Florida Senate - 2011 CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 2144, 1st Eng.
Barcode 784096
LEGISLATIVE ACTION
Senate . House
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Floor: AD/CR .
05/06/2011 09:23 PM .
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The Conference Committee on SB 2144, 1st Eng. recommended the
following:
1 Senate Conference Committee Amendment (with title
2 amendment)
3
4 Delete everything after the enacting clause
5 and insert:
6 Section 1. Paragraph (a) of subsection (3) of section
7 400.23, Florida Statutes, is amended to read:
8 400.23 Rules; evaluation and deficiencies; licensure
9 status.—
10 (3)(a)1. The agency shall adopt rules providing minimum
11 staffing requirements for nursing home facilities homes. These
12 requirements must shall include, for each nursing home facility:
13 a. A minimum weekly average of certified nursing assistant
14 and licensed nursing staffing combined of 3.6 3.9 hours of
15 direct care per resident per day. As used in this sub
16 subparagraph, a week is defined as Sunday through Saturday.
17 b. A minimum certified nursing assistant staffing of 2.5
18 2.7 hours of direct care per resident per day. A facility may
19 not staff below one certified nursing assistant per 20
20 residents.
21 c. A minimum licensed nursing staffing of 1.0 hour of
22 direct care per resident per day. A facility may not staff below
23 one licensed nurse per 40 residents.
24 2. Nursing assistants employed under s. 400.211(2) may be
25 included in computing the staffing ratio for certified nursing
26 assistants only if their job responsibilities include only
27 nursing-assistant-related duties.
28 3. Each nursing home facility must document compliance with
29 staffing standards as required under this paragraph and post
30 daily the names of staff on duty for the benefit of facility
31 residents and the public.
32 4. The agency shall recognize the use of licensed nurses
33 for compliance with minimum staffing requirements for certified
34 nursing assistants if, provided that the nursing home facility
35 otherwise meets the minimum staffing requirements for licensed
36 nurses and that the licensed nurses are performing the duties of
37 a certified nursing assistant. Unless otherwise approved by the
38 agency, licensed nurses counted toward the minimum staffing
39 requirements for certified nursing assistants must exclusively
40 perform the duties of a certified nursing assistant for the
41 entire shift and not also be counted toward the minimum staffing
42 requirements for licensed nurses. If the agency approved a
43 facility’s request to use a licensed nurse to perform both
44 licensed nursing and certified nursing assistant duties, the
45 facility must allocate the amount of staff time specifically
46 spent on certified nursing assistant duties for the purpose of
47 documenting compliance with minimum staffing requirements for
48 certified and licensed nursing staff. In no event may The hours
49 of a licensed nurse with dual job responsibilities may not be
50 counted twice.
51 Section 2. Section 408.815, Florida Statutes, is amended to
52 read:
53 408.815 License or application denial; revocation.—
54 (1) In addition to the grounds provided in authorizing
55 statutes, grounds that may be used by the agency for denying and
56 revoking a license or change of ownership application include
57 any of the following actions by a controlling interest:
58 (a) False representation of a material fact in the license
59 application or omission of any material fact from the
60 application.
61 (b) An intentional or negligent act materially affecting
62 the health or safety of a client of the provider.
63 (c) A violation of this part, authorizing statutes, or
64 applicable rules.
65 (d) A demonstrated pattern of deficient performance.
66 (e) The applicant, licensee, or controlling interest has
67 been or is currently excluded, suspended, or terminated from
68 participation in the state Medicaid program, the Medicaid
69 program of any other state, or the Medicare program.
70 (2) If a licensee lawfully continues to operate while a
71 denial or revocation is pending in litigation, the licensee must
72 continue to meet all other requirements of this part,
73 authorizing statutes, and applicable rules and must file
74 subsequent renewal applications for licensure and pay all
75 licensure fees. The provisions of ss. 120.60(1) and
76 408.806(3)(c) do shall not apply to renewal applications filed
77 during the time period in which the litigation of the denial or
78 revocation is pending until that litigation is final.
79 (3) An action under s. 408.814 or denial of the license of
80 the transferor may be grounds for denial of a change of
81 ownership application of the transferee.
82 (4) Unless an applicant is determined by the agency to
83 satisfy the provisions of subsection (5) for the action in
84 question, the agency shall deny an application for a license or
85 license renewal based upon any of the following actions of an
86 applicant, a controlling interest of the applicant, or any
87 entity in which a controlling interest of the applicant was an
88 owner or officer when the following actions occurred In addition
89 to the grounds provided in authorizing statutes, the agency
90 shall deny an application for a license or license renewal if
91 the applicant or a person having a controlling interest in an
92 applicant has been:
93 (a) A conviction or Convicted of, or enters a plea of
94 guilty or nolo contendere to, regardless of adjudication, a
95 felony under chapter 409, chapter 817, chapter 893, 21 U.S.C.
