HB 1811

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

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

willful misrepresentation, or abuse under the Medicaid

program; prohibiting the accounting practice of

extrapolation for calculating penalties for Medicaid

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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

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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

132

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

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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

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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

292

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

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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

317

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

318

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

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the clinical systems and operational competence to manage risk

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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

367

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

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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

389

and that these services assist the community-based care lead

390

agencies in meeting the goals and outcomes of the child welfare

391

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

395

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

398

rate in any area is insufficient to provide appropriate

399

services, the agency may adjust the capitation rate to ensure

400

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

401

use existing general revenue to address any additional required

402

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

403

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

406

federal authorization, shall develop policies and procedures

407

that allow for certification of local and state funds.

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5. Children residing in a statewide inpatient psychiatric

409

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

410

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

413

pursuant to this paragraph.

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

415

agency shall in its procurement document require an entity

416

providing comprehensive behavioral health care services to

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prevent the displacement of indigent care patients by enrollees

418

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

422

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

430

pursuant to chapter 395 must be offered an opportunity to accept

431

or decline a contract to participate in any provider network for

432

prepaid behavioral health services.

433

434

by one or more federally qualified health centers or an entity

435

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

438

recipients. Such prepaid health care services entity must be

439

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

440

prohibited from serving Medicaid recipients on a prepaid basis,

441

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

442

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

443

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

444

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

445

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

447

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

448

financial reserve, quality assurance, and patient rights

449

requirements as established by the agency. The agency shall

450

award contracts on a competitive bid basis and shall select

451

bidders based upon price and quality of care. Medicaid

452

recipients assigned to a demonstration project shall be chosen

453

equally from those who would otherwise have been assigned to

454

prepaid plans and MediPass. The agency is authorized to seek

455

federal Medicaid waivers as necessary to implement the

456

provisions of this section.

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(e) An entity that provides comprehensive behavioral

458

health care services to certain Medicaid recipients through an

459

administrative services organization agreement. Such an entity

460

must possess the clinical systems and operational competence to

461

provide comprehensive health care to Medicaid recipients. As

462

used in this paragraph, the term "comprehensive behavioral

463

health care services" means covered mental health and substance

464

abuse treatment services that are available to Medicaid

465

recipients. Any contract awarded under this paragraph must be

466

competitively procured. The agency must ensure that Medicaid

467

recipients have available the choice of at least two managed

468

care plans for their behavioral health care services.

469

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

470

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

471

to Medicaid recipients with degenerative neurological diseases

472

and other diseases or disabling conditions associated with high

473

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

474

disabled persons and to reduce Medicaid reimbursed costs for

475

inpatient, outpatient, and emergency department services. The

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

477

(g) Children's provider networks that provide care

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coordination and care management for Medicaid-eligible pediatric

479

patients, primary care, authorization of specialty care, and

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other urgent and emergency care through organized providers

481

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

484

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

485

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

488

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

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to elderly recipients. Such prepaid health care services

490

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

491

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

492

this paragraph that demonstrates to the satisfaction of the

493

Office of Insurance Regulation that it is backed by the full

494

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

495

may be exempted from s. 641.225.

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

497

s. 391.021.

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

499

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

500

new Medicaid procedure codes for emergency and crisis care,

501

supportive residential services, and other services designed to

502

maximize the use of Medicaid funds for Medicaid-eligible

503

recipients. The agency shall include in the agreement developed

504

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

505

match requirements for these new procedure codes are met by

506

certifying eligible general revenue or local funds that are

507

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

510

projection of the number of procedures to be delivered during

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

512

the certified match procedures, and accountability mechanisms,

513

projects the earnings associated with these procedures, and

514

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

515

implemented in any part until approved by the Legislative Budget

516

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

518

Legislature.

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

520

entity otherwise authorized by this section on a prepaid or

521

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

522

recipients. An entity may provide prepaid services to

523

recipients, either directly or through arrangements with other

524

entities, if each entity involved in providing services:

525

(a) Is organized primarily for the purpose of providing

526

health care or other services of the type regularly offered to

527

Medicaid recipients.;

528

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

529

agency for quality, appropriateness, and timeliness.;

530

531

insolvency protection and ensures that neither enrolled Medicaid

532

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

533

entity.;

534

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

535

financial plan that the agency finds to be fiscally sound and

536

that provides for working capital in the form of cash or

537

equivalent liquid assets excluding revenues from Medicaid

538

premium payments equal to at least the first 3 months of

539

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

540

(e) Furnishes evidence satisfactory to the agency of

541

adequate liability insurance coverage or an adequate plan of

542

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

543

the furnishing of health care.;

544

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

545

review of its medical facilities and services, as required by

546

the agency.~~; and~~

547

(g) Provides organizational, operational, financial, and

548

other information required by the agency.

549

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

550

basis with any health insurer that:

551

(a) Pays for health care services provided to enrolled

552

Medicaid recipients in exchange for a premium payment paid by

553

the agency.;

554

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

555

556

of the Florida Insurance Code and is currently in good standing

557

with the Office of Insurance Regulation.

558

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

559

basis with an exclusive provider organization to provide health

560

care services to Medicaid recipients provided that the exclusive

561

provider organization meets applicable managed care plan

562

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

563

and 627.6472, and other applicable provisions of law.

564

(9) The Agency for Health Care Administration may provide

565

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

566

service basis to Medicaid recipients through arrangements with a

567

statewide chiropractic preferred provider organization

568

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

569

agency shall ensure that the benefit limits and prior

570

authorization requirements in the current Medicaid program shall

571

apply to the services provided by the chiropractic preferred

572

provider organization.

573

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

574

sum basis for Medicaid services with an entity which knows or

575

reasonably should know that any officer, director, agent,

576

managing employee, or owner of stock or beneficial interest in

577

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

578

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

579

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

580

(a) Fraud;

581

(b) Violation of federal or state antitrust statutes,

582

including those proscribing price fixing between competitors and

583

the allocation of customers among competitors;

584

585

forgery, income tax evasion, bribery, falsification or

586

destruction of records, making false statements, receiving

587

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

588

589

(d) Any crime in any jurisdiction which directly relates

590

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

591

basis.

592

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

593

apply for waivers of applicable federal laws and regulations as

594

necessary to implement more appropriate systems of health care

595

for Medicaid recipients and reduce the cost of the Medicaid

596

program to the state and federal governments and shall implement

597

such programs, after legislative approval, within a reasonable

598

period of time after federal approval. These programs must be

599

designed primarily to reduce the need for inpatient care,

600

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

601

other high-cost services.

602

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

603

as authorized by this subsection, the agency shall provide

604

notice and an opportunity for public comment. Notice shall be

605

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

606

advance notice and shall be published in the Florida

607

Administrative Weekly not less than 28 days prior to the

608

intended action.

609

(b) Notwithstanding s. 216.292, funds that are

610

appropriated to the Department of Elderly Affairs for the

611

Assisted Living for the Elderly Medicaid waiver and are not

612

expended shall be transferred to the agency to fund Medicaid-

613

reimbursed nursing home care.

614

(12) The agency shall establish a postpayment utilization

615

control program designed to identify recipients who may

616

inappropriately overuse or underuse Medicaid services and shall

617

provide methods to correct such misuse.

618

(13) The agency shall develop and provide coordinated

619

systems of care for Medicaid recipients and may contract with

620

public or private entities to develop and administer such

621

systems of care among public and private health care providers

622

in a given geographic area.

623

(14) The agency shall operate or contract for the

624

operation of utilization management and incentive systems

625

designed to encourage cost-effective use services.

626

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

627

Assessment and Review (CARES) nursing facility preadmission

628

screening program to ensure that Medicaid payment for nursing

629

facility care is made only for individuals whose conditions

630

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

631

provided in the setting most appropriate to the needs of the

632

person and in the most economical manner possible. The CARES

633

program shall also ensure that individuals participating in

634

Medicaid home and community-based waiver programs meet criteria

635

for those programs, consistent with approved federal waivers.

636

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

637

interagency agreement with the Department of Elderly Affairs.

638

639

for a Medicaid recipient, the agency must verify that the

640

nursing facility preadmission screening program has determined

641

that the individual requires nursing facility care and that the

642

individual cannot be safely served in community-based programs.

643

The nursing facility preadmission screening program shall refer

644

a Medicaid recipient to a community-based program if the

645

individual could be safely served at a lower cost and the

646

recipient chooses to participate in such program.

647

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

648

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

649

Policy describing the operations of the CARES program. The

650

report must describe:

651

1. Rate of diversion to community alternative programs.;

652

2. CARES program staffing needs to achieve additional

653

diversions.;

654

3. Reasons the program is unable to place individuals in

655

less restrictive settings when such individuals desired such

656

services and could have been served in such settings.;

657

4. Barriers to appropriate placement, including barriers

658

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

659

programs.~~; and~~

660

5. Statutory changes necessary to ensure that individuals

661

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

662

restrictive environment.

663

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

664

and price patterns within the Medicaid program which are not

665

cost-effective or medically appropriate and assess the

666

effectiveness of new or alternate methods of providing and

667

monitoring service, and may implement such methods as it

668

considers appropriate. Such methods may include disease

669

management initiatives, an integrated and systematic approach

670

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

671

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

672

prevention strategies, clinical-practice improvement, clinical

673

interventions and protocols, outcomes research, information

674

technology, and other tools and resources to reduce overall

675

costs and improve measurable outcomes.

676

(b) The responsibility of the agency under this subsection

677

shall include the development of capabilities to identify actual

678

and optimal practice patterns; patient and provider educational

679

initiatives; methods for determining patient compliance with

680

prescribed treatments; fraud, waste, and abuse prevention and

681

detection programs; and beneficiary case management programs.

682

1. The practice pattern identification program shall

683

evaluate practitioner prescribing patterns based on national and

684

regional practice guidelines, comparing practitioners to their

685

peer groups. The agency and its Drug Utilization Review Board

686

shall consult with the Department of Health and a panel of

687

practicing health care professionals consisting of the

688

following: the Speaker of the House of Representatives and the

689

President of the Senate shall each appoint three physicians

690

licensed under chapter 458 or chapter 459; and the Governor

691

shall appoint two pharmacists licensed under chapter 465 and one

692

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

693

of the panel members shall expire at the discretion of the

694

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

695

1999, regardless of the number of appointments made by that

696

date. The advisory panel shall be responsible for evaluating

697

treatment guidelines and recommending ways to incorporate their

698

use in the practice pattern identification program.

699

Practitioners who are prescribing inappropriately or

700

inefficiently, as determined by the agency, may have their

701

prescribing of certain drugs subject to prior authorization or

702

may be terminated from all participation in the Medicaid

703

program.

704

2. The agency shall also develop educational interventions

705

designed to promote the proper use of medications by providers

706

and beneficiaries.

707

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

708

abuse initiative that may include a surety bond or letter of

709

credit requirement for participating pharmacies, enhanced

710

provider auditing practices, the use of additional fraud and

711

abuse software, recipient management programs for beneficiaries

712

inappropriately using their benefits, and other steps that will

713

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

714

initiative shall address enforcement efforts to reduce the

715

number and use of counterfeit prescriptions.

716

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

717

an entity in the state to implement a wireless handheld clinical

718

pharmacology drug information database for practitioners. The

719

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

720

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

721

program and to otherwise further the intent of this paragraph.

722

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

723

implement this paragraph.

724

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

725

shall, in addition to meeting any applicable statutory surplus

726

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

727

investments that mature in less than 180 days allowable as

728

admitted assets by the Office of Insurance Regulation, and

729

restricted funds or deposits controlled by the agency or the

730

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

731

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

732

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

733

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

734

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

735

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

736

shall prohibit the entity from engaging in marketing and

737

preenrollment activities, shall cease to process new

738

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

739

required balance is achieved. The requirements of this

740

subsection do not apply:

741

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

742

incurred by the contracting entity; or

743

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

744

guaranteed in writing by a guaranteeing organization which:

745

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

746

assets in excess of $50 million; or

747

2. Submits a written guarantee acceptable to the agency

748

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

749

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

750

until the agency receives proof of satisfaction of all

751

outstanding obligations incurred under the contract.

752

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

753

prepaid or fixed-sum basis to establish a restricted insolvency

754

protection account with a federally guaranteed financial

755

institution licensed to do business in this state. The entity

756

shall deposit into that account 5 percent of the capitation

757

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

758

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

759

restricted insolvency protection account may be drawn upon with

760

the authorized signatures of two persons designated by the

761

entity and two representatives of the agency. If the agency

762

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

763

account solely with the two authorized signatures of

764

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

765

meet financial obligations incurred by the entity under the

766

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

767

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

768

the entity upon receipt of proof of satisfaction of all

769

outstanding obligations incurred under this contract.

