Senate Bill sb0428c2

    Florida Senate - 2005                     CS for CS for SB 428

    By the Committees on Health and Human Services Appropriations;
    Health Care; and Senator Rich




    603-2303-05

  1                      A bill to be entitled

  2         An act relating to developmental disabilities;

  3         amending s. 409.912, F.S.; requiring the Agency

  4         for Health Care Administration to develop a

  5         model waiver program to serve children with

  6         specified disorders; requiring the agency to

  7         seek federal waiver approval and implement the

  8         approved waiver subject to availability of

  9         funds and certain limitations; authorizing

10         rules; providing an appropriation; providing an

11         effective date.

12  

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

14  

15         Section 1.  Subsection (50) is added to section

16  409.912, Florida Statutes, to read:

17         409.912  Cost-effective purchasing of health care.--The

18  agency shall purchase goods and services for Medicaid

19  recipients in the most cost-effective manner consistent with

20  the delivery of quality medical care. To ensure that medical

21  services are effectively utilized, the agency may, in any

22  case, require a confirmation or second physician's opinion of

23  the correct diagnosis for purposes of authorizing future

24  services under the Medicaid program. This section does not

25  restrict access to emergency services or poststabilization

26  care services as defined in 42 C.F.R. part 438.114. Such

27  confirmation or second opinion shall be rendered in a manner

28  approved by the agency. The agency shall maximize the use of

29  prepaid per capita and prepaid aggregate fixed-sum basis

30  services when appropriate and other alternative service

31  delivery and reimbursement methodologies, including

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    Florida Senate - 2005                     CS for CS for SB 428
    603-2303-05




 1  competitive bidding pursuant to s. 287.057, designed to

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

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

 4  minimize the exposure of recipients to the need for acute

 5  inpatient, custodial, and other institutional care and the

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

 7  agency may mandate prior authorization, drug therapy

 8  management, or disease management participation for certain

 9  populations of Medicaid beneficiaries, certain drug classes,

10  or particular drugs to prevent fraud, abuse, overuse, and

11  possible dangerous drug interactions. The Pharmaceutical and

12  Therapeutics Committee shall make recommendations to the

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

14  agency shall inform the Pharmaceutical and Therapeutics

15  Committee of its decisions regarding drugs subject to prior

16  authorization. The agency is authorized to limit the entities

17  it contracts with or enrolls as Medicaid providers by

18  developing a provider network through provider credentialing.

19  The agency may limit its network based on the assessment of

20  beneficiary access to care, provider availability, provider

21  quality standards, time and distance standards for access to

22  care, the cultural competence of the provider network,

23  demographic characteristics of Medicaid beneficiaries,

24  practice and provider-to-beneficiary standards, appointment

25  wait times, beneficiary use of services, provider turnover,

26  provider profiling, provider licensure history, previous

27  program integrity investigations and findings, peer review,

28  provider Medicaid policy and billing compliance records,

29  clinical and medical record audits, and other factors.

30  Providers shall not be entitled to enrollment in the Medicaid

31  

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    Florida Senate - 2005                     CS for CS for SB 428
    603-2303-05




 1  provider network. The agency is authorized to seek federal

 2  waivers necessary to implement this policy.

 3         (50)  The agency shall work with the Agency for Persons

 4  with Disabilities to develop a model home and community-based

 5  waiver to serve children who are diagnosed with familial

 6  dysautonomia or Riley-Day syndrome caused by a mutation of the

 7  IKBKAP gene on chromosome 9. The agency shall seek federal

 8  waiver approval and implement the approved waiver subject to

 9  the availability of funds and any limitations provided in the

10  General Appropriations Act. The agency may adopt rules to

11  implement this waiver program.

12         Section 2.  The sums of $171,840 from the General

13  Revenue Fund and $246,160 from the Medical Care Trust Fund are

14  appropriated to the Agency for Health Care Administration for

15  the purpose of implementing this act during the 2005-2006

16  fiscal year.

17         Section 3.  This act shall take effect July 1, 2005.

18  

19          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
20                          CS for SB 428

21                                 

22  Provides $171,840 from the General Revenue Fund and $246,160
    from the Medical Care Trust Fund to the Agency for Health Care
23  Administration.

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