Amendment
Bill No. 5007

Amendment No. 549523

CHAMBER ACTION
Senate		House
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1	The Conference Committee on HB 5007 offered the following:
2
3	Conference Committee Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Subsection (16) of section 391.026, Florida
6	Statutes, is amended to read:
7	391.026  Powers and duties of the department.--The
8	department shall have the following powers, duties, and
9	responsibilities:
10	(16)  To receive and manage health care premiums,
11	capitation payments, and funds from federal, state, local, and
12	private entities for the program. The department may contract
13	with a third-party administrator for processing claims,
14	monitoring medical expenses, and other related services
15	necessary to the efficient and cost-effective operation of the
16	Children's Medical Services network. The department is
17	authorized to maintain a minimum reserve for the Children's
18	Medical Services network in an amount that is the greater of:
19	(a)  Ten percent of total projected expenditures for Title
20	XIX-funded and Title XXI-funded children; or
21	(b)  Two percent of total annualized payments from the
22	Agency for Health Care Administration for Title XIX and Title
23	XXI of the Social Security Act.
24	Section 2.  Paragraph (e) of subsection (15) of section
25	400.141, Florida Statutes, is amended to read:
26	400.141  Administration and management of nursing home
27	facilities.--Every licensed facility shall comply with all
28	applicable standards and rules of the agency and shall:
29	(15)  Submit semiannually to the agency, or more frequently
30	if requested by the agency, information regarding facility
31	staff-to-resident ratios, staff turnover, and staff stability,
32	including information regarding certified nursing assistants,
33	licensed nurses, the director of nursing, and the facility
34	administrator. For purposes of this reporting:
35	(e)  A nursing facility which does not have a conditional
36	license may be cited for failure to comply with the standards in
37	s. 400.23(3)(a)1.a. only if it has failed to meet those
38	standards on 2 consecutive days or if it has failed to meet at
39	least 97 percent of those standards on any one day.
40
41	Nothing in this section shall limit the agency's ability to
42	impose a deficiency or take other actions if a facility does not
43	have enough staff to meet the residents' needs.
44
45	Facilities that have been awarded a Gold Seal under the program
46	established in s. 400.235 may develop a plan to provide
47	certified nursing assistant training as prescribed by federal
48	regulations and state rules and may apply to the agency for
49	approval of their program.
50	Section 3.  Paragraph (d) of subsection (5) of section
51	400.179, Florida Statutes, is amended to read:
52	400.179  Sale or transfer of ownership of a nursing
53	facility; liability for Medicaid underpayments and
54	overpayments.--
55	(5)  Because any transfer of a nursing facility may expose
56	the fact that Medicaid may have underpaid or overpaid the
57	transferor, and because in most instances, any such underpayment
58	or overpayment can only be determined following a formal field
59	audit, the liabilities for any such underpayments or
60	overpayments shall be as follows:
61	(d)  Where the transfer involves a facility that has been
62	leased by the transferor:
63	1.  The transferee shall, as a condition to being issued a
64	license by the agency, acquire, maintain, and provide proof to
65	the agency of a bond with a term of 30 months, renewable
66	annually, in an amount not less than the total of 3 months'
67	months Medicaid payments to the facility computed on the basis
68	of the preceding 12-month average Medicaid payments to the
69	facility.
70	2.  A leasehold licensee may meet the requirements of
71	subparagraph 1. by payment of a nonrefundable fee, paid at
72	initial licensure, paid at the time of any subsequent change of
73	ownership, and paid at the time of any subsequent annual license
74	renewal, in the amount of 1 2 percent of the total of 3 months'
75	Medicaid payments to the facility computed on the basis of the
76	preceding 12-month average Medicaid payments to the facility. If
77	a preceding 12-month average is not available, projected
78	Medicaid payments may be used. The fee shall be deposited into
79	the Health Care Trust Fund and shall be accounted for separately
80	as a Medicaid nursing home overpayment account. These fees shall
81	be used at the sole discretion of the agency to repay nursing
82	home Medicaid overpayments. Payment of this fee shall not
83	release the licensee from any liability for any Medicaid
84	overpayments, nor shall payment bar the agency from seeking to
85	recoup overpayments from the licensee and any other liable
86	party. As a condition of exercising this lease bond alternative,
87	licensees paying this fee must maintain an existing lease bond
88	through the end of the 30-month term period of that bond. The
89	agency is herein granted specific authority to promulgate all
90	rules pertaining to the administration and management of this
91	account, including withdrawals from the account, subject to
92	federal review and approval. This provision shall take effect
93	upon becoming law and shall apply to any leasehold license
94	application. The financial viability of the Medicaid nursing
95	home overpayment account shall be determined by the agency
96	through annual review of the account balance and the amount of
97	total outstanding, unpaid Medicaid overpayments owing from
98	leasehold licensees to the agency as determined by final agency
99	audits.
100	3.  The leasehold licensee may meet the bond requirement
101	through other arrangements acceptable to the agency. The agency
102	is herein granted specific authority to promulgate rules
103	pertaining to lease bond arrangements.
104	4.  All existing nursing facility licensees, operating the
105	facility as a leasehold, shall acquire, maintain, and provide
106	proof to the agency of the 30-month bond required in
107	subparagraph 1., above, on and after July 1, 1993, for each
108	license renewal.
109	5.  It shall be the responsibility of all nursing facility
110	operators, operating the facility as a leasehold, to renew the
111	30-month bond and to provide proof of such renewal to the agency
112	annually at the time of application for license renewal.
113	6.  Any failure of the nursing facility operator to
114	acquire, maintain, renew annually, or provide proof to the
115	agency shall be grounds for the agency to deny, cancel, revoke,
116	or suspend the facility license to operate such facility and to
117	take any further action, including, but not limited to,
118	enjoining the facility, asserting a moratorium, or applying for
119	a receiver, deemed necessary to ensure compliance with this
120	section and to safeguard and protect the health, safety, and
121	welfare of the facility's residents. A lease agreement required
122	as a condition of bond financing or refinancing under s. 154.213
123	by a health facilities authority or required under s. 159.30 by
124	a county or municipality is not a leasehold for purposes of this
125	paragraph and is not subject to the bond requirement of this
126	paragraph.
127	Section 4.  Paragraph (a) of subsection (3) of section
128	400.23, Florida Statutes, is amended to read:
129	400.23  Rules; evaluation and deficiencies; licensure
130	status.--
131	(3)(a)1.  The agency shall adopt rules providing minimum
132	staffing requirements for nursing homes. These requirements
133	shall include, for each nursing home facility:,
134	a.  A minimum certified nursing assistant staffing of 2.3
135	hours of direct care per resident per day beginning January 1,
136	2002, increasing to 2.6 hours of direct care per resident per
137	day beginning January 1, 2003, and increasing to 2.7 2.9 hours
138	of direct care per resident per day beginning January 1, 2007
139	July 1, 2006. Beginning January 1, 2002, no facility shall staff
140	below one certified nursing assistant per 20 residents, and a
141	minimum licensed nursing staffing of 1.0 hour of direct resident
142	care per resident per day but never below one licensed nurse per
143	40 residents.
144	b.  Beginning January 1, 2007, a minimum weekly average
145	certified nursing assistant staffing of 2.9 hours of direct care
146	per resident per day. For the purpose of this sub-subparagraph,
147	a week is defined as Sunday through Saturday.
148	2.  Nursing assistants employed under s. 400.211(2) may be
149	included in computing the staffing ratio for certified nursing
150	assistants only if their job responsibilities include only
151	nursing-assistant-related duties they provide nursing assistance
152	services to residents on a full-time basis.
153	3.  Each nursing home must document compliance with
154	staffing standards as required under this paragraph and post
155	daily the names of staff on duty for the benefit of facility
156	residents and the public.
157	4.  The agency shall recognize the use of licensed nurses
158	for compliance with minimum staffing requirements for certified
159	nursing assistants, provided that the facility otherwise meets
160	the minimum staffing requirements for licensed nurses and that
161	the licensed nurses are performing the duties of a certified
162	nursing assistant. Unless otherwise approved by the agency,
163	licensed nurses counted toward the minimum staffing requirements
164	for certified nursing assistants must exclusively perform the
165	duties of a certified nursing assistant for the entire shift and
166	not also be counted toward the minimum staffing requirements for
167	licensed nurses. If the agency approved a facility's request to
168	use a licensed nurse to perform both licensed nursing and
169	certified nursing assistant duties, the facility must allocate
170	the amount of staff time specifically spent on certified nursing
171	assistant duties for the purpose of documenting compliance with
172	minimum staffing requirements for certified and licensed nursing
173	staff. In no event may the hours of a licensed nurse with dual
174	job responsibilities be counted twice.
175	Section 5.  Subsections (12) through (27) of section
176	409.811, Florida Statutes, are renumbered as subsections (11)
177	through (26), respectively, and present subsection (11) of that
178	section is amended to read:
179	409.811  Definitions relating to Florida KidCare Act.--As
180	used in ss. 409.810-409.820, the term:
181	(11)  "Enrollment ceiling" means the maximum number of
182	children receiving premium assistance payments, excluding
183	children enrolled in Medicaid, that may be enrolled at any time
184	in the Florida KidCare program. The maximum number shall be
185	established annually in the General Appropriations Act or by
186	general law.
187	Section 6.  Subsections (1) and (2) of section 409.8134,
188	Florida Statutes, are amended to read:
189	409.8134  Program enrollment and expenditure ceiling
190	ceilings.--
191	(1)  Except for the Medicaid program, a ceiling shall be
192	placed on annual federal and state expenditures for and on
193	enrollment in the Florida KidCare program as provided each year
194	in the General Appropriations Act.
195	(2)  The Florida KidCare program may conduct enrollment at
196	any time throughout the year for the purpose of enrolling
197	children eligible for all program components listed in s.
