions.--As used in ss. 895.01-895.08, the

2347

term:

2348

(1) "Racketeering activity" means to commit, to attempt to

2349

commit, to conspire to commit, or to solicit, coerce, or

2350

intimidate another person to commit:

2351

(a) Any crime which is chargeable by indictment or

2352

information under the following provisions of the Florida

2353

Statutes:

2354

1. Section 210.18, relating to evasion of payment of

2355

cigarette taxes.

2356

2. Section 403.727(3)(b), relating to environmental

2357

control.

2358

3. Section 414.39, relating to public assistance fraud.

2359

4. Section 409.920 or section 409.9201, relating to

2360

Medicaid ~~provider~~ fraud.

2361

5. Section 440.105 or s. 440.106, relating to workers'

2362

compensation.

2363

6. Sections 499.0051, 499.0052, 499.0053, 499.0054, and

2364

499.0691, relating to crimes involving contraband and

2365

adulterated drugs.

2366

7. Part IV of chapter 501, relating to telemarketing.

2367

8. Chapter 517, relating to sale of securities and

2368

investor protection.

2369

9. Section 550.235, s. 550.3551, or s. 550.3605, relating

2370

to dogracing and horseracing.

2371

10. Chapter 550, relating to jai alai frontons.

2372

11. Chapter 552, relating to the manufacture,

2373

distribution, and use of explosives.

2374

12. Chapter 560, relating to money transmitters, if the

2375

violation is punishable as a felony.

2376

13. Chapter 562, relating to beverage law enforcement.

2377

14. Section 624.401, relating to transacting insurance

2378

without a certificate of authority, s. 624.437(4)(c)1., relating

2379

to operating an unauthorized multiple-employer welfare

2380

arrangement, or s. 626.902(1)(b), relating to representing or

2381

aiding an unauthorized insurer.

2382

15. Section 655.50, relating to reports of currency

2383

transactions, when such violation is punishable as a felony.

2384

16. Chapter 687, relating to interest and usurious

2385

practices.

2386

17. Section 721.08, s. 721.09, or s. 721.13, relating to

2387

real estate timeshare plans.

2388

18. Chapter 782, relating to homicide.

2389

19. Chapter 784, relating to assault and battery.

2390

20. Chapter 787, relating to kidnapping.

2391

21. Chapter 790, relating to weapons and firearms.

2392

22. Section 796.03, s. 796.04, s. 796.05, or s. 796.07,

2393

relating to prostitution.

2394

23. Chapter 806, relating to arson.

2395

24. Section 810.02(2)(c), relating to specified burglary

2396

of a dwelling or structure.

2397

25. Chapter 812, relating to theft, robbery, and related

2398

crimes.

2399

26. Chapter 815, relating to computer-related crimes.

2400

27. Chapter 817, relating to fraudulent practices, false

2401

pretenses, fraud generally, and credit card crimes.

2402

28. Chapter 825, relating to abuse, neglect, or

2403

exploitation of an elderly person or disabled adult.

2404

29. Section 827.071, relating to commercial sexual

2405

exploitation of children.

2406

30. Chapter 831, relating to forgery and counterfeiting.

2407

31. Chapter 832, relating to issuance of worthless checks

2408

and drafts.

2409

32. Section 836.05, relating to extortion.

2410

33. Chapter 837, relating to perjury.

2411

34. Chapter 838, relating to bribery and misuse of public

2412

office.

2413

35. Chapter 843, relating to obstruction of justice.

2414

36. Section 847.011, s. 847.012, s. 847.013, s. 847.06, or

2415

s. 847.07, relating to obscene literature and profanity.

2416

37. Section 849.09, s. 849.14, s. 849.15, s. 849.23, or s.

2417

849.25, relating to gambling.

2418

38. Chapter 874, relating to criminal street gangs.

2419

39. Chapter 893, relating to drug abuse prevention and

2420

control.

2421

40. Chapter 896, relating to offenses related to financial

2422

transactions.

2423

41. Sections 914.22 and 914.23, relating to tampering with

2424

a witness, victim, or informant, and retaliation against a

2425

witness, victim, or informant.

2426

42. Sections 918.12 and 918.13, relating to tampering with

2427

jurors and evidence.