96 ss. 801-970, or 42 U.S.C. ss. 1395-1396, Medicaid fraud,
97 Medicare fraud, or insurance fraud, unless the sentence and any
98 subsequent period of probation for such convictions or plea
99 ended more than 15 years before prior to the date of the
100 application; or
101 (b) Termination Terminated for cause from the Medicare
102 Florida Medicaid program or a state Medicaid program pursuant to
103 s. 409.913, unless the applicant has been in good standing with
104 the Medicare program or a state the Florida Medicaid program for
105 the most recent 5 years and the termination occurred at least 20
106 years before the date of the application.; or
107 (c) Terminated for cause, pursuant to the appeals
108 procedures established by the state or Federal Government, from
109 the federal Medicare program or from any other state Medicaid
110 program, unless the applicant has been in good standing with a
111 state Medicaid program or the federal Medicare program for the
112 most recent 5 years and the termination occurred at least 20
113 years prior to the date of the application.
114 (5) For any application subject to denial under subsection
115 (4), the agency may consider mitigating circumstances as
116 applicable, including, but not limited to:
117 (a) Completion or lawful release from confinement,
118 supervision, or sanction, including the terms of probation, and
119 full restitution;
120 (b) Execution of a compliance plan with the agency;
121 (c) Compliance with an integrity agreement or compliance
122 plan with another government agency;
123 (d) Determination by any state Medicaid program or the
124 Medicare program that the controlling interest or entity in
125 which the controlling interest was an owner or officer is
126 currently allowed to participate in the state Medicaid program
127 or the Medicare program, directly as a provider or indirectly as
128 an owner or officer of a provider entity;
129 (e) Continuation of licensure by the controlling interest
130 or entity in which the controlling interest was an owner or
131 officer, directly as a licensee or indirectly as an owner or
132 officer of a licensed entity in the state where the action
133 occurred;
134 (f) Overall impact upon the public health, safety, or
135 welfare; or
136 (g) Determination that a license denial is not commensurate
137 with the prior action taken by the Medicare or state Medicaid
138 program.
139
140 After considering the circumstances set forth in this
141 subsection, the agency shall grant the license, with or without
142 conditions, grant a provisional license for a period of no more
143 than the licensure cycle, with or without conditions, or deny
144 the license.
145 (6) In order to ensure the health, safety, and welfare of
146 clients when a license has been denied, revoked, or is set to
147 terminate, the agency may extend the license expiration date for
148 up to 30 days for the sole purpose of allowing the safe and
149 orderly discharge of clients. The agency may impose conditions
150 on the extension, including, but not limited to, prohibiting or
151 limiting admissions, expedited discharge planning, required
152 status reports, and mandatory monitoring by the agency or third
153 parties. When imposing these conditions, the agency shall
154 consider the nature and number of clients, the availability and
155 location of acceptable alternative placements, and the ability
156 of the licensee to continue providing care to the clients. The
157 agency may terminate the extension or modify the conditions at
158 any time. This authority is in addition to any other authority
159 granted to the agency under chapter 120, this part, and
160 authorizing statutes but creates no right or entitlement to an
161 extension of a license expiration date.
162 Section 3. Subsections (1) and (2) of section 409.904,
163 Florida Statutes, are amended to read:
164 409.904 Optional payments for eligible persons.—The agency
165 may make payments for medical assistance and related services on
166 behalf of the following persons who are determined to be
167 eligible subject to the income, assets, and categorical
168 eligibility tests set forth in federal and state law. Payment on
169 behalf of these Medicaid eligible persons is subject to the
170 availability of moneys and any limitations established by the
171 General Appropriations Act or chapter 216.
172 (1) Effective January 1, 2006, and Subject to federal
173 waiver approval, a person who is age 65 or older or is
174 determined to be disabled, whose income is at or below 88
175 percent of the federal poverty level, whose assets do not exceed
176 established limitations, and who is not eligible for Medicare
177 or, if eligible for Medicare, is also eligible for and receiving
178 Medicaid-covered institutional care services, hospice services,
179 or home and community-based services. The agency shall seek
180 federal authorization through a waiver to provide this coverage.
181 This subsection expires June 30, 2011.
182 (2)(a) A family, a pregnant woman, a child under age 21, a
183 person age 65 or over, or a blind or disabled person, who would
184 be eligible under any group listed in s. 409.903(1), (2), or
185 (3), except that the income or assets of such family or person
186 exceed established limitations. For a family or person in one of
187 these coverage groups, medical expenses are deductible from
188 income in accordance with federal requirements in order to make
189 a determination of eligibility. A family or person eligible
190 under the coverage known as the “medically needy,” is eligible
191 to receive the same services as other Medicaid recipients, with
192 the exception of services in skilled nursing facilities and
193 intermediate care facilities for the developmentally disabled.
194 This paragraph expires June 30, 2011.
195 (b) Effective July 1, 2011, a pregnant woman or a child
196 younger than 21 years of age who would be eligible under any
197 group listed in s. 409.903, except that the income or assets of
198 such group exceed established limitations. For a person in one
199 of these coverage groups, medical expenses are deductible from
200 income in accordance with federal requirements in order to make
201 a determination of eligibility. A person eligible under the
202 coverage known as the “medically needy” is eligible to receive
203 the same services as other Medicaid recipients, with the
204 exception of services in skilled nursing facilities and
205 intermediate care facilities for the developmentally disabled.