198	409.813 except Medicaid. The four Florida KidCare administrators
199	shall work together to ensure that the year-round enrollment
200	period is announced statewide. Eligible children shall be
201	enrolled on a first-come, first-served basis using the date the
202	enrollment application is received. Enrollment shall immediately
203	cease when the expenditure enrollment ceiling is reached. Year-
204	round enrollment shall only be held if the Social Services
205	Estimating Conference determines that sufficient federal and
206	state funds will be available to finance the increased
207	enrollment through federal fiscal year 2007. Any individual who
208	is not enrolled must reapply by submitting a new application.
209	The application for the Florida KidCare program shall be valid
210	for a period of 120 days after the date it was received. At the
211	end of the 120-day period, if the applicant has not been
212	enrolled in the program, the application shall be invalid and
213	the applicant shall be notified of the action. The applicant may
214	resubmit the application after notification of the action taken
215	by the program. Except for the Medicaid program, whenever the
216	Social Services Estimating Conference determines that there are
217	presently, or will be by the end of the current fiscal year,
218	insufficient funds to finance the current or projected
219	enrollment in the Florida KidCare program, all additional
220	enrollment must cease and additional enrollment may not resume
221	until sufficient funds are available to finance such enrollment.
222	Section 7.  Paragraph (d) of subsection (5) of section
223	409.814, Florida Statutes, is amended to read:
224	409.814  Eligibility.--A child who has not reached 19 years
225	of age whose family income is equal to or below 200 percent of
226	the federal poverty level is eligible for the Florida KidCare
227	program as provided in this section. For enrollment in the
228	Children's Medical Services Network, a complete application
229	includes the medical or behavioral health screening. If,
230	subsequently, an individual is determined to be ineligible for
231	coverage, he or she must immediately be disenrolled from the
232	respective Florida KidCare program component.
233	(5)  A child whose family income is above 200 percent of
234	the federal poverty level or a child who is excluded under the
235	provisions of subsection (4) may participate in the Florida
236	KidCare program, excluding the Medicaid program, but is subject
237	to the following provisions:
238	(d)  Children described in this subsection are not counted
239	in the annual enrollment ceiling for the Florida KidCare
240	program.
241	Section 8.  Paragraphs (c) through (g) of subsection (3) of
242	section 409.818, Florida Statutes, are redesignated as
243	paragraphs (b) through (f), respectively, and present paragraphs
244	(b) and (g) of subsection (3) of that section are amended to
245	read:
246	409.818  Administration.--In order to implement ss.
247	409.810-409.820, the following agencies shall have the following
248	duties:
249	(3)  The Agency for Health Care Administration, under the
250	authority granted in s. 409.914(1), shall:
251	(b)  Annually calculate the program enrollment ceiling
252	based on estimated per child premium assistance payments and the
253	estimated appropriation available for the program.
254	(f)(g)  Adopt rules necessary for calculating premium
255	assistance payment levels, calculating the program enrollment
256	ceiling, making premium assistance payments, monitoring access
257	and quality assurance standards, investigating and resolving
258	complaints and grievances, administering the Medikids program,
259	and approving health benefits coverage.
260
261	The agency is designated the lead state agency for Title XXI of
262	the Social Security Act for purposes of receipt of federal
263	funds, for reporting purposes, and for ensuring compliance with
264	federal and state regulations and rules.
265	Section 9.  Subsection (5) of section 409.904, Florida
266	Statutes, is amended to read:
267	409.904  Optional payments for eligible persons.--The
268	agency may make payments for medical assistance and related
269	services on behalf of the following persons who are determined
270	to be eligible subject to the income, assets, and categorical
271	eligibility tests set forth in federal and state law. Payment on
272	behalf of these Medicaid eligible persons is subject to the
273	availability of moneys and any limitations established by the
274	General Appropriations Act or chapter 216.
275	(5)  Subject to specific federal authorization, a
276	postpartum woman living in a family that has an income that is
277	at or below 185 percent of the most current federal poverty
278	level is eligible for family planning services as specified in
279	s. 409.905(3) for a period of up to 24 months following a loss
280	of Medicaid benefits pregnancy for which Medicaid paid for
281	pregnancy-related services.
282	Section 10.  Paragraph (d) of subsection (5) of section
283	409.905, Florida Statutes, is amended to read:
284	409.905  Mandatory Medicaid services.--The agency may make
285	payments for the following services, which are required of the
286	state by Title XIX of the Social Security Act, furnished by
287	Medicaid providers to recipients who are determined to be
288	eligible on the dates on which the services were provided. Any
289	service under this section shall be provided only when medically
290	necessary and in accordance with state and federal law.
291	Mandatory services rendered by providers in mobile units to
292	Medicaid recipients may be restricted by the agency. Nothing in
293	this section shall be construed to prevent or limit the agency
294	from adjusting fees, reimbursement rates, lengths of stay,
295	number of visits, number of services, or any other adjustments
296	necessary to comply with the availability of moneys and any
297	limitations or directions provided for in the General
298	Appropriations Act or chapter 216.
299	(5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay for
300	all covered services provided for the medical care and treatment
301	of a recipient who is admitted as an inpatient by a licensed
302	physician or dentist to a hospital licensed under part I of
303	chapter 395. However, the agency shall limit the payment for
304	inpatient hospital services for a Medicaid recipient 21 years of
305	age or older to 45 days or the number of days necessary to
306	comply with the General Appropriations Act.
307	(d)  The agency shall implement a hospitalist program in
308	nonteaching certain high-volume participating hospitals, select
309	counties, or statewide. The program shall require hospitalists
310	to authorize and manage Medicaid recipients' hospital admissions
311	and lengths of stay. Individuals who are dually eligible for
312	Medicare and Medicaid are exempted from this requirement.
313	Medicaid participating physicians and other practitioners with
314	hospital admitting privileges shall coordinate and review
315	admissions of Medicaid recipients with the hospitalist. The
316	agency may competitively bid a contract for selection of a
317	single qualified organization to provide hospitalist services.
318	The agency may procure hospitalist services by individual county
319	or may combine counties in a single procurement. The qualified
320	organization shall contract with or employ board-eligible board
321	certified physicians in Miami-Dade, Palm Beach, Hillsborough,
322	Pasco, and Pinellas Counties who are full-time dedicated
323	employees of the contractor and have no outside practice. Where
324	used, the hospitalist program shall replace the existing
325	hospital utilization review program. The agency is authorized to
326	seek federal waivers to implement this program.
327	Section 11.  Paragraph (b) of subsection (1) and
328	subsections (12) and (23) of section 409.906, Florida Statutes,
329	are amended to read:
330	409.906  Optional Medicaid services.--Subject to specific
331	appropriations, the agency may make payments for services which
332	are optional to the state under Title XIX of the Social Security
333	Act and are furnished by Medicaid providers to recipients who
334	are determined to be eligible on the dates on which the services
335	were provided. Any optional service that is provided shall be
336	provided only when medically necessary and in accordance with
337	state and federal law. Optional services rendered by providers
338	in mobile units to Medicaid recipients may be restricted or
339	prohibited by the agency. Nothing in this section shall be
340	construed to prevent or limit the agency from adjusting fees,
341	reimbursement rates, lengths of stay, number of visits, or
342	number of services, or making any other adjustments necessary to
343	comply with the availability of moneys and any limitations or
344	directions provided for in the General Appropriations Act or
345	chapter 216. If necessary to safeguard the state's systems of
346	providing services to elderly and disabled persons and subject
347	to the notice and review provisions of s. 216.177, the Governor
348	may direct the Agency for Health Care Administration to amend
349	the Medicaid state plan to delete the optional Medicaid service
350	known as "Intermediate Care Facilities for the Developmentally
351	Disabled." Optional services may include:
352	(1)  ADULT DENTAL SERVICES.--
353	(b)  Beginning July 1, 2006 January 1, 2005, the agency may
354	pay for full or partial dentures, the procedures required to
355	seat full or partial dentures, and the repair and reline of full
356	or partial dentures, provided by or under the direction of a
357	licensed dentist, for a recipient who is 21 years of age or
358	older.
359	(12)  CHILDREN'S HEARING SERVICES.--The agency may pay for
360	hearing and related services, including hearing evaluations,
361	hearing aid devices, dispensing of the hearing aid, and related
362	repairs, if provided to a recipient younger than 21 years of age
363	by a licensed hearing aid specialist, otolaryngologist,
364	otologist, audiologist, or physician.
365	(23)  CHILDREN'S VISUAL SERVICES.--The agency may pay for
366	visual examinations, eyeglasses, and eyeglass repairs for a
367	recipient younger than 21 years of age, if they are prescribed
368	by a licensed physician specializing in diseases of the eye or
369	by a licensed optometrist. Eyeglasses for adult recipients shall
370	be limited to two pairs per year per recipient, except a third
371	pair may be provided after prior authorization.
372	Section 12.  Paragraph (a) of subsection (9) of section
373	409.907, Florida Statutes, is amended to read:
374	409.907  Medicaid provider agreements.--The agency may make
375	payments for medical assistance and related services rendered to
376	Medicaid recipients only to an individual or entity who has a
377	provider agreement in effect with the agency, who is performing
378	services or supplying goods in accordance with federal, state,
379	and local law, and who agrees that no person shall, on the
380	grounds of handicap, race, color, or national origin, or for any
381	other reason, be subjected to discrimination under any program
382	or activity for which the provider receives payment from the
383	agency.
384	(9)  Upon receipt of a completed, signed, and dated
385	application, and completion of any necessary background
386	investigation and criminal history record check, the agency must
387	either:
388	(a)  Enroll the applicant as a Medicaid provider no earlier
389	than the effective date of the approval of the provider
390	application. With respect to providers who were recently granted
391	a change of ownership and those who primarily provide emergency
392	medical services transportation or emergency services and care
393	pursuant to s. 395.1041 or s. 401.45, or services provided by
394	entities under s. 409.91255, and out-of-state providers, upon
395	approval of the provider application., The enrollment effective
396	date shall be of approval is considered to be the date the
397	agency receives the provider application. Payment for any claims
398	for services provided to Medicaid recipients between the date of
399	receipt of the application and the date of approval is
400	contingent on applying any and all applicable audits and edits
401	contained in the agency's claims adjudication and payment
402	processing systems; or
403	Section 13.  Paragraph (b) of subsection (2) of section
404	409.908, Florida Statutes, is amended to read:
405	409.908  Reimbursement of Medicaid providers.--Subject to
406	specific appropriations, the agency shall reimburse Medicaid
407	providers, in accordance with state and federal law, according
408	to methodologies set forth in the rules of the agency and in
409	policy manuals and handbooks incorporated by reference therein.