2428

Section 14. Section 905.34, Florida Statutes, is amended

2429

to read:

2430

905.34 Powers and duties; law applicable.--The

2431

jurisdiction of a statewide grand jury impaneled under this

2432

chapter shall extend throughout the state. The subject matter

2433

jurisdiction of the statewide grand jury shall be limited to the

2434

offenses of:

2435

(1) Bribery, burglary, carjacking, home-invasion robbery,

2436

criminal usury, extortion, gambling, kidnapping, larceny,

2437

murder, prostitution, perjury, and robbery;

2438

(2) Crimes involving narcotic or other dangerous drugs;

2439

(3) Any violation of the provisions of the Florida RICO

2440

(Racketeer Influenced and Corrupt Organization) Act, including

2441

any offense listed in the definition of racketeering activity in

2442

s. 895.02(1)(a), providing such listed offense is investigated

2443

in connection with a violation of s. 895.03 and is charged in a

2444

separate count of an information or indictment containing a

2445

count charging a violation of s. 895.03, the prosecution of

2446

which listed offense may continue independently if the

2447

prosecution of the violation of s. 895.03 is terminated for any

2448

reason;

2449

(4) Any violation of the provisions of the Florida Anti-

2450

Fencing Act;

2451

(5) Any violation of the provisions of the Florida

2452

Antitrust Act of 1980, as amended;

2453

(6) Any violation of the provisions of chapter 815;

2454

(7) Any crime involving, or resulting in, fraud or deceit

2455

upon any person;

2456

(8) Any violation of s. 847.0135, s. 847.0137, or s.

2457

847.0138 relating to computer pornography and child exploitation

2458

prevention, or any offense related to a violation of s.

2459

847.0135, s. 847.0137, or s. 847.0138; or

2460

(9) Any criminal violation of part I of chapter 499; or

2461

(10) Any criminal violation of s. 409.920 or s. 409.9201;

2462

2463

or any attempt, solicitation, or conspiracy to commit any

2464

violation of the crimes specifically enumerated above, when any

2465

such offense is occurring, or has occurred, in two or more

2466

judicial circuits as part of a related transaction or when any

2467

such offense is connected with an organized criminal conspiracy

2468

affecting two or more judicial circuits. The statewide grand

2469

jury may return indictments and presentments irrespective of the

2470

county or judicial circuit where the offense is committed or

2471

triable. If an indictment is returned, it shall be certified and

2472

transferred for trial to the county where the offense was

2473

committed. The powers and duties of, and law applicable to,

2474

county grand juries shall apply to a statewide grand jury except

2475

when such powers, duties, and law are inconsistent with the

2476

provisions of ss. 905.31-905.40.

2477

Section 15. Paragraph (a) of subsection (2) of section

2478

932.701, Florida Statutes, is amended to read:

2479

932.701 Short title; definitions.--

2480

(2) As used in the Florida Contraband Forfeiture Act:

2481

(a) "Contraband article" means:

2482

1. Any controlled substance as defined in chapter 893 or

2483

any substance, device, paraphernalia, or currency or other means

2484

of exchange that was used, was attempted to be used, or was

2485

intended to be used in violation of any provision of chapter

2486

893, if the totality of the facts presented by the state is

2487

clearly sufficient to meet the state's burden of establishing

2488

probable cause to believe that a nexus exists between the

2489

article seized and the narcotics activity, whether or not the

2490

use of the contraband article can be traced to a specific

2491

narcotics transaction.

2492

2. Any gambling paraphernalia, lottery tickets, money,

2493

currency, or other means of exchange which was used, was

2494

attempted, or intended to be used in violation of the gambling

2495

laws of the state.

2496

3. Any equipment, liquid or solid, which was being used,

2497

is being used, was attempted to be used, or intended to be used

2498

in violation of the beverage or tobacco laws of the state.

2499

4. Any motor fuel upon which the motor fuel tax has not

2500

been paid as required by law.

2501

5. Any personal property, including, but not limited to,

2502

any vessel, aircraft, item, object, tool, substance, device,

2503

weapon, machine, vehicle of any kind, money, securities, books,

2504

records, research, negotiable instruments, or currency, which

2505

was used or was attempted to be used as an instrumentality in

2506

the commission of, or in aiding or abetting in the commission

2507

of, any felony, whether or not comprising an element of the

2508

felony, or which is acquired by proceeds obtained as a result of

2509

a violation of the Florida Contraband Forfeiture Act.

2510

6. Any real property, including any right, title,

2511

leasehold, or other interest in the whole of any lot or tract of

2512

land, which was used, is being used, or was attempted to be used

2513

as an instrumentality in the commission of, or in aiding or

2514

abetting in the commission of, any felony, or which is acquired

2515

by proceeds obtained as a result of a violation of the Florida

2516

Contraband Forfeiture Act.

2517

7. Any personal property, including, but not limited to,

2518

equipment, money, securities, books, records, research,

2519

negotiable instruments, currency, or any vessel, aircraft, item,

2520

object, tool, substance, device, weapon, machine, or vehicle of

2521

any kind in the possession of or belonging to any person who

2522

takes aquaculture products in violation of s. 812.014(2)(c).

2523

8. Any motor vehicle offered for sale in violation of s.

2524

320.28.

2525

9. Any motor vehicle used during the course of committing

2526

an offense in violation of s. 322.34(9)(a).