206 Section 4. Paragraphs (d), (e), and (f) of subsection (5)
207 of section 409.905, Florida Statutes, are amended to read:
208 409.905 Mandatory Medicaid services.—The agency may make
209 payments for the following services, which are required of the
210 state by Title XIX of the Social Security Act, furnished by
211 Medicaid providers to recipients who are determined to be
212 eligible on the dates on which the services were provided. Any
213 service under this section shall be provided only when medically
214 necessary and in accordance with state and federal law.
215 Mandatory services rendered by providers in mobile units to
216 Medicaid recipients may be restricted by the agency. Nothing in
217 this section shall be construed to prevent or limit the agency
218 from adjusting fees, reimbursement rates, lengths of stay,
219 number of visits, number of services, or any other adjustments
220 necessary to comply with the availability of moneys and any
221 limitations or directions provided for in the General
222 Appropriations Act or chapter 216.
223 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
224 all covered services provided for the medical care and treatment
225 of a recipient who is admitted as an inpatient by a licensed
226 physician or dentist to a hospital licensed under part I of
227 chapter 395. However, the agency shall limit the payment for
228 inpatient hospital services for a Medicaid recipient 21 years of
229 age or older to 45 days or the number of days necessary to
230 comply with the General Appropriations Act.
231 (d) The agency shall implement a hospitalist program in
232 nonteaching hospitals, select counties, or statewide. The
233 program shall require hospitalists to manage Medicaid
234 recipients’ hospital admissions and lengths of stay. Individuals
235 who are dually eligible for Medicare and Medicaid are exempted
236 from this requirement. Medicaid participating physicians and
237 other practitioners with hospital admitting privileges shall
238 coordinate and review admissions of Medicaid recipients with the
239 hospitalist. The agency may competitively bid a contract for
240 selection of a single qualified organization to provide
241 hospitalist services. The agency may procure hospitalist
242 services by individual county or may combine counties in a
243 single procurement. The qualified organization shall contract
244 with or employ board-eligible physicians in Miami-Dade, Palm
245 Beach, Hillsborough, Pasco, and Pinellas Counties. The agency is
246 authorized to seek federal waivers to implement this program.
247 (d)(e) The agency shall implement a comprehensive
248 utilization management program for hospital neonatal intensive
249 care stays in certain high-volume participating hospitals,
250 select counties, or statewide, and shall replace existing
251 hospital inpatient utilization management programs for neonatal
252 intensive care admissions. The program shall be designed to
253 manage the lengths of stay for children being treated in
254 neonatal intensive care units and must seek the earliest
255 medically appropriate discharge to the child’s home or other
256 less costly treatment setting. The agency may competitively bid
257 a contract for the selection of a qualified organization to
258 provide neonatal intensive care utilization management services.
259 The agency may is authorized to seek any federal waivers to
260 implement this initiative.
261 (e)(f) The agency may develop and implement a program to
262 reduce the number of hospital readmissions among the non
263 Medicare population eligible in areas 9, 10, and 11.
264 Section 5. Paragraph (b) of subsection (2) and subsections
265 (14) and (23) of section 409.908, Florida Statutes, are amended
266 to read:
267 409.908 Reimbursement of Medicaid providers.—Subject to
268 specific appropriations, the agency shall reimburse Medicaid
269 providers, in accordance with state and federal law, according
270 to methodologies set forth in the rules of the agency and in
271 policy manuals and handbooks incorporated by reference therein.
272 These methodologies may include fee schedules, reimbursement
273 methods based on cost reporting, negotiated fees, competitive
274 bidding pursuant to s. 287.057, and other mechanisms the agency
275 considers efficient and effective for purchasing services or
276 goods on behalf of recipients. If a provider is reimbursed based
277 on cost reporting and submits a cost report late and that cost
278 report would have been used to set a lower reimbursement rate
279 for a rate semester, then the provider’s rate for that semester
280 shall be retroactively calculated using the new cost report, and
281 full payment at the recalculated rate shall be effected
282 retroactively. Medicare-granted extensions for filing cost
283 reports, if applicable, shall also apply to Medicaid cost
284 reports. Payment for Medicaid compensable services made on
285 behalf of Medicaid eligible persons is subject to the
286 availability of moneys and any limitations or directions
287 provided for in the General Appropriations Act or chapter 216.
288 Further, nothing in this section shall be construed to prevent
289 or limit the agency from adjusting fees, reimbursement rates,
290 lengths of stay, number of visits, or number of services, or
291 making any other adjustments necessary to comply with the
292 availability of moneys and any limitations or directions
293 provided for in the General Appropriations Act, provided the
294 adjustment is consistent with legislative intent.
