Florida Senate - 2011 COMMITTEE AMENDMENT
Bill No. SB 1458
Barcode 235806
LEGISLATIVE ACTION
Senate . House
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The Committee on Health Regulation (Garcia) recommended the
following:
1 Senate Amendment to Amendment (423426) (with title
2 amendment)
3
4 Between lines 75 and 76
5 insert:
6 Section 4. Subsection (41) of section 409.912, Florida
7 Statutes, is amended to read:
8 409.912 Cost-effective purchasing of health care.—The
9 agency shall purchase goods and services for Medicaid recipients
10 in the most cost-effective manner consistent with the delivery
11 of quality medical care. To ensure that medical services are
12 effectively utilized, the agency may, in any case, require a
13 confirmation or second physician’s opinion of the correct
14 diagnosis for purposes of authorizing future services under the
15 Medicaid program. This section does not restrict access to
16 emergency services or poststabilization care services as defined
17 in 42 C.F.R. part 438.114. Such confirmation or second opinion
18 shall be rendered in a manner approved by the agency. The agency
19 shall maximize the use of prepaid per capita and prepaid
20 aggregate fixed-sum basis services when appropriate and other
21 alternative service delivery and reimbursement methodologies,
22 including competitive bidding pursuant to s. 287.057, designed
23 to facilitate the cost-effective purchase of a case-managed
24 continuum of care. The agency shall also require providers to
25 minimize the exposure of recipients to the need for acute
26 inpatient, custodial, and other institutional care and the
27 inappropriate or unnecessary use of high-cost services. The
28 agency shall contract with a vendor to monitor and evaluate the
29 clinical practice patterns of providers in order to identify
30 trends that are outside the normal practice patterns of a
31 provider’s professional peers or the national guidelines of a
32 provider’s professional association. The vendor must be able to
33 provide information and counseling to a provider whose practice
34 patterns are outside the norms, in consultation with the agency,
35 to improve patient care and reduce inappropriate utilization.
36 The agency may mandate prior authorization, drug therapy
37 management, or disease management participation for certain
38 populations of Medicaid beneficiaries, certain drug classes, or
39 particular drugs to prevent fraud, abuse, overuse, and possible
40 dangerous drug interactions. The Pharmaceutical and Therapeutics
41 Committee shall make recommendations to the agency on drugs for
42 which prior authorization is required. The agency shall inform
43 the Pharmaceutical and Therapeutics Committee of its decisions
44 regarding drugs subject to prior authorization. The agency is
45 authorized to limit the entities it contracts with or enrolls as
46 Medicaid providers by developing a provider network through
47 provider credentialing. The agency may competitively bid single
48 source-provider contracts if procurement of goods or services
49 results in demonstrated cost savings to the state without
50 limiting access to care. The agency may limit its network based
51 on the assessment of beneficiary access to care, provider
52 availability, provider quality standards, time and distance
53 standards for access to care, the cultural competence of the
54 provider network, demographic characteristics of Medicaid
55 beneficiaries, practice and provider-to-beneficiary standards,
56 appointment wait times, beneficiary use of services, provider
57 turnover, provider profiling, provider licensure history,
58 previous program integrity investigations and findings, peer
59 review, provider Medicaid policy and billing compliance records,
60 clinical and medical record audits, and other factors. Providers
61 shall not be entitled to enrollment in the Medicaid provider
62 network. The agency shall determine instances in which allowing
63 Medicaid beneficiaries to purchase durable medical equipment and
64 other goods is less expensive to the Medicaid program than long
65 term rental of the equipment or goods. The agency may establish
66 rules to facilitate purchases in lieu of long-term rentals in
67 order to protect against fraud and abuse in the Medicaid program
68 as defined in s. 409.913. The agency may seek federal waivers
69 necessary to administer these policies.
70 (41) The agency shall establish provide for the development
71 of a demonstration project by establishment in Miami-Dade County
72 of a long-term-care facility and a psychiatric facility licensed
73 pursuant to chapter 395 to improve access to health care for a
74 predominantly minority, medically underserved, and medically
75 complex population and to evaluate alternatives to nursing home
76 care and general acute care for such population. Such project is
77 to be located in a health care condominium and collocated
78 colocated with licensed facilities providing a continuum of
79 care. These projects are The establishment of this project is
80 not subject to the provisions of s. 408.036 or s. 408.039.
81
82 ================= T I T L E A M E N D M E N T ================
83 And the title is amended as follows:
84 Delete lines 2259 - 2268
85 and insert:
86 An act relating to assisted care communities; amending
87 s. 400.141, F.S.; revising licensing requirements for
88 registered pharmacists under contract with a nursing
89 home and related health care facilities; amending s.
90 408.810, F.S.; providing additional licensing
91 requirements for assisted living facilities; amending
92 s. 408.820, F.S.; providing that certain assisted
93 living facilities are exempt from requirements of part
94 II of ch. 408, F.S., related to health care licensing;
95 amending s. 409.912, F.S.; requiring the Agency for
96 Health Care Administration to provide for the
97 development of a demonstration project for a
98 psychiatric facility in Miami-Dade County; amending s.
99 429.01, F.S.;