2527

10. Any real property, including any right, title,

2528

leasehold, or other interest in the whole of any lot or tract of

2529

land, which is acquired by proceeds obtained as a result of

2530

Medicaid provider fraud under s. 409.920; any personal property,

2531

including, but not limited to, equipment, money, securities,

2532

books, records, research, negotiable instruments, or currency;

2533

or any vessel, aircraft, item, object, tool, substance, device,

2534

weapon, machine, or vehicle of any kind in the possession of or

2535

belonging to any person which is acquired by proceeds obtained

2536

as a result of Medicaid provider fraud under s. 409.920.

2537

Section 16. Paragraph (l) is added to subsection (5) of

2538

section 932.7055, Florida Statutes, to read:

2539

932.7055 Disposition of liens and forfeited property.--

2540

(5) If the seizing agency is a state agency, all remaining

2541

proceeds shall be deposited into the General Revenue Fund.

2542

However, if the seizing agency is:

2543

(l) The Medicaid Fraud Control Unit of the Department of

2544

Legal Affairs, the proceeds accrued pursuant to the provisions

2545

of the Florida Contraband Forfeiture Act shall be deposited into

2546

the Grants and Donations Trust Fund to be used for investigation

2547

and prosecution of Medicaid fraud, abuse, neglect, and other

2548

related cases by the Medicaid Fraud Control Unit.

2549

Section 17. Paragraphs (a), (b), and (e) of subsection (4)

2550

of section 394.9082, Florida Statutes, are amended to read:

2551

394.9082 Behavioral health service delivery strategies.--

2552

(4) CONTRACT FOR SERVICES.--

2553

(a) The Department of Children and Family Services and the

2554

Agency for Health Care Administration may contract for the

2555

provision or management of behavioral health services with a

2556

managing entity in at least two geographic areas. Both the

2557

Department of Children and Family Services and the Agency for

2558

Health Care Administration must contract with the same managing

2559

entity in any distinct geographic area where the strategy

2560

operates. This managing entity shall be accountable at a minimum

2561

for the delivery of behavioral health services specified and

2562

funded by the department and the agency. The geographic area

2563

must be of sufficient size in population and have enough public

2564

funds for behavioral health services to allow for flexibility

2565

and maximum efficiency. Notwithstanding the provisions of s.

2566

409.912(4)~~(3)~~(b)1. and 2., at least one service delivery

2567

strategy must be in one of the service districts in the

2568

catchment area of G. Pierce Wood Memorial Hospital.

2569

(b) Under one of the service delivery strategies, the

2570

Department of Children and Family Services may contract with a

2571

prepaid mental health plan that operates under s. 409.912 to be

2572

the managing entity. Under this strategy, the Department of

2573

Children and Family Services is not required to competitively

2574

procure those services and, notwithstanding other provisions of

2575

law, may employ prospective payment methodologies that the

2576

department finds are necessary to improve client care or

2577

institute more efficient practices. The Department of Children

2578

and Family Services may employ in its contract any provision of

2579

the current prepaid behavioral health care plan authorized under

2580

s. 409.912(4)~~(3)~~(a) and (b), or any other provision necessary to

2581

improve quality, access, continuity, and price. Any contracts

2582

under this strategy in Area 6 of the Agency for Health Care

2583

Administration or in the prototype region under s. 20.19(7) of

2584

the Department of Children and Family Services may be entered

2585

with the existing substance abuse treatment provider network if

2586

an administrative services organization is part of its network.

2587

In Area 6 of the Agency for Health Care Administration or in the

2588

prototype region of the Department of Children and Family

2589

Services, the Department of Children and Family Services and the

2590

Agency for Health Care Administration may employ alternative

2591

service delivery and financing methodologies, which may include

2592

prospective payment for certain population groups. The

2593

population groups that are to be provided these substance abuse

2594

services would include at a minimum: individuals and families

2595

receiving family safety services; Medicaid-eligible children,

2596

adolescents, and adults who are substance-abuse-impaired; or

2597

current recipients and persons at risk of needing cash

2598

assistance under Florida's welfare reform initiatives.

2599

(e) The cost of the managing entity contract shall be

2600

funded through a combination of funds from the Department of

2601

Children and Family Services and the Agency for Health Care

2602

Administration. To operate the managing entity, the Department

2603

of Children and Family Services and the Agency for Health Care

2604

Administration may not expend more than 10 percent of the annual

2605

appropriations for mental health and substance abuse treatment

2606

services prorated to the geographic areas and must include all

2607

behavioral health Medicaid funds, including psychiatric

2608

inpatient funds. This restriction does not apply to a prepaid

2609

behavioral health plan that is authorized under s.

2610

409.912(4)~~(3)~~(a) and (b).

