Amendment
Bill No. SB 2144

Amendment No. 082773

CHAMBER ACTION
Senate		House
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1	Representative Hudson offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5
6	Section 1.  Subsections (1) and (2) of section 409.904,
7	Florida Statutes, are amended to read:
8	409.904  Optional payments for eligible persons.-The agency
9	may make payments for medical assistance and related services on
10	behalf of the following persons who are determined to be
11	eligible subject to the income, assets, and categorical
12	eligibility tests set forth in federal and state law. Payment on
13	behalf of these Medicaid eligible persons is subject to the
14	availability of moneys and any limitations established by the
15	General Appropriations Act or chapter 216.
16	(1)  Effective January 1, 2006, and subject to federal
17	waiver approval, a person who is age 65 or older or is
18	determined to be disabled, whose income is at or below 88
19	percent of the federal poverty level, whose assets do not exceed
20	established limitations, and who is not eligible for Medicare
21	or, if eligible for Medicare, is also eligible for and receiving
22	Medicaid-covered institutional care services, hospice services,
23	or home and community-based services. The agency shall seek
24	federal authorization through a waiver to provide this coverage.
25	This subsection expires June 30, 2011.
26	(2)(a)  A family, a pregnant woman, a child under age 21, a
27	person age 65 or over, or a blind or disabled person, who would
28	be eligible under any group listed in s. 409.903(1), (2), or
29	(3), except that the income or assets of such family or person
30	exceed established limitations. For a family or person in one of
31	these coverage groups, medical expenses are deductible from
32	income in accordance with federal requirements in order to make
33	a determination of eligibility. A family or person eligible
34	under the coverage known as the "medically needy," is eligible
35	to receive the same services as other Medicaid recipients, with
36	the exception of services in skilled nursing facilities and
37	intermediate care facilities for the developmentally disabled.
38	This paragraph expires June 30, 2011.
39	(b)  Effective July 1, 2011, a pregnant woman or a child
40	younger than 21 years of age who would be eligible under any
41	group listed in s. 409.903, except that the income or assets of
42	such group exceed established limitations. For a person in one
43	of these coverage groups, medical expenses are deductible from
44	income in accordance with federal requirements in order to make
45	a determination of eligibility. A person eligible under the
46	coverage known as the "medically needy" is eligible to receive
47	the same services as other Medicaid recipients, with the
48	exception of services in skilled nursing facilities and
49	intermediate care facilities for the developmentally disabled.
50	Section 2.  Subsections (7) and (12) of section 409.906,
51	Florida Statutes, are amended to read:
52	409.906  Optional Medicaid services.-Subject to specific
53	appropriations, the agency may make payments for services which
54	are optional to the state under Title XIX of the Social Security
55	Act and are furnished by Medicaid providers to recipients who
56	are determined to be eligible on the dates on which the services
57	were provided. Any optional service that is provided shall be
58	provided only when medically necessary and in accordance with
59	state and federal law. Optional services rendered by providers
60	in mobile units to Medicaid recipients may be restricted or
61	prohibited by the agency. Nothing in this section shall be
62	construed to prevent or limit the agency from adjusting fees,
63	reimbursement rates, lengths of stay, number of visits, or
64	number of services, or making any other adjustments necessary to
65	comply with the availability of moneys and any limitations or
66	directions provided for in the General Appropriations Act or
67	chapter 216. If necessary to safeguard the state's systems of
68	providing services to elderly and disabled persons and subject
69	to the notice and review provisions of s. 216.177, the Governor
70	may direct the Agency for Health Care Administration to amend
71	the Medicaid state plan to delete the optional Medicaid service
72	known as "Intermediate Care Facilities for the Developmentally
73	Disabled." Optional services may include:
74	(7)  CHIROPRACTIC SERVICES.-Effective October 1, 2011, the
75	agency may pay for manual manipulation of the spine and initial
76	services, screening, and X rays provided to a recipient under
77	the age of 21 by a licensed chiropractic physician.
78	(12)  HEARING SERVICES.-Effective October 1, 2011, the
79	agency may pay for hearing and related services, including
80	hearing evaluations, hearing aid devices, dispensing of the
81	hearing aid, and related repairs, if provided to a recipient
82	under the age of 21 by a licensed hearing aid specialist,
83	otolaryngologist, otologist, audiologist, or physician.
84	Section 3.  Subsections (14) and (23) of section 409.908,
85	Florida Statutes, are amended to read:
86	409.908  Reimbursement of Medicaid providers.-Subject to
87	specific appropriations, the agency shall reimburse Medicaid
88	providers, in accordance with state and federal law, according
89	to methodologies set forth in the rules of the agency and in
90	policy manuals and handbooks incorporated by reference therein.
91	These methodologies may include fee schedules, reimbursement
92	methods based on cost reporting, negotiated fees, competitive
93	bidding pursuant to s. 287.057, and other mechanisms the agency
94	considers efficient and effective for purchasing services or
95	goods on behalf of recipients. If a provider is reimbursed based
96	on cost reporting and submits a cost report late and that cost
97	report would have been used to set a lower reimbursement rate
98	for a rate semester, then the provider's rate for that semester
99	shall be retroactively calculated using the new cost report, and
100	full payment at the recalculated rate shall be effected
101	retroactively. Medicare-granted extensions for filing cost
102	reports, if applicable, shall also apply to Medicaid cost
103	reports. Payment for Medicaid compensable services made on
104	behalf of Medicaid eligible persons is subject to the
105	availability of moneys and any limitations or directions
106	provided for in the General Appropriations Act or chapter 216.
107	Further, nothing in this section shall be construed to prevent
108	or limit the agency from adjusting fees, reimbursement rates,
109	lengths of stay, number of visits, or number of services, or
110	making any other adjustments necessary to comply with the
111	availability of moneys and any limitations or directions
112	provided for in the General Appropriations Act, provided the
113	adjustment is consistent with legislative intent.