410	These methodologies may include fee schedules, reimbursement
411	methods based on cost reporting, negotiated fees, competitive
412	bidding pursuant to s. 287.057, and other mechanisms the agency
413	considers efficient and effective for purchasing services or
414	goods on behalf of recipients. If a provider is reimbursed based
415	on cost reporting and submits a cost report late and that cost
416	report would have been used to set a lower reimbursement rate
417	for a rate semester, then the provider's rate for that semester
418	shall be retroactively calculated using the new cost report, and
419	full payment at the recalculated rate shall be effected
420	retroactively. Medicare-granted extensions for filing cost
421	reports, if applicable, shall also apply to Medicaid cost
422	reports. Payment for Medicaid compensable services made on
423	behalf of Medicaid eligible persons is subject to the
424	availability of moneys and any limitations or directions
425	provided for in the General Appropriations Act or chapter 216.
426	Further, nothing in this section shall be construed to prevent
427	or limit the agency from adjusting fees, reimbursement rates,
428	lengths of stay, number of visits, or number of services, or
429	making any other adjustments necessary to comply with the
430	availability of moneys and any limitations or directions
431	provided for in the General Appropriations Act, provided the
432	adjustment is consistent with legislative intent.
433	(2)
434	(b)  Subject to any limitations or directions provided for
435	in the General Appropriations Act, the agency shall establish
436	and implement a Florida Title XIX Long-Term Care Reimbursement
437	Plan (Medicaid) for nursing home care in order to provide care
438	and services in conformance with the applicable state and
439	federal laws, rules, regulations, and quality and safety
440	standards and to ensure that individuals eligible for medical
441	assistance have reasonable geographic access to such care.
442	1.  Changes of ownership or of licensed operator may or may
443	do not qualify for increases in reimbursement rates associated
444	with the change of ownership or of licensed operator. The agency
445	may shall amend the Title XIX Long Term Care Reimbursement Plan
446	to provide that the initial nursing home reimbursement rates,
447	for the operating, patient care, and MAR components, associated
448	with related and unrelated party changes of ownership or
449	licensed operator filed on or after September 1, 2001, are
450	equivalent to the previous owner's reimbursement rate.
451	2.  The agency shall amend the long-term care reimbursement
452	plan and cost reporting system to create direct care and
453	indirect care subcomponents of the patient care component of the
454	per diem rate. These two subcomponents together shall equal the
455	patient care component of the per diem rate. Separate cost-based
456	ceilings shall be calculated for each patient care subcomponent.
457	The direct care subcomponent of the per diem rate shall be
458	limited by the cost-based class ceiling, and the indirect care
459	subcomponent may shall be limited by the lower of the cost-based
460	class ceiling, the target rate class ceiling, or the individual
461	provider target.
462	3.  The direct care subcomponent shall include salaries and
463	benefits of direct care staff providing nursing services
464	including registered nurses, licensed practical nurses, and
465	certified nursing assistants who deliver care directly to
466	residents in the nursing home facility. This excludes nursing
467	administration, minimum data set, and care plan coordinators,
468	staff development, and staffing coordinator.
469	4.  All other patient care costs shall be included in the
470	indirect care cost subcomponent of the patient care per diem
471	rate. There shall be no costs directly or indirectly allocated
472	to the direct care subcomponent from a home office or management
473	company.
474	5.  On July 1 of each year, the agency shall report to the
475	Legislature direct and indirect care costs, including average
476	direct and indirect care costs per resident per facility and
477	direct care and indirect care salaries and benefits per category
478	of staff member per facility.
479	6.  In order to offset the cost of general and professional
480	liability insurance, the agency shall amend the plan to allow
481	for interim rate adjustments to reflect increases in the cost of
482	general or professional liability insurance for nursing homes.
483	This provision shall be implemented to the extent existing
484	appropriations are available.
485
486	It is the intent of the Legislature that the reimbursement plan
487	achieve the goal of providing access to health care for nursing
488	home residents who require large amounts of care while
489	encouraging diversion services as an alternative to nursing home
490	care for residents who can be served within the community. The
491	agency shall base the establishment of any maximum rate of
492	payment, whether overall or component, on the available moneys
493	as provided for in the General Appropriations Act. The agency
494	may base the maximum rate of payment on the results of
495	scientifically valid analysis and conclusions derived from
496	objective statistical data pertinent to the particular maximum
497	rate of payment.
498	Section 14.  Paragraph (c) of subsection (1) of section
499	409.9081, Florida Statutes, is amended to read:
500	409.9081  Copayments.--
501	(1)  The agency shall require, subject to federal
502	regulations and limitations, each Medicaid recipient to pay at
503	the time of service a nominal copayment for the following
504	Medicaid services:
505	(c)  Hospital emergency department visits for nonemergency
506	care: 5 percent of up to the first $300 of the Medicaid payment
507	for emergency room services, not to exceed $15 for each
508	emergency department visit.
509	Section 15.  Subsections (2), (3), and (4) of section
510	409.911, Florida Statutes, are amended to read:
511	409.911  Disproportionate share program.--Subject to
512	specific allocations established within the General
513	Appropriations Act and any limitations established pursuant to
514	chapter 216, the agency shall distribute, pursuant to this
515	section, moneys to hospitals providing a disproportionate share
516	of Medicaid or charity care services by making quarterly
517	Medicaid payments as required. Notwithstanding the provisions of
518	s. 409.915, counties are exempt from contributing toward the
519	cost of this special reimbursement for hospitals serving a
520	disproportionate share of low-income patients.
521	(2)  The Agency for Health Care Administration shall use
522	the following actual audited data to determine the Medicaid days
523	and charity care to be used in calculating the disproportionate
524	share payment:
525	(a)  The average of the 1998, 1999, and 2000, 2001, and
526	2002 audited disproportionate share data to determine each
527	hospital's Medicaid days and charity care for the 2006-2007
528	2004-2005 state fiscal year and the average of the 1999, 2000,
529	and 2001 audited disproportionate share data to determine the
530	Medicaid days and charity care for the 2005-2006 state fiscal
531	year.
532	(b)  If the Agency for Health Care Administration does not
533	have the prescribed 3 years of audited disproportionate share
534	data as noted in paragraph (a) for a hospital, the agency shall
535	use the average of the years of the audited disproportionate
536	share data as noted in paragraph (a) which is available.
537	(c)  In accordance with s. 1923(b) of the Social Security
538	Act, a hospital with a Medicaid inpatient utilization rate
539	greater than one standard deviation above the statewide mean or
540	a hospital with a low-income utilization rate of 25 percent or
541	greater shall qualify for reimbursement.
542	(3)  Hospitals that qualify for a disproportionate share
543	payment solely under paragraph (2)(c) shall have their payment
544	calculated in accordance with the following formulas:
545
546	DSHP = (HMD/TMSD) x $1 million
547
548	Where:
549	DSHP = disproportionate share hospital payment.
550	HMD = hospital Medicaid days.
551	TSD = total state Medicaid days.
552
553	Any funds not allocated to hospitals qualifying under this
554	section shall be redistributed to the non-state government owned
555	or operated hospitals with greater than 3,100 3,300 Medicaid
556	days.
557	(4)  The following formulas shall be used to pay
558	disproportionate share dollars to public hospitals:
559	(a)  For state mental health hospitals:
560
561	DSHP = (HMD/TMDMH) x TAAMH
562
563	shall be the difference between the federal cap for Institutions
564	for Mental Diseases and the amounts paid under the mental health
565	disproportionate share program.
566
567	Where:
568	DSHP = disproportionate share hospital payment.
569	HMD = hospital Medicaid days.
570	TMDHH = total Medicaid days for state mental health
571	hospitals.
572	TAAMH = total amount available for mental health hospitals.
573	(b)  For non-state government owned or operated hospitals
574	with 3,100 3,300 or more Medicaid days:
575
576	DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)]
577	x TAAPH
578	TAAPH = TAA - TAAMH
579
580	Where:
581	TAA = total available appropriation.
582	TAAPH = total amount available for public hospitals.
583	DSHP = disproportionate share hospital payments.
584	HMD = hospital Medicaid days.
585	TMD = total state Medicaid days for public hospitals.
586	HCCD = hospital charity care dollars.
587	TCCD = total state charity care dollars for public non-
588	state hospitals.
589
590	1.  For the 2005-2006 state fiscal year only, the DSHP for
591	the public nonstate hospitals shall be computed using a weighted
592	average of the disproportionate share payments for the 2004-2005
593	state fiscal year which uses an average of the 1998, 1999, and
594	2000 audited disproportionate share data and the
595	disproportionate share payments for the 2005-2006 state fiscal
596	year as computed using the formula above and using the average
597	of the 1999, 2000, and 2001 audited disproportionate share data.
598	The final DSHP for the public nonstate hospitals shall be
599	computed as an average using the calculated payments for the
600	2005-2006 state fiscal year weighted at 65 percent and the
601	disproportionate share payments for the 2004-2005 state fiscal
602	year weighted at 35 percent.
603	2.  The TAAPH shall be reduced by $6,365,257 before
604	computing the DSHP for each public hospital. The $6,365,257
605	shall be distributed equally between the public hospitals that
606	are also designated statutory teaching hospitals.
607	(c)  For non-state government owned or operated hospitals
608	with less than 3,100 3,300 Medicaid days, a total of $750,000
609	shall be distributed equally among these hospitals.