2611

Section 18. Subsection (6) of section 400.0077, Florida

2612

Statutes, is amended to read:

2613

400.0077 Confidentiality.--

2614

(6) This section does not limit the subpoena power of the

2615

Attorney General pursuant to s. 409.920(9)~~(8)~~(b).

2616

Section 19. Paragraph (a) of subsection (4) of section

2617

409.9065, Florida Statutes, is amended to read:

2618

409.9065 Pharmaceutical expense assistance.--

2619

(4) ADMINISTRATION.--The pharmaceutical expense assistance

2620

program shall be administered by the agency, in collaboration

2621

with the Department of Elderly Affairs and the Department of

2622

Children and Family Services.

2623

(a) The agency shall, by rule, establish for the

2624

pharmaceutical expense assistance program eligibility

2625

requirements; limits on participation; benefit limitations,

2626

including copayments; a requirement for generic drug

2627

substitution; and other program parameters comparable to those

2628

of the Medicaid program. Individuals eligible to participate in

2629

this program are not subject to the limit of four brand name

2630

drugs per month per recipient as specified in s.

2631

409.912(40)~~(38)~~(a). There shall be no monetary limit on

2632

prescription drugs purchased with discounts of less than 51

2633

percent unless the agency determines there is a risk of a

2634

funding shortfall in the program. If the agency determines there

2635

is a risk of a funding shortfall, the agency may establish

2636

monetary limits on prescription drugs which shall not be less

2637

than $160 worth of prescription drugs per month.

2638

Section 20. Subsection (1) of section 409.9071, Florida

2639

Statutes, is amended to read:

2640

409.9071 Medicaid provider agreements for school districts

2641

certifying state match.--

2642

(1) The agency shall submit a state plan amendment by

2643

September 1, 1997, for the purpose of obtaining federal

2644

authorization to reimburse school-based services as provided in

2645

former s. 236.0812 pursuant to the rehabilitative services

2646

option provided under 42 U.S.C. s. 1396d(a)(13). For purposes of

2647

this section, billing agent consulting services shall be

2648

considered billing agent services, as that term is used in s.

2649

409.913(10)~~(9)~~, and, as such, payments to such persons shall not

2650

be based on amounts for which they bill nor based on the amount

2651

a provider receives from the Medicaid program. This provision

2652

shall not restrict privatization of Medicaid school-based

2653

services. Subject to any limitations provided for in the General

2654

Appropriations Act, the agency, in compliance with appropriate

2655

federal authorization, shall develop policies and procedures and

2656

shall allow for certification of state and local education funds

2657

which have been provided for school-based services as specified

2658

in s. 1011.70 and authorized by a physician's order where

2659

required by federal Medicaid law. Any state or local funds

2660

certified pursuant to this section shall be for children with

2661

specified disabilities who are eligible for both Medicaid and

2662

part B or part H of the Individuals with Disabilities Education

2663

Act (IDEA), or the exceptional student education program, or who

2664

have an individualized educational plan.

2665

Section 21. Subsection (4) of section 409.908, Florida

2666

Statutes, is amended to read:

2667

409.908 Reimbursement of Medicaid providers.--Subject to

2668

specific appropriations, the agency shall reimburse Medicaid

2669

providers, in accordance with state and federal law, according

2670

to methodologies set forth in the rules of the agency and in

2671

policy manuals and handbooks incorporated by reference therein.

2672

These methodologies may include fee schedules, reimbursement

2673

methods based on cost reporting, negotiated fees, competitive

2674

bidding pursuant to s. 287.057, and other mechanisms the agency

2675

considers efficient and effective for purchasing services or

2676

goods on behalf of recipients. If a provider is reimbursed based

2677

on cost reporting and submits a cost report late and that cost

2678

report would have been used to set a lower reimbursement rate

2679

for a rate semester, then the provider's rate for that semester

2680

shall be retroactively calculated using the new cost report, and

2681

full payment at the recalculated rate shall be affected

2682

retroactively. Medicare-granted extensions for filing cost

2683

reports, if applicable, shall also apply to Medicaid cost

2684

reports. Payment for Medicaid compensable services made on

2685

behalf of Medicaid eligible persons is subject to the

2686

availability of moneys and any limitations or directions

2687

provided for in the General Appropriations Act or chapter 216.

2688

Further, nothing in this section shall be construed to prevent

2689

or limit the agency from adjusting fees, reimbursement rates,

2690

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

2691

making any other adjustments necessary to comply with the

2692

availability of moneys and any limitations or directions

2693

provided for in the General Appropriations Act, provided the

2694

adjustment is consistent with legislative intent.