295 (2)
296 (b) Subject to any limitations or directions provided for
297 in the General Appropriations Act, the agency shall establish
298 and implement a state Florida Title XIX Long-Term Care
299 Reimbursement Plan (Medicaid) for nursing home care in order to
300 provide care and services in conformance with the applicable
301 state and federal laws, rules, regulations, and quality and
302 safety standards and to ensure that individuals eligible for
303 medical assistance have reasonable geographic access to such
304 care.
305 1. The agency shall amend the long-term care reimbursement
306 plan and cost reporting system to create direct care and
307 indirect care subcomponents of the patient care component of the
308 per diem rate. These two subcomponents together shall equal the
309 patient care component of the per diem rate. Separate cost-based
310 ceilings shall be calculated for each patient care subcomponent.
311 The direct care subcomponent of the per diem rate shall be
312 limited by the cost-based class ceiling, and the indirect care
313 subcomponent may be limited by the lower of the cost-based class
314 ceiling, the target rate class ceiling, or the individual
315 provider target.
316 2. The direct care subcomponent shall include salaries and
317 benefits of direct care staff providing nursing services
318 including registered nurses, licensed practical nurses, and
319 certified nursing assistants who deliver care directly to
320 residents in the nursing home facility. This excludes nursing
321 administration, minimum data set, and care plan coordinators,
322 staff development, and staffing coordinator, and the
323 administrative portion of the minimum data set and care plan
324 coordinators.
325 3. All other patient care costs shall be included in the
326 indirect care cost subcomponent of the patient care per diem
327 rate. There shall be no Costs may not be allocated directly or
328 indirectly allocated to the direct care subcomponent from a home
329 office or management company.
330 4. On July 1 of each year, the agency shall report to the
331 Legislature direct and indirect care costs, including average
332 direct and indirect care costs per resident per facility and
333 direct care and indirect care salaries and benefits per category
334 of staff member per facility.
335 5. In order to offset the cost of general and professional
336 liability insurance, the agency shall amend the plan to allow
337 for interim rate adjustments to reflect increases in the cost of
338 general or professional liability insurance for nursing homes.
339 This provision shall be implemented to the extent existing
340 appropriations are available.
341
342 It is the intent of the Legislature that the reimbursement plan
343 achieve the goal of providing access to health care for nursing
344 home residents who require large amounts of care while
345 encouraging diversion services as an alternative to nursing home
346 care for residents who can be served within the community. The
347 agency shall base the establishment of any maximum rate of
348 payment, whether overall or component, on the available moneys
349 as provided for in the General Appropriations Act. The agency
350 may base the maximum rate of payment on the results of
351 scientifically valid analysis and conclusions derived from
352 objective statistical data pertinent to the particular maximum
353 rate of payment.
354 (14) A provider of prescribed drugs shall be reimbursed the
355 least of the amount billed by the provider, the provider’s usual
356 and customary charge, or the Medicaid maximum allowable fee
357 established by the agency, plus a dispensing fee. The Medicaid
358 maximum allowable fee for ingredient cost must will be based on
359 the lowest lower of: the average wholesale price (AWP) minus
360 16.4 percent, the wholesaler acquisition cost (WAC) plus 1.5
361 4.75 percent, the federal upper limit (FUL), the state maximum
362 allowable cost (SMAC), or the usual and customary (UAC) charge
363 billed by the provider.
364 (a) Medicaid providers must are required to dispense
365 generic drugs if available at lower cost and the agency has not
366 determined that the branded product is more cost-effective,
367 unless the prescriber has requested and received approval to
368 require the branded product.
369 (b) The agency shall is directed to implement a variable
370 dispensing fee for payments for prescribed medicines while
371 ensuring continued access for Medicaid recipients. The variable
372 dispensing fee may be based upon, but not limited to, either or
373 both the volume of prescriptions dispensed by a specific
374 pharmacy provider, the volume of prescriptions dispensed to an
375 individual recipient, and dispensing of preferred-drug-list
376 products.
377 (c) The agency may increase the pharmacy dispensing fee
378 authorized by statute and in the annual General Appropriations
379 Act by $0.50 for the dispensing of a Medicaid preferred-drug
380 list product and reduce the pharmacy dispensing fee by $0.50 for
381 the dispensing of a Medicaid product that is not included on the
382 preferred drug list.
383 (d) The agency may establish a supplemental pharmaceutical
384 dispensing fee to be paid to providers returning unused unit
385 dose packaged medications to stock and crediting the Medicaid
386 program for the ingredient cost of those medications if the
387 ingredient costs to be credited exceed the value of the
388 supplemental dispensing fee.
389 (e) The agency may is authorized to limit reimbursement for
390 prescribed medicine in order to comply with any limitations or
391 directions provided for in the General Appropriations Act, which
392 may include implementing a prospective or concurrent utilization
393 review program.
394 (23)(a) The agency shall establish rates at a level that
395 ensures no increase in statewide expenditures resulting from a
396 change in unit costs for 2 fiscal years effective July 1, 2011
397 2009. Reimbursement rates for the 2 fiscal years shall be as
398 provided in the General Appropriations Act.
399 (b) This subsection applies to the following provider
400 types:
401 1. Inpatient hospitals.