770

(b) The agency may waive the insolvency protection account

771

requirement in writing when evidence is on file with the agency

772

of adequate insolvency insurance and reinsurance that will

773

protect enrollees if the entity becomes unable to meet its

774

obligations.

775

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

776

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

777

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

778

authorized geographic service area as specified in its contract

779

with the agency, and that provides services authorized by the

780

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

781

physician for the provision of services or according to the

782

lesser of the following:

783

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

784

public by the hospital or physician; or

785

(b) The Florida Medicaid reimbursement rate established

786

for the hospital or physician.

787

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

788

contractor has been approved by the Office of Insurance

789

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

790

assignment or transfer of the appropriate Medicaid prepaid

791

contract upon request of the surviving entity of the merger or

792

acquisition if the contractor and the other entity have been in

793

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

794

period, unless the agency determines that the assignment or

795

transfer would be detrimental to the Medicaid recipients or the

796

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

797

have failed accreditation or committed any material violation of

798

the requirements of s. 641.52 and must meet the Medicaid

799

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

800

acquisition means a change in controlling interest of an entity,

801

including an asset or stock purchase.

802

(21) Any entity contracting with the agency pursuant to

803

this section to provide health care services to Medicaid

804

recipients is prohibited from engaging in any of the following

805

practices or activities:

806

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

807

limited to, attempts to discourage participation on the basis of

808

actual or perceived health status.

809

(b) Activities that could mislead or confuse recipients,

810

or misrepresent the organization, its marketing representatives,

811

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

812

limited to:

813

1. False or misleading claims that marketing

814

representatives are employees or representatives of the state or

815

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

816

by whom they are reimbursed.

817

2. False or misleading claims that the entity is

818

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

819

other organization which has not certified its endorsement in

820

writing to the entity.

821

3. False or misleading claims that the state or county

822

recommends that a Medicaid recipient enroll with an entity.

823

4. Claims that a Medicaid recipient will lose benefits

824

under the Medicaid program, or any other health or welfare

825

benefits to which the recipient is legally entitled, if the

826

recipient does not enroll with the entity.

827

828

consideration for enrollment, except as authorized by subsection

829

(24)~~(22)~~.

830

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

831

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

832

a presentation.

833

(e) Solicitation of Medicaid recipients by marketing

834

representatives stationed in state offices unless approved and

835

supervised by the agency or its agent and approved by the

836

affected state agency when solicitation occurs in an office of

837

the state agency. The agency shall ensure that marketing

838

representatives stationed in state offices shall market their

839

managed care plans to Medicaid recipients only in designated

840

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

841

activities in the state office.

842

(f) Enrollment of Medicaid recipients.

843

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

844

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

845

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

846

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

847

violation. In no event shall such fine exceed an aggregate

848

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

849

the same action. With respect to any knowing and willful

850

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

851

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

852

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

853

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

854

willful violations arising out of the same action.

855

(23) A health maintenance organization or a person or

856

entity exempt from chapter 641 that is under contract with the

857

agency for the provision of health care services to Medicaid

858

recipients may not use or distribute marketing materials used to

859

solicit Medicaid recipients, unless such materials have been

860

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

861

apply to general advertising and marketing materials used by a

862

health maintenance organization to solicit both non-Medicaid

863

subscribers and Medicaid recipients.

864

(24) Upon approval by the agency, health maintenance

865

organizations and persons or entities exempt from chapter 641

866

that are under contract with the agency for the provision of

867

health care services to Medicaid recipients may be permitted

868

within the capitation rate to provide additional health benefits

869

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

870

available, provide reasonable value to the recipient, and are

871

provided at no additional cost to the state.

872

(25) The agency shall utilize the statewide health

873

maintenance organization complaint hotline for the purpose of

874

investigating and resolving Medicaid and prepaid health plan

875

complaints, maintaining a record of complaints and confirmed

876

problems, and receiving disenrollment requests made by

877

recipients.

878

(26) The agency shall require the publication of the

879

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

880

consumer services telephone numbers and the "800" telephone

881

number of the statewide health maintenance organization

882

complaint hotline on each Medicaid identification card issued by

883

a health maintenance organization or prepaid health plan

884

contracting with the agency to serve Medicaid recipients and on

885

each subscriber handbook issued to a Medicaid recipient.

886

(27) The agency shall establish a health care quality

887

improvement system for those entities contracting with the

888

agency pursuant to this section, incorporating all the standards

889

and guidelines developed by the Medicaid Bureau of the Health

890

Care Financing Administration as a part of the quality assurance

891

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

892

limited to, the following:

893

(a) Guidelines for internal quality assurance programs,

894

including standards for:

895

1. Written quality assurance program descriptions.

896

2. Responsibilities of the governing body for monitoring,

897

evaluating, and making improvements to care.

898

3. An active quality assurance committee.

899

4. Quality assurance program supervision.

900

5. Requiring the program to have adequate resources to

901

effectively carry out its specified activities.

902

6. Provider participation in the quality assurance

903

program.

904

7. Delegation of quality assurance program activities.

905

8. Credentialing and recredentialing.

906

9. Enrollee rights and responsibilities.

907

10. Availability and accessibility to services and care.

908

11. Ambulatory care facilities.

909

12. Accessibility and availability of medical records, as

910

well as proper recordkeeping and process for record review.

911

13. Utilization review.

912

14. A continuity of care system.

913

15. Quality assurance program documentation.

914

16. Coordination of quality assurance activity with other

915

management activity.

916

17. Delivering care to pregnant women and infants; to

917

elderly and disabled recipients, especially those who are at

918

risk of institutional placement; to persons with developmental

919

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

920

conditions.

921

(b) Guidelines which require the entities to conduct

922

quality-of-care studies which:

923

1. Target specific conditions and specific health service

924

delivery issues for focused monitoring and evaluation.

925

2. Use clinical care standards or practice guidelines to

926

objectively evaluate the care the entity delivers or fails to

927

deliver for the targeted clinical conditions and health services

928

delivery issues.

929

3. Use quality indicators derived from the clinical care

930

standards or practice guidelines to screen and monitor care and

931

services delivered.

932

933

contractor which require: focused studies of patterns of care;

934

individual care review in specific situations; and followup

935

activities on previous pattern-of-care study findings and

936

individual-care-review findings. In designing the external

937

quality review function and determining how it is to operate as

938

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

939

agency shall construct its external quality review organization

940

and entity contracts to address each of the following:

941

1. Delineating the role of the external quality review

942

organization.

943

2. Length of the external quality review organization

944

contract with the state.

945

3. Participation of the contracting entities in designing

946

external quality review organization review activities.

947

4. Potential variation in the type of clinical conditions

948

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

949

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

950

studies to be conducted for each plan.

951

6. Methods for implementing focused studies.

952

7. Individual care review.

953

8. Followup activities.

954

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

955

services for which an entity has already been compensated, an

956

entity contracting with the agency pursuant to this section

957

shall achieve an annual Early and Periodic Screening, Diagnosis,

958

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

959

percent for those recipients continuously enrolled for at least

960

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

961

screening rate shall be calculated. For any entity which does

962

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

963

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

964

does not meet the standard established in the corrective action

965

plan during the specified timeframe, the agency is authorized to

966

impose appropriate contract sanctions. At least annually, the

967

agency shall publicly release the EPSDT Services screening rates

968

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

969

serve Medicaid recipients.

970

(29) The agency shall perform enrollments and

971

disenrollments for Medicaid recipients who are eligible for

972

MediPass or managed care plans. Notwithstanding the prohibition

973

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

974

perform preenrollments of Medicaid recipients under the

975

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

976

this section, "preenrollment" means the provision of marketing

977

and educational materials to a Medicaid recipient and assistance

978

in completing the application forms, but shall not include

979

actual enrollment into a managed care plan. An application for

980

enrollment shall not be deemed complete until the agency or its

981

agent verifies that the recipient made an informed, voluntary

982

choice. The agency, in cooperation with the Department of

983

Children and Family Services, may test new marketing initiatives

984

to inform Medicaid recipients about their managed care options

985

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

986

the effectiveness of such initiatives. The agency may contract

987

with a third party to perform managed care plan and MediPass

988

enrollment and disenrollment services for Medicaid recipients

989

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

990

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

991

a third-party enrollment and disenrollment contract, and for

992

agency supervision and management of the managed care plan

993

enrollment and disenrollment contract.

994

(30) Any lists of providers made available to Medicaid

995

recipients, MediPass enrollees, or managed care plan enrollees

996

shall be arranged alphabetically showing the provider's name and

997

specialty and, separately, by specialty in alphabetical order.

998

(31) The agency shall establish an enhanced managed care

999

quality assurance oversight function, to include at least the

1000

following components:

1001

(a) At least quarterly analysis and followup, including

1002

sanctions as appropriate, of managed care participant

1003

utilization of services.

1004

(b) At least quarterly analysis and followup, including

1005

sanctions as appropriate, of quality findings of the Medicaid

1006

peer review organization and other external quality assurance

1007

programs.

1008

1009

sanctions as appropriate, of the fiscal viability of managed

1010

care plans.

1011

(d) At least quarterly analysis and followup, including

1012

sanctions as appropriate, of managed care participant

1013

satisfaction and disenrollment surveys.

1014

(e) The agency shall conduct regular and ongoing Medicaid

1015

recipient satisfaction surveys.

1016

1017

The analyses and followup activities conducted by the agency

1018

under its enhanced managed care quality assurance oversight

1019

function shall not duplicate the activities of accreditation

1020

reviewers for entities regulated under part III of chapter 641,

1021

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

1022

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

1023

the agency to provide health care services to Medicaid

1024

recipients shall annually conduct a background check with the

1025

Florida Department of Law Enforcement of all persons with

1026

ownership interest of 5 percent or more or executive management

1027

responsibility for the managed care plan and shall submit to the

1028

agency information concerning any such person who has been found

1029

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

1030

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

1031

435.03.

1032

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

1033

a Medicaid managed care plan enrollee who wishes to enter

1034

hospice care may be disenrolled from the managed care plan

1035

within 24 hours after contacting the agency regarding such

1036

request. The agency rule shall include a methodology for the

1037

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

1038

if payment has been made for the enrollment month when

1039

disenrollment occurs.

1040

(34) The agency and entities which contract with the

1041

agency to provide health care services to Medicaid recipients

1042

under this section or s. 409.9122 must comply with the

1043

provisions of s. 641.513 in providing emergency services and

1044

care to Medicaid recipients and MediPass recipients.

1045

(35) All entities providing health care services to

1046

Medicaid recipients shall make available, and encourage all

1047

pregnant women and mothers with infants to receive, and provide

1048

documentation in the medical records to reflect, the following:

1049

(a) Healthy Start prenatal or infant screening.

1050

(b) Healthy Start care coordination, when screening or

1051

other factors indicate need.

1052

1053

prenatal or infant screening results.

1054

(d) Immunizations in accordance with recommendations of

1055

the Advisory Committee on Immunization Practices of the United

1056

States Public Health Service and the American Academy of

1057

Pediatrics, as appropriate.

1058

(e) Counseling and services for family planning to all

1059

women and their partners.

1060

(f) A scheduled postpartum visit for the purpose of

1061

voluntary family planning, to include discussion of all methods

1062

of contraception, as appropriate.

1063

(g) Referral to the Special Supplemental Nutrition Program

1064

for Women, Infants, and Children (WIC).

1065

(36) Any entity that provides Medicaid prepaid health plan

1066

services shall ensure the appropriate coordination of health

1067

care services with an assisted living facility in cases where a

1068

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

1069

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

1070

the entity is at risk for Medicaid targeted case management and

1071

behavioral health services, the entity shall inform the assisted

1072

living facility of the procedures to follow should an emergent

1073

condition arise.

1074

(37) The agency may seek and implement federal waivers

1075

necessary to provide for cost-effective purchasing of home

1076

health services, private duty nursing services, transportation,

1077

independent laboratory services, and durable medical equipment

1078

and supplies through competitive bidding pursuant to s. 287.057.

1079

The agency may request appropriate waivers from the federal

1080

Health Care Financing Administration in order to competitively

1081

bid such services. The agency may exclude providers not selected

1082

through the bidding process from the Medicaid provider network.