2695

(4) Subject to any limitations or directions provided for

2696

in the General Appropriations Act, alternative health plans,

2697

health maintenance organizations, and prepaid health plans shall

2698

be reimbursed a fixed, prepaid amount negotiated, or

2699

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

2700

prospectively paid to the provider monthly for each Medicaid

2701

recipient enrolled. The amount may not exceed the average amount

2702

the agency determines it would have paid, based on claims

2703

experience, for recipients in the same or similar category of

2704

eligibility. The agency shall calculate capitation rates on a

2705

regional basis and, beginning September 1, 1995, shall include

2706

age-band differentials in such calculations. Effective July 1,

2707

2001, the cost of exempting statutory teaching hospitals,

2708

specialty hospitals, and community hospital education program

2709

hospitals from reimbursement ceilings and the cost of special

2710

Medicaid payments shall not be included in premiums paid to

2711

health maintenance organizations or prepaid health care plans.

2712

Each rate semester, the agency shall calculate and publish a

2713

Medicaid hospital rate schedule that does not reflect either

2714

special Medicaid payments or the elimination of rate

2715

reimbursement ceilings, to be used by hospitals and Medicaid

2716

health maintenance organizations, in order to determine the

2717

Medicaid rate referred to in ss. 409.912(19)~~(17)~~, 409.9128(5),

2718

and 641.513(6).

2719

Section 22. Subsections (1) and (2) of section 409.91196,

2720

Florida Statutes, are amended to read:

2721

409.91196 Supplemental rebate agreements; confidentiality

2722

of records and meetings.--

2723

(1) Trade secrets, rebate amount, percent of rebate,

2724

manufacturer's pricing, and supplemental rebates which are

2725

contained in records of the Agency for Health Care

2726

Administration and its agents with respect to supplemental

2727

rebate negotiations and which are prepared pursuant to a

2728

supplemental rebate agreement under s. 409.912(40)~~(38)~~(a)7. are

2729

confidential and exempt from s. 119.07 and s. 24(a), Art. I of

2730

the State Constitution.

2731

(2) Those portions of meetings of the Medicaid

2732

Pharmaceutical and Therapeutics Committee at which trade

2733

secrets, rebate amount, percent of rebate, manufacturer's

2734

pricing, and supplemental rebates are disclosed for discussion

2735

or negotiation of a supplemental rebate agreement under s.

2736

409.912(40)~~(38)~~(a)7. are exempt from s. 286.011 and s. 24(b),

2737

Art. I of the State Constitution.

2738

Section 23. Paragraph (f) of subsection (2) of section

2739

409.9122, Florida Statutes, is amended to read:

2740

409.9122 Mandatory Medicaid managed care enrollment;

2741

programs and procedures.--

2742

(2)

2743

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

2744

care plan or MediPass provider, the agency shall assign the

2745

Medicaid recipient to a managed care plan or MediPass provider.

2746

Medicaid recipients who are subject to mandatory assignment but

2747

who fail to make a choice shall be assigned to managed care

2748

plans until an enrollment of 40 percent in MediPass and 60

2749

percent in managed care plans is achieved. Once this enrollment

2750

is achieved, the assignments shall be divided in order to

2751

maintain an enrollment in MediPass and managed care plans which

2752

is in a 40 percent and 60 percent proportion, respectively.

2753

Thereafter, assignment of Medicaid recipients who fail to make a

2754

choice shall be based proportionally on the preferences of

2755

recipients who have made a choice in the previous period. Such

2756

proportions shall be revised at least quarterly to reflect an

2757

update of the preferences of Medicaid recipients. The agency

2758

shall disproportionately assign Medicaid-eligible recipients who

2759

are required to but have failed to make a choice of managed care

2760

plan or MediPass, including children, and who are to be assigned

2761

to the MediPass program to children's networks as described in

2762

s. 409.912(4)~~(3)~~(g), Children's Medical Services network as

2763

defined in s. 391.021, exclusive provider organizations,

2764

provider service networks, minority physician networks, and

2765

pediatric emergency department diversion programs authorized by

2766

this chapter or the General Appropriations Act, in such manner

2767

as the agency deems appropriate, until the agency has determined

2768

that the networks and programs have sufficient numbers to be

2769

economically operated. For purposes of this paragraph, when

2770

referring to assignment, the term "managed care plans" includes

2771

health maintenance organizations, exclusive provider

2772

organizations, provider service networks, minority physician

2773

networks, Children's Medical Services network, and pediatric

2774

emergency department diversion programs authorized by this

2775

chapter or the General Appropriations Act. When making

2776

assignments, the agency shall take into account the following

2777

criteria:

2778

1. A managed care plan has sufficient network capacity to

2779

meet the need of members.

2780

2. The managed care plan or MediPass has previously

2781

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

2782

plan's primary care providers or MediPass providers has

2783

previously provided health care to the recipient.

2784

3. The agency has knowledge that the member has previously

2785

expressed a preference for a particular managed care plan or

2786

MediPass provider as indicated by Medicaid fee-for-service

2787

claims data, but has failed to make a choice.