402 2. Outpatient hospitals.
403 3. Nursing homes.
404 4. County health departments.
405 5. Community intermediate care facilities for the
406 developmentally disabled.
407 6. Prepaid health plans.
408 (c) The agency shall apply the effect of this subsection to
409 the reimbursement rates for nursing home diversion programs.
410 (c) The agency shall create a workgroup on hospital
411 reimbursement, a workgroup on nursing facility reimbursement,
412 and a workgroup on managed care plan payment. The workgroups
413 shall evaluate alternative reimbursement and payment
414 methodologies for hospitals, nursing facilities, and managed
415 care plans, including prospective payment methodologies for
416 hospitals and nursing facilities. The nursing facility workgroup
417 shall also consider price-based methodologies for indirect care
418 and acuity adjustments for direct care. The agency shall submit
419 a report on the evaluated alternative reimbursement
420 methodologies to the relevant committees of the Senate and the
421 House of Representatives by November 1, 2009.
422 (d) This subsection expires June 30, 2011.
423 Section 6. Subsection (2) and paragraph (d) of subsection
424 (3) of section 409.9082, Florida Statutes, are amended to read:
425 409.9082 Quality assessment on nursing home facility
426 providers; exemptions; purpose; federal approval required;
427 remedies.—
428 (2) Effective April 1, 2009, a quality assessment there is
429 imposed upon each nursing home facility a quality assessment.
430 The aggregated amount of assessments for all nursing home
431 facilities in a given year shall be an amount not exceeding the
432 maximum percentage allowed under federal law 5.5 percent of the
433 total aggregate net patient service revenue of assessed
434 facilities. The agency shall calculate the quality assessment
435 rate annually on a per-resident-day basis, exclusive of those
436 resident days funded by the Medicare program, as reported by the
437 facilities. The per-resident-day assessment rate must shall be
438 uniform except as prescribed in subsection (3). Each facility
439 shall report monthly to the agency its total number of resident
440 days, exclusive of Medicare Part A resident days, and shall
441 remit an amount equal to the assessment rate times the reported
442 number of days. The agency shall collect, and each facility
443 shall pay, the quality assessment each month. The agency shall
444 collect the assessment from nursing home facility providers by
445 no later than the 15th day of the next succeeding calendar
446 month. The agency shall notify providers of the quality
447 assessment and provide a standardized form to complete and
448 submit with payments. The collection of the nursing home
449 facility quality assessment shall commence no sooner than 5 days
450 after the agency’s initial payment of the Medicaid rates
451 containing the elements prescribed in subsection (4). Nursing
452 home facilities may not create a separate line-item charge for
453 the purpose of passing through the assessment through to
454 residents.
455 (3)
456 (d) Effective July 1, 2011 2009, the agency may exempt from
457 the quality assessment or apply a lower quality assessment rate
458 to a qualified public, nonstate-owned or operated nursing home
459 facility whose total annual indigent census days are greater
460 than 20 25 percent of the facility’s total annual census days.
461 Section 7. Subsection (8) of section 409.9083, Florida
462 Statutes, is amended to read:
463 409.9083 Quality assessment on privately operated
464 intermediate care facilities for the developmentally disabled;
465 exemptions; purpose; federal approval required; remedies.—
466 (8) This section is repealed October 1, 2011.
467 Section 8. Paragraph (a) of subsection (2) of section
468 409.911, Florida Statutes, is amended, and paragraph (d) is
469 added to subsection (4) of that section, to read:
470 409.911 Disproportionate share program.—Subject to specific
471 allocations established within the General Appropriations Act
472 and any limitations established pursuant to chapter 216, the
473 agency shall distribute, pursuant to this section, moneys to
474 hospitals providing a disproportionate share of Medicaid or
475 charity care services by making quarterly Medicaid payments as
476 required. Notwithstanding the provisions of s. 409.915, counties
477 are exempt from contributing toward the cost of this special
478 reimbursement for hospitals serving a disproportionate share of
479 low-income patients.
480 (2) The Agency for Health Care Administration shall use the
481 following actual audited data to determine the Medicaid days and
482 charity care to be used in calculating the disproportionate
483 share payment:
484 (a) The average of the 2004, 2005, and 2006 2003, 2004, and
485 2005 audited disproportionate share data to determine each
486 hospital’s Medicaid days and charity care for the 2011-2012
487 2010-2011 state fiscal year.
488 (4) The following formulas shall be used to pay
489 disproportionate share dollars to public hospitals:
490 (d) Any nonstate government owned or operated hospital
491 eligible for payments under this section on July 1, 2011,
492 remains eligible for payments during the 2011-2012 state fiscal
493 year.