610	Section 16.  Section 409.9113, Florida Statutes, is amended
611	to read:
612	409.9113  Disproportionate share program for teaching
613	hospitals.--In addition to the payments made under ss. 409.911
614	and 409.9112, the Agency for Health Care Administration shall
615	make disproportionate share payments to statutorily defined
616	teaching hospitals for their increased costs associated with
617	medical education programs and for tertiary health care services
618	provided to the indigent. This system of payments shall conform
619	with federal requirements and shall distribute funds in each
620	fiscal year for which an appropriation is made by making
621	quarterly Medicaid payments. Notwithstanding s. 409.915,
622	counties are exempt from contributing toward the cost of this
623	special reimbursement for hospitals serving a disproportionate
624	share of low-income patients. For the state fiscal year 2006-
625	2007 2005-2006, the agency shall not distribute the moneys
626	provided in the General Appropriations Act to statutorily
627	defined teaching hospitals and family practice teaching
628	hospitals under the teaching hospital disproportionate share
629	program. The funds provided for statutorily defined teaching
630	hospitals shall be distributed in the same proportion as the
631	state fiscal year 2003-2004 teaching hospital disproportionate
632	share funds were distributed. The funds provided for family
633	practice teaching hospitals shall be distributed equally among
634	family practice teaching hospitals.
635	(1)  On or before September 15 of each year, the Agency for
636	Health Care Administration shall calculate an allocation
637	fraction to be used for distributing funds to state statutory
638	teaching hospitals. Subsequent to the end of each quarter of the
639	state fiscal year, the agency shall distribute to each statutory
640	teaching hospital, as defined in s. 408.07, an amount determined
641	by multiplying one-fourth of the funds appropriated for this
642	purpose by the Legislature times such hospital's allocation
643	fraction. The allocation fraction for each such hospital shall
644	be determined by the sum of three primary factors, divided by
645	three. The primary factors are:
646	(a)  The number of nationally accredited graduate medical
647	education programs offered by the hospital, including programs
648	accredited by the Accreditation Council for Graduate Medical
649	Education and the combined Internal Medicine and Pediatrics
650	programs acceptable to both the American Board of Internal
651	Medicine and the American Board of Pediatrics at the beginning
652	of the state fiscal year preceding the date on which the
653	allocation fraction is calculated. The numerical value of this
654	factor is the fraction that the hospital represents of the total
655	number of programs, where the total is computed for all state
656	statutory teaching hospitals.
657	(b)  The number of full-time equivalent trainees in the
658	hospital, which comprises two components:
659	1.  The number of trainees enrolled in nationally
660	accredited graduate medical education programs, as defined in
661	paragraph (a). Full-time equivalents are computed using the
662	fraction of the year during which each trainee is primarily
663	assigned to the given institution, over the state fiscal year
664	preceding the date on which the allocation fraction is
665	calculated. The numerical value of this factor is the fraction
666	that the hospital represents of the total number of full-time
667	equivalent trainees enrolled in accredited graduate programs,
668	where the total is computed for all state statutory teaching
669	hospitals.
670	2.  The number of medical students enrolled in accredited
671	colleges of medicine and engaged in clinical activities,
672	including required clinical clerkships and clinical electives.
673	Full-time equivalents are computed using the fraction of the
674	year during which each trainee is primarily assigned to the
675	given institution, over the course of the state fiscal year
676	preceding the date on which the allocation fraction is
677	calculated. The numerical value of this factor is the fraction
678	that the given hospital represents of the total number of full-
679	time equivalent students enrolled in accredited colleges of
680	medicine, where the total is computed for all state statutory
681	teaching hospitals.
682
683	The primary factor for full-time equivalent trainees is computed
684	as the sum of these two components, divided by two.
685	(c)  A service index that comprises three components:
686	1.  The Agency for Health Care Administration Service
687	Index, computed by applying the standard Service Inventory
688	Scores established by the Agency for Health Care Administration
689	to services offered by the given hospital, as reported on
690	Worksheet A-2 for the last fiscal year reported to the agency
691	before the date on which the allocation fraction is calculated.
692	The numerical value of this factor is the fraction that the
693	given hospital represents of the total Agency for Health Care
694	Administration Service Index values, where the total is computed
695	for all state statutory teaching hospitals.
696	2.  A volume-weighted service index, computed by applying
697	the standard Service Inventory Scores established by the Agency
698	for Health Care Administration to the volume of each service,
699	expressed in terms of the standard units of measure reported on
700	Worksheet A-2 for the last fiscal year reported to the agency
701	before the date on which the allocation factor is calculated.
702	The numerical value of this factor is the fraction that the
703	given hospital represents of the total volume-weighted service
704	index values, where the total is computed for all state
705	statutory teaching hospitals.
706	3.  Total Medicaid payments to each hospital for direct
707	inpatient and outpatient services during the fiscal year
708	preceding the date on which the allocation factor is calculated.
709	This includes payments made to each hospital for such services
710	by Medicaid prepaid health plans, whether the plan was
711	administered by the hospital or not. The numerical value of this
712	factor is the fraction that each hospital represents of the
713	total of such Medicaid payments, where the total is computed for
714	all state statutory teaching hospitals.
715
716	The primary factor for the service index is computed as the sum
717	of these three components, divided by three.
718	(2)  By October 1 of each year, the agency shall use the
719	following formula to calculate the maximum additional
720	disproportionate share payment for statutorily defined teaching
721	hospitals:
722
723	TAP = THAF x A
724
725	Where:
726	TAP = total additional payment.
727	THAF = teaching hospital allocation factor.
728	A = amount appropriated for a teaching hospital
729	disproportionate share program.
730	Section 17.  Section 409.9117, Florida Statutes, is amended
731	to read:
732	409.9117  Primary care disproportionate share program.--For
733	the state fiscal year 2006-2007 2005-2006, the agency shall not
734	distribute moneys under the primary care disproportionate share
735	program.
736	(1)  If federal funds are available for disproportionate
737	share programs in addition to those otherwise provided by law,
738	there shall be created a primary care disproportionate share
739	program.
740	(2)  The following formula shall be used by the agency to
741	calculate the total amount earned for hospitals that participate
742	in the primary care disproportionate share program:
743
744	TAE = HDSP/THDSP
745
746	Where:
747	TAE = total amount earned by a hospital participating in
748	the primary care disproportionate share program.
749	HDSP = the prior state fiscal year primary care
750	disproportionate share payment to the individual hospital.
751	THDSP = the prior state fiscal year total primary care
752	disproportionate share payments to all hospitals.
753	(3)  The total additional payment for hospitals that
754	participate in the primary care disproportionate share program
755	shall be calculated by the agency as follows:
756
757	TAP = TAE x TA
758
759	Where:
760	TAP = total additional payment for a primary care hospital.
761	TAE = total amount earned by a primary care hospital.
762	TA = total appropriation for the primary care
763	disproportionate share program.
764	(4)  In the establishment and funding of this program, the
765	agency shall use the following criteria in addition to those
766	specified in s. 409.911, payments may not be made to a hospital
767	unless the hospital agrees to:
768	(a)  Cooperate with a Medicaid prepaid health plan, if one
769	exists in the community.
770	(b)  Ensure the availability of primary and specialty care
771	physicians to Medicaid recipients who are not enrolled in a
772	prepaid capitated arrangement and who are in need of access to
773	such physicians.
774	(c)  Coordinate and provide primary care services free of
775	charge, except copayments, to all persons with incomes up to 100
776	percent of the federal poverty level who are not otherwise
777	covered by Medicaid or another program administered by a
778	governmental entity, and to provide such services based on a
779	sliding fee scale to all persons with incomes up to 200 percent
780	of the federal poverty level who are not otherwise covered by
781	Medicaid or another program administered by a governmental
782	entity, except that eligibility may be limited to persons who
783	reside within a more limited area, as agreed to by the agency
784	and the hospital.
785	(d)  Contract with any federally qualified health center,
786	if one exists within the agreed geopolitical boundaries,
787	concerning the provision of primary care services, in order to
788	guarantee delivery of services in a nonduplicative fashion, and
789	to provide for referral arrangements, privileges, and
790	admissions, as appropriate. The hospital shall agree to provide
791	at an onsite or offsite facility primary care services within 24
792	hours to which all Medicaid recipients and persons eligible
793	under this paragraph who do not require emergency room services
794	are referred during normal daylight hours.
795	(e)  Cooperate with the agency, the county, and other
796	entities to ensure the provision of certain public health
797	services, case management, referral and acceptance of patients,
798	and sharing of epidemiological data, as the agency and the
799	hospital find mutually necessary and desirable to promote and
800	protect the public health within the agreed geopolitical
801	boundaries.
802	(f)  In cooperation with the county in which the hospital
803	resides, develop a low-cost, outpatient, prepaid health care
804	program to persons who are not eligible for the Medicaid
805	program, and who reside within the area.
806	(g)  Provide inpatient services to residents within the
807	area who are not eligible for Medicaid or Medicare, and who do
808	not have private health insurance, regardless of ability to pay,
809	on the basis of available space, except that nothing shall
810	prevent the hospital from establishing bill collection programs
811	based on ability to pay.
812	(h)  Work with the Florida Healthy Kids Corporation, the
813	Florida Health Care Purchasing Cooperative, and business health
814	coalitions, as appropriate, to develop a feasibility study and
815	plan to provide a low-cost comprehensive health insurance plan
816	to persons who reside within the area and who do not have access
817	to such a plan.
818	(i)  Work with public health officials and other experts to
819	provide community health education and prevention activities
820	designed to promote healthy lifestyles and appropriate use of
821	health services.
822	(j)  Work with the local health council to develop a plan
823	for promoting access to affordable health care services for all
824	persons who reside within the area, including, but not limited
825	to, public health services, primary care services, inpatient
826	services, and affordable health insurance generally.
827
828	Any hospital that fails to comply with any of the provisions of
829	this subsection, or any other contractual condition, may not
830	receive payments under this section until full compliance is
831	achieved.