114	(14)  A provider of prescribed drugs shall be reimbursed
115	the least of the amount billed by the provider, the provider's
116	usual and customary charge, or the Medicaid maximum allowable
117	fee established by the agency, plus a dispensing fee. The
118	Medicaid maximum allowable fee for ingredient cost shall will be
119	based on the lowest lower of: the average wholesale price (AWP)
120	minus 16.4 percent, the wholesaler acquisition cost (WAC) plus
121	3.75 4.75 percent, the federal upper limit (FUL), the state
122	maximum allowable cost (SMAC), or the usual and customary (UAC)
123	charge billed by the provider. Medicaid providers are required
124	to dispense generic drugs if available at lower cost and the
125	agency has not determined that the branded product is more cost-
126	effective, unless the prescriber has requested and received
127	approval to require the branded product. The agency is directed
128	to implement a variable dispensing fee for payments for
129	prescribed medicines while ensuring continued access for
130	Medicaid recipients. The variable dispensing fee may be based
131	upon, but not limited to, either or both the volume of
132	prescriptions dispensed by a specific pharmacy provider, the
133	volume of prescriptions dispensed to an individual recipient,
134	and dispensing of preferred-drug-list products. The agency may
135	increase the pharmacy dispensing fee authorized by statute and
136	in the annual General Appropriations Act by $0.50 for the
137	dispensing of a Medicaid preferred-drug-list product and reduce
138	the pharmacy dispensing fee by $0.50 for the dispensing of a
139	Medicaid product that is not included on the preferred drug
140	list. The agency may establish a supplemental pharmaceutical
141	dispensing fee to be paid to providers returning unused unit-
142	dose packaged medications to stock and crediting the Medicaid
143	program for the ingredient cost of those medications if the
144	ingredient costs to be credited exceed the value of the
145	supplemental dispensing fee. The agency is authorized to limit
146	reimbursement for prescribed medicine in order to comply with
147	any limitations or directions provided for in the General
148	Appropriations Act, which may include implementing a prospective
149	or concurrent utilization review program.
150	(23)(a)  The agency shall establish rates at a level that
151	ensures no increase in statewide expenditures resulting from a
152	change in unit costs for 2 fiscal years effective July 1, 2011
153	2009. Reimbursement rates for the 2 fiscal years shall be as
154	provided in the General Appropriations Act.
155	(b)  This subsection applies to the following provider
156	types:
157	1.  Inpatient hospitals.
158	2.  Outpatient hospitals.
159	3.  Nursing homes.
160	4.  County health departments.
161	5.  Community intermediate care facilities for the
162	developmentally disabled.
163	6.  Prepaid health plans.
164
165	The agency shall apply the effect of this subsection to the
166	reimbursement rates for nursing home diversion programs.
167	(c)  The agency shall create a workgroup on hospital
168	reimbursement, a workgroup on nursing facility reimbursement,
169	and a workgroup on managed care plan payment. The workgroups
170	shall evaluate alternative reimbursement and payment
171	methodologies for hospitals, nursing facilities, and managed
172	care plans, including prospective payment methodologies for
173	hospitals and nursing facilities. The nursing facility workgroup
174	shall also consider price-based methodologies for indirect care
175	and acuity adjustments for direct care. The agency shall submit
176	a report on the evaluated alternative reimbursement
177	methodologies to the relevant committees of the Senate and the
178	House of Representatives by November 1, 2009.
179	(d)  This subsection expires June 30, 2011.
180	Section 4.  Subsection (2) of section 409.9082, Florida
181	Statutes, is amended to read:
182	409.9082  Quality assessment on nursing home facility
183	providers; exemptions; purpose; federal approval required;
184	remedies.-
185	(2)  Effective April 1, 2009, there is imposed upon each
186	nursing home facility a quality assessment. The aggregated
187	amount of assessments for all nursing home facilities in a given
188	year shall be an amount not exceeding the maximum percentage
189	allowed under federal law 5.5 percent of the total aggregate net
190	patient service revenue of assessed facilities. The agency shall
191	calculate the quality assessment rate annually on a per-
192	resident-day basis, exclusive of those resident days funded by
193	the Medicare program, as reported by the facilities. The per-
194	resident-day assessment rate shall be uniform except as
195	prescribed in subsection (3). Each facility shall report monthly
196	to the agency its total number of resident days, exclusive of
197	Medicare Part A resident days, and shall remit an amount equal
198	to the assessment rate times the reported number of days. The
199	agency shall collect, and each facility shall pay, the quality
200	assessment each month. The agency shall collect the assessment
201	from nursing home facility providers by no later than the 15th
202	of the next succeeding calendar month. The agency shall notify
203	providers of the quality assessment and provide a standardized
204	form to complete and submit with payments. The collection of the
205	nursing home facility quality assessment shall commence no
206	sooner than 5 days after the agency's initial payment of the
207	Medicaid rates containing the elements prescribed in subsection
208	(4). Nursing home facilities may not create a separate line-item
209	charge for the purpose of passing through the assessment to
210	residents.
211	Section 5.  Subsection (8) of section 409.9083, Florida
212	Statutes, is amended to read:
213	409.9083  Quality assessment on privately operated
214	intermediate care facilities for the developmentally disabled;
215	exemptions; purpose; federal approval required; remedies.-
216	(8)  This section is repealed October 1, 2011.
217	Section 6.  Paragraph (a) of subsection (2) of section
218	409.911, Florida Statutes, is amended to read:
219	409.911  Disproportionate share program.-Subject to
220	specific allocations established within the General
221	Appropriations Act and any limitations established pursuant to
222	chapter 216, the agency shall distribute, pursuant to this
223	section, moneys to hospitals providing a disproportionate share
224	of Medicaid or charity care services by making quarterly
225	Medicaid payments as required. Notwithstanding the provisions of
226	s. 409.915, counties are exempt from contributing toward the
227	cost of this special reimbursement for hospitals serving a
228	disproportionate share of low-income patients.
229	(2)  The Agency for Health Care Administration shall use
230	the following actual audited data to determine the Medicaid days
231	and charity care to be used in calculating the disproportionate
232	share payment:
233	(a)  The average of the 2004, 2005, and 2006 2003, 2004,
234	and 2005 audited disproportionate share data to determine each
235	hospital's Medicaid days and charity care for the 2011-2012
236	2010-2011 state fiscal year.
237	Section 7.  Section 409.9112, Florida Statutes, is amended
238	to read:
239	409.9112  Disproportionate share program for regional
240	perinatal intensive care centers.-In addition to the payments
241	made under s. 409.911, the agency shall design and implement a
242	system for making disproportionate share payments to those
243	hospitals that participate in the regional perinatal intensive
244	care center program established pursuant to chapter 383. The
245	system of payments must conform to federal requirements and
246	distribute funds in each fiscal year for which an appropriation
247	is made by making quarterly Medicaid payments. Notwithstanding
248	s. 409.915, counties are exempt from contributing toward the
249	cost of this special reimbursement for hospitals serving a
250	disproportionate share of low-income patients. For the 2011-2012
251	2010-2011 state fiscal year, the agency may not distribute
252	moneys under the regional perinatal intensive care centers
253	disproportionate share program.