2788

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

2789

providers are geographically accessible to the recipient's

2790

residence.

2791

Section 24. Subsection (3) of section 409.9131, Florida

2792

Statutes, is amended to read:

2793

409.9131 Special provisions relating to integrity of the

2794

Medicaid program.--

2795

(3) ONSITE RECORDS REVIEW.--As specified in s.

2796

409.913(9)~~(8)~~, the agency may investigate, review, or analyze a

2797

physician's medical records concerning Medicaid patients. The

2798

physician must make such records available to the agency during

2799

normal business hours. The agency must provide notice to the

2800

physician at least 24 hours before such visit. The agency and

2801

physician shall make every effort to set a mutually agreeable

2802

time for the agency's visit during normal business hours and

2803

within the 24-hour period. If such a time cannot be agreed upon,

2804

the agency may set the time.

2805

Section 25. Subsection (2) of section 430.608, Florida

2806

Statutes, is amended to read:

2807

430.608 Confidentiality of information.--

2808

(2) This section does not, however, limit the subpoena

2809

authority of the Medicaid Fraud Control Unit of the Department

2810

of Legal Affairs pursuant to s. 409.920(9)~~(8)~~(b).

2811

Section 26. Section 636.0145, Florida Statutes, is amended

2812

to read:

2813

636.0145 Certain entities contracting with

2814

Medicaid.--Notwithstanding the requirements of s.

2815

Notwithstanding the requirements of s. 409.912(4)~~(3)~~(b), an

2816

entity that is providing comprehensive inpatient and outpatient

2817

mental health care services to certain Medicaid recipients in

2818

Hillsborough, Highlands, Hardee, Manatee, and Polk Counties

2819

through a capitated, prepaid arrangement pursuant to the federal

2820

waiver provided for in s. 409.905(5) must become licensed under

2821

chapter 636 by December 31, 1998. Any entity licensed under this

2822

chapter which provides services solely to Medicaid recipients

2823

under a contract with Medicaid shall be exempt from ss. 636.017,

2824

636.018, 636.022, 636.028, and 636.034.

2825

Section 27. Subsection (3) of section 641.225, Florida

2826

Statutes, is amended to read:

2827

641.225 Surplus requirements.--

2828

(3)(a) An entity providing prepaid capitated services

2829

which is authorized under s. 409.912(4)~~(3)~~(a) and which applies

2830

for a certificate of authority is subject to the minimum surplus

2831

requirements set forth in subsection (1), unless the entity is

2832

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

2833

located.

2834

(b) An entity providing prepaid capitated services which

2835

is authorized under s. 409.912(4)~~(3)~~(b) or (c), and which

2836

applies for a certificate of authority is subject to the minimum

2837

surplus requirements set forth in s. 409.912.

2838

Section 28. Subsection (4) of section 641.386, Florida

2839

Statutes, is amended to read:

2840

641.386 Agent licensing and appointment required;

2841

exceptions.--

2842

(4) All agents and health maintenance organizations shall

2843

comply with and be subject to the applicable provisions of ss.

2844

641.309 and 409.912(21)~~(19)~~, and all companies and entities

2845

appointing agents shall comply with s. 626.451, when marketing

2846

for any health maintenance organization licensed pursuant to

2847

this part, including those organizations under contract with the

2848

Agency for Health Care Administration to provide health care

2849

services to Medicaid recipients or any private entity providing

2850

health care services to Medicaid recipients pursuant to a

2851

prepaid health plan contract with the Agency for Health Care

2852

Administration.

2853

Section 29. For the purpose of incorporating the amendment

2854

to section 409.920, Florida Statutes, in a reference thereto,

2855

paragraph (g) of subsection (3) of section 921.0022, Florida

2856

Statutes, is reenacted to read:

2857

921.0022 Criminal Punishment Code; offense severity

2858

ranking chart.--

2859

(3) OFFENSE SEVERITY RANKING CHART

FloridaStatute

FelonyDegree

Description

2860

(g) LEVEL 7

2861

316.027(1)(b)

2nd

Accident involving death, failure to stop; leaving scene.

2862

316.193(3)(c)2.

3rd

DUI resulting in serious bodily injury.

2863

327.35(3)(c)2.

3rd

Vessel BUI resulting in serious bodily injury.

2864

402.319(2)

2nd

Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.

2865

409.920(2)

3rd

Medicaid provider fraud.

2866

456.065(2)

3rd

Practicing a health care profession without a license.

2867

456.065(2)

2nd

Practicing a health care profession without a license which results in serious bodily injury.

2868

458.327(1)

3rd

Practicing medicine without a license.

2869

459.013(1)

3rd

Practicing osteopathic medicine without a license.