832	Section 18.  Paragraph (a) of subsection (39) and
833	subsection (44) of section 409.912, Florida Statutes, are
834	amended to read:
835	409.912  Cost-effective purchasing of health care.--The
836	agency shall purchase goods and services for Medicaid recipients
837	in the most cost-effective manner consistent with the delivery
838	of quality medical care. To ensure that medical services are
839	effectively utilized, the agency may, in any case, require a
840	confirmation or second physician's opinion of the correct
841	diagnosis for purposes of authorizing future services under the
842	Medicaid program. This section does not restrict access to
843	emergency services or poststabilization care services as defined
844	in 42 C.F.R. part 438.114. Such confirmation or second opinion
845	shall be rendered in a manner approved by the agency. The agency
846	shall maximize the use of prepaid per capita and prepaid
847	aggregate fixed-sum basis services when appropriate and other
848	alternative service delivery and reimbursement methodologies,
849	including competitive bidding pursuant to s. 287.057, designed
850	to facilitate the cost-effective purchase of a case-managed
851	continuum of care. The agency shall also require providers to
852	minimize the exposure of recipients to the need for acute
853	inpatient, custodial, and other institutional care and the
854	inappropriate or unnecessary use of high-cost services. The
855	agency shall contract with a vendor to monitor and evaluate the
856	clinical practice patterns of providers in order to identify
857	trends that are outside the normal practice patterns of a
858	provider's professional peers or the national guidelines of a
859	provider's professional association. The vendor must be able to
860	provide information and counseling to a provider whose practice
861	patterns are outside the norms, in consultation with the agency,
862	to improve patient care and reduce inappropriate utilization.
863	The agency may mandate prior authorization, drug therapy
864	management, or disease management participation for certain
865	populations of Medicaid beneficiaries, certain drug classes, or
866	particular drugs to prevent fraud, abuse, overuse, and possible
867	dangerous drug interactions. The Pharmaceutical and Therapeutics
868	Committee shall make recommendations to the agency on drugs for
869	which prior authorization is required. The agency shall inform
870	the Pharmaceutical and Therapeutics Committee of its decisions
871	regarding drugs subject to prior authorization. The agency is
872	authorized to limit the entities it contracts with or enrolls as
873	Medicaid providers by developing a provider network through
874	provider credentialing. The agency may competitively bid single-
875	source-provider contracts if procurement of goods or services
876	results in demonstrated cost savings to the state without
877	limiting access to care. The agency may limit its network based
878	on the assessment of beneficiary access to care, provider
879	availability, provider quality standards, time and distance
880	standards for access to care, the cultural competence of the
881	provider network, demographic characteristics of Medicaid
882	beneficiaries, practice and provider-to-beneficiary standards,
883	appointment wait times, beneficiary use of services, provider
884	turnover, provider profiling, provider licensure history,
885	previous program integrity investigations and findings, peer
886	review, provider Medicaid policy and billing compliance records,
887	clinical and medical record audits, and other factors. Providers
888	shall not be entitled to enrollment in the Medicaid provider
889	network. The agency shall determine instances in which allowing
890	Medicaid beneficiaries to purchase durable medical equipment and
891	other goods is less expensive to the Medicaid program than long-
892	term rental of the equipment or goods. The agency may establish
893	rules to facilitate purchases in lieu of long-term rentals in
894	order to protect against fraud and abuse in the Medicaid program
895	as defined in s. 409.913. The agency may seek federal waivers
896	necessary to administer these policies.
897	(39)(a)  The agency shall implement a Medicaid prescribed-
898	drug spending-control program that includes the following
899	components:
900	1.  A Medicaid preferred drug list, which shall be a
901	listing of cost-effective therapeutic options recommended by the
902	Medicaid Pharmacy and Therapeutics Committee established
903	pursuant to s. 409.91195 and adopted by the agency for each
904	therapeutic class on the preferred drug list. At the discretion
905	of the committee, and when feasible, the preferred drug list
906	should include at least two products in a therapeutic class. The
907	agency may post the preferred drug list and updates to the
908	preferred drug list on an Internet website without following the
909	rulemaking procedures of chapter 120. Antiretroviral agents are
910	excluded from the preferred drug list. The agency shall also
911	limit the amount of a prescribed drug dispensed to no more than
912	a 34-day supply unless the drug products' smallest marketed
913	package is greater than a 34-day supply, or the drug is
914	determined by the agency to be a maintenance drug in which case
915	a 100-day maximum supply may be authorized. The agency is
916	authorized to seek any federal waivers necessary to implement
917	these cost-control programs and to continue participation in the
918	federal Medicaid rebate program, or alternatively to negotiate
919	state-only manufacturer rebates. The agency may adopt rules to
920	implement this subparagraph. The agency shall continue to
921	provide unlimited contraceptive drugs and items. The agency must
922	establish procedures to ensure that:
923	a.  There will be a response to a request for prior
924	consultation by telephone or other telecommunication device
925	within 24 hours after receipt of a request for prior
926	consultation; and
927	b.  A 72-hour supply of the drug prescribed will be
928	provided in an emergency or when the agency does not provide a
929	response within 24 hours as required by sub-subparagraph a.
930	2.  Reimbursement to pharmacies for Medicaid prescribed
931	drugs shall be set at the lesser of: the average wholesale price
932	(AWP) minus 15.4 percent, the wholesaler acquisition cost (WAC)
933	plus 5.75 percent, the federal upper limit (FUL), the state
934	maximum allowable cost (SMAC), or the usual and customary (UAC)
935	charge billed by the provider.
936	3.  The agency shall develop and implement a process for
937	managing the drug therapies of Medicaid recipients who are using
938	significant numbers of prescribed drugs each month. The
939	management process may include, but is not limited to,
940	comprehensive, physician-directed medical-record reviews, claims
941	analyses, and case evaluations to determine the medical
942	necessity and appropriateness of a patient's treatment plan and
943	drug therapies. The agency may contract with a private
944	organization to provide drug-program-management services. The
945	Medicaid drug benefit management program shall include
946	initiatives to manage drug therapies for HIV/AIDS patients,
947	patients using 20 or more unique prescriptions in a 180-day
948	period, and the top 1,000 patients in annual spending. The
949	agency shall enroll any Medicaid recipient in the drug benefit
950	management program if he or she meets the specifications of this
951	provision and is not enrolled in a Medicaid health maintenance
952	organization.
953	4.  The agency may limit the size of its pharmacy network
954	based on need, competitive bidding, price negotiations,
955	credentialing, or similar criteria. The agency shall give
956	special consideration to rural areas in determining the size and
957	location of pharmacies included in the Medicaid pharmacy
958	network. A pharmacy credentialing process may include criteria
959	such as a pharmacy's full-service status, location, size,
960	patient educational programs, patient consultation, disease
961	management services, and other characteristics. The agency may
962	impose a moratorium on Medicaid pharmacy enrollment when it is
963	determined that it has a sufficient number of Medicaid-
964	participating providers. The agency must allow dispensing
965	practitioners to participate as a part of the Medicaid pharmacy
966	network regardless of the practitioner's proximity to any other
967	entity that is dispensing prescription drugs under the Medicaid
968	program. A dispensing practitioner must meet all credentialing
969	requirements applicable to his or her practice, as determined by
970	the agency.
971	5.  The agency shall develop and implement a program that
972	requires Medicaid practitioners who prescribe drugs to use a
973	counterfeit-proof prescription pad for Medicaid prescriptions.
974	The agency shall require the use of standardized counterfeit-
975	proof prescription pads by Medicaid-participating prescribers or
976	prescribers who write prescriptions for Medicaid recipients. The
977	agency may implement the program in targeted geographic areas or
978	statewide.
979	6.  The agency may enter into arrangements that require
980	manufacturers of generic drugs prescribed to Medicaid recipients
981	to provide rebates of at least 15.1 percent of the average
982	manufacturer price for the manufacturer's generic products.
983	These arrangements shall require that if a generic-drug
984	manufacturer pays federal rebates for Medicaid-reimbursed drugs
985	at a level below 15.1 percent, the manufacturer must provide a
986	supplemental rebate to the state in an amount necessary to
987	achieve a 15.1-percent rebate level.
988	7.  The agency may establish a preferred drug list as
989	described in this subsection, and, pursuant to the establishment
990	of such preferred drug list, it is authorized to negotiate
991	supplemental rebates from manufacturers that are in addition to
992	those required by Title XIX of the Social Security Act and at no
993	less than 14 percent of the average manufacturer price as
994	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
995	the federal or supplemental rebate, or both, equals or exceeds
996	29 percent. There is no upper limit on the supplemental rebates
997	the agency may negotiate. The agency may determine that specific
998	products, brand-name or generic, are competitive at lower rebate
999	percentages. Agreement to pay the minimum supplemental rebate
1000	percentage will guarantee a manufacturer that the Medicaid
1001	Pharmaceutical and Therapeutics Committee will consider a
1002	product for inclusion on the preferred drug list. However, a
1003	pharmaceutical manufacturer is not guaranteed placement on the
1004	preferred drug list by simply paying the minimum supplemental
1005	rebate. Agency decisions will be made on the clinical efficacy
1006	of a drug and recommendations of the Medicaid Pharmaceutical and
1007	Therapeutics Committee, as well as the price of competing
1008	products minus federal and state rebates. The agency is
1009	authorized to contract with an outside agency or contractor to
1010	conduct negotiations for supplemental rebates. For the purposes
1011	of this section, the term "supplemental rebates" means cash
1012	rebates. Effective July 1, 2004, value-added programs as a
1013	substitution for supplemental rebates are prohibited. The agency
1014	is authorized to seek any federal waivers to implement this
1015	initiative.
1016	8.  The Agency for Health Care Administration shall expand
1017	home delivery of pharmacy products. To assist Medicaid patients
1018	in securing their prescriptions and reduce program costs, the
1019	agency shall expand its current mail-order-pharmacy diabetes-
1020	supply program to include all generic and brand-name drugs used
1021	by Medicaid patients with diabetes. Medicaid recipients in the
1022	current program may obtain nondiabetes drugs on a voluntary
1023	basis. This initiative is limited to the geographic area covered
1024	by the current contract. The agency may seek and implement any
1025	federal waivers necessary to implement this subparagraph.
1026	9.  The agency shall limit to one dose per month any drug
1027	prescribed to treat erectile dysfunction.
1028	10.a.  The agency may implement a Medicaid behavioral drug
1029	management system. The agency may contract with a vendor that
1030	has experience in operating behavioral drug management systems
1031	to implement this program. The agency is authorized to seek
1032	federal waivers to implement this program.