1083

(38) The Agency for Health Care Administration is directed

1084

to issue a request for proposal or intent to negotiate to

1085

implement on a demonstration basis an outpatient specialty

1086

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

1087

As used in this subsection, the term "outpatient specialty

1088

services" means clinical laboratory, diagnostic imaging, and

1089

specified home medical services to include durable medical

1090

equipment, prosthetics and orthotics, and infusion therapy.

1091

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

1092

Medicaid managed care outpatient specialty services must, at a

1093

minimum, meet the following criteria:

1094

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

1095

Regulation under part II of chapter 641.

1096

2. The entity must be experienced in providing outpatient

1097

specialty services.

1098

3. The entity must demonstrate to the satisfaction of the

1099

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

1100

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

1101

complaints and grievance process to assist Medicaid recipients

1102

enrolled in the pilot managed care program to resolve complaints

1103

and grievances.

1104

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

1105

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

1106

to determine the cost-effectiveness and effects on utilization,

1107

access, and quality of providing outpatient specialty services

1108

to Medicaid recipients on a prepaid, capitated basis.

1109

1110

the prepaid health clinic each year that the demonstration

1111

program is in effect. The prepaid health clinic is responsible

1112

for all expenses incurred by the agency in conducting a quality

1113

assurance review.

1114

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

1115

outpatient specialty services to Medicaid recipients shall

1116

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

1117

agency, for the purpose of conducting the evaluation required in

1118

paragraph (e).

1119

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

1120

managed care program and report its findings to the Governor and

1121

the Legislature by no later than January 1, 2001.

1122

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

1123

profit organizations based in this state for the purpose of

1124

providing vision screening.

1125

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

1126

drug spending-control program that includes the following

1127

components:

1128

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

1129

for adult Medicaid recipients is limited to the dispensing of

1130

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

1131

exempt from this restriction. Antiretroviral agents are excluded

1132

from this limitation. No requirements for prior authorization or

1133

other restrictions on medications used to treat mental illnesses

1134

such as schizophrenia, severe depression, or bipolar disorder

1135

may be imposed on Medicaid recipients. Medications that will be

1136

available without restriction for persons with mental illnesses

1137

include atypical antipsychotic medications, conventional

1138

antipsychotic medications, selective serotonin reuptake

1139

inhibitors, and other medications used for the treatment of

1140

serious mental illnesses. The agency shall also limit the amount

1141

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

1142

The agency shall continue to provide unlimited generic drugs,

1143

contraceptive drugs and items, and diabetic supplies. Although a

1144

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

1145

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

1146

authorize exceptions to the brand-name-drug restriction based

1147

upon the treatment needs of the patients, only when such

1148

exceptions are based on prior consultation provided by the

1149

agency or an agency contractor, but the agency must establish

1150

procedures to ensure that:

1151

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

1152

consultation by telephone or other telecommunication device

1153

within 24 hours after receipt of a request for prior

1154

consultation.;

1155

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

1156

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

1157

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

1158

c. Except for the exception for nursing home residents and

1159

other institutionalized adults and except for drugs on the

1160

restricted formulary for which prior authorization may be sought

1161

by an institutional or community pharmacy, prior authorization

1162

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

1163

the prescriber and not by the pharmacy. When prior authorization

1164

is granted for a patient in an institutional setting beyond the

1165

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

1166

months and monthly prior authorization is not required for that

1167

patient.

1168

2. Reimbursement to pharmacies for Medicaid prescribed

1169

drugs shall be set at the average wholesale price less 13.25

1170

percent.

1171

3. The agency shall develop and implement a process for

1172

managing the drug therapies of Medicaid recipients who are using

1173

significant numbers of prescribed drugs each month. The

1174

management process may include, but is not limited to,

1175

comprehensive, physician-directed medical-record reviews, claims

1176

analyses, and case evaluations to determine the medical

1177

necessity and appropriateness of a patient's treatment plan and

1178

drug therapies. The agency may contract with a private

1179

organization to provide drug-program-management services. The

1180

Medicaid drug benefit management program shall include

1181

initiatives to manage drug therapies for HIV/AIDS patients,

1182

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

1183

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

1184

agency shall enroll any Medicaid patient in the drug benefit

1185

management program if he or she meets the specifications of this

1186

provision and is not enrolled in a Medicaid health maintenance

1187

organization.

1188

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

1189

based on need, competitive bidding, price negotiations,

1190

credentialing, or similar criteria. The agency shall give

1191

special consideration to rural areas in determining the size and

1192

location of pharmacies included in the Medicaid pharmacy

1193

network. A pharmacy credentialing process may include criteria

1194

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

1195

patient educational programs, patient consultation, disease-

1196

management services, and other characteristics. The agency may

1197

impose a moratorium on Medicaid pharmacy enrollment when it is

1198

determined that it has a sufficient number of Medicaid-

1199

participating providers.

1200

5. The agency shall develop and implement a program that

1201

requires Medicaid practitioners who prescribe drugs to use a

1202

counterfeit-proof prescription pad for Medicaid prescriptions.

1203

The agency shall require the use of standardized counterfeit-

1204

proof prescription pads by Medicaid-participating prescribers or

1205

prescribers who write prescriptions for Medicaid recipients. The

1206

agency may implement the program in targeted geographic areas or

1207

statewide.

1208

6. The agency may enter into arrangements that require

1209

manufacturers of generic drugs prescribed to Medicaid recipients

1210

to provide rebates of at least 15.1 percent of the average

1211

manufacturer price for the manufacturer's generic products.

1212

These arrangements shall require that if a generic-drug

1213

manufacturer pays federal rebates for Medicaid-reimbursed drugs

1214

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

1215

supplemental rebate to the state in an amount necessary to

1216

achieve a 15.1-percent rebate level.

1217

7. The agency may establish a preferred drug formulary in

1218

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

1219

establishment of such formulary, it is authorized to negotiate

1220

supplemental rebates from manufacturers that are in addition to

1221

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

1222

less than 10 percent of the average manufacturer price as

1223

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

1224

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

1225

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

1226

the agency may negotiate. The agency may determine that specific

1227

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

1228

percentages. Agreement to pay the minimum supplemental rebate

1229

percentage will guarantee a manufacturer that the Medicaid

1230

Pharmaceutical and Therapeutics Committee will consider a

1231

product for inclusion on the preferred drug formulary. However,

1232

a pharmaceutical manufacturer is not guaranteed placement on the

1233

formulary by simply paying the minimum supplemental rebate.

1234

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

1235

and recommendations of the Medicaid Pharmaceutical and

1236

Therapeutics Committee, as well as the price of competing

1237

products minus federal and state rebates. The agency is

1238

authorized to contract with an outside agency or contractor to

1239

conduct negotiations for supplemental rebates. For the purposes

1240

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

1241

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

1242

that offset a Medicaid expenditure. Such other program benefits

1243

may include, but are not limited to, disease management

1244

programs, drug product donation programs, drug utilization

1245

control programs, prescriber and beneficiary counseling and

1246

education, fraud and abuse initiatives, and other services or

1247

administrative investments with guaranteed savings to the

1248

Medicaid program in the same year the rebate reduction is

1249

included in the General Appropriations Act. The agency is

1250

authorized to seek any federal waivers to implement this

1251

initiative.

1252

8. The agency shall establish an advisory committee for

1253

the purposes of studying the feasibility of using a restricted

1254

drug formulary for nursing home residents and other

1255

institutionalized adults. The committee shall be comprised of

1256

seven members appointed by the Secretary of Health Care

1257

Administration. The committee members shall include two

1258

physicians licensed under chapter 458 or chapter 459; three

1259

pharmacists licensed under chapter 465 and appointed from a list

1260

of recommendations provided by the Florida Long-Term Care

1261

Pharmacy Alliance; and two pharmacists licensed under chapter

1262

465.

1263

9. The Agency for Health Care Administration shall expand

1264

home delivery of pharmacy products. To assist Medicaid patients

1265

in securing their prescriptions and reduce program costs, the

1266

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

1267

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

1268

by Medicaid patients with diabetes. Medicaid recipients in the

1269

current program may obtain nondiabetes drugs on a voluntary

1270

basis. This initiative is limited to the geographic area covered

1271

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

1272

federal waivers necessary to implement this subparagraph.

1273

(b) The agency shall implement this subsection to the

1274

extent that funds are appropriated to administer the Medicaid

1275

prescribed-drug spending-control program. The agency may

1276

contract all or any part of this program to private

1277

organizations.

1278

1279

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

1280

House of Representatives which must include, but need not be

1281

limited to, the progress made in implementing this subsection

1282

and its effect on Medicaid prescribed-drug expenditures.

1283

(41) Notwithstanding the provisions of chapter 287, the

1284

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

1285

fiscal intermediary services one or more times for such periods

1286

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

1287

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

1288

original contract.

1289

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

1290

demonstration project by establishment in Miami-Dade County of a

1291

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

1292

improve access to health care for a predominantly minority,

1293

medically underserved, and medically complex population and to

1294

evaluate alternatives to nursing home care and general acute

1295

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

1296

health care condominium and colocated with licensed facilities

1297

providing a continuum of care. The establishment of this project

1298

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

1299

The agency shall report its findings to the Governor, the

1300

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

1301

Representatives by January 1, 2003.

1302

(43) The agency shall develop and implement a utilization

1303

management program for Medicaid-eligible recipients for the

1304

management of occupational, physical, respiratory, and speech

1305

therapies. The agency shall establish a utilization program that

1306

may require prior authorization in order to ensure medically

1307

necessary and cost-effective treatments. The program shall be

1308

operated in accordance with a federally approved waiver program

1309

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

1310

state plan amendment to implement this program. The agency may

1311

also competitively procure these services from an outside vendor

1312

on a regional or statewide basis.

1313

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

1314

basis with appropriately licensed prepaid dental health plans to

1315

provide dental services.

1316

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

1317

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

1318

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

1319

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

1320

not medically necessary, limiting the receipt of goods or

1321

services to medically necessary providers after the 21-day

1322

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

1323

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

1324

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

1325

limitation does not apply to emergency services and care

1326

provided to the recipient in a hospital emergency department.

1327

The agency shall seek any federal waivers necessary to implement

1328

this subsection. The agency shall adopt any rules necessary to

1329

comply with or administer this subsection.

1330

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

1331

to terminate the eligibility of a Medicaid recipient who is

1332

found to have committed fraud, through judicial or

1333

administrative determination, two times in a period of five

1334

years.

1335

(47) The agency shall conduct a study of available

1336

electronic systems for purposes of verifying identity and

1337

eligibility of a Medicaid recipient. The agency shall recommend

1338

to the Legislature a plan to implement an electronic

1339

verification system for Medicaid recipients by January 31, 2005.

1340

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

1341

Medicaid provider network. The agency may implement a Medicaid

1342

fee for service provider network controls, including, but not

1343

limited to, competitive procurement and provider credentialing.

1344

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

1345

provider network based upon the following considerations:

1346

beneficiary access to care, provider availability, provider

1347

quality standards and quality assurance processes, cultural

1348

competency, demographic characteristics of beneficiaries,

1349

practice standards, service wait times, provider turnover,

1350

provider licensure and accreditation history, program integrity

1351

history, peer review, Medicaid policy and billing compliance

1352

record, clinical and medical record audit findings, and such

1353

other areas as deemed necessary by the agency to ensure the

1354

integrity of the program.