254	(1)  The following formula shall be used by the agency to
255	calculate the total amount earned for hospitals that participate
256	in the regional perinatal intensive care center program:
257
258	TAE = HDSP/THDSP
259	Where:
260	TAE = total amount earned by a regional perinatal intensive
261	care center.
262	HDSP = the prior state fiscal year regional perinatal
263	intensive care center disproportionate share payment to the
264	individual hospital.
265	THDSP = the prior state fiscal year total regional
266	perinatal intensive care center disproportionate share payments
267	to all hospitals.
268
269	(2)  The total additional payment for hospitals that
270	participate in the regional perinatal intensive care center
271	program shall be calculated by the agency as follows:
272
273	TAP = TAE x TA
274	Where:
275	TAP = total additional payment for a regional perinatal
276	intensive care center.
277	TAE = total amount earned by a regional perinatal intensive
278	care center.
279	TA = total appropriation for the regional perinatal
280	intensive care center disproportionate share program.
281
282	(3)  In order to receive payments under this section, a
283	hospital must be participating in the regional perinatal
284	intensive care center program pursuant to chapter 383 and must
285	meet the following additional requirements:
286	(a)  Agree to conform to all departmental and agency
287	requirements to ensure high quality in the provision of
288	services, including criteria adopted by departmental and agency
289	rule concerning staffing ratios, medical records, standards of
290	care, equipment, space, and such other standards and criteria as
291	the department and agency deem appropriate as specified by rule.
292	(b)  Agree to provide information to the department and
293	agency, in a form and manner to be prescribed by rule of the
294	department and agency, concerning the care provided to all
295	patients in neonatal intensive care centers and high-risk
296	maternity care.
297	(c)  Agree to accept all patients for neonatal intensive
298	care and high-risk maternity care, regardless of ability to pay,
299	on a functional space-available basis.
300	(d)  Agree to develop arrangements with other maternity and
301	neonatal care providers in the hospital's region for the
302	appropriate receipt and transfer of patients in need of
303	specialized maternity and neonatal intensive care services.
304	(e)  Agree to establish and provide a developmental
305	evaluation and services program for certain high-risk neonates,
306	as prescribed and defined by rule of the department.
307	(f)  Agree to sponsor a program of continuing education in
308	perinatal care for health care professionals within the region
309	of the hospital, as specified by rule.
310	(g)  Agree to provide backup and referral services to the
311	county health departments and other low-income perinatal
312	providers within the hospital's region, including the
313	development of written agreements between these organizations
314	and the hospital.
315	(h)  Agree to arrange for transportation for high-risk
316	obstetrical patients and neonates in need of transfer from the
317	community to the hospital or from the hospital to another more
318	appropriate facility.
319	(4)  Hospitals which fail to comply with any of the
320	conditions in subsection (3) or the applicable rules of the
321	department and agency may not receive any payments under this
322	section until full compliance is achieved. A hospital which is
323	not in compliance in two or more consecutive quarters may not
324	receive its share of the funds. Any forfeited funds shall be
325	distributed by the remaining participating regional perinatal
326	intensive care center program hospitals.
327	Section 8.  Section 409.9113, Florida Statutes, is amended
328	to read:
329	409.9113  Disproportionate share program for teaching
330	hospitals.-In addition to the payments made under ss. 409.911
331	and 409.9112, the agency shall make disproportionate share
332	payments to statutorily defined teaching hospitals for their
333	increased costs associated with medical education programs and
334	for tertiary health care services provided to the indigent. This
335	system of payments must conform to federal requirements and
336	distribute funds in each fiscal year for which an appropriation
337	is made by making quarterly Medicaid payments. Notwithstanding
338	s. 409.915, counties are exempt from contributing toward the
339	cost of this special reimbursement for hospitals serving a
340	disproportionate share of low-income patients. For the 2011-2012
341	2010-2011 state fiscal year, the agency shall distribute the
342	moneys provided in the General Appropriations Act to statutorily
343	defined teaching hospitals and family practice teaching
344	hospitals under the teaching hospital disproportionate share
345	program. The funds provided for statutorily defined teaching
346	hospitals shall be distributed in the same proportion as the
347	state fiscal year 2003-2004 teaching hospital disproportionate
348	share funds were distributed or as otherwise provided in the
349	General Appropriations Act. The funds provided for family
350	practice teaching hospitals shall be distributed equally among
351	family practice teaching hospitals.
352	(1)  On or before September 15 of each year, the agency
353	shall calculate an allocation fraction to be used for
354	distributing funds to state statutory teaching hospitals.
355	Subsequent to the end of each quarter of the state fiscal year,
356	the agency shall distribute to each statutory teaching hospital,
357	as defined in s. 408.07, an amount determined by multiplying
358	one-fourth of the funds appropriated for this purpose by the
359	Legislature times such hospital's allocation fraction. The
360	allocation fraction for each such hospital shall be determined
361	by the sum of the following three primary factors, divided by
362	three:
363	(a)  The number of nationally accredited graduate medical
364	education programs offered by the hospital, including programs
365	accredited by the Accreditation Council for Graduate Medical
366	Education and the combined Internal Medicine and Pediatrics
367	programs acceptable to both the American Board of Internal
368	Medicine and the American Board of Pediatrics at the beginning
369	of the state fiscal year preceding the date on which the
370	allocation fraction is calculated. The numerical value of this
371	factor is the fraction that the hospital represents of the total
372	number of programs, where the total is computed for all state
373	statutory teaching hospitals.
374	(b)  The number of full-time equivalent trainees in the
375	hospital, which comprises two components:
376	1.  The number of trainees enrolled in nationally
377	accredited graduate medical education programs, as defined in
378	paragraph (a). Full-time equivalents are computed using the
379	fraction of the year during which each trainee is primarily
380	assigned to the given institution, over the state fiscal year
381	preceding the date on which the allocation fraction is
382	calculated. The numerical value of this factor is the fraction
383	that the hospital represents of the total number of full-time
384	equivalent trainees enrolled in accredited graduate programs,
385	where the total is computed for all state statutory teaching
386	hospitals.
387	2.  The number of medical students enrolled in accredited
388	colleges of medicine and engaged in clinical activities,
389	including required clinical clerkships and clinical electives.
390	Full-time equivalents are computed using the fraction of the
391	year during which each trainee is primarily assigned to the
392	given institution, over the course of the state fiscal year
393	preceding the date on which the allocation fraction is
394	calculated. The numerical value of this factor is the fraction
395	that the given hospital represents of the total number of full-
396	time equivalent students enrolled in accredited colleges of
397	medicine, where the total is computed for all state statutory
398	teaching hospitals.