1033	b.  The agency, in conjunction with the Department of
1034	Children and Family Services, may implement the Medicaid
1035	behavioral drug management system that is designed to improve
1036	the quality of care and behavioral health prescribing practices
1037	based on best practice guidelines, improve patient adherence to
1038	medication plans, reduce clinical risk, and lower prescribed
1039	drug costs and the rate of inappropriate spending on Medicaid
1040	behavioral drugs. The program may include the following
1041	elements:
1042	(I)  Provide for the development and adoption of best
1043	practice guidelines for behavioral health-related drugs such as
1044	antipsychotics, antidepressants, and medications for treating
1045	bipolar disorders and other behavioral conditions; translate
1046	them into practice; review behavioral health prescribers and
1047	compare their prescribing patterns to a number of indicators
1048	that are based on national standards; and determine deviations
1049	from best practice guidelines.
1050	(II)  Implement processes for providing feedback to and
1051	educating prescribers using best practice educational materials
1052	and peer-to-peer consultation.
1053	(III)  Assess Medicaid beneficiaries who are outliers in
1054	their use of behavioral health drugs with regard to the numbers
1055	and types of drugs taken, drug dosages, combination drug
1056	therapies, and other indicators of improper use of behavioral
1057	health drugs.
1058	(IV)  Alert prescribers to patients who fail to refill
1059	prescriptions in a timely fashion, are prescribed multiple same-
1060	class behavioral health drugs, and may have other potential
1061	medication problems.
1062	(V)  Track spending trends for behavioral health drugs and
1063	deviation from best practice guidelines.
1064	(VI)  Use educational and technological approaches to
1065	promote best practices, educate consumers, and train prescribers
1066	in the use of practice guidelines.
1067	(VII)  Disseminate electronic and published materials.
1068	(VIII)  Hold statewide and regional conferences.
1069	(IX)  Implement a disease management program with a model
1070	quality-based medication component for severely mentally ill
1071	individuals and emotionally disturbed children who are high
1072	users of care.
1073	11.a.  The agency shall implement a Medicaid prescription
1074	drug management system. The agency may contract with a vendor
1075	that has experience in operating prescription drug management
1076	systems in order to implement this system. Any management system
1077	that is implemented in accordance with this subparagraph must
1078	rely on cooperation between physicians and pharmacists to
1079	determine appropriate practice patterns and clinical guidelines
1080	to improve the prescribing, dispensing, and use of drugs in the
1081	Medicaid program. The agency may seek federal waivers to
1082	implement this program.
1083	b.  The drug management system must be designed to improve
1084	the quality of care and prescribing practices based on best
1085	practice guidelines, improve patient adherence to medication
1086	plans, reduce clinical risk, and lower prescribed drug costs and
1087	the rate of inappropriate spending on Medicaid prescription
1088	drugs. The program must:
1089	(I)  Provide for the development and adoption of best
1090	practice guidelines for the prescribing and use of drugs in the
1091	Medicaid program, including translating best practice guidelines
1092	into practice; reviewing prescriber patterns and comparing them
1093	to indicators that are based on national standards and practice
1094	patterns of clinical peers in their community, statewide, and
1095	nationally; and determine deviations from best practice
1096	guidelines.
1097	(II)  Implement processes for providing feedback to and
1098	educating prescribers using best practice educational materials
1099	and peer-to-peer consultation.
1100	(III)  Assess Medicaid recipients who are outliers in their
1101	use of a single or multiple prescription drugs with regard to
1102	the numbers and types of drugs taken, drug dosages, combination
1103	drug therapies, and other indicators of improper use of
1104	prescription drugs.
1105	(IV)  Alert prescribers to patients who fail to refill
1106	prescriptions in a timely fashion, are prescribed multiple drugs
1107	that may be redundant or contraindicated, or may have other
1108	potential medication problems.
1109	(V)  Track spending trends for prescription drugs and
1110	deviation from best practice guidelines.
1111	(VI)  Use educational and technological approaches to
1112	promote best practices, educate consumers, and train prescribers
1113	in the use of practice guidelines.
1114	(VII)  Disseminate electronic and published materials.
1115	(VIII)  Hold statewide and regional conferences.
1116	(IX)  Implement disease management programs in cooperation
1117	with physicians and pharmacists, along with a model quality-
1118	based medication component for individuals having chronic
1119	medical conditions.
1120	12.  The agency is authorized to contract for drug rebate
1121	administration, including, but not limited to, calculating
1122	rebate amounts, invoicing manufacturers, negotiating disputes
1123	with manufacturers, and maintaining a database of rebate
1124	collections.
1125	13.  The agency may specify the preferred daily dosing form
1126	or strength for the purpose of promoting best practices with
1127	regard to the prescribing of certain drugs as specified in the
1128	General Appropriations Act and ensuring cost-effective
1129	prescribing practices.
1130	14.  The agency may require prior authorization for
1131	Medicaid-covered prescribed drugs. The agency may, but is not
1132	required to, prior-authorize the use of a product:
1133	a.  For an indication not approved in labeling;
1134	b.  To comply with certain clinical guidelines; or
1135	c.  If the product has the potential for overuse, misuse,
1136	or abuse.
1137
1138	The agency may require the prescribing professional to provide
1139	information about the rationale and supporting medical evidence
1140	for the use of a drug. The agency may post prior authorization
1141	criteria and protocol and updates to the list of drugs that are
1142	subject to prior authorization on an Internet website without
1143	amending its rule or engaging in additional rulemaking.
1144	15.  The agency, in conjunction with the Pharmaceutical and
1145	Therapeutics Committee, may require age-related prior
1146	authorizations for certain prescribed drugs. The agency may
1147	preauthorize the use of a drug for a recipient who may not meet
1148	the age requirement or may exceed the length of therapy for use
1149	of this product as recommended by the manufacturer and approved
1150	by the Food and Drug Administration. Prior authorization may
1151	require the prescribing professional to provide information
1152	about the rationale and supporting medical evidence for the use
1153	of a drug.
1154	16.  The agency shall implement a step-therapy prior
1155	authorization approval process for medications excluded from the
1156	preferred drug list. Medications listed on the preferred drug
1157	list must be used within the previous 12 months prior to the
1158	alternative medications that are not listed. The step-therapy
1159	prior authorization may require the prescriber to use the
1160	medications of a similar drug class or for a similar medical
1161	indication unless contraindicated in the Food and Drug
1162	Administration labeling. The trial period between the specified
1163	steps may vary according to the medical indication. The step-
1164	therapy approval process shall be developed in accordance with
1165	the committee as stated in s. 409.91195(7) and (8). A drug
1166	product may be approved without meeting the step-therapy prior
1167	authorization criteria if the prescribing physician provides the
1168	agency with additional written medical or clinical documentation
1169	that the product is medically necessary because:
1170	a.  There is not a drug on the preferred drug list to treat
1171	the disease or medical condition which is an acceptable clinical
1172	alternative;
1173	b.  The alternatives have been ineffective in the treatment
1174	of the beneficiary's disease; or
1175	c.  Based on historic evidence and known characteristics of
1176	the patient and the drug, the drug is likely to be ineffective,
1177	or the number of doses have been ineffective.
1178
1179	The agency shall work with the physician to determine the best
1180	alternative for the patient. The agency may adopt rules waiving
1181	the requirements for written clinical documentation for specific
1182	drugs in limited clinical situations.
1183	17.  The agency shall implement a return and reuse program
1184	for drugs dispensed by pharmacies to institutional recipients,
1185	which includes payment of a $5 restocking fee for the
1186	implementation and operation of the program. The return and
1187	reuse program shall be implemented electronically and in a
1188	manner that promotes efficiency. The program must permit a
1189	pharmacy to exclude drugs from the program if it is not
1190	practical or cost-effective for the drug to be included and must
1191	provide for the return to inventory of drugs that cannot be
1192	credited or returned in a cost-effective manner. The agency
1193	shall determine if the program has reduced the amount of
1194	Medicaid prescription drugs which are destroyed on an annual
1195	basis and if there are additional ways to ensure more
1196	prescription drugs are not destroyed which could safely be
1197	reused. The agency's conclusion and recommendations shall be
1198	reported to the Legislature by December 1, 2005.
1199	(44)  The Agency for Health Care Administration shall
1200	ensure that any Medicaid managed care plan as defined in s.
1201	409.9122(2)(f)(h), whether paid on a capitated basis or a shared
1202	savings basis, is cost-effective. For purposes of this
1203	subsection, the term "cost-effective" means that a network's
1204	per-member, per-month costs to the state, including, but not
1205	limited to, fee-for-service costs, administrative costs, and
1206	case-management fees, if any, must be no greater than the
1207	state's costs associated with contracts for Medicaid services
1208	established under subsection (3), which may shall be actuarially
1209	adjusted for health status case mix, model, and service area.
1210	The agency shall conduct actuarially sound adjustments for
1211	health status audits adjusted for case mix and model in order to
1212	ensure such cost-effectiveness and shall publish the audit
1213	results on its Internet website and submit the audit results
1214	annually to the Governor, the President of the Senate, and the
1215	Speaker of the House of Representatives no later than December
1216	31 of each year. Contracts established pursuant to this
1217	subsection which are not cost-effective may not be renewed.