2870

460.411(1)

3rd

Practicing chiropractic medicine without a license.

2871

461.012(1)

3rd

Practicing podiatric medicine without a license.

2872

462.17

3rd

Practicing naturopathy without a license.

2873

463.015(1)

3rd

Practicing optometry without a license.

2874

464.016(1)

3rd

Practicing nursing without a license.

2875

465.015(2)

3rd

Practicing pharmacy without a license.

2876

466.026(1)

3rd

Practicing dentistry or dental hygiene without a license.

2877

467.201

3rd

Practicing midwifery without a license.

2878

468.366

3rd

Delivering respiratory care services without a license.

2879

483.828(1)

3rd

Practicing as clinical laboratory personnel without a license.

2880

483.901(9)

3rd

Practicing medical physics without a license.

2881

484.013(1)(c)

3rd

Preparing or dispensing optical devices without a prescription.

2882

484.053

3rd

Dispensing hearing aids without a license.

2883

494.0018(2)

1st

Conviction of any violation of ss. 494.001-494.0077 in which the total money and property unlawfully obtained exceeded $50,000 and there were five or more victims.

2884

560.123(8)(b)1.

3rd

Failure to report currency or payment instruments exceeding $300 but less than $20,000 by money transmitter.

2885

560.125(5)(a)

3rd

Money transmitter business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.

2886

655.50(10)(b)1.

3rd

Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.

2887

782.051(3)

2nd

Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.

2888

782.07(1)

2nd

Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).

2889

782.071

2nd

Killing of human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).

2890

782.072

2nd

Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).

2891

784.045(1)(a)1.

2nd

Aggravated battery; intentionally causing great bodily harm or disfigurement.

2892

784.045(1)(a)2.

2nd

Aggravated battery; using deadly weapon.

2893

784.045(1)(b)

2nd

Aggravated battery; perpetrator aware victim pregnant.

2894

784.048(4)

3rd

Aggravated stalking; violation of injunction or court order.

2895

784.07(2)(d)

1st

Aggravated battery on law enforcement officer.

2896

784.074(1)(a)

1st

Aggravated battery on sexually violent predators facility staff.

2897

784.08(2)(a)

1st

Aggravated battery on a person 65 years of age or older.

2898

784.081(1)

1st

Aggravated battery on specified official or employee.

2899

784.082(1)

1st

Aggravated battery by detained person on visitor or other detainee.

2900

784.083(1)

1st

Aggravated battery on code inspector.

2901

790.07(4)

1st

Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).

2902

790.16(1)

1st

Discharge of a machine gun under specified circumstances.

2903

790.165(2)

2nd

Manufacture, sell, possess, or deliver hoax bomb.

2904

790.165(3)

2nd

Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.

2905

790.166(3)

2nd

Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.

2906

790.166(4)

2nd

Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.

2907

796.03

2nd

Procuring any person under 16 years for prostitution.

2908

800.04(5)(c)1.

2nd

Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.

2909

800.04(5)(c)2.

2nd

Lewd or lascivious molestation; victim 12 years of age or older but less than 16 years; offender 18 years or older.

2910

806.01(2)

2nd

Maliciously damage structure by fire or explosive.

2911

810.02(3)(a)

2nd

Burglary of occupied dwelling; unarmed; no assault or battery.

2912

810.02(3)(b)

2nd

Burglary of unoccupied dwelling; unarmed; no assault or battery.

2913

810.02(3)(d)

2nd

Burglary of occupied conveyance; unarmed; no assault or battery.

2914

812.014(2)(a)

1st

Property stolen, valued at $100,000 or more; cargo stolen valued at $50,000 or more; property stolen while causing other property damage; 1st degree grand theft.

2915

812.014(2)(b)3.

2nd

Property stolen, emergency medical equipment; 2nd degree grand theft.

2916

812.0145(2)(a)

1st

Theft from person 65 years of age or older; $50,000 or more.

2917

812.019(2)

1st

Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.

2918

812.131(2)(a)

2nd

Robbery by sudden snatching.

2919

812.133(2)(b)

1st

Carjacking; no firearm, deadly weapon, or other weapon.

2920

817.234(8)(a)

2nd

Solicitation of motor vehicle accident victims with intent to defraud.

2921

817.234(9)

2nd

Organizing, planning, or participating in an intentional motor vehicle collision.

2922

817.234(11)(c)

1st

Insurance fraud; property value $100,000 or more.

2923

817.2341(2)(b)& (3)(b)

1st

Making false entries of material fact or false statements regarding property values relating to the solvency of an insuring entity which are a significant cause of the insolvency of that entity.

2924

825.102(3)(b)

2nd

Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.

2925

825.103(2)(b)

2nd

Exploiting an elderly person or disabled adult and property is valued at $20,000 or more, but less than $100,000.