399
400	The primary factor for full-time equivalent trainees is computed
401	as the sum of these two components, divided by two.
402	(c)  A service index that comprises three components:
403	1.  The Agency for Health Care Administration Service
404	Index, computed by applying the standard Service Inventory
405	Scores established by the agency to services offered by the
406	given hospital, as reported on Worksheet A-2 for the last fiscal
407	year reported to the agency before the date on which the
408	allocation fraction is calculated. The numerical value of this
409	factor is the fraction that the given hospital represents of the
410	total Agency for Health Care Administration Service Index
411	values, where the total is computed for all state statutory
412	teaching hospitals.
413	2.  A volume-weighted service index, computed by applying
414	the standard Service Inventory Scores established by the Agency
415	for Health Care Administration to the volume of each service,
416	expressed in terms of the standard units of measure reported on
417	Worksheet A-2 for the last fiscal year reported to the agency
418	before the date on which the allocation factor is calculated.
419	The numerical value of this factor is the fraction that the
420	given hospital represents of the total volume-weighted service
421	index values, where the total is computed for all state
422	statutory teaching hospitals.
423	3.  Total Medicaid payments to each hospital for direct
424	inpatient and outpatient services during the fiscal year
425	preceding the date on which the allocation factor is calculated.
426	This includes payments made to each hospital for such services
427	by Medicaid prepaid health plans, whether the plan was
428	administered by the hospital or not. The numerical value of this
429	factor is the fraction that each hospital represents of the
430	total of such Medicaid payments, where the total is computed for
431	all state statutory teaching hospitals.
432
433	The primary factor for the service index is computed as the sum
434	of these three components, divided by three.
435	(2)  By October 1 of each year, the agency shall use the
436	following formula to calculate the maximum additional
437	disproportionate share payment for statutorily defined teaching
438	hospitals:
439	TAP = THAF x A
440	Where:
441	TAP = total additional payment.
442	THAF = teaching hospital allocation factor.
443	A = amount appropriated for a teaching hospital
444	disproportionate share program.
445	Section 9.  Section 409.9117, Florida Statutes, is amended
446	to read:
447	409.9117  Primary care disproportionate share program.-For
448	the 2011-2012 2010-2011 state fiscal year, the agency shall not
449	distribute moneys under the primary care disproportionate share
450	program.
451	(1)  If federal funds are available for disproportionate
452	share programs in addition to those otherwise provided by law,
453	there shall be created a primary care disproportionate share
454	program.
455	(2)  The following formula shall be used by the agency to
456	calculate the total amount earned for hospitals that participate
457	in the primary care disproportionate share program:
458
459	TAE = HDSP/THDSP
460	Where:
461	TAE = total amount earned by a hospital participating in
462	the primary care disproportionate share program.
463	HDSP = the prior state fiscal year primary care
464	disproportionate share payment to the individual hospital.
465	THDSP = the prior state fiscal year total primary care
466	disproportionate share payments to all hospitals.
467
468	(3)  The total additional payment for hospitals that
469	participate in the primary care disproportionate share program
470	shall be calculated by the agency as follows:
471
472	TAP = TAE x TA
473
474	Where:
475	TAP = total additional payment for a primary care hospital.
476	TAE = total amount earned by a primary care hospital.
477	TA = total appropriation for the primary care
478	disproportionate share program.
479
480	(4)  In the establishment and funding of this program, the
481	agency shall use the following criteria in addition to those
482	specified in s. 409.911, and payments may not be made to a
483	hospital unless the hospital agrees to:
484	(a)  Cooperate with a Medicaid prepaid health plan, if one
485	exists in the community.
486	(b)  Ensure the availability of primary and specialty care
487	physicians to Medicaid recipients who are not enrolled in a
488	prepaid capitated arrangement and who are in need of access to
489	such physicians.
490	(c)  Coordinate and provide primary care services free of
491	charge, except copayments, to all persons with incomes up to 100
492	percent of the federal poverty level who are not otherwise
493	covered by Medicaid or another program administered by a
494	governmental entity, and to provide such services based on a
495	sliding fee scale to all persons with incomes up to 200 percent
496	of the federal poverty level who are not otherwise covered by
497	Medicaid or another program administered by a governmental
498	entity, except that eligibility may be limited to persons who
499	reside within a more limited area, as agreed to by the agency
500	and the hospital.
501	(d)  Contract with any federally qualified health center,
502	if one exists within the agreed geopolitical boundaries,
503	concerning the provision of primary care services, in order to
504	guarantee delivery of services in a nonduplicative fashion, and
505	to provide for referral arrangements, privileges, and
506	admissions, as appropriate. The hospital shall agree to provide
507	at an onsite or offsite facility primary care services within 24
508	hours to which all Medicaid recipients and persons eligible
509	under this paragraph who do not require emergency room services
510	are referred during normal daylight hours.
511	(e)  Cooperate with the agency, the county, and other
512	entities to ensure the provision of certain public health
513	services, case management, referral and acceptance of patients,
514	and sharing of epidemiological data, as the agency and the
515	hospital find mutually necessary and desirable to promote and
516	protect the public health within the agreed geopolitical
517	boundaries.
518	(f)  In cooperation with the county in which the hospital
519	resides, develop a low-cost, outpatient, prepaid health care
520	program to persons who are not eligible for the Medicaid
521	program, and who reside within the area.
522	(g)  Provide inpatient services to residents within the
523	area who are not eligible for Medicaid or Medicare, and who do
524	not have private health insurance, regardless of ability to pay,
525	on the basis of available space, except that hospitals may not
526	be prevented from establishing bill collection programs based on
527	ability to pay.
528	(h)  Work with the Florida Healthy Kids Corporation, the
529	Florida Health Care Purchasing Cooperative, and business health
530	coalitions, as appropriate, to develop a feasibility study and
531	plan to provide a low-cost comprehensive health insurance plan
532	to persons who reside within the area and who do not have access
533	to such a plan.
534	(i)  Work with public health officials and other experts to
535	provide community health education and prevention activities
536	designed to promote healthy lifestyles and appropriate use of
537	health services.
538	(j)  Work with the local health council to develop a plan
539	for promoting access to affordable health care services for all
540	persons who reside within the area, including, but not limited
541	to, public health services, primary care services, inpatient
542	services, and affordable health insurance generally.
543
544	Any hospital that fails to comply with any of the provisions of
545	this subsection, or any other contractual condition, may not
546	receive payments under this section until full compliance is
547	achieved.