1355

Section 6. Section 409.913, Florida Statutes, is amended

1356

to read:

1357

409.913 Oversight of the integrity of the Medicaid

1358

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

1359

activities of Florida Medicaid recipients, and providers and

1360

their representatives, to ensure that fraudulent and abusive

1361

behavior and neglect of recipients occur to the minimum extent

1362

possible, and to recover overpayments and impose sanctions as

1363

appropriate. Beginning January 1, 2003, and each year

1364

thereafter, the agency and the Medicaid Fraud Control Unit of

1365

the Department of Legal Affairs shall submit a joint report to

1366

the Legislature documenting the effectiveness of the state's

1367

efforts to control Medicaid fraud and abuse and to recover

1368

Medicaid overpayments during the previous fiscal year. The

1369

report must describe the number of cases opened and investigated

1370

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

1371

the cases closed each year; the amount of overpayments alleged

1372

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

1373

fines or penalties imposed; any reductions in overpayment

1374

amounts negotiated in settlement agreements or by other means;

1375

the amount of final agency determinations of overpayments; the

1376

amount deducted from federal claiming as a result of

1377

overpayments; the amount of overpayments recovered each year;

1378

the amount of cost of investigation recovered each year; the

1379

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

1380

opened until the overpayment is paid in full; the amount

1381

determined as uncollectible and the portion of the uncollectible

1382

amount subsequently reclaimed from the Federal Government; the

1383

number of providers, by type, that are terminated from

1384

participation in the Medicaid program as a result of fraud and

1385

abuse; and all costs associated with discovering and prosecuting

1386

cases of Medicaid overpayments and making recoveries in such

1387

cases. The report must also document actions taken to prevent

1388

overpayments and the number of providers prevented from

1389

enrolling in or reenrolling in the Medicaid program as a result

1390

of documented Medicaid fraud and abuse and must recommend

1391

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

1392

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

1393

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

1394

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

1395

(a) "Abuse" means:

1396

1. Provider practices that are inconsistent with generally

1397

accepted business or medical practices and that result in an

1398

unnecessary cost to the Medicaid program or in reimbursement for

1399

goods or services that are not medically necessary or that fail

1400

to meet professionally recognized standards for health care.

1401

2. Recipient practices that result in unnecessary cost to

1402

the Medicaid program.

1403

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

1404

an overpayment has occurred.

1405

1406

misrepresentation made by a person with the knowledge that the

1407

deception results in unauthorized benefit to herself or himself

1408

or another person. The term includes any act that constitutes

1409

fraud under applicable federal or state law.

1410

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

1411

goods or services necessary to palliate the effects of a

1412

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

1413

alleviate, or preclude deterioration of a condition that

1414

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

1415

or infirmity, which goods or services are provided in accordance

1416

with generally accepted standards of medical practice. For

1417

purposes of determining Medicaid reimbursement, the agency is

1418

the final arbiter of medical necessity. Determinations of

1419

medical necessity must be made by a licensed physician employed

1420

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

1421

information available at the time the goods or services are

1422

provided.

1423

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

1424

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

1425

result of inaccurate or improper cost reporting, improper

1426

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

1427

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

1428

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

1429

whether or not such person is enrolled in the Medicaid program

1430

or is a provider of health care.

1431

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

1432

contract or otherwise, reviews, investigations, analyses,

1433

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

1434

abuse, overpayment, or recipient neglect in the Medicaid program

1435

and shall report the findings of any overpayments in audit

1436

reports as appropriate.

1437

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

1438

prepayment review of provider claims to ensure cost-effective

1439

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

1440

is in accordance with applicable provisions of all Medicaid

1441

rules, regulations, handbooks, and policies and in accordance

1442

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

1443

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

1444

recipients. Such prepayment reviews may be conducted as

1445

determined appropriate by the agency, without any suspicion or

1446

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

1447

year. Unless the agency has reliable evidence of fraud,

1448

misrepresentation, abuse, or neglect, claims shall be

1449

adjudicated for denial or payment within 90 days after receipt

1450

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

1451

reliable evidence of fraud, misrepresentation, abuse, or

1452

neglect, claims shall be adjudicated for denial of payment

1453

within 180 days after complete documentation has been received

1454

by the agency for review.

1455

(4) Any suspected criminal violation identified by the

1456

agency must be referred to the Medicaid Fraud Control Unit of

1457

the Office of the Attorney General for investigation. The agency

1458

and the Attorney General shall enter into a memorandum of

1459

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

1460

protocol for regularly sharing information and coordinating

1461

casework. The protocol must establish a procedure for the

1462

referral by the agency of cases involving suspected Medicaid

1463

fraud to the Medicaid Fraud Control Unit for investigation, and

1464

the return to the agency of those cases where investigation

1465

determines that administrative action by the agency is

1466

appropriate. Offices of the Medicaid program integrity program

1467

and the Medicaid Fraud Control Unit of the Department of Legal

1468

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

1469

agency and the Department of Legal Affairs shall periodically

1470

conduct joint training and other joint activities designed to

1471

increase communication and coordination in recovering

1472

overpayments.

1473

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

1474

services that are paid for by the Medicaid program reviewed by

1475

an appropriate peer-review organization designated by the

1476

agency. The written findings of the applicable peer-review

1477

organization are admissible in any court or administrative

1478

proceeding as evidence of medical necessity or the lack thereof.

1479

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

1480

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

1481

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

1482

responsibility of the provider to furnish and keep the agency

1483

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

1484

Service proof of mailing or certified or registered mailing of

1485

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

1486

enrollment file constitutes sufficient proof of notice. Any

1487

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

1488

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

1489

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

1490

program, a provider has an affirmative duty to supervise the

1491

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

1492

to have been provided, to supervise and be responsible for

1493

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

1494

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

1495

that:

1496

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

1497

provider prior to submitting the claim.

1498

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

1499

medically necessary.

1500

1501

general public by the provider's peers.

1502

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

1503

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

1504

copayments, coinsurance, or deductibles as are authorized by the

1505

agency.

1506

(e) Are provided in accord with applicable provisions of

1507

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

1508

accordance with federal, state, and local law.

1509

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

1510

or services were provided, demonstrating the medical necessity

1511

for the goods or services rendered. Medicaid goods or services

1512

are excessive or not medically necessary unless both the medical

1513

basis and the specific need for them are fully and properly

1514

documented in the recipient's medical record.

1515

1516

The agency may deny payment or require repayment for goods or

1517

services that are not presented as required in this subsection.

1518

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

1519

for any prescription for medications, medical supplies, or

1520

medical services if the prescription was written by a physician

1521

or other prescribing practitioner who is not enrolled in the

1522

Medicaid program. This subsection does not apply:

1523

(a) In instances involving bona fide emergency medical

1524

conditions as determined by the agency;

1525

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

1526

hospital emergency department, hospital inpatient or hospital

1527

outpatient setting, or nursing home;

1528

1529

Medicaid providers as determined by the agency;

1530

(d) To prescribing physicians who are board-certified

1531

specialists treating Medicaid recipients referred for treatment

1532

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

1533

(e) To prescriptions written for dually eligible Medicare

1534

beneficiaries by an authorized Medicare provider who is not

1535

enrolled in the Medicaid program;

1536

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

1537

Medicaid program but who provide a medically necessary service

1538

or prescription not otherwise reasonably available from a

1539

Medicaid-enrolled physician; or

1540

(g) In instances where the agency cannot practically

1541

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

1542

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

1543

paragraph shall expire July 1, 2005.

1544

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

1545

professional, financial, and business records pertaining to

1546

services and goods furnished to a Medicaid recipient and billed

1547

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

1548

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

1549

analyze such records, which must be made available during normal

1550

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

1551

patient treatment would be disrupted. The provider is

1552

responsible for furnishing to the agency, and keeping the agency

1553

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

1554

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

1555

records from a provider is neither curtailed nor limited during

1556

a period of litigation between the agency and the provider.

1557

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

1558

persons participating in the preparation of a Medicaid claim

1559

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

1560

the amount a provider receives from the Medicaid program.

1561

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

1562

for inappropriate, medically unnecessary, or excessive goods or

1563

services from the person furnishing them, the person under whose

1564

supervision they were furnished, or the person causing them to

1565

be furnished.

1566

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

1567

pursuant to an investigation of a Medicaid provider, or the

1568

authorized representative or agent of a provider, relating to an

1569

allegation of fraud, abuse, or neglect are confidential and

1570

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

1571

(a) Until the agency takes final agency action with

1572

respect to the provider and requires repayment of any

1573

overpayment, or imposes an administrative sanction;

1574

(b) Until the Attorney General refers the case for

1575

criminal prosecution;

1576

1577

without merit; or

1578

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

1579

otherwise protected by law.

1580

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

1581

Medicaid provider in the Medicaid program and may seek civil

1582

remedies or impose other administrative sanctions against a

1583

Medicaid provider, if the provider has been:

1584

(a) Convicted of a criminal offense related to the

1585

delivery of any health care goods or services, including the

1586

performance of management or administrative functions relating

1587

to the delivery of health care goods or services;

1588

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

1589

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

1590

profession; or

1591

1592

neglected or physically abused a patient in connection with the

1593

delivery of health care goods or services.

1594

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

1595

from participation in the Medicaid program or the Medicare

1596

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

1597

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

1598

participation in the Florida Medicaid program for a period no

1599

less than that imposed by the Federal Government or any other

1600

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

1601

program while such foreign suspension or termination remains in

1602

effect. This sanction is in addition to all other remedies

1603

provided by law.

1604

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

1605

including, but not limited to, the remedies provided in

1606

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

1607

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

1608

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

1609

licensing agency of any state;

1610

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

1611

refused access to Medicaid-related records to an auditor,

1612

investigator, or other authorized employee or agent of the

1613

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

1614

Government;

1615

1616

available such Medicaid-related records as the agency has found

1617

necessary to determine whether Medicaid payments are or were due

1618

and the amounts thereof;

1619

(d) The provider has failed to maintain medical records

1620

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

1621

authorization is required, demonstrating the necessity and

1622

appropriateness of the goods or services rendered;

1623

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

1624

Medicaid provider publications that have been adopted by

1625

reference as rules in the Florida Administrative Code; with

1626

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

1627

provisions of the provider agreement between the agency and the

1628

provider; or with certifications found on claim forms or on

1629

transmittal forms for electronically submitted claims that are

1630

submitted by the provider or authorized representative, as such

1631

provisions apply to the Medicaid program;

1632

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

1633

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

1634

furnishing of, goods or services to a recipient which are

1635

inappropriate, unnecessary, excessive, or harmful to the

1636

recipient or are of inferior quality;

1637

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

1638

provide goods or services that are medically necessary;

1639

(h) The provider or an authorized representative of the

1640

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

1641

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

1642

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

1643

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

1644

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

1645

(i) The provider or an authorized representative of the

1646

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

1647

services, has submitted or caused to be submitted a Medicaid

1648

provider enrollment application, a request for prior

1649

authorization for Medicaid services, a drug exception request,

1650

or a Medicaid cost report that contains materially false or

1651

incorrect information;

1652

(j) The provider or an authorized representative of the

1653

provider has collected from or billed a recipient or a

1654

recipient's responsible party improperly for amounts that should

1655

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

1656

billing the Medicaid program for the same service;

1657

(k) The provider or an authorized representative of the

1658

provider has included in a cost report costs that are not

1659

allowable under a Florida Title XIX reimbursement plan, after

1660

the provider or authorized representative had been advised in an

1661

audit exit conference or audit report that the costs were not

1662

allowable;

1663

(l) The provider is charged by information or indictment

1664

with fraudulent billing practices. The sanction applied for this

1665

reason is limited to suspension of the provider's participation

1666

in the Medicaid program for the duration of the indictment

1667

unless the provider is found guilty pursuant to the information

1668

or indictment;

1669

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

1670

prescribed the goods or services is found liable for negligent

1671

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

1672

(n) The provider fails to demonstrate that it had

1673

available during a specific audit or review period sufficient

1674

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

1675

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

1676

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

1677

reporting requirements of s. 409.907;

1678

(p) The agency has received reliable information of

1679

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

1680

1681

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

1682

repayment schedule.

1683

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

1684

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

1685

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

1686

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

1687

than 1 year. Suspension shall preclude participation in the

1688

Medicaid program, which includes any action that results in a

1689

claim for payment to the Medicaid program as a result of

1690

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

1691

person to furnish goods or services.

1692

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

1693

than 1 year to 20 years. Termination shall preclude

1694

participation in the Medicaid program, which includes any action

1695

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

1696

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

1697

causing a person to furnish goods or services.

1698

1699

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

1700

refusing to furnish Medicaid-related records or refusing access

1701

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

1702

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

1703

Medicaid recipient; each instance of including an unallowable

1704

cost on a hospital or nursing home Medicaid cost report after

1705

the provider or authorized representative has been advised in an

1706

audit exit conference or previous audit report of the cost

1707

unallowability; each instance of furnishing a Medicaid recipient

1708

goods or professional services that are inappropriate or of

1709

inferior quality as determined by competent peer judgment; each

1710

instance of knowingly submitting a materially false or erroneous

1711

Medicaid provider enrollment application, request for prior

1712

authorization for Medicaid services, drug exception request, or

1713

cost report; each instance of inappropriate prescribing of drugs

1714

for a Medicaid recipient as determined by competent peer

1715

judgment; and each false or erroneous Medicaid claim leading to

1716

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

1717

this section, to be a separate violation.