494 Section 9. Section 409.9112, Florida Statutes, is amended
495 to read:
496 409.9112 Disproportionate share program for regional
497 perinatal intensive care centers.—In addition to the payments
498 made under s. 409.911, the agency shall design and implement a
499 system for making disproportionate share payments to those
500 hospitals that participate in the regional perinatal intensive
501 care center program established pursuant to chapter 383. The
502 system of payments must conform to federal requirements and
503 distribute funds in each fiscal year for which an appropriation
504 is made by making quarterly Medicaid payments. Notwithstanding
505 s. 409.915, counties are exempt from contributing toward the
506 cost of this special reimbursement for hospitals serving a
507 disproportionate share of low-income patients. For the 2011-2012
508 2010-2011 state fiscal year, the agency may not distribute
509 moneys under the regional perinatal intensive care centers
510 disproportionate share program.
511 (1) The following formula shall be used by the agency to
512 calculate the total amount earned for hospitals that participate
513 in the regional perinatal intensive care center program:
514
515 TAE = HDSP/THDSP
516
517 Where:
518 TAE = total amount earned by a regional perinatal intensive
519 care center.
520 HDSP = the prior state fiscal year regional perinatal
521 intensive care center disproportionate share payment to the
522 individual hospital.
523 THDSP = the prior state fiscal year total regional
524 perinatal intensive care center disproportionate share payments
525 to all hospitals.
526
527 (2) The total additional payment for hospitals that
528 participate in the regional perinatal intensive care center
529 program shall be calculated by the agency as follows:
530
531 TAP = TAE x TA
532
533 Where:
534 TAP = total additional payment for a regional perinatal
535 intensive care center.
536 TAE = total amount earned by a regional perinatal intensive
537 care center.
538 TA = total appropriation for the regional perinatal
539 intensive care center disproportionate share program.
540
541 (3) In order to receive payments under this section, a
542 hospital must be participating in the regional perinatal
543 intensive care center program pursuant to chapter 383 and must
544 meet the following additional requirements:
545 (a) Agree to conform to all departmental and agency
546 requirements to ensure high quality in the provision of
547 services, including criteria adopted by departmental and agency
548 rule concerning staffing ratios, medical records, standards of
549 care, equipment, space, and such other standards and criteria as
550 the department and agency deem appropriate as specified by rule.
551 (b) Agree to provide information to the Department of
552 Health and the agency, in a form and manner to be prescribed by
553 rule of the department and agency, concerning the care provided
554 to all patients in neonatal intensive care centers and high-risk
555 maternity care.
556 (c) Agree to accept all patients for neonatal intensive
557 care and high-risk maternity care, regardless of ability to pay,
558 on a functional space-available basis.
559 (d) Agree to develop arrangements with other maternity and
560 neonatal care providers in the hospital’s region for the
561 appropriate receipt and transfer of patients in need of
562 specialized maternity and neonatal intensive care services.
563 (e) Agree to establish and provide a developmental
564 evaluation and services program for certain high-risk neonates,
565 as prescribed and defined by rule of the department.
566 (f) Agree to sponsor a program of continuing education in
567 perinatal care for health care professionals within the region
568 of the hospital, as specified by rule.
569 (g) Agree to provide backup and referral services to the
570 county health departments and other low-income perinatal
571 providers within the hospital’s region, including the
572 development of written agreements between these organizations
573 and the hospital.
574 (h) Agree to arrange for transportation for high-risk
575 obstetrical patients and neonates in need of transfer from the
576 community to the hospital or from the hospital to another more
577 appropriate facility.
578 (4) Hospitals that which fail to comply with any of the
579 conditions in subsection (3) or the applicable rules of the
580 Department of Health and the agency may not receive any payments
581 under this section until full compliance is achieved. A hospital
582 that which is not in compliance in two or more consecutive
583 quarters may not receive its share of the funds. Any forfeited
584 funds shall be distributed by the remaining participating
585 regional perinatal intensive care center program hospitals.
586 Section 10. Section 409.9113, Florida Statutes, is amended
587 to read:
588 409.9113 Disproportionate share program for teaching
589 hospitals.—In addition to the payments made under ss. 409.911
590 and 409.9112, the agency shall make disproportionate share
591 payments to statutorily defined teaching hospitals, as defined
592 in s. 408.07, for their increased costs associated with medical
593 education programs and for tertiary health care services
594 provided to the indigent. This system of payments must conform
595 to federal requirements and distribute funds in each fiscal year
596 for which an appropriation is made by making quarterly Medicaid
597 payments. Notwithstanding s. 409.915, counties are exempt from
598 contributing toward the cost of this special reimbursement for
599 hospitals serving a disproportionate share of low-income
600 patients. For the 2011-2012 2010-2011 state fiscal year, the
601 agency shall distribute the moneys provided in the General
602 Appropriations Act to statutorily defined teaching hospitals and
603 family practice teaching hospitals, as defined in s. 395.805,
604 pursuant to this section under the teaching hospital
605 disproportionate share program. The funds provided for
606 statutorily defined teaching hospitals shall be distributed in
607 the same proportion as the state fiscal year 2003-2004 teaching
608 hospital disproportionate share funds were distributed or as
609 otherwise provided in the General Appropriations Act. The funds
610 provided for family practice teaching hospitals shall be
611 distributed equally among family practice teaching hospitals.
612 (1) On or before September 15 of each year, the agency
613 shall calculate an allocation fraction to be used for
614 distributing funds to state statutory teaching hospitals.