548	Section 10.  Paragraph (b) of subsection (16) and paragraph
549	(a) of subsection (39) of section 409.912, Florida Statutes, are
550	amended to read:
551	409.912  Cost-effective purchasing of health care.-The
552	agency shall purchase goods and services for Medicaid recipients
553	in the most cost-effective manner consistent with the delivery
554	of quality medical care. To ensure that medical services are
555	effectively utilized, the agency may, in any case, require a
556	confirmation or second physician's opinion of the correct
557	diagnosis for purposes of authorizing future services under the
558	Medicaid program. This section does not restrict access to
559	emergency services or poststabilization care services as defined
560	in 42 C.F.R. part 438.114. Such confirmation or second opinion
561	shall be rendered in a manner approved by the agency. The agency
562	shall maximize the use of prepaid per capita and prepaid
563	aggregate fixed-sum basis services when appropriate and other
564	alternative service delivery and reimbursement methodologies,
565	including competitive bidding pursuant to s. 287.057, designed
566	to facilitate the cost-effective purchase of a case-managed
567	continuum of care. The agency shall also require providers to
568	minimize the exposure of recipients to the need for acute
569	inpatient, custodial, and other institutional care and the
570	inappropriate or unnecessary use of high-cost services. The
571	agency shall contract with a vendor to monitor and evaluate the
572	clinical practice patterns of providers in order to identify
573	trends that are outside the normal practice patterns of a
574	provider's professional peers or the national guidelines of a
575	provider's professional association. The vendor must be able to
576	provide information and counseling to a provider whose practice
577	patterns are outside the norms, in consultation with the agency,
578	to improve patient care and reduce inappropriate utilization.
579	The agency may mandate prior authorization, drug therapy
580	management, or disease management participation for certain
581	populations of Medicaid beneficiaries, certain drug classes, or
582	particular drugs to prevent fraud, abuse, overuse, and possible
583	dangerous drug interactions. The Pharmaceutical and Therapeutics
584	Committee shall make recommendations to the agency on drugs for
585	which prior authorization is required. The agency shall inform
586	the Pharmaceutical and Therapeutics Committee of its decisions
587	regarding drugs subject to prior authorization. The agency is
588	authorized to limit the entities it contracts with or enrolls as
589	Medicaid providers by developing a provider network through
590	provider credentialing. The agency may competitively bid single-
591	source-provider contracts if procurement of goods or services
592	results in demonstrated cost savings to the state without
593	limiting access to care. The agency may limit its network based
594	on the assessment of beneficiary access to care, provider
595	availability, provider quality standards, time and distance
596	standards for access to care, the cultural competence of the
597	provider network, demographic characteristics of Medicaid
598	beneficiaries, practice and provider-to-beneficiary standards,
599	appointment wait times, beneficiary use of services, provider
600	turnover, provider profiling, provider licensure history,
601	previous program integrity investigations and findings, peer
602	review, provider Medicaid policy and billing compliance records,
603	clinical and medical record audits, and other factors. Providers
604	shall not be entitled to enrollment in the Medicaid provider
605	network. The agency shall determine instances in which allowing
606	Medicaid beneficiaries to purchase durable medical equipment and
607	other goods is less expensive to the Medicaid program than long-
608	term rental of the equipment or goods. The agency may establish
609	rules to facilitate purchases in lieu of long-term rentals in
610	order to protect against fraud and abuse in the Medicaid program
611	as defined in s. 409.913. The agency may seek federal waivers
612	necessary to administer these policies.
613	(16)
614	(b)  The responsibility of the agency under this subsection
615	shall include the development of capabilities to identify actual
616	and optimal practice patterns; patient and provider educational
617	initiatives; methods for determining patient compliance with
618	prescribed treatments; fraud, waste, and abuse prevention and
619	detection programs; and beneficiary case management programs.
620	1.  The practice pattern identification program shall
621	evaluate practitioner prescribing patterns based on national and
622	regional practice guidelines, comparing practitioners to their
623	peer groups. The agency and its Drug Utilization Review Board
624	shall consult with the Department of Health and a panel of
625	practicing health care professionals consisting of the
626	following: the Speaker of the House of Representatives and the
627	President of the Senate shall each appoint three physicians
628	licensed under chapter 458 or chapter 459; and the Governor
629	shall appoint two pharmacists licensed under chapter 465 and one
630	dentist licensed under chapter 466 who is an oral surgeon. Terms
631	of the panel members shall expire at the discretion of the
632	appointing official. The advisory panel shall be responsible for
633	evaluating treatment guidelines and recommending ways to
634	incorporate their use in the practice pattern identification
635	program. Practitioners who are prescribing inappropriately or
636	inefficiently, as determined by the agency, may have their
637	prescribing of certain drugs subject to prior authorization or
638	may be terminated from all participation in the Medicaid
639	program.
640	2.  The agency shall also develop educational interventions
641	designed to promote the proper use of medications by providers
642	and beneficiaries.
643	3.  The agency shall implement a pharmacy fraud, waste, and
644	abuse initiative that may include a surety bond or letter of
645	credit requirement for participating pharmacies, enhanced
646	provider auditing practices, the use of additional fraud and
647	abuse software, recipient management programs for beneficiaries
648	inappropriately using their benefits, and other steps that will
649	eliminate provider and recipient fraud, waste, and abuse. The
650	initiative shall address enforcement efforts to reduce the
651	number and use of counterfeit prescriptions.
652	4.  By September 30, 2002, The agency may shall contract
653	with an entity in the state to provide electronic access to
654	Medicaid prescription refill data and information relating to
655	the Medicaid Preferred Drug List to Medicaid providers implement
656	a wireless handheld clinical pharmacology drug information
657	database for practitioners. The initiative shall be designed to
658	enhance the agency's efforts to reduce fraud, abuse, and errors
659	in the prescription drug benefit program and to otherwise
660	further the intent of this paragraph.
661	5.  By April 1, 2006, the agency shall contract with an
662	entity to design a database of clinical utilization information
663	or electronic medical records for Medicaid providers. This
664	system must be web-based and allow providers to review on a
665	real-time basis the utilization of Medicaid services, including,
666	but not limited to, physician office visits, inpatient and
667	outpatient hospitalizations, laboratory and pathology services,
668	radiological and other imaging services, dental care, and
669	patterns of dispensing prescription drugs in order to coordinate
670	care and identify potential fraud and abuse.
671	6.  The agency may apply for any federal waivers needed to
672	administer this paragraph.