1718

(d) Immediate suspension, if the agency has received

1719

information of patient abuse or neglect or of any act prohibited

1720

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

1721

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

1722

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

1723

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

1724

(f) Imposition of liens against provider assets,

1725

including, but not limited to, financial assets and real

1726

property, not to exceed the amount of fines or recoveries

1727

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

1728

due or recoverable.

1729

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

1730

time.

1731

(h) Comprehensive followup reviews of providers every 6

1732

months to ensure that they are billing Medicaid correctly.

1733

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

1734

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

1735

the agency every 6 months while in effect.

1736

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

1737

recovery of a fine or overpayment.

1738

1739

The Secretary of Health Care Administration may make a

1740

determination that imposition of a sanction or disincentive is

1741

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

1742

a sanction or disincentive shall not be imposed.

1743

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

1744

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

1745

termination, the agency shall consider:

1746

(a) The seriousness and extent of the violation or

1747

violations.

1748

(b) Any prior history of violations by the provider

1749

relating to the delivery of health care programs which resulted

1750

in either a criminal conviction or in administrative sanction or

1751

penalty.

1752

1753

management control of Medicaid statutes, rules, regulations, or

1754

policies after written notification to the provider of improper

1755

practice or instance of violation.

1756

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

1757

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

1758

provider.

1759

(e) Any action by a licensing agency respecting the

1760

provider in any state in which the provider operates or has

1761

operated.

1762

(f) The apparent impact on access by recipients to

1763

Medicaid services if the provider is suspended or terminated, in

1764

the best judgment of the agency.

1765

1766

The agency shall document the basis for all sanctioning actions

1767

and recommendations.

1768

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

1769

or terminate a particular provider working for a group provider,

1770

and may suspend or terminate Medicaid participation at a

1771

specific location, rather than or in addition to taking action

1772

against an entire group.

1773

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

1774

conducting followup reviews of a sampling of providers who have

1775

a history of overpayment under the Medicaid program. This

1776

process must consider the magnitude of previous fraud or abuse

1777

and the potential effect of continued fraud or abuse on Medicaid

1778

costs.

1779

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

1780

provider, the agency must use accepted and valid auditing,

1781

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

1782

combinations thereof. Appropriate statistical methods may

1783

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

1784

population, parametric and nonparametric statistics, tests of

1785

hypotheses, and other generally accepted statistical methods.

1786

Appropriate analytical methods may include, but are not limited

1787

to, reviews to determine variances between the quantities of

1788

products that a provider had on hand and available to be

1789

purveyed to Medicaid recipients during the review period and the

1790

quantities of the same products paid for by the Medicaid program

1791

for the same period, taking into appropriate consideration sales

1792

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

1793

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

1794

court proceeding, the agency may introduce the results of such

1795

statistical methods as evidence of overpayment.

1796

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

1797

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

1798

to the provider showing the calculation of overpayments.

1799

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

1800

papers, showing an overpayment to a provider constitutes

1801

evidence of the overpayment. A provider may not present or

1802

elicit testimony, either on direct examination or cross-

1803

examination in any court or administrative proceeding, regarding

1804

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

1805

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

1806

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

1807

acquisition, sales, divestment, or inventory is documented by

1808

written invoices, written inventory records, or other competent

1809

written documentary evidence maintained in the normal course of

1810

the provider's business. Notwithstanding the applicable rules of

1811

discovery, all documentation that will be offered as evidence at

1812

an administrative hearing on a Medicaid overpayment must be

1813

exchanged by all parties at least 14 days before the

1814

administrative hearing or must be excluded from consideration.

1815

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

1816

committed by a provider which is conducted pursuant to this

1817

section, the agency is entitled to recover all investigative,

1818

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

1819

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

1820

ultimately prevailed.

1821

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

1822

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

1823

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

1824

reasonable in relation to the seriousness of the violation and

1825

must be set taking into consideration the financial resources,

1826

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

1827

of demonstrating such factors.

1828

1829

determined by the agency if the agency determines that an

1830

extreme hardship would result to the provider from immediate

1831

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

1832

by any means authorized by law.

1833

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

1834

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

1835

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

1836

any provider or other person who is regulated by another state

1837

entity, the agency shall notify that other entity of the

1838

imposition of the sanction. Such notification must include the

1839

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

1840

reasons for sanction.

1841

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

1842

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

1843

evidence that the circumstances giving rise to the need for a

1844

withholding of payments involve fraud, willful

1845

misrepresentation, or abuse under the Medicaid program, or a

1846

crime committed while rendering goods or services to Medicaid

1847

recipients, pending completion of legal proceedings. If it is

1848

determined that fraud, willful misrepresentation, abuse, or a

1849

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

1850

provider within 14 days after such determination with interest

1851

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

1852

accordance with this paragraph shall be placed in a suspended

1853

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

1854

ultimately due the provider shall be made within 14 days.

1855

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

1856

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

1857

be furnished by a person who has been suspended or terminated

1858

from the Medicaid program or Medicare program by the Federal

1859

Government or any state.

1860

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

1861

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

1862

of the overpayment by the agency, and payment arrangements must

1863

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

1864

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

1865

schedule may be terminated by the agency for nonpayment or

1866

partial payment.

1867

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

1868

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

1869

stipulation or settlement, may collect the moneys owed by all

1870

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

1871

any fiscal intermediary of Medicare benefits that the state has

1872

a superior right of payment. Upon receipt of such written

1873

notification, the Medicare fiscal intermediary shall remit to

1874

the state the sum claimed.

1875

(e) The agency may institute amnesty programs to allow

1876

Medicaid providers the opportunity to voluntarily repay

1877

overpayments. The agency may adopt rules to administer such

1878

programs.

1879

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

1880

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

1881

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

1882

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

1883

recipient has engaged in solicitation in violation of s. 409.920

1884

or that the recipient has otherwise abused the Medicaid program.

1885

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

1886

has made a probable cause determination and alleged that an

1887

overpayment to a Medicaid provider has occurred, the agency,

1888

after notice to the provider, may:

1889

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

1890

of an administrative hearing pursuant to chapter 120, any

1891

medical assistance reimbursement payments until such time as the

1892

overpayment is recovered, unless within 30 days after receiving

1893

notice thereof the provider:

1894

1. Makes repayment in full; or

1895

2. Establishes a repayment plan that is satisfactory to

1896

the Agency for Health Care Administration.

1897

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

1898

of an administrative hearing pursuant to chapter 120, medical

1899

assistance reimbursement payments if the terms of a repayment

1900

plan are not adhered to by the provider.

1901

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

1902

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

1903

the agency.

1904

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

1905

agency and the Medicaid Fraud Control Unit of the Department of

1906

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

1907

Medicaid related records in order to determine the total output

1908

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

1909

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

1910

services used in the provider's total practice.

1911

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

1912

participation in the Medicaid program if the provider fails to

1913

reimburse an overpayment that has been determined by final

1914

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

1915

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

1916

entered into a repayment agreement.

1917

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

1918

pursuant to chapter 120, such hearing must be conducted within

1919

90 days following assignment of an administrative law judge,

1920

absent exceptionally good cause shown as determined by the

1921

administrative law judge or hearing officer. Upon issuance of a

1922

final order, the outstanding balance of the amount determined to

1923

constitute the overpayment shall become due. If a provider fails

1924

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

1925

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

1926

plan or settlement agreement, the agency may withhold medical

1927

assistance reimbursement payments until the amount due is paid

1928

in full.

1929

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

1930

agency shall have the power to inspect, during normal business

1931

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

1932

manufacturer, or any other place in which drugs and medical

1933

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

1934

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

1935

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

1936

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

1937

prior notice of any such inspection. The notice must identify

1938

the provider whose records will be inspected, and the inspection

1939

shall include only records specifically related to that

1940

provider.

1941

(33) In accordance with federal law, Medicaid recipients

1942

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

1943

limited, restricted, or suspended from Medicaid eligibility for

1944

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

1945

or designee.

1946

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

1947

agency may limit the number of schedules II and III refill

1948

prescription claims submitted from a pharmacy provider. The

1949

agency shall limit the allowable amount of reimbursement of

1950

prescription refill claims for schedules II and III

1951

pharmaceuticals if the agency or the Medicaid Fraud Control Unit

1952

determines that the specific prescription refill was not

1953

requested by the Medicaid recipient or authorized representative

1954

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

1955

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

1956

request must be consistent with the original prescription.

1957

(35) The Office of Program Policy Analysis and Government

1958

Accountability shall provide a report to the President of the

1959

Senate and the Speaker of the House of Representatives on a

1960

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

1961

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

1962

lost to fraud and abuse.

1963

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

1964

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

1965

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

1966

409.9131 Special provisions relating to integrity of the

1967

Medicaid program.--

1968

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

1969

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

1970

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

1971

order to assess the medical necessity, appropriateness, and

1972

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

1973

customarily furnished by the physician's peers and to recognized

1974

health care standards, and, in cases involving determination of

1975

medical necessity, to determine whether the documentation in the

1976

physician's records is adequate.

1977

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

1978

determination of overpayment to a physician, the agency must:

1979

(b) Refer all physician service claims for peer review

1980

when the agency's preliminary analysis indicates that an

1981

evaluation of the medical necessity, appropriateness, and

1982

quality of care needs to be undertaken to determine a potential

1983

overpayment, and before any formal proceedings are initiated

1984

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

1985

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

1986

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

1987

other certification, the following statement must immediately

1988

precede the dated signature of the provider's administrator or

1989

chief financial officer on such cost report:

1990

1991

"I certify that I am familiar with the laws and

1992

regulations regarding the provision of health care

1993

services under the Florida Medicaid program, including

1994

the laws and regulations relating to claims for

1995

Medicaid reimbursements and payments, and that the

1996

services identified in this cost report were provided

1997

in compliance with such laws and regulations."

1998

1999

Section 8. Section 409.920, Florida Statutes, is amended

2000

to read:

2001

409.920 Medicaid provider fraud.--

2002

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

2003

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

2004

Administration.

2005

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

2006

corporation, partnership, organization, or other legal entity

2007

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

2008

adjudicate claims under the Medicaid program.

2009

2010

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

2011

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

2012

itemized claim for payment; or

2013

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

2014

cost report, books of account, or other documents supporting

2015

such claim.

2016

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

2017

and intentionally and not because of mistake or accident. As

2018

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

2019

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

2020

means that an act was committed voluntarily and purposely, with

2021

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

2022

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

2023

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

2024

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

2025

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

2026

(2) It is unlawful to:

2027

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

2028

the making of any false statement or false representation of a

2029

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

2030

to the agency or its fiscal agent for payment.

2031

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

2032

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

2033

authorized to be reimbursed by the Medicaid program.

2034

2035

of value, other than an authorized copayment from a Medicaid

2036

recipient, from any source in addition to the amount legally

2037

payable for an item or service provided to a Medicaid recipient

2038

under the Medicaid program or knowingly fail to credit the

2039

agency or its fiscal agent for any payment received from a

2040

third-party source.

2041

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

2042

false statement or false representation of a material fact, by

2043

commission or omission, in any document containing items of

2044

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

2045

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

2046

service provided by a provider.

2047

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

2048

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

2049

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

2050

return for referring an individual to a person for the

2051

furnishing or arranging for the furnishing of any item or

2052

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

2053

under the Medicaid program, or in return for obtaining,

2054

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

2055

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

2056

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

2057

part, under the Medicaid program.

2058

(f) Knowingly submit false or misleading information or

2059

statements to the Medicaid program for the purpose of being

2060

accepted as a Medicaid provider.

2061

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

2062

identification number or a Medicaid recipient's identification

2063

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

2064

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

2065

reimbursed by the Medicaid program.

2066

2067

A person who violates this subsection commits a felony of the

2068

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

2069

or s. 775.084.

2070

(3) The repayment of Medicaid payments wrongfully

2071

obtained, or the offer or endeavor to repay Medicaid funds

2072

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

2073

ground for dismissal of, criminal charges brought under this

2074

section.

2075

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

2076

or intended to be furnished to any recipient of benefits under

2077

the Medicaid program, regardless of whether reimbursement is

2078

ever actually made by the program.