1218	Section 19.  Paragraphs (f) and (k) of subsection (2) of
1219	section 409.9122, Florida Statutes, are amended to read:
1220	409.9122  Mandatory Medicaid managed care enrollment;
1221	programs and procedures.--
1222	(2)
1223	(f)  When a Medicaid recipient does not choose a managed
1224	care plan or MediPass provider, the agency shall assign the
1225	Medicaid recipient to a managed care plan or MediPass provider.
1226	Medicaid recipients who are subject to mandatory assignment but
1227	who fail to make a choice shall be assigned to managed care
1228	plans until an enrollment of 35 40 percent in MediPass and 65 60
1229	percent in managed care plans, of all those eligible to choose
1230	managed care, is achieved. Once this enrollment is achieved, the
1231	assignments shall be divided in order to maintain an enrollment
1232	in MediPass and managed care plans which is in a 35 40 percent
1233	and 65 60 percent proportion, respectively. Thereafter,
1234	assignment of Medicaid recipients who fail to make a choice
1235	shall be based proportionally on the preferences of recipients
1236	who have made a choice in the previous period. Such proportions
1237	shall be revised at least quarterly to reflect an update of the
1238	preferences of Medicaid recipients. The agency shall
1239	disproportionately assign Medicaid-eligible recipients who are
1240	required to but have failed to make a choice of managed care
1241	plan or MediPass, including children, and who are to be assigned
1242	to the MediPass program to children's networks as described in
1243	s. 409.912(4)(g), Children's Medical Services Network as defined
1244	in s. 391.021, exclusive provider organizations, provider
1245	service networks, minority physician networks, and pediatric
1246	emergency department diversion programs authorized by this
1247	chapter or the General Appropriations Act, in such manner as the
1248	agency deems appropriate, until the agency has determined that
1249	the networks and programs have sufficient numbers to be
1250	economically operated. For purposes of this paragraph, when
1251	referring to assignment, the term "managed care plans" includes
1252	health maintenance organizations, exclusive provider
1253	organizations, provider service networks, minority physician
1254	networks, Children's Medical Services Network, and pediatric
1255	emergency department diversion programs authorized by this
1256	chapter or the General Appropriations Act. When making
1257	assignments, the agency shall take into account the following
1258	criteria:
1259	1.  A managed care plan has sufficient network capacity to
1260	meet the need of members.
1261	2.  The managed care plan or MediPass has previously
1262	enrolled the recipient as a member, or one of the managed care
1263	plan's primary care providers or MediPass providers has
1264	previously provided health care to the recipient.
1265	3.  The agency has knowledge that the member has previously
1266	expressed a preference for a particular managed care plan or
1267	MediPass provider as indicated by Medicaid fee-for-service
1268	claims data, but has failed to make a choice.
1269	4.  The managed care plan's or MediPass primary care
1270	providers are geographically accessible to the recipient's
1271	residence.
1272	(k)  When a Medicaid recipient does not choose a managed
1273	care plan or MediPass provider, the agency shall assign the
1274	Medicaid recipient to a managed care plan, except in those
1275	counties in which there are fewer than two managed care plans
1276	accepting Medicaid enrollees, in which case assignment shall be
1277	to a managed care plan or a MediPass provider. Medicaid
1278	recipients in counties with fewer than two managed care plans
1279	accepting Medicaid enrollees who are subject to mandatory
1280	assignment but who fail to make a choice shall be assigned to
1281	managed care plans until an enrollment of 35 40 percent in
1282	MediPass and 65 60 percent in managed care plans, of all those
1283	eligible to choose managed care, is achieved. Once that
1284	enrollment is achieved, the assignments shall be divided in
1285	order to maintain an enrollment in MediPass and managed care
1286	plans which is in a 35 40 percent and 65 60 percent proportion,
1287	respectively. In service areas 1 and 6 of the Agency for Health
1288	Care Administration where the agency is contracting for the
1289	provision of comprehensive behavioral health services through a
1290	capitated prepaid arrangement, recipients who fail to make a
1291	choice shall be assigned equally to MediPass or a managed care
1292	plan. For purposes of this paragraph, when referring to
1293	assignment, the term "managed care plans" includes exclusive
1294	provider organizations, provider service networks, Children's
1295	Medical Services Network, minority physician networks, and
1296	pediatric emergency department diversion programs authorized by
1297	this chapter or the General Appropriations Act. When making
1298	assignments, the agency shall take into account the following
1299	criteria:
1300	1.  A managed care plan has sufficient network capacity to
1301	meet the need of members.
1302	2.  The managed care plan or MediPass has previously
1303	enrolled the recipient as a member, or one of the managed care
1304	plan's primary care providers or MediPass providers has
1305	previously provided health care to the recipient.
1306	3.  The agency has knowledge that the member has previously
1307	expressed a preference for a particular managed care plan or
1308	MediPass provider as indicated by Medicaid fee-for-service
1309	claims data, but has failed to make a choice.
1310	4.  The managed care plan's or MediPass primary care
1311	providers are geographically accessible to the recipient's
1312	residence.
1313	5.  The agency has authority to make mandatory assignments
1314	based on quality of service and performance of managed care
1315	plans.
1316	Section 20.  Section 409.9301, Florida Statutes, is created
1317	to read:
1318	409.9301  Pharmaceutical expense assistance.--
1319	(1)  PROGRAM ESTABLISHED.--A program is established in the
1320	Agency for Health Care Administration to provide pharmaceutical
1321	expense assistance to individuals diagnosed with cancer or
1322	individuals who have received organ transplants who were
1323	medically needy recipients prior to January 1, 2006.
1324	(2)  ELIGIBILITY.--Eligibility for the program is limited
1325	to an individual who:
1326	(a)  Is a resident of this state;
1327	(b)  Was a Medicaid recipient under the Florida Medicaid
1328	medically needy program prior to January 1, 2006;
1329	(c)  Is eligible for Medicare;
1330	(d)  Is a cancer patient or an organ transplant recipient;
1331	and
1332	(e)  Requests to be enrolled in the program.
1333	(3)  BENEFITS.--Subject to an appropriation in the General
1334	Appropriations Act and the availability of funds, the Agency for
1335	Health Care Administration shall pay, using Medicaid payment
1336	policies, the Medicare Part-B prescription drug coinsurance and
1337	deductibles for Medicare Part-B medications that treat eligible
1338	cancer and organ transplant patients.
1339	(4)  ADMINISTRATION.--The pharmaceutical expense assistance
1340	program shall be administered by the agency, in collaboration
1341	with the Department of Elderly Affairs and the Department of
1342	Children and Family Services.
1343	(a)  The agency may adopt rules pursuant to ss. 120.536(1)
1344	and 120.54 to implement the provisions of this section.
1345	(b)  By January 1 of each year, the agency shall report to
1346	the Legislature on the operation of the program. The report
1347	shall include information on the number of individuals served,
1348	use rates, and expenditures under the program.
1349	(5)  NONENTITLEMENT.--The pharmaceutical expense assistance
1350	program established by this section is not an entitlement. The
1351	agency may develop a waiting list based on application dates to
1352	use in enrolling individuals when funds become available for
1353	unfilled enrollment slots.
1354	Section 21.  Subsection (17) is added to section 430.04,
1355	Florida Statutes, to read:
1356	430.04  Duties and responsibilities of the Department of
1357	Elderly Affairs.--The Department of Elderly Affairs shall:
1358	(17)  Be designated as a state agency that is eligible to
1359	receive federal funds for adults who are eligible for assistance
1360	through the portion of the federal Child and Adult Care Food
1361	Program for adults, which is referred to as the Adult Care Food
1362	Program, and that is responsible for establishing and
1363	administering the program. The purpose of the Adult Care Food
1364	Program is to provide nutritious and wholesome meals and snacks
1365	for adults in nonresidential day care centers or residential
1366	treatment facilities. To ensure the quality and integrity of the
1367	program, the department shall develop standards and procedures
1368	that govern sponsoring organizations and adult day care centers.
1369	The department shall follow federal requirements and may adopt
1370	any rules necessary pursuant to ss. 120.536(1) and 120.54 for
1371	the implementation of the Adult Care Food Program. With respect
1372	to the Adult Care Food Program, the department shall adopt rules
1373	pursuant to ss. 120.536(1) and 120.54 that implement relevant
1374	federal regulations, including 7 C.F.R. part 226. The rules may
1375	address, at a minimum, the program requirements and procedures
1376	identified in this subsection.
1377	Section 22.  Subsection (5) of section 430.705, Florida
1378	Statutes, is amended to read:
1379	430.705  Implementation of the long-term care community
1380	diversion pilot projects.--
1381	(5)  A prospective participant who applies for the
1382	long-term care community diversion pilot project and is
1383	determined by the Comprehensive Assessment Review and Evaluation
1384	for Long-Term Care Services (CARES) Program within the
1385	Department of Elderly Affairs to be medically eligible, but has
1386	not been determined financially eligible by the Department of
1387	Children and Family Services, shall be designated "Medicaid
1388	Pending." CARES shall determine each applicant's eligibility
1389	within 22 days after receiving the application. Contractors may
1390	elect to provide services to Medicaid Pending individuals until
1391	their financial eligibility is determined. If the individual is
1392	determined financially eligible, the agency shall pay the
1393	contractor that provided the services a capitated rate
1394	retroactive to the first of the month following the CARES
1395	eligibility determination. If the individual is not financially
1396	eligible for Medicaid, the contractor may terminate services and
1397	seek reimbursement from the individual. In order to achieve
1398	rapid enrollment into the program and efficient diversion of
1399	applicants from nursing home care, the department and the agency
1400	shall allow enrollment of Medicaid beneficiaries on the date
1401	that eligibility for the community diversion pilot project is
1402	approved. The provider shall receive a prorated capitated rate
1403	for those enrollees who are enrolled after the first of each
1404	month.
1405	Section 23.  Paragraph (b) of subsection (5) of section
1406	624.91, Florida Statutes, is amended to read:
1407	624.91  The Florida Healthy Kids Corporation Act.--
1408	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.--
1409	(b)  The Florida Healthy Kids Corporation shall:
1410	1.  Arrange for the collection of any family, local
1411	contributions, or employer payment or premium, in an amount to
1412	be determined by the board of directors, to provide for payment
1413	of premiums for comprehensive insurance coverage and for the
1414	actual or estimated administrative expenses.
1415	2.  Arrange for the collection of any voluntary
1416	contributions to provide for payment of premiums for children
1417	who are not eligible for medical assistance under Title XXI of
1418	the Social Security Act. Each fiscal year, the corporation shall
1419	establish a local match policy for the enrollment of non-Title-
1420	XXI-eligible children in the Healthy Kids program. By May 1 of
1421	each year, the corporation shall provide written notification of
1422	the amount to be remitted to the corporation for the following
1423	fiscal year under that policy. Local match sources may include,
1424	but are not limited to, funds provided by municipalities,
1425	counties, school boards, hospitals, health care providers,
1426	charitable organizations, special taxing districts, and private
1427	organizations. The minimum local match cash contributions
1428	required each fiscal year and local match credits shall be
1429	determined by the General Appropriations Act. The corporation
1430	shall calculate a county's local match rate based upon that
1431	county's percentage of the state's total non-Title-XXI
1432	expenditures as reported in the corporation's most recently
1433	audited financial statement. In awarding the local match
1434	credits, the corporation may consider factors including, but not
1435	limited to, population density, per capita income, and existing
1436	child-health-related expenditures and services.