2926

827.03(3)(b)

2nd

Neglect of a child causing great bodily harm, disability, or disfigurement.

2927

827.04(3)

3rd

Impregnation of a child under 16 years of age by person 21 years of age or older.

2928

837.05(2)

3rd

Giving false information about alleged capital felony to a law enforcement officer.

2929

838.015

2nd

Bribery.

2930

838.016

2nd

Unlawful compensation or reward for official behavior.

2931

838.021(3)(a)

2nd

Unlawful harm to a public servant.

2932

838.22

2nd

Bid tampering.

2933

872.06

2nd

Abuse of a dead human body.

2934

893.13(1)(c)1.

1st

Sell, manufacture, or deliver cocaine (or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4.) within 1,000 feet of a child care facility, school, or state, county, or municipal park or publicly owned recreational facility or community center.

2935

893.13(1)(e)1.

1st

Sell, manufacture, or deliver cocaine or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4., within 1,000 feet of property used for religious services or a specified business site.

2936

893.13(4)(a)

1st

Deliver to minor cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs).

2937

893.135(1)(a)1.

1st

Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.

2938

893.135(1)(b)1.a.

1st

Trafficking in cocaine, more than 28 grams, less than 200 grams.

2939

893.135(1)(c)1.a.

1st

Trafficking in illegal drugs, more than 4 grams, less than 14 grams.

2940

893.135(1)(d)1.

1st

Trafficking in phencyclidine, more than 28 grams, less than 200 grams.

2941

893.135(1)(e)1.

1st

Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.

2942

893.135(1)(f)1.

1st

Trafficking in amphetamine, more than 14 grams, less than 28 grams.

2943

893.135(1)(g)1.a.

1st

Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.

2944

893.135(1)(h)1.a.

1st

Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.

2945

893.135(1)(j)1.a.

1st

Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.

2946

893.135(1)(k)2.a.

1st

Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.

2947

896.101(5)(a)

3rd

Money laundering, financial transactions exceeding $300 but less than $20,000.

2948

896.104(4)(a)1.

3rd

Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.

2949

2950

Section 30. For the purpose of incorporating the amendment

2951

to section 932.701, Florida Statutes, in a reference thereto,

2952

subsection (6) of section 705.101, Florida Statutes, is

2953

reenacted to read:

2954

705.101 Definitions.--As used in this chapter:

2955

(6) "Unclaimed evidence" means any tangible personal

2956

property, including cash, not included within the definition of

2957

"contraband article," as provided in s. 932.701(2), which was

2958

seized by a law enforcement agency, was intended for use in a

2959

criminal or quasi-criminal proceeding, and is retained by the

2960

law enforcement agency or the clerk of the county or circuit

2961

court for 60 days after the final disposition of the proceeding

2962

and to which no claim of ownership has been made.

2963

Section 31. For the purpose of incorporating the amendment

2964

to section 932.701, Florida Statutes, in references thereto,

2965

subsection (4) of section 932.703, Florida Statutes, is

2966

reenacted to read:

2967

932.703 Forfeiture of contraband article; exceptions.--

2968

(4) In any incident in which possession of any contraband

2969

article defined in s. 932.701(2)(a) constitutes a felony, the

2970

vessel, motor vehicle, aircraft, other personal property, or

2971

real property in or on which such contraband article is located

2972

at the time of seizure shall be contraband subject to

2973

forfeiture. It shall be presumed in the manner provided in s.

2974

90.302(2) that the vessel, motor vehicle, aircraft, other

2975

personal property, or real property in which or on which such

2976

contraband article is located at the time of seizure is being

2977

used or was attempted or intended to be used in a manner to

2978

facilitate the transportation, carriage, conveyance,

2979

concealment, receipt, possession, purchase, sale, barter,

2980

exchange, or giving away of a contraband article defined in s.

2981

932.701(2).

2982

Section 32. The Agency for Health Care Administration

2983

shall report to the President of the Senate and the Speaker of

2984

the House of Representatives, by January 1, 2005, on the

2985

feasibility of creating a database of valid prescriber

2986

information for the purpose of notifying pharmacies of

2987

prescribers qualified to write prescriptions for Medicaid

2988

beneficiaries, or in the alternative, of prescribers not

2989

qualified to write prescriptions for Medicaid beneficiaries. The

2990

report shall include information on the system changes necessary

2991

to implement this paragraph, as well as the cost of implementing

2992

the changes.

2993

Section 33. The sum of $262,087 is appropriated from the

2994

Medical Quality Assurance Trust Fund to the Department of

2995

Health, and four full-time-equivalent positions are authorized,

2996

for the purpose of implementing the provisions of this act

2997

during the 2004-2005 fiscal year.

2998

Section 34. This act shall take effect upon becoming a

2999

law.

CODING: Words ~~stricken~~ are deletions; words underlined are additions.