673	(39)(a)  The agency shall implement a Medicaid prescribed-
674	drug spending-control program that includes the following
675	components:
676	1.  A Medicaid preferred drug list, which shall be a
677	listing of cost-effective therapeutic options recommended by the
678	Medicaid Pharmacy and Therapeutics Committee established
679	pursuant to s. 409.91195 and adopted by the agency for each
680	therapeutic class on the preferred drug list. At the discretion
681	of the committee, and when feasible, the preferred drug list
682	should include at least two products in a therapeutic class. The
683	agency may post the preferred drug list and updates to the
684	preferred drug list on an Internet website without following the
685	rulemaking procedures of chapter 120. Antiretroviral agents are
686	excluded from the preferred drug list. The agency shall also
687	limit the amount of a prescribed drug dispensed to no more than
688	a 34-day supply unless the drug products' smallest marketed
689	package is greater than a 34-day supply, or the drug is
690	determined by the agency to be a maintenance drug in which case
691	a 100-day maximum supply may be authorized. The agency is
692	authorized to seek any federal waivers necessary to implement
693	these cost-control programs and to continue participation in the
694	federal Medicaid rebate program, or alternatively to negotiate
695	state-only manufacturer rebates. The agency may adopt rules to
696	implement this subparagraph. The agency shall continue to
697	provide unlimited contraceptive drugs and items. The agency must
698	establish procedures to ensure that:
699	a.  There is a response to a request for prior consultation
700	by telephone or other telecommunication device within 24 hours
701	after receipt of a request for prior consultation; and
702	b.  A 72-hour supply of the drug prescribed is provided in
703	an emergency or when the agency does not provide a response
704	within 24 hours as required by sub-subparagraph a.
705	2.  Reimbursement to pharmacies for Medicaid prescribed
706	drugs shall be set at the lowest lesser of: the average
707	wholesale price (AWP) minus 16.4 percent, the wholesaler
708	acquisition cost (WAC) plus 3.75 4.75 percent, the federal upper
709	limit (FUL), the state maximum allowable cost (SMAC), or the
710	usual and customary (UAC) charge billed by the provider.
711	3.  The agency shall develop and implement a process for
712	managing the drug therapies of Medicaid recipients who are using
713	significant numbers of prescribed drugs each month. The
714	management process may include, but is not limited to,
715	comprehensive, physician-directed medical-record reviews, claims
716	analyses, and case evaluations to determine the medical
717	necessity and appropriateness of a patient's treatment plan and
718	drug therapies. The agency may contract with a private
719	organization to provide drug-program-management services. The
720	Medicaid drug benefit management program shall include
721	initiatives to manage drug therapies for HIV/AIDS patients,
722	patients using 20 or more unique prescriptions in a 180-day
723	period, and the top 1,000 patients in annual spending. The
724	agency shall enroll any Medicaid recipient in the drug benefit
725	management program if he or she meets the specifications of this
726	provision and is not enrolled in a Medicaid health maintenance
727	organization.
728	4.  The agency may limit the size of its pharmacy network
729	based on need, competitive bidding, price negotiations,
730	credentialing, or similar criteria. The agency shall give
731	special consideration to rural areas in determining the size and
732	location of pharmacies included in the Medicaid pharmacy
733	network. A pharmacy credentialing process may include criteria
734	such as a pharmacy's full-service status, location, size,
735	patient educational programs, patient consultation, disease
736	management services, and other characteristics. The agency may
737	impose a moratorium on Medicaid pharmacy enrollment when it is
738	determined that it has a sufficient number of Medicaid-
739	participating providers. The agency must allow dispensing
740	practitioners to participate as a part of the Medicaid pharmacy
741	network regardless of the practitioner's proximity to any other
742	entity that is dispensing prescription drugs under the Medicaid
743	program. A dispensing practitioner must meet all credentialing
744	requirements applicable to his or her practice, as determined by
745	the agency.
746	5.  The agency shall develop and implement a program that
747	requires Medicaid practitioners who prescribe drugs to use a
748	counterfeit-proof prescription pad for Medicaid prescriptions.
749	The agency shall require the use of standardized counterfeit-
750	proof prescription pads by Medicaid-participating prescribers or
751	prescribers who write prescriptions for Medicaid recipients. The
752	agency may implement the program in targeted geographic areas or
753	statewide.
754	6.  The agency may enter into arrangements that require
755	manufacturers of generic drugs prescribed to Medicaid recipients
756	to provide rebates of at least 15.1 percent of the average
757	manufacturer price for the manufacturer's generic products.
758	These arrangements shall require that if a generic-drug
759	manufacturer pays federal rebates for Medicaid-reimbursed drugs
760	at a level below 15.1 percent, the manufacturer must provide a
761	supplemental rebate to the state in an amount necessary to
762	achieve a 15.1-percent rebate level.
763	7.  The agency may establish a preferred drug list as
764	described in this subsection, and, pursuant to the establishment
765	of such preferred drug list, it is authorized to negotiate
766	supplemental rebates from manufacturers that are in addition to
767	those required by Title XIX of the Social Security Act and at no
768	less than 14 percent of the average manufacturer price as
769	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
770	the federal or supplemental rebate, or both, equals or exceeds
771	29 percent. There is no upper limit on the supplemental rebates
772	the agency may negotiate. The agency may determine that specific
773	products, brand-name or generic, are competitive at lower rebate
774	percentages. Agreement to pay the minimum supplemental rebate
775	percentage will guarantee a manufacturer that the Medicaid
776	Pharmaceutical and Therapeutics Committee will consider a
777	product for inclusion on the preferred drug list. However, a
778	pharmaceutical manufacturer is not guaranteed placement on the
779	preferred drug list by simply paying the minimum supplemental
780	rebate. Agency decisions will be made on the clinical efficacy
781	of a drug and recommendations of the Medicaid Pharmaceutical and
782	Therapeutics Committee, as well as the price of competing
783	products minus federal and state rebates. The agency is
784	authorized to contract with an outside agency or contractor to
785	conduct negotiations for supplemental rebates. For the purposes
786	of this section, the term "supplemental rebates" means cash
787	rebates. Effective July 1, 2004, value-added programs as a
788	substitution for supplemental rebates are prohibited. The agency
789	is authorized to seek any federal waivers to implement this
790	initiative.