2079

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

2080

fiscal agent which relate to Medicaid provider fraud are

2081

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

2082

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

2083

its fiscal agent which contained a false statement or a false

2084

representation of a material fact, by commission or omission,

2085

unless satisfactorily explained, gives rise to an inference that

2086

the person whose signature appears as the provider's authorizing

2087

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

2088

agency electronic claim submission agreement submitted for

2089

claims made to the fiscal agent by electronic means, had

2090

knowledge of the false statement or false representation. This

2091

subsection applies whether the signature appears on the claim

2092

form or the electronic claim submission agreement by means of

2093

handwriting, typewriting, facsimile signature stamp, computer

2094

impulse, initials, or otherwise.

2095

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

2096

agent of a document containing items of income and expense,

2097

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

2098

fiscal agent to determine a general or specific rate of payment

2099

and which document contains a false statement or a false

2100

representation of a material fact, by commission or omission,

2101

unless satisfactorily explained, gives rise to the inference

2102

that the person who signed the certification of the document had

2103

knowledge of the false statement or representation. This

2104

subsection applies whether the signature appears on the document

2105

by means of handwriting, typewriting, facsimile signature stamp,

2106

electronic transmission, initials, or otherwise.

2107

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

2108

program of Medicaid fraud control. To accomplish this purpose,

2109

the Attorney General shall:

2110

(a) Investigate the possible criminal violation of any

2111

applicable state law pertaining to fraud in the administration

2112

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

2113

or in the activities of providers of health care under the

2114

Medicaid program.

2115

(b) Investigate the alleged abuse or neglect of patients

2116

in health care facilities receiving payments under the Medicaid

2117

program, in coordination with the agency.

2118

2119

private funds in health care facilities receiving payments under

2120

the Medicaid program.

2121

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

2122

appropriate state attorney all violations indicating a

2123

substantial potential for criminal prosecution.

2124

(e) Refer to the agency all suspected abusive activities

2125

not of a criminal or fraudulent nature.

2126

(f) Safeguard the privacy rights of all individuals and

2127

provide safeguards to prevent the use of patient medical records

2128

for any reason beyond the scope of a specific investigation for

2129

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

2130

(g) Publicize to state employees and the public the

2131

ability of persons to bring suit under the provisions of the

2132

Florida False Claims Act and the potential for the persons

2133

bringing a civil action under the Florida False Claims Act to

2134

obtain a monetary award.

2135

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

2136

under this section, the Attorney General may:

2137

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

2138

excluding a physician, participating in the Medicaid program to

2139

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

2140

relevant in determining the existence of fraud in the Medicaid

2141

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

2142

to investigate alleged misappropriation of patients' private

2143

funds. A participating physician is required to make available

2144

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

2145

determining the existence of fraud in the Medicaid program,

2146

alleged abuse or neglect of patients, or alleged

2147

misappropriation of patients' private funds. The accounts or

2148

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

2149

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

2150

written consent.

2151

(b) Subpoena witnesses or materials, including medical

2152

records relating to Medicaid recipients, within or outside the

2153

state and, through any duly designated employee, administer

2154

oaths and affirmations and collect evidence for possible use in

2155

either civil or criminal judicial proceedings.

2156

2157

attorney or law enforcement agency in the investigation and

2158

prosecution of any violation of this section.

2159

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

2160

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

2161

812.035 and this chapter.

2162

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

2163

overpayment to a provider of health care under the Medicaid

2164

program which is discovered during the course of an

2165

investigation.

2166

Section 9. Section 409.9201, Florida Statutes, is created

2167

to read:

2168

409.9201 Medicaid fraud.--

2169

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

2170

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

2171

limited to, finished dosage forms or active ingredients that are

2172

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

2173

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

2174

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

2175

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

2176

program for the property dispensed or the market value of a

2177

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

2178

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

2179

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

2180

within a reasonable time after the offense.

2181

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

2182

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

2183

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

2184

paid for by the Medicaid program commits a felony.

2185

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

2186

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

2187

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

2188

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

2189

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

2190

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

2191

775.084.

2192

2193

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

2194

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

2195

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

2196

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

2197

for by the Medicaid program and intended for use by another

2198

person commits a felony.

2199

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

2200

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

2201

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

2202

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

2203

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

2204

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

2205

2206

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

2207

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

2208

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

2209

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

2210

representation to any person for the purpose of obtaining goods

2211

or services from the Medicaid program commits a felony.

2212

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

2213

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

2214

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

2215

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

2216

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

2217

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

2218

775.084.

2219

2220

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

2221

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

2222

2223

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

2224

services involved in distinct transactions committed during a

2225

single scheme or course of conduct, whether involving a single

2226

person or several persons, may be aggregated when determining

2227

the punishment for the offense.

2228

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

2229

section 456.072, Florida Statutes, to read:

2230

456.072 Grounds for discipline; penalties; enforcement.--

2231

(1) The following acts shall constitute grounds for which

2232

the disciplinary actions specified in subsection (2) may be

2233

taken:

2234

(ff) Engaging in a pattern of practice when prescribing

2235

medicinal drugs or controlled substances which demonstrates a

2236

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

2237

any provision of this chapter, a violation of the applicable

2238

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

2239

this chapter or the applicable practice act of the prescribing

2240

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

2241

initiate an investigation and establish such a pattern from

2242

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

2243

department.

2244

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

2245

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

2246

section, to read:

2247

465.188 Medicaid audits of pharmacies.--

2248

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

2249

Medicaid-related records of a pharmacy licensed under chapter

2250

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

2251

this section.

2252

(a) The agency conducting the audit must give the

2253

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

2254

for each audit cycle.

2255

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

2256

this state.

2257

2258

typographical error, scrivener's error, or computer error

2259

regarding a document or record required under the Medicaid

2260

program does not constitute a willful violation and is not

2261

subject to criminal penalties without proof of intent to commit

2262

fraud.

2263

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

2264

order for drugs or medicinal supplies written or transmitted by

2265

any means of communication for purposes of validating the

2266

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

2267

narcotic drug.

2268

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

2269

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

2270

projection based on the number of patients served having a

2271

similar diagnosis or on the number of similar orders or refills

2272

for similar drugs.

2273

(f) Each pharmacy shall be audited under the same

2274

standards and parameters.

2275

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

2276

to produce documentation to address any discrepancy found during

2277

an audit.

2278

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

2279

calendar year.

2280

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

2281

of any month due to the high volume of prescriptions filled

2282

during that time.

2283

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

2284

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

2285

report shall be delivered to the pharmacist within 6 months

2286

after receipt of the preliminary audit report or final appeal,

2287

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

2288

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

2289

only to audits of claims submitted for payment subsequent to

2290

July 11, 2003. Notwithstanding any other provisions in this

2291

section, the agency conducting the audit shall not use the

2292

accounting practice of extrapolation in calculating penalties

2293

for Medicaid audits.

2294

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

2295

conducted by the Agency for Health Care Administration when the

2296

agency has reliable evidence that the claim that is the subject

2297

of the audit involves fraud, willful misrepresentation, or abuse

2298

under the Medicaid program.

2299

Section 12. Section 812.0191, Florida Statutes, is created

2300

to read:

2301

812.0191 Property paid for in whole or in part by the

2302

Medicaid program.--

2303

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

2304

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

2305

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

2306

property furnished or intended to be furnished to a recipient of

2307

benefits under the Medicaid program.

2308

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

2309

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

2310

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

2311

market value cannot be determined, the term means the

2312

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

2313

within a reasonable time after the offense.

2314

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

2315

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

2316

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

2317

felony.

2318

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

2319

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

2320

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

2321

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

2322

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

2323

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

2324

775.084.

2325

2326

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

2327

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

2328

2329

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

2330

drugs, or other property involved in distinct transactions

2331

committed during a single scheme or course of conduct, whether

2332

involving a single person or several persons, may be aggregated

2333

when determining the punishment for the offense.

2334

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

2335

finances, directs, manages, or supervises the obtaining of

2336

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

2337

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

2338

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

2339

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

2340

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

2341

895.02, Florida Statutes, is amended to read:

2342

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

2343

term:

2344

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

2345

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

2346

intimidate another person to commit:

2347

(a) Any crime which is chargeable by indictment or

2348

information under the following provisions of the Florida

2349

Statutes:

2350

1. Section 210.18, relating to evasion of payment of

2351

cigarette taxes.

2352

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

2353

control.

2354

3. Section 414.39, relating to public assistance fraud.

2355

4. Section 409.920 or section 409.9201, relating to

2356

Medicaid ~~provider~~ fraud.

2357

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

2358

compensation.

2359

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

2360

499.0691, relating to crimes involving contraband and

2361

adulterated drugs.

2362

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

2363

8. Chapter 517, relating to sale of securities and

2364

investor protection.

2365

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

2366

to dogracing and horseracing.

2367

10. Chapter 550, relating to jai alai frontons.

2368

11. Chapter 552, relating to the manufacture,

2369

distribution, and use of explosives.

2370

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

2371

violation is punishable as a felony.

2372

13. Chapter 562, relating to beverage law enforcement.

2373

14. Section 624.401, relating to transacting insurance

2374

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

2375

to operating an unauthorized multiple-employer welfare

2376

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

2377

aiding an unauthorized insurer.

2378

15. Section 655.50, relating to reports of currency

2379

transactions, when such violation is punishable as a felony.

2380

16. Chapter 687, relating to interest and usurious

2381

practices.

2382

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

2383

real estate timeshare plans.

2384

18. Chapter 782, relating to homicide.

2385

19. Chapter 784, relating to assault and battery.

2386

20. Chapter 787, relating to kidnapping.

2387

21. Chapter 790, relating to weapons and firearms.

2388

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

2389

relating to prostitution.

2390

23. Chapter 806, relating to arson.

2391

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

2392

of a dwelling or structure.

2393

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

2394

crimes.

2395

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

2396

27. Chapter 817, relating to fraudulent practices, false

2397

pretenses, fraud generally, and credit card crimes.

2398

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

2399

exploitation of an elderly person or disabled adult.

2400

29. Section 827.071, relating to commercial sexual

2401

exploitation of children.

2402

30. Chapter 831, relating to forgery and counterfeiting.

2403

31. Chapter 832, relating to issuance of worthless checks

2404

and drafts.

2405

32. Section 836.05, relating to extortion.

2406

33. Chapter 837, relating to perjury.

2407

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

2408

office.

2409

35. Chapter 843, relating to obstruction of justice.

2410

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

2411

s. 847.07, relating to obscene literature and profanity.

2412

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

2413

849.25, relating to gambling.

2414

38. Chapter 874, relating to criminal street gangs.

2415

39. Chapter 893, relating to drug abuse prevention and

2416

control.

2417

40. Chapter 896, relating to offenses related to financial

2418

transactions.

2419

41. Sections 914.22 and 914.23, relating to tampering with

2420

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

2421

witness, victim, or informant.

2422

42. Sections 918.12 and 918.13, relating to tampering with

2423

jurors and evidence.

2424

Section 14. Section 905.34, Florida Statutes, is amended

2425

to read:

2426

905.34 Powers and duties; law applicable.--The

2427

jurisdiction of a statewide grand jury impaneled under this

2428

chapter shall extend throughout the state. The subject matter

2429

jurisdiction of the statewide grand jury shall be limited to the

2430

offenses of:

2431

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

2432

criminal usury, extortion, gambling, kidnapping, larceny,

2433

murder, prostitution, perjury, and robbery;

2434

(2) Crimes involving narcotic or other dangerous drugs;

2435

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

2436

(Racketeer Influenced and Corrupt Organization) Act, including

2437

any offense listed in the definition of racketeering activity in

2438

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

2439

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

2440

separate count of an information or indictment containing a

2441

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

2442

which listed offense may continue independently if the

2443

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

2444

reason;

2445

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

2446

Fencing Act;

2447

(5) Any violation of the provisions of the Florida

2448

Antitrust Act of 1980, as amended;

2449

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

2450

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

2451

upon any person;

2452

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

2453

847.0138 relating to computer pornography and child exploitation

2454

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

2455

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

2456

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

2457

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

2458

2459

or any attempt, solicitation, or conspiracy to commit any

2460

violation of the crimes specifically enumerated above, when any

2461

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

2462

judicial circuits as part of a related transaction or when any

2463

such offense is connected with an organized criminal conspiracy

2464

affecting two or more judicial circuits. The statewide grand

2465

jury may return indictments and presentments irrespective of the

2466

county or judicial circuit where the offense is committed or

2467

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

2468

transferred for trial to the county where the offense was

2469

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

2470

county grand juries shall apply to a statewide grand jury except

2471

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

2472

provisions of ss. 905.31-905.40.

