Senate Bill sb2226
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Florida Senate - 2006 SB 2226
By Senator Rich
34-1155A-06
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 waiver program to serve children and adults
6 with specified disorders; requiring the agency
7 to seek federal approval and implement the
8 approved waiver in the General Appropriations
9 Act; providing an appropriation; providing an
10 effective date.
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12 Be It Enacted by the Legislature of the State of Florida:
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14 Section 1. Subsection (51) of section 409.912, Florida
15 Statutes, is amended to read:
16 409.912 Cost-effective purchasing of health care.--The
17 agency shall purchase goods and services for Medicaid
18 recipients in the most cost-effective manner consistent with
19 the delivery of quality medical care. To ensure that medical
20 services are effectively utilized, the agency may, in any
21 case, require a confirmation or second physician's opinion of
22 the correct diagnosis for purposes of authorizing future
23 services under the Medicaid program. This section does not
24 restrict access to emergency services or poststabilization
25 care services as defined in 42 C.F.R. part 438.114. Such
26 confirmation or second opinion shall be rendered in a manner
27 approved by the agency. The agency shall maximize the use of
28 prepaid per capita and prepaid aggregate fixed-sum basis
29 services when appropriate and other alternative service
30 delivery and reimbursement methodologies, including
31 competitive bidding pursuant to s. 287.057, designed to
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Florida Senate - 2006 SB 2226
34-1155A-06
1 facilitate the cost-effective purchase of a case-managed
2 continuum of care. The agency shall also require providers to
3 minimize the exposure of recipients to the need for acute
4 inpatient, custodial, and other institutional care and the
5 inappropriate or unnecessary use of high-cost services. The
6 agency shall contract with a vendor to monitor and evaluate
7 the clinical practice patterns of providers in order to
8 identify trends that are outside the normal practice patterns
9 of a provider's professional peers or the national guidelines
10 of a provider's professional association. The vendor must be
11 able to provide information and counseling to a provider whose
12 practice patterns are outside the norms, in consultation with
13 the agency, to improve patient care and reduce inappropriate
14 utilization. The agency may mandate prior authorization, drug
15 therapy management, or disease management participation for
16 certain populations of Medicaid beneficiaries, certain drug
17 classes, or particular drugs to prevent fraud, abuse, overuse,
18 and possible dangerous drug interactions. The Pharmaceutical
19 and Therapeutics Committee shall make recommendations to the
20 agency on drugs for which prior authorization is required. The
21 agency shall inform the Pharmaceutical and Therapeutics
22 Committee of its decisions regarding drugs subject to prior
23 authorization. The agency is authorized to limit the entities
24 it contracts with or enrolls as Medicaid providers by
25 developing a provider network through provider credentialing.
26 The agency may competitively bid single-source-provider
27 contracts if procurement of goods or services results in
28 demonstrated cost savings to the state without limiting access
29 to care. The agency may limit its network based on the
30 assessment of beneficiary access to care, provider
31 availability, provider quality standards, time and distance
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Florida Senate - 2006 SB 2226
34-1155A-06
1 standards for access to care, the cultural competence of the
2 provider network, demographic characteristics of Medicaid
3 beneficiaries, practice and provider-to-beneficiary standards,
4 appointment wait times, beneficiary use of services, provider
5 turnover, provider profiling, provider licensure history,
6 previous program integrity investigations and findings, peer
7 review, provider Medicaid policy and billing compliance
8 records, clinical and medical record audits, and other
9 factors. Providers shall not be entitled to enrollment in the
10 Medicaid provider network. The agency shall determine
11 instances in which allowing Medicaid beneficiaries to purchase
12 durable medical equipment and other goods is less expensive to
13 the Medicaid program than long-term rental of the equipment or
14 goods. The agency may establish rules to facilitate purchases
15 in lieu of long-term rentals in order to protect against fraud
16 and abuse in the Medicaid program as defined in s. 409.913.
17 The agency may seek federal waivers necessary to administer
18 these policies.
19 (51) The agency shall work with the Agency for Persons
20 with Disabilities to develop a model home and community-based
21 waiver to serve children and adults who are diagnosed with
22 familial dysautonomia or Riley-Day syndrome caused by a
23 mutation of the IKBKAP gene on chromosome 9. The agency shall
24 seek federal waiver approval and implement the approved waiver
25 subject to the availability of funds and any limitations
26 provided in the General Appropriations Act. The agency may
27 adopt rules to implement this waiver program.
28 Section 2. The sums of $171,840 from the General
29 Revenue Fund and $246,160 from the Medical Care Trust Fund are
30 appropriated to the Agency for Health Care Administration for
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Florida Senate - 2006 SB 2226
34-1155A-06
1 the purpose of implementing this act during the 2006-2007
2 fiscal year.
3 Section 3. This act shall take effect upon becoming a
4 law.
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7 SENATE SUMMARY
8 Requires the Agency for Health Care Administration to
develop a waiver program to serve children and adults
9 with specified disorders. Requires the agency to seek
federal approval and implement the approved waiver
10 without being subject to the availability of funds and
certain limitations. Provides an appropriation.
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