791	8.  The Agency for Health Care Administration shall expand
792	home delivery of pharmacy products. The agency is authorized to
793	amend the state plan and issue a procurement, as necessary, in
794	order to implement this program. The procurements shall include
795	agreements with a pharmacy or pharmacies located in the state to
796	provide mail order delivery services at no cost to the
797	recipients who elect to receive home delivery of pharmacy
798	products. The procurement shall focus on serving recipients with
799	chronic diseases for which pharmacy expenditures represent a
800	significant portion of Medicaid pharmacy expenditures or which
801	impact a significant portion of the Medicaid population. To
802	assist Medicaid patients in securing their prescriptions and
803	reduce program costs, the agency shall expand its current mail-
804	order-pharmacy diabetes-supply program to include all generic
805	and brand-name drugs used by Medicaid patients with diabetes.
806	Medicaid recipients in the current program may obtain
807	nondiabetes drugs on a voluntary basis. This initiative is
808	limited to the geographic area covered by the current contract.
809	The agency may seek and implement any federal waivers necessary
810	to implement this subparagraph.
811	9.  The agency shall limit to one dose per month any drug
812	prescribed to treat erectile dysfunction.
813	10.a.  The agency may implement a Medicaid behavioral drug
814	management system. The agency may contract with a vendor that
815	has experience in operating behavioral drug management systems
816	to implement this program. The agency is authorized to seek
817	federal waivers to implement this program.
818	b.  The agency, in conjunction with the Department of
819	Children and Family Services, may implement the Medicaid
820	behavioral drug management system that is designed to improve
821	the quality of care and behavioral health prescribing practices
822	based on best practice guidelines, improve patient adherence to
823	medication plans, reduce clinical risk, and lower prescribed
824	drug costs and the rate of inappropriate spending on Medicaid
825	behavioral drugs. The program may include the following
826	elements:
827	(I)  Provide for the development and adoption of best
828	practice guidelines for behavioral health-related drugs such as
829	antipsychotics, antidepressants, and medications for treating
830	bipolar disorders and other behavioral conditions; translate
831	them into practice; review behavioral health prescribers and
832	compare their prescribing patterns to a number of indicators
833	that are based on national standards; and determine deviations
834	from best practice guidelines.
835	(II)  Implement processes for providing feedback to and
836	educating prescribers using best practice educational materials
837	and peer-to-peer consultation.
838	(III)  Assess Medicaid beneficiaries who are outliers in
839	their use of behavioral health drugs with regard to the numbers
840	and types of drugs taken, drug dosages, combination drug
841	therapies, and other indicators of improper use of behavioral
842	health drugs.
843	(IV)  Alert prescribers to patients who fail to refill
844	prescriptions in a timely fashion, are prescribed multiple same-
845	class behavioral health drugs, and may have other potential
846	medication problems.
847	(V)  Track spending trends for behavioral health drugs and
848	deviation from best practice guidelines.
849	(VI)  Use educational and technological approaches to
850	promote best practices, educate consumers, and train prescribers
851	in the use of practice guidelines.
852	(VII)  Disseminate electronic and published materials.
853	(VIII)  Hold statewide and regional conferences.
854	(IX)  Implement a disease management program with a model
855	quality-based medication component for severely mentally ill
856	individuals and emotionally disturbed children who are high
857	users of care.
858	11.a.  The agency shall implement a Medicaid prescription
859	drug management system. The agency may contract with a vendor
860	that has experience in operating prescription drug management
861	systems in order to implement this system. Any management system
862	that is implemented in accordance with this subparagraph must
863	rely on cooperation between physicians and pharmacists to
864	determine appropriate practice patterns and clinical guidelines
865	to improve the prescribing, dispensing, and use of drugs in the
866	Medicaid program. The agency may seek federal waivers to
867	implement this program.
868	b.  The drug management system must be designed to improve
869	the quality of care and prescribing practices based on best
870	practice guidelines, improve patient adherence to medication
871	plans, reduce clinical risk, and lower prescribed drug costs and
872	the rate of inappropriate spending on Medicaid prescription
873	drugs. The program must:
874	(I)  Provide for the development and adoption of best
875	practice guidelines for the prescribing and use of drugs in the
876	Medicaid program, including translating best practice guidelines
877	into practice; reviewing prescriber patterns and comparing them
878	to indicators that are based on national standards and practice
879	patterns of clinical peers in their community, statewide, and
880	nationally; and determine deviations from best practice
881	guidelines.
882	(II)  Implement processes for providing feedback to and
883	educating prescribers using best practice educational materials
884	and peer-to-peer consultation.
885	(III)  Assess Medicaid recipients who are outliers in their
886	use of a single or multiple prescription drugs with regard to
887	the numbers and types of drugs taken, drug dosages, combination
888	drug therapies, and other indicators of improper use of
889	prescription drugs.
890	(IV)  Alert prescribers to patients who fail to refill
891	prescriptions in a timely fashion, are prescribed multiple drugs
892	that may be redundant or contraindicated, or may have other
893	potential medication problems.
894	(V)  Track spending trends for prescription drugs and
895	deviation from best practice guidelines.
896	(VI)  Use educational and technological approaches to
897	promote best practices, educate consumers, and train prescribers
898	in the use of practice guidelines.
899	(VII)  Disseminate electronic and published materials.
900	(VIII)  Hold statewide and regional conferences.
901	(IX)  Implement disease management programs in cooperation
902	with physicians and pharmacists, along with a model quality-
903	based medication component for individuals having chronic
904	medical conditions.
905	12.  The agency is authorized to contract for drug rebate
906	administration, including, but not limited to, calculating
907	rebate amounts, invoicing manufacturers, negotiating disputes
908	with manufacturers, and maintaining a database of rebate
909	collections.
910	13.  The agency may specify the preferred daily dosing form
911	or strength for the purpose of promoting best practices with
912	regard to the prescribing of certain drugs as specified in the
913	General Appropriations Act and ensuring cost-effective
914	prescribing practices.
915	14.  The agency may require prior authorization for
916	Medicaid-covered prescribed drugs. The agency may, but is not
917	required to, prior-authorize the use of a product:
918	a.  For an indication not approved in labeling;
919	b.  To comply with certain clinical guidelines; or
920	c.  If the product has the potential for overuse, misuse,
921	or abuse.
922
923	The agency may require the prescribing professional to provide
924	information about the rationale and supporting medical evidence
925	for the use of a drug. The agency may post prior authorization
926	criteria and protocol and updates to the list of drugs that are
927	subject to prior authorization on an Internet website without
928	amending its rule or engaging in additional rulemaking.
929	15.  The agency, in conjunction with the Pharmaceutical and
930	Therapeutics Committee, may require age-related prior
931	authorizations for certain prescribed drugs. The agency may
932	preauthorize the use of a drug for a recipient who may not meet
933	the age requirement or may exceed the length of therapy for use
934	of this product as recommended by the manufacturer and approved
935	by the Food and Drug Administration. Prior authorization may
936	require the prescribing professional to provide information
937	about the rationale and supporting medical evidence for the use
938	of a drug.