2473

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

2474

932.701, Florida Statutes, is amended to read:

2475

932.701 Short title; definitions.--

2476

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

2477

(a) "Contraband article" means:

2478

1. Any controlled substance as defined in chapter 893 or

2479

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

2480

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

2481

intended to be used in violation of any provision of chapter

2482

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

2483

clearly sufficient to meet the state's burden of establishing

2484

probable cause to believe that a nexus exists between the

2485

article seized and the narcotics activity, whether or not the

2486

use of the contraband article can be traced to a specific

2487

narcotics transaction.

2488

2. Any gambling paraphernalia, lottery tickets, money,

2489

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

2490

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

2491

laws of the state.

2492

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

2493

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

2494

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

2495

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

2496

been paid as required by law.

2497

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

2498

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

2499

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

2500

records, research, negotiable instruments, or currency, which

2501

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

2502

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

2503

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

2504

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

2505

a violation of the Florida Contraband Forfeiture Act.

2506

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

2507

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

2508

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

2509

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

2510

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

2511

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

2512

Contraband Forfeiture Act.

2513

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

2514

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

2515

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

2516

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

2517

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

2518

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

2519

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

2520

320.28.

2521

9. Any motor vehicle used during the course of committing

2522

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

2523

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

2524

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

2525

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

2526

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

2527

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

2528

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

2529

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

2530

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

2531

belonging to any person which is acquired by proceeds obtained

2532

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

2533

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

2534

section 932.7055, Florida Statutes, to read:

2535

932.7055 Disposition of liens and forfeited property.--

2536

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

2537

proceeds shall be deposited into the General Revenue Fund.

2538

However, if the seizing agency is:

2539

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

2540

Legal Affairs, the proceeds accrued pursuant to the provisions

2541

of the Florida Contraband Forfeiture Act shall be deposited into

2542

the Grants and Donations Trust Fund to be used for investigation

2543

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

2544

related cases by the Medicaid Fraud Control Unit.

2545

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

2546

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

2547

394.9082 Behavioral health service delivery strategies.--

2548

(4) CONTRACT FOR SERVICES.--

2549

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

2550

Agency for Health Care Administration may contract for the

2551

provision or management of behavioral health services with a

2552

managing entity in at least two geographic areas. Both the

2553

Department of Children and Family Services and the Agency for

2554

Health Care Administration must contract with the same managing

2555

entity in any distinct geographic area where the strategy

2556

operates. This managing entity shall be accountable at a minimum

2557

for the delivery of behavioral health services specified and

2558

funded by the department and the agency. The geographic area

2559

must be of sufficient size in population and have enough public

2560

funds for behavioral health services to allow for flexibility

2561

and maximum efficiency. Notwithstanding the provisions of s.

2562

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

2563

strategy must be in one of the service districts in the

2564

catchment area of G. Pierce Wood Memorial Hospital.

2565

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

2566

Department of Children and Family Services may contract with a

2567

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

2568

the managing entity. Under this strategy, the Department of

2569

Children and Family Services is not required to competitively

2570

procure those services and, notwithstanding other provisions of

2571

law, may employ prospective payment methodologies that the

2572

department finds are necessary to improve client care or

2573

institute more efficient practices. The Department of Children

2574

and Family Services may employ in its contract any provision of

2575

the current prepaid behavioral health care plan authorized under

2576

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

2577

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

2578

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

2579

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

2580

the Department of Children and Family Services may be entered

2581

with the existing substance abuse treatment provider network if

2582

an administrative services organization is part of its network.

2583

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

2584

prototype region of the Department of Children and Family

2585

Services, the Department of Children and Family Services and the

2586

Agency for Health Care Administration may employ alternative

2587

service delivery and financing methodologies, which may include

2588

prospective payment for certain population groups. The

2589

population groups that are to be provided these substance abuse

2590

services would include at a minimum: individuals and families

2591

receiving family safety services; Medicaid-eligible children,

2592

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

2593

current recipients and persons at risk of needing cash

2594

assistance under Florida's welfare reform initiatives.

2595

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

2596

funded through a combination of funds from the Department of

2597

Children and Family Services and the Agency for Health Care

2598

Administration. To operate the managing entity, the Department

2599

of Children and Family Services and the Agency for Health Care

2600

Administration may not expend more than 10 percent of the annual

2601

appropriations for mental health and substance abuse treatment

2602

services prorated to the geographic areas and must include all

2603

behavioral health Medicaid funds, including psychiatric

2604

inpatient funds. This restriction does not apply to a prepaid

2605

behavioral health plan that is authorized under s.

2606

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

2607

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

2608

Statutes, is amended to read:

2609

400.0077 Confidentiality.--

2610

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

2611

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

2612

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

2613

409.9065, Florida Statutes, is amended to read:

2614

409.9065 Pharmaceutical expense assistance.--

2615

(4) ADMINISTRATION.--The pharmaceutical expense assistance

2616

program shall be administered by the agency, in collaboration

2617

with the Department of Elderly Affairs and the Department of

2618

Children and Family Services.

2619

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

2620

pharmaceutical expense assistance program eligibility

2621

requirements; limits on participation; benefit limitations,

2622

including copayments; a requirement for generic drug

2623

substitution; and other program parameters comparable to those

2624

of the Medicaid program. Individuals eligible to participate in

2625

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

2626

drugs per month per recipient as specified in s.

2627

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

2628

prescription drugs purchased with discounts of less than 51

2629

percent unless the agency determines there is a risk of a

2630

funding shortfall in the program. If the agency determines there

2631

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

2632

monetary limits on prescription drugs which shall not be less

2633

than $160 worth of prescription drugs per month.

2634

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

2635

Statutes, is amended to read:

2636

409.9071 Medicaid provider agreements for school districts

2637

certifying state match.--

2638

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

2639

September 1, 1997, for the purpose of obtaining federal

2640

authorization to reimburse school-based services as provided in

2641

former s. 236.0812 pursuant to the rehabilitative services

2642

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

2643

this section, billing agent consulting services shall be

2644

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

2645

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

2646

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

2647

a provider receives from the Medicaid program. This provision

2648

shall not restrict privatization of Medicaid school-based

2649

services. Subject to any limitations provided for in the General

2650

Appropriations Act, the agency, in compliance with appropriate

2651

federal authorization, shall develop policies and procedures and

2652

shall allow for certification of state and local education funds

2653

which have been provided for school-based services as specified

2654

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

2655

required by federal Medicaid law. Any state or local funds

2656

certified pursuant to this section shall be for children with

2657

specified disabilities who are eligible for both Medicaid and

2658

part B or part H of the Individuals with Disabilities Education

2659

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

2660

have an individualized educational plan.

2661

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

2662

Statutes, is amended to read:

2663

409.908 Reimbursement of Medicaid providers.--Subject to

2664

specific appropriations, the agency shall reimburse Medicaid

2665

providers, in accordance with state and federal law, according

2666

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

2667

policy manuals and handbooks incorporated by reference therein.

2668

These methodologies may include fee schedules, reimbursement

2669

methods based on cost reporting, negotiated fees, competitive

2670

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

2671

considers efficient and effective for purchasing services or

2672

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

2673

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

2674

report would have been used to set a lower reimbursement rate

2675

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

2676

shall be retroactively calculated using the new cost report, and

2677

full payment at the recalculated rate shall be affected

2678

retroactively. Medicare-granted extensions for filing cost

2679

reports, if applicable, shall also apply to Medicaid cost

2680

reports. Payment for Medicaid compensable services made on

2681

behalf of Medicaid eligible persons is subject to the

2682

availability of moneys and any limitations or directions

2683

provided for in the General Appropriations Act or chapter 216.

2684

Further, nothing in this section shall be construed to prevent

2685

or limit the agency from adjusting fees, reimbursement rates,

2686

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

2687

making any other adjustments necessary to comply with the

2688

availability of moneys and any limitations or directions

2689

provided for in the General Appropriations Act, provided the

2690

adjustment is consistent with legislative intent.

2691

(4) Subject to any limitations or directions provided for

2692

in the General Appropriations Act, alternative health plans,

2693

health maintenance organizations, and prepaid health plans shall

2694

be reimbursed a fixed, prepaid amount negotiated, or

2695

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

2696

prospectively paid to the provider monthly for each Medicaid

2697

recipient enrolled. The amount may not exceed the average amount

2698

the agency determines it would have paid, based on claims

2699

experience, for recipients in the same or similar category of

2700

eligibility. The agency shall calculate capitation rates on a

2701

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

2702

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

2703

2001, the cost of exempting statutory teaching hospitals,

2704

specialty hospitals, and community hospital education program

2705

hospitals from reimbursement ceilings and the cost of special

2706

Medicaid payments shall not be included in premiums paid to

2707

health maintenance organizations or prepaid health care plans.

2708

Each rate semester, the agency shall calculate and publish a

2709

Medicaid hospital rate schedule that does not reflect either

2710

special Medicaid payments or the elimination of rate

2711

reimbursement ceilings, to be used by hospitals and Medicaid

2712

health maintenance organizations, in order to determine the

2713

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

2714

and 641.513(6).

2715

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

2716

Florida Statutes, are amended to read:

2717

409.91196 Supplemental rebate agreements; confidentiality

2718

of records and meetings.--

2719

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

2720

manufacturer's pricing, and supplemental rebates which are

2721

contained in records of the Agency for Health Care

2722

Administration and its agents with respect to supplemental

2723

rebate negotiations and which are prepared pursuant to a

2724

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

2725

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

2726

the State Constitution.

2727

(2) Those portions of meetings of the Medicaid

2728

Pharmaceutical and Therapeutics Committee at which trade

2729

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

2730

pricing, and supplemental rebates are disclosed for discussion

2731

or negotiation of a supplemental rebate agreement under s.

2732

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

2733

Art. I of the State Constitution.

2734

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

2735

409.9122, Florida Statutes, is amended to read:

2736

409.9122 Mandatory Medicaid managed care enrollment;

2737

programs and procedures.--

2738

(2)

2739

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

2740

care plan or MediPass provider, the agency shall assign the

2741

Medicaid recipient to a managed care plan or MediPass provider.

2742

Medicaid recipients who are subject to mandatory assignment but

2743

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

2744

plans until an enrollment of 40 percent in MediPass and 60

2745

percent in managed care plans is achieved. Once this enrollment

2746

is achieved, the assignments shall be divided in order to

2747

maintain an enrollment in MediPass and managed care plans which

2748

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

2749

Thereafter, assignment of Medicaid recipients who fail to make a

2750

choice shall be based proportionally on the preferences of

2751

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

2752

proportions shall be revised at least quarterly to reflect an

2753

update of the preferences of Medicaid recipients. The agency

2754

shall disproportionately assign Medicaid-eligible recipients who

2755

are required to but have failed to make a choice of managed care

2756

plan or MediPass, including children, and who are to be assigned

2757

to the MediPass program to children's networks as described in

2758

s. 409.912(4)~~(3)~~(g), Children's Medical Services network as

2759

defined in s. 391.021, exclusive provider organizations,

2760

provider service networks, minority physician networks, and

2761

pediatric emergency department diversion programs authorized by

2762

this chapter or the General Appropriations Act, in such manner

2763

as the agency deems appropriate, until the agency has determined

2764

that the networks and programs have sufficient numbers to be

2765

economically operated. For purposes of this paragraph, when

2766

referring to assignment, the term "managed care plans" includes

2767

health maintenance organizations, exclusive provider

2768

organizations, provider service networks, minority physician

2769

networks, Children's Medical Services network, and pediatric

2770

emergency department diversion programs authorized by this

2771

chapter or the General Appropriations Act. When making

2772

assignments, the agency shall take into account the following

2773

criteria:

2774

1. A managed care plan has sufficient network capacity to

2775

meet the need of members.

2776

2. The managed care plan or MediPass has previously

2777

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

2778

plan's primary care providers or MediPass providers has

2779

previously provided health care to the recipient.

2780

3. The agency has knowledge that the member has previously

2781

expressed a preference for a particular managed care plan or

2782

MediPass provider as indicated by Medicaid fee-for-service

2783

claims data, but has failed to make a choice.

2784

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

2785

providers are geographically accessible to the recipient's

2786

residence.

2787

Section 24. Subsection (3) of section 409.9131, Florida

2788

Statutes, is amended to read:

2789

409.9131 Special provisions relating to integrity of the

2790

Medicaid program.--

2791

(3) ONSITE RECORDS REVIEW.--As specified in s.