615 Subsequent to the end of each quarter of the state fiscal year,
616 the agency shall distribute to each statutory teaching hospital,
617 as defined in s. 408.07, an amount determined by multiplying
618 one-fourth of the funds appropriated for this purpose by the
619 Legislature times such hospital’s allocation fraction. The
620 allocation fraction for each such hospital shall be determined
621 by the sum of the following three primary factors, divided by
622 three:
623 (a) The number of nationally accredited graduate medical
624 education programs offered by the hospital, including programs
625 accredited by the Accreditation Council for Graduate Medical
626 Education and the combined Internal Medicine and Pediatrics
627 programs acceptable to both the American Board of Internal
628 Medicine and the American Board of Pediatrics at the beginning
629 of the state fiscal year preceding the date on which the
630 allocation fraction is calculated. The numerical value of this
631 factor is the fraction that the hospital represents of the total
632 number of programs, where the total is computed for all state
633 statutory teaching hospitals.
634 (b) The number of full-time equivalent trainees in the
635 hospital, which comprises two components:
636 1. The number of trainees enrolled in nationally accredited
637 graduate medical education programs, as defined in paragraph
638 (a). Full-time equivalents are computed using the fraction of
639 the year during which each trainee is primarily assigned to the
640 given institution, over the state fiscal year preceding the date
641 on which the allocation fraction is calculated. The numerical
642 value of this factor is the fraction that the hospital
643 represents of the total number of full-time equivalent trainees
644 enrolled in accredited graduate programs, where the total is
645 computed for all state statutory teaching hospitals.
646 2. The number of medical students enrolled in accredited
647 colleges of medicine and engaged in clinical activities,
648 including required clinical clerkships and clinical electives.
649 Full-time equivalents are computed using the fraction of the
650 year during which each trainee is primarily assigned to the
651 given institution, over the course of the state fiscal year
652 preceding the date on which the allocation fraction is
653 calculated. The numerical value of this factor is the fraction
654 that the given hospital represents of the total number of full
655 time equivalent students enrolled in accredited colleges of
656 medicine, where the total is computed for all state statutory
657 teaching hospitals.
658
659 The primary factor for full-time equivalent trainees is computed
660 as the sum of these two components, divided by two.
661 (c) A service index that comprises three components:
662 1. The Agency for Health Care Administration Service Index,
663 computed by applying the standard Service Inventory Scores
664 established by the agency to services offered by the given
665 hospital, as reported on Worksheet A-2 for the last fiscal year
666 reported to the agency before the date on which the allocation
667 fraction is calculated. The numerical value of this factor is
668 the fraction that the given hospital represents of the total
669 Agency for Health Care Administration Service index values,
670 where the total is computed for all state statutory teaching
671 hospitals.
672 2. A volume-weighted service index, computed by applying
673 the standard Service Inventory Scores established by the agency
674 for Health Care Administration to the volume of each service,
675 expressed in terms of the standard units of measure reported on
676 Worksheet A-2 for the last fiscal year reported to the agency
677 before the date on which the allocation factor is calculated.
678 The numerical value of this factor is the fraction that the
679 given hospital represents of the total volume-weighted service
680 index values, where the total is computed for all state
681 statutory teaching hospitals.
682 3. Total Medicaid payments to each hospital for direct
683 inpatient and outpatient services during the fiscal year
684 preceding the date on which the allocation factor is calculated.
685 This includes payments made to each hospital for such services
686 by Medicaid prepaid health plans, whether the plan was
687 administered by the hospital or not. The numerical value of this
688 factor is the fraction that each hospital represents of the
689 total of such Medicaid payments, where the total is computed for
690 all state statutory teaching hospitals.
691
692 The primary factor for the service index is computed as the sum
693 of these three components, divided by three.
694 (2) By October 1 of each year, the agency shall use the
695 following formula to calculate the maximum additional
696 disproportionate share payment for statutory statutorily defined
697 teaching hospitals:
698
699 TAP = THAF x A
700
701 Where:
702 TAP = total additional payment.
703 THAF = teaching hospital allocation factor.
704 A = amount appropriated for a teaching hospital
705 disproportionate share program.
706 Section 11. Section 409.9117, Florida Statutes, is amended
707 to read:
708 409.9117 Primary care disproportionate share program.—For
709 the 2011-2012 2010-2011 state fiscal year, the agency shall not
710 distribute moneys under the primary care disproportionate share
711 program.
712 (1) If federal funds are available for disproportionate
713 share programs in addition to those otherwise provided by law,
714 there shall be created a primary care disproportionate share
715 program shall be established.
716 (2) The following formula shall be used by the agency to
717 calculate the total amount earned for hospitals that participate
718 in the primary care disproportionate share program:
719
720 TAE = HDSP/THDSP
721
722 Where:
723 TAE = total amount earned by a hospital participating in
724 the primary care disproportionate share program.
725 HDSP = the prior state fiscal year primary care
726 disproportionate share payment to the individual hospital.