939	16.  The agency shall implement a step-therapy prior
940	authorization approval process for medications excluded from the
941	preferred drug list. Medications listed on the preferred drug
942	list must be used within the previous 12 months prior to the
943	alternative medications that are not listed. The step-therapy
944	prior authorization may require the prescriber to use the
945	medications of a similar drug class or for a similar medical
946	indication unless contraindicated in the Food and Drug
947	Administration labeling. The trial period between the specified
948	steps may vary according to the medical indication. The step-
949	therapy approval process shall be developed in accordance with
950	the committee as stated in s. 409.91195(7) and (8). A drug
951	product may be approved without meeting the step-therapy prior
952	authorization criteria if the prescribing physician provides the
953	agency with additional written medical or clinical documentation
954	that the product is medically necessary because:
955	a.  There is not a drug on the preferred drug list to treat
956	the disease or medical condition which is an acceptable clinical
957	alternative;
958	b.  The alternatives have been ineffective in the treatment
959	of the beneficiary's disease; or
960	c.  Based on historic evidence and known characteristics of
961	the patient and the drug, the drug is likely to be ineffective,
962	or the number of doses have been ineffective.
963
964	The agency shall work with the physician to determine the best
965	alternative for the patient. The agency may adopt rules waiving
966	the requirements for written clinical documentation for specific
967	drugs in limited clinical situations.
968	17.  The agency shall implement a return and reuse program
969	for drugs dispensed by pharmacies to institutional recipients,
970	which includes payment of a $5 restocking fee for the
971	implementation and operation of the program. The return and
972	reuse program shall be implemented electronically and in a
973	manner that promotes efficiency. The program must permit a
974	pharmacy to exclude drugs from the program if it is not
975	practical or cost-effective for the drug to be included and must
976	provide for the return to inventory of drugs that cannot be
977	credited or returned in a cost-effective manner. The agency
978	shall determine if the program has reduced the amount of
979	Medicaid prescription drugs which are destroyed on an annual
980	basis and if there are additional ways to ensure more
981	prescription drugs are not destroyed which could safely be
982	reused. The agency's conclusion and recommendations shall be
983	reported to the Legislature by December 1, 2005.
984	Section 11.  Notwithstanding s. 430.707, Florida Statutes,
985	and subject to federal approval of the application to be a site
986	for the Program of All-inclusive Care for the Elderly, the
987	Agency for Health Care Administration shall contract with one
988	private health care organization, the sole member of which is a
989	private, not-for-profit corporation that owns and manages health
990	care organizations which provide comprehensive long-term care
991	services, including nursing home, assisted living, independent
992	housing, home care, adult day care, and care management, with a
993	board-certified, trained geriatrician as the medical director.
994	This organization shall provide these services to frail and
995	elderly persons who reside in Palm Beach County. The
996	organization shall be exempt from the requirements of chapter
997	641, Florida Statutes. The agency, in consultation with the
998	Department of Elderly Affairs and subject to an appropriation,
999	shall approve up to 150 initial enrollees in the Program of All-
1000	inclusive Care for the Elderly established by this organization
1001	to serve elderly persons who reside in Palm Beach County.
1002	Section 12.  This act shall take effect July 1, 2011.
1003
1004
1005	-----------------------------------------------------
1006	T I T L E  A M E N D M E N T
1007	Remove the entire title and insert:
1008	A bill to be entitled
1009	An act relating to Medicaid services; amending s. 409.904,
1010	F.S.; repealing the sunset of provisions authorizing the
1011	federal waiver for certain persons age 65 and older or who
1012	have a disability; repealing the sunset of provisions
1013	authorizing a specified medically needy program;
1014	eliminating the limit to services placed on the medically
1015	needy program for pregnant women and children younger than
1016	age 21; amending s. 409.906, F.S.; eliminating adult
1017	Medicaid optional coverage for chiropractic services;
1018	eliminating adult Medicaid optional coverage for hearing
1019	services; amending s. 409.908, F.S.; updating the formula
1020	used for calculating reimbursements to Medicaid providers
1021	for prescribed drugs; continuing the requirement that the
1022	Agency for Health Care Administration set certain
1023	institutional provider reimbursement rates in a manner
1024	that results in no automatic cost-based statewide
1025	expenditure increase; deleting an obsolete requirement to
1026	establish workgroups to evaluate alternate reimbursement
1027	and payment methods; eliminating the repeal date of the
1028	suspension of the use of cost data to set certain
1029	institutional provider reimbursement rates; amending s.
1030	409.9082, F.S.; revising the allowed aggregated amount of
1031	assessments for all nursing home facilities to conform
1032	with federal law; amending s. 409.9083, F.S.; eliminating
1033	the repeal date of the quality assessment on privately
1034	operated intermediate care facilities for the
1035	developmentally disabled; amending s. 409.911, F.S.;
1036	updating the audited data specified for use in calculating
1037	disproportionate share; amending s. 409.9112, F.S.;
1038	continuing the prohibition against distributing moneys
1039	under the perinatal intensive care centers
1040	disproportionate share program; amending s. 409.9113,
1041	F.S.; continuing authorization for the distribution of
1042	moneys to certain teaching hospitals under the
1043	disproportionate share program; amending s. 409.9117,
1044	F.S.; continuing the prohibition against distributing
1045	moneys under the primary care disproportionate share
1046	program; amending s. 409.912, F.S.; allowing the agency to
1047	continue to contract for electronic access to certain
1048	pharmacology drug information; eliminating the requirement
1049	to implement a wireless handheld clinical pharmacology
1050	drug information database for practitioners; updating the
1051	formula used for calculating reimbursement to Medicaid
1052	providers for prescribed drugs; authorizing the agency to
1053	seek federal approval and to issue a procurement in order
1054	to implement a home delivery of pharmacy products program;
1055	establishing the provisions for the procurement and the
1056	program; eliminating the requirement for the expansion of
1057	the mail-order-pharmacy diabetes-supply program;
1058	eliminating certain provisions of the Medicaid
1059	prescription drug management program; authorizing the
1060	agency to contract with an organization to provide certain
1061	benefits under a federal program in Palm Beach County;
1062	providing an exemption from ch. 641, F.S., for the
1063	organization; authorizing, subject to appropriation,
1064	enrollment slots for the Program of All-inclusive Care for
1065	the Elderly in Palm Beach County; providing an effective
1066	date.

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