1437	3.  Subject to the provisions of s. 409.8134, accept
1438	voluntary supplemental local match contributions that comply
1439	with the requirements of Title XXI of the Social Security Act
1440	for the purpose of providing additional coverage in contributing
1441	counties under Title XXI.
1442	4.  Establish the administrative and accounting procedures
1443	for the operation of the corporation.
1444	5.  Establish, with consultation from appropriate
1445	professional organizations, standards for preventive health
1446	services and providers and comprehensive insurance benefits
1447	appropriate to children, provided that such standards for rural
1448	areas shall not limit primary care providers to board-certified
1449	pediatricians.
1450	6.  Determine eligibility for children seeking to
1451	participate in the Title XXI-funded components of the Florida
1452	KidCare program consistent with the requirements specified in s.
1453	409.814, as well as the non-Title-XXI-eligible children as
1454	provided in subsection (3).
1455	7.  Establish procedures under which providers of local
1456	match to, applicants to and participants in the program may have
1457	grievances reviewed by an impartial body and reported to the
1458	board of directors of the corporation.
1459	8.  Establish participation criteria and, if appropriate,
1460	contract with an authorized insurer, health maintenance
1461	organization, or third-party administrator to provide
1462	administrative services to the corporation.
1463	9.  Establish enrollment criteria which shall include
1464	penalties or waiting periods of not fewer than 60 days for
1465	reinstatement of coverage upon voluntary cancellation for
1466	nonpayment of family premiums.
1467	10.  Contract with authorized insurers or any provider of
1468	health care services, meeting standards established by the
1469	corporation, for the provision of comprehensive insurance
1470	coverage to participants. Such standards shall include criteria
1471	under which the corporation may contract with more than one
1472	provider of health care services in program sites. Health plans
1473	shall be selected through a competitive bid process. The Florida
1474	Healthy Kids Corporation shall purchase goods and services in
1475	the most cost-effective manner consistent with the delivery of
1476	quality medical care. The maximum administrative cost for a
1477	Florida Healthy Kids Corporation contract shall be 15 percent.
1478	For health care contracts, the minimum medical loss ratio for a
1479	Florida Healthy Kids Corporation contract shall be 85 percent.
1480	For dental contracts, the remaining compensation to be paid to
1481	the authorized insurer or provider under a Florida Healthy Kids
1482	Corporation contract shall be no less than an amount which is 85
1483	percent of premium; to the extent any contract provision does
1484	not provide for this minimum compensation, this section shall
1485	prevail. The health plan selection criteria and scoring system,
1486	and the scoring results, shall be available upon request for
1487	inspection after the bids have been awarded.
1488	11.  Establish disenrollment criteria in the event local
1489	matching funds are insufficient to cover enrollments.
1490	12.  Develop and implement a plan to publicize the Florida
1491	Healthy Kids Corporation, the eligibility requirements of the
1492	program, and the procedures for enrollment in the program and to
1493	maintain public awareness of the corporation and the program.
1494	13.  Secure staff necessary to properly administer the
1495	corporation. Staff costs shall be funded from state and local
1496	matching funds and such other private or public funds as become
1497	available. The board of directors shall determine the number of
1498	staff members necessary to administer the corporation.
1499	14.  Provide a report annually to the Governor, Chief
1500	Financial Officer, Commissioner of Education, Senate President,
1501	Speaker of the House of Representatives, and Minority Leaders of
1502	the Senate and the House of Representatives.
1503	15.  Establish benefit packages which conform to the
1504	provisions of the Florida KidCare program, as created in ss.
1505	409.810-409.820.
1506	Section 24.  The Office of Program Policy Analysis and
1507	Government Accountability shall review the functions currently
1508	performed by the Comprehensive Assessment Review and Evaluation
1509	for Long-Term Care Services (CARES) Program within the
1510	Department of Elderly Affairs. The Office of Program Policy
1511	Analysis and Government Accountability shall identify the
1512	factors affecting the time currently required for CARES staff to
1513	assess an individual's eligibility for long-term care services.
1514	As part of this study, the Office of Program Policy Analysis and
1515	Government Accountability shall also examine circumstances that
1516	could delay an individual's placement into the long-term care
1517	community diversion pilot project. The Office of Program Policy
1518	Analysis and Government Accountability shall report its findings
1519	to the President of the Senate and the Speaker of the House of
1520	Representatives by February 1, 2007.
1521	Section 25.  Section 409.8201, Florida Statutes, is
1522	repealed.
1523	Section 26.  This act shall take effect July 1, 2006.
1524
1525	======= T I T L E  A M E N D M E N T ========
1526	Remove the entire title and insert:
1527	A bill to be entitled
1528	An act relating to health care; amending s. 391.026, F.S.;
1529	requiring the Department of Health to contract with a
1530	third-party administrator for certain services necessary
1531	to the operation of the Children's Medical Services
1532	network; authorizing the department to maintain a
1533	specified minimum reserve for the network; amending s.
1534	400.141, F.S.; providing a reference for purposes of
1535	assessing compliance with standards for staffing levels in
1536	nursing homes; amending s. 400.179, F.S.; revising the
1537	amount of a certain fee to be paid by a leasehold licensee
1538	upon transfer of ownership of a nursing facility under
1539	certain circumstances; amending s. 400.23, F.S.; revising
1540	minimum staffing requirements for nursing homes; amending
1541	s. 409.811, F.S.; deleting the definition of the term
1542	"enrollment ceiling"; amending s. 409.8134, F.S.; deleting
1543	references to enrollment ceilings for the Florida KidCare
1544	program; providing for enrollment to cease when the
1545	expenditure ceiling is reached; amending ss. 409.814 and
1546	409.818, F.S.; deleting references to enrollment ceilings
1547	for the Florida KidCare program; amending s. 409.904,
1548	F.S.; revising requirements relating to eligibility of
1549	certain women for family planning services; amending s.
1550	409.905, F.S.; revising provisions relating to the
1551	implementation of a hospitalist program; authorizing the
1552	Agency for Health Care Administration to procure
1553	hospitalist services by individual county or combined
1554	counties; requiring a qualified organization to contract
1555	with or employ board-eligible physicians in specified
1556	counties; amending s. 409.906, F.S.; revising provisions
1557	relating to optional dental, hearing, and visual services
1558	covered by Medicaid; amending s. 409.907, F.S.; revising
1559	the enrollment effective date for Medicaid providers;
1560	providing procedures for payment for certain claims for
1561	services; amending s. 409.908, F.S.; revising provisions
1562	relating to the effect of changes of ownership or of
1563	licensed operator of a Medicaid provider on reimbursement
1564	rates under certain circumstances; revising provisions to
1565	permit rather than require a certain limit on the indirect
1566	care component of the long-term care reimbursement plan;
1567	amending s. 409.9081, F.S.; revising the limitation on
1568	Medicaid recipient copayments for emergency room services;
1569	amending s. 409.911, F.S., relating to the hospital
1570	disproportionate share program; revising the method for
1571	calculating disproportionate share payments to hospitals;
1572	deleting obsolete provisions; amending s. 409.9113, F.S.;
1573	providing guidelines for distribution of disproportionate
1574	share funds to certain teaching hospitals; amending s.
1575	409.9117, F.S., relating to the primary care
1576	disproportionate share program; revising the time period
1577	during which the agency shall not distribute certain
1578	moneys; amending s. 409.912, F.S., relating to cost-
1579	effective purchasing of health care; authorizing the
1580	agency to post a preferred drug list and updates thereto
1581	on an Internet website without following the rulemaking
1582	procedures of ch. 120, F.S.; providing that adjustments
1583	for health status be considered in agency evaluations of
1584	the cost-effectiveness of Medicaid managed care plans;
1585	amending s. 409.9122, F.S.; revising enrollment limits for
1586	Medicaid recipients who are subject to mandatory
1587	assignment to managed care plans and MediPass; creating s.
1588	409.9301, F.S.; establishing a pharmaceutical expense
1589	assistance program; providing eligibility requirements;
1590	providing for the Agency for Health Care Administration to
1591	pay certain coinsurance and deductibles for specified
1592	medications; requiring the agency, in collaboration with
1593	the Department of Elderly Affairs and the Department of
1594	Children and Family Services, to administer the program;
1595	authorizing the agency to adopt rules; requiring a report
1596	to the Legislature; declaring that the program is not an
1597	entitlement; providing for a waiting list; amending s.
1598	430.04, F.S.; designating the Department of Elderly
1599	Affairs as the state agency to receive federal funds for
1600	adults eligible for assistance through the Adult Care Food
1601	Program; requiring the department to develop standards and
1602	procedures to govern sponsoring organizations and adult
1603	day care centers for certain purposes; providing
1604	rulemaking authority to the department; amending s.
1605	430.705, F.S., relating to implementation of the long-term
1606	care community diversion pilot projects; providing for
1607	certain prospective participants in the pilot projects to
1608	be designated "Medicaid Pending" while eligibility is
1609	determined; providing conditions for reimbursement of
1610	contractors; amending s. 624.91, F.S.; deleting provisions
1611	requiring the Florida Healthy Kids Corporation to
1612	establish a local match policy for the enrollment of
1613	certain children in the Healthy Kids program; requiring
1614	the Office of Program Policy Analysis and Government
1615	Accountability to review functions performed by the
1616	Comprehensive Assessment Review and Evaluation for Long-
1617	Term Care Services Program; requiring a report to the
1618	Legislature; repealing s. 409.8201, F.S., relating to the
1619	enrollment ceiling for the non-Medicaid portion of the
1620	Florida KidCare program; providing an effective date.

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