2792

409.913(9)~~(8)~~, the agency may investigate, review, or analyze a

2793

physician's medical records concerning Medicaid patients. The

2794

physician must make such records available to the agency during

2795

normal business hours. The agency must provide notice to the

2796

physician at least 24 hours before such visit. The agency and

2797

physician shall make every effort to set a mutually agreeable

2798

time for the agency's visit during normal business hours and

2799

within the 24-hour period. If such a time cannot be agreed upon,

2800

the agency may set the time.

2801

Section 25. Subsection (2) of section 430.608, Florida

2802

Statutes, is amended to read:

2803

430.608 Confidentiality of information.--

2804

(2) This section does not, however, limit the subpoena

2805

authority of the Medicaid Fraud Control Unit of the Department

2806

of Legal Affairs pursuant to s. 409.920(9)~~(8)~~(b).

2807

Section 26. Section 636.0145, Florida Statutes, is amended

2808

to read:

2809

636.0145 Certain entities contracting with

2810

Medicaid.--Notwithstanding the requirements of s.

2811

Notwithstanding the requirements of s. 409.912(4)~~(3)~~(b), an

2812

entity that is providing comprehensive inpatient and outpatient

2813

mental health care services to certain Medicaid recipients in

2814

Hillsborough, Highlands, Hardee, Manatee, and Polk Counties

2815

through a capitated, prepaid arrangement pursuant to the federal

2816

waiver provided for in s. 409.905(5) must become licensed under

2817

chapter 636 by December 31, 1998. Any entity licensed under this

2818

chapter which provides services solely to Medicaid recipients

2819

under a contract with Medicaid shall be exempt from ss. 636.017,

2820

636.018, 636.022, 636.028, and 636.034.

2821

Section 27. Subsection (3) of section 641.225, Florida

2822

Statutes, is amended to read:

2823

641.225 Surplus requirements.--

2824

(3)(a) An entity providing prepaid capitated services

2825

which is authorized under s. 409.912(4)~~(3)~~(a) and which applies

2826

for a certificate of authority is subject to the minimum surplus

2827

requirements set forth in subsection (1), unless the entity is

2828

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

2829

located.

2830

(b) An entity providing prepaid capitated services which

2831

is authorized under s. 409.912(4)~~(3)~~(b) or (c), and which

2832

applies for a certificate of authority is subject to the minimum

2833

surplus requirements set forth in s. 409.912.

2834

Section 28. Subsection (4) of section 641.386, Florida

2835

Statutes, is amended to read:

2836

641.386 Agent licensing and appointment required;

2837

exceptions.--

2838

(4) All agents and health maintenance organizations shall

2839

comply with and be subject to the applicable provisions of ss.

2840

641.309 and 409.912(21)~~(19)~~, and all companies and entities

2841

appointing agents shall comply with s. 626.451, when marketing

2842

for any health maintenance organization licensed pursuant to

2843

this part, including those organizations under contract with the

2844

Agency for Health Care Administration to provide health care

2845

services to Medicaid recipients or any private entity providing

2846

health care services to Medicaid recipients pursuant to a

2847

prepaid health plan contract with the Agency for Health Care

2848

Administration.

2849

Section 29. For the purpose of incorporating the amendment

2850

to section 409.920, Florida Statutes, in a reference thereto,

2851

paragraph (g) of subsection (3) of section 921.0022, Florida

2852

Statutes, is reenacted to read:

2853

921.0022 Criminal Punishment Code; offense severity

2854

ranking chart.--

2855

(3) OFFENSE SEVERITY RANKING CHART

FloridaStatute

FelonyDegree

Description

2856

(g) LEVEL 7

2857

316.027(1)(b)

2nd

Accident involving death, failure to stop; leaving scene.

2858

316.193(3)(c)2.

3rd

DUI resulting in serious bodily injury.

2859

327.35(3)(c)2.

3rd

Vessel BUI resulting in serious bodily injury.

2860

402.319(2)

2nd

Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.

2861

409.920(2)

3rd

Medicaid provider fraud.

2862

456.065(2)

3rd

Practicing a health care profession without a license.

2863

456.065(2)

2nd

Practicing a health care profession without a license which results in serious bodily injury.

2864

458.327(1)

3rd

Practicing medicine without a license.

2865

459.013(1)

3rd

Practicing osteopathic medicine without a license.

2866

460.411(1)

3rd

Practicing chiropractic medicine without a license.

2867

461.012(1)

3rd

Practicing podiatric medicine without a license.

2868

462.17

3rd

Practicing naturopathy without a license.

2869

463.015(1)

3rd

Practicing optometry without a license.

2870

464.016(1)

3rd

Practicing nursing without a license.

2871

465.015(2)

3rd

Practicing pharmacy without a license.

2872

466.026(1)

3rd

Practicing dentistry or dental hygiene without a license.

2873

467.201

3rd

Practicing midwifery without a license.

2874

468.366

3rd

Delivering respiratory care services without a license.

2875

483.828(1)

3rd

Practicing as clinical laboratory personnel without a license.

2876

483.901(9)

3rd

Practicing medical physics without a license.

2877

484.013(1)(c)

3rd

Preparing or dispensing optical devices without a prescription.

2878

484.053

3rd

Dispensing hearing aids without a license.

2879

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.

2880

560.123(8)(b)1.

3rd

Failure to report currency or payment instruments exceeding $300 but less than $20,000 by money transmitter.

2881

560.125(5)(a)

3rd

Money transmitter business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.

2882

655.50(10)(b)1.

3rd

Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.

2883

782.051(3)

2nd

Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.

2884

782.07(1)

2nd

Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).

2885

782.071

2nd

Killing of human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).

2886

782.072

2nd

Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).

2887

784.045(1)(a)1.

2nd

Aggravated battery; intentionally causing great bodily harm or disfigurement.

2888

784.045(1)(a)2.

2nd

Aggravated battery; using deadly weapon.

2889

784.045(1)(b)

2nd

Aggravated battery; perpetrator aware victim pregnant.

2890

784.048(4)

3rd

Aggravated stalking; violation of injunction or court order.

2891

784.07(2)(d)

1st

Aggravated battery on law enforcement officer.

2892

784.074(1)(a)

1st

Aggravated battery on sexually violent predators facility staff.

2893

784.08(2)(a)

1st

Aggravated battery on a person 65 years of age or older.

2894

784.081(1)

1st

Aggravated battery on specified official or employee.

2895

784.082(1)

1st

Aggravated battery by detained person on visitor or other detainee.

2896

784.083(1)

1st

Aggravated battery on code inspector.

2897

790.07(4)

1st

Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).

2898

790.16(1)

1st

Discharge of a machine gun under specified circumstances.

2899

790.165(2)

2nd

Manufacture, sell, possess, or deliver hoax bomb.

2900

790.165(3)

2nd

Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.

2901

790.166(3)

2nd

Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.

2902

790.166(4)

2nd

Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.

2903

796.03

2nd

Procuring any person under 16 years for prostitution.

2904

800.04(5)(c)1.

2nd

Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.

2905

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.

2906

806.01(2)

2nd

Maliciously damage structure by fire or explosive.

2907

810.02(3)(a)

2nd

Burglary of occupied dwelling; unarmed; no assault or battery.

2908

810.02(3)(b)

2nd

Burglary of unoccupied dwelling; unarmed; no assault or battery.

2909

810.02(3)(d)

2nd

Burglary of occupied conveyance; unarmed; no assault or battery.

2910

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.

2911

812.014(2)(b)3.

2nd

Property stolen, emergency medical equipment; 2nd degree grand theft.

2912

812.0145(2)(a)

1st

Theft from person 65 years of age or older; $50,000 or more.

2913

812.019(2)

1st

Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.

2914

812.131(2)(a)

2nd

Robbery by sudden snatching.

2915

812.133(2)(b)

1st

Carjacking; no firearm, deadly weapon, or other weapon.

2916

817.234(8)(a)

2nd

Solicitation of motor vehicle accident victims with intent to defraud.

2917

817.234(9)

2nd

Organizing, planning, or participating in an intentional motor vehicle collision.

2918

817.234(11)(c)

1st

Insurance fraud; property value $100,000 or more.

2919

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.

2920

825.102(3)(b)

2nd

Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.

2921

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.

2922

827.03(3)(b)

2nd

Neglect of a child causing great bodily harm, disability, or disfigurement.

2923

827.04(3)

3rd

Impregnation of a child under 16 years of age by person 21 years of age or older.

2924

837.05(2)

3rd

Giving false information about alleged capital felony to a law enforcement officer.

2925

838.015

2nd

Bribery.

2926

838.016

2nd

Unlawful compensation or reward for official behavior.

2927

838.021(3)(a)

2nd

Unlawful harm to a public servant.

2928

838.22

2nd

Bid tampering.

2929

872.06

2nd

Abuse of a dead human body.

2930

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.

2931

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.

2932

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).

2933

893.135(1)(a)1.

1st

Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.

2934

893.135(1)(b)1.a.

1st

Trafficking in cocaine, more than 28 grams, less than 200 grams.

2935

893.135(1)(c)1.a.

1st

Trafficking in illegal drugs, more than 4 grams, less than 14 grams.

2936

893.135(1)(d)1.

1st

Trafficking in phencyclidine, more than 28 grams, less than 200 grams.

2937

893.135(1)(e)1.

1st

Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.

2938

893.135(1)(f)1.

1st

Trafficking in amphetamine, more than 14 grams, less than 28 grams.

2939

893.135(1)(g)1.a.

1st

Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.

2940

893.135(1)(h)1.a.

1st

Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.

2941

893.135(1)(j)1.a.

1st

Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.

2942

893.135(1)(k)2.a.

1st

Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.

2943

896.101(5)(a)

3rd

Money laundering, financial transactions exceeding $300 but less than $20,000.

2944

896.104(4)(a)1.

3rd

Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.

2945

2946

Section 30. For the purpose of incorporating the amendment

2947

to section 932.701, Florida Statutes, in a reference thereto,

2948

subsection (6) of section 705.101, Florida Statutes, is

2949

reenacted to read:

2950

705.101 Definitions.--As used in this chapter:

2951

(6) "Unclaimed evidence" means any tangible personal

2952

property, including cash, not included within the definition of

2953

"contraband article," as provided in s. 932.701(2), which was

2954

seized by a law enforcement agency, was intended for use in a

2955

criminal or quasi-criminal proceeding, and is retained by the

2956

law enforcement agency or the clerk of the county or circuit

2957

court for 60 days after the final disposition of the proceeding

2958

and to which no claim of ownership has been made.

2959

Section 31. For the purpose of incorporating the amendment

2960

to section 932.701, Florida Statutes, in references thereto,

2961

subsection (4) of section 932.703, Florida Statutes, is

2962

reenacted to read:

2963

932.703 Forfeiture of contraband article; exceptions.--

2964

(4) In any incident in which possession of any contraband

2965

article defined in s. 932.701(2)(a) constitutes a felony, the

2966

vessel, motor vehicle, aircraft, other personal property, or

2967

real property in or on which such contraband article is located

2968

at the time of seizure shall be contraband subject to

2969

forfeiture. It shall be presumed in the manner provided in s.

2970

90.302(2) that the vessel, motor vehicle, aircraft, other

2971

personal property, or real property in which or on which such

2972

contraband article is located at the time of seizure is being

2973

used or was attempted or intended to be used in a manner to

2974

facilitate the transportation, carriage, conveyance,

2975

concealment, receipt, possession, purchase, sale, barter,

2976

exchange, or giving away of a contraband article defined in s.

2977

932.701(2).

2978

Section 32. The Agency for Health Care Administration

2979

shall report to the President of the Senate and the Speaker of

2980

the House of Representatives, by January 1, 2005, on the

2981

feasibility of creating a database of valid prescriber

2982

information for the purpose of notifying pharmacies of

2983

prescribers qualified to write prescriptions for Medicaid

2984

beneficiaries, or in the alternative, of prescribers not

2985

qualified to write prescriptions for Medicaid beneficiaries. The

2986

report shall include information on the system changes necessary

2987

to implement this paragraph, as well as the cost of implementing

2988

the changes.

2989

Section 33. The sum of $262,087 is appropriated from the

2990

Medical Quality Assurance Trust Fund to the Department of

2991

Health, and four full-time-equivalent positions are authorized,

2992

for the purpose of implementing the provisions of this act

2993

during the 2004-2005 fiscal year.

2994

Section 34. This act shall take effect upon becoming a

2995

law.

CODING: Words ~~stricken~~ are deletions; words underlined are additions.