727 THDSP = the prior state fiscal year total primary care
728 disproportionate share payments to all hospitals.
729
730 (3) The total additional payment for hospitals that
731 participate in the primary care disproportionate share program
732 shall be calculated by the agency as follows:
733
734 TAP = TAE x TA
735
736 Where:
737 TAP = total additional payment for a primary care hospital.
738 TAE = total amount earned by a primary care hospital.
739 TA = total appropriation for the primary care
740 disproportionate share program.
741
742 (4) In establishing the establishment and funding of this
743 program, the agency shall use the following criteria in addition
744 to those specified in s. 409.911, and payments may not be made
745 to a hospital unless the hospital agrees to:
746 (a) Cooperate with a Medicaid prepaid health plan, if one
747 exists in the community.
748 (b) Ensure the availability of primary and specialty care
749 physicians to Medicaid recipients who are not enrolled in a
750 prepaid capitated arrangement and who are in need of access to
751 such physicians.
752 (c) Coordinate and provide primary care services free of
753 charge, except copayments, to all persons with incomes up to 100
754 percent of the federal poverty level who are not otherwise
755 covered by Medicaid or another program administered by a
756 governmental entity, and to provide such services based on a
757 sliding fee scale to all persons with incomes up to 200 percent
758 of the federal poverty level who are not otherwise covered by
759 Medicaid or another program administered by a governmental
760 entity, except that eligibility may be limited to persons who
761 reside within a more limited area, as agreed to by the agency
762 and the hospital.
763 (d) Contract with any federally qualified health center, if
764 one exists within the agreed geopolitical boundaries, concerning
765 the provision of primary care services, in order to guarantee
766 delivery of services in a nonduplicative fashion, and to provide
767 for referral arrangements, privileges, and admissions, as
768 appropriate. The hospital shall agree to provide at an onsite or
769 offsite facility primary care services within 24 hours at an
770 onsite or offsite facility to which all Medicaid recipients and
771 persons eligible under this paragraph who do not require
772 emergency room services are referred during normal daylight
773 hours.
774 (e) Cooperate with the agency, the county, and other
775 entities to ensure the provision of certain public health
776 services, case management, referral and acceptance of patients,
777 and sharing of epidemiological data, as the agency and the
778 hospital find mutually necessary and desirable to promote and
779 protect the public health within the agreed geopolitical
780 boundaries.
781 (f) In cooperation with the county in which the hospital
782 resides, develop a low-cost, outpatient, prepaid health care
783 program to persons who are not eligible for the Medicaid
784 program, and who reside within the area.
785 (g) Provide inpatient services to residents within the area
786 who are not eligible for Medicaid or Medicare, and who do not
787 have private health insurance, regardless of ability to pay, on
788 the basis of available space, except that hospitals may not be
789 prevented from establishing bill collection programs based on
790 ability to pay.
791 (h) Work with the Florida Healthy Kids Corporation, the
792 Florida Health Care Purchasing Cooperative, and business health
793 coalitions, as appropriate, to develop a feasibility study and
794 plan to provide a low-cost comprehensive health insurance plan
795 to persons who reside within the area and who do not have access
796 to such a plan.
797 (i) Work with public health officials and other experts to
798 provide community health education and prevention activities
799 designed to promote healthy lifestyles and appropriate use of
800 health services.
801 (j) Work with the local health council to develop a plan
802 for promoting access to affordable health care services for all
803 persons who reside within the area, including, but not limited
804 to, public health services, primary care services, inpatient
805 services, and affordable health insurance generally.
806
807 Any hospital that fails to comply with any of the provisions of
808 this subsection, or any other contractual condition, may not
809 receive payments under this section until full compliance is
810 achieved.
811 Section 12. Paragraph (b) of subsection (4), paragraph (b)
812 of subsection (16), and paragraph (a) of subsection (39) of
813 section 409.912, Florida Statutes, are amended to read:
814 409.912 Cost-effective purchasing of health care.—The
815 agency shall purchase goods and services for Medicaid recipients
816 in the most cost-effective manner consistent with the delivery
817 of quality medical care. To ensure that medical services are
818 effectively utilized, the agency may, in any case, require a
819 confirmation or second physician’s opinion of the correct
820 diagnosis for purposes of authorizing future services under the
821 Medicaid program. This section does not restrict access to
822 emergency services or poststabilization care services as defined
823 in 42 C.F.R. part 438.114. Such confirmation or second opinion
824 shall be rendered in a manner approved by the agency. The agency
825 shall maximize the use of prepaid per capita and prepaid
826 aggregate fixed-sum basis services when appropriate and other
827 alternative service delivery and reimbursement methodologies,
828 including competitive bidding pursuant to s. 287.057, designed
829 to facilitate the cost-effective purchase of a case-managed
830 continuum of care. The agency shall also require providers to
831 minimize the exposure of recipients to the need for acute
832 inpatient, custodial, and other institutional care and the
833 inappropriate or unnecessary use of high-cost services. The
834 agency shall contract with a vendor to monitor and evaluate the
835 clinical practice patterns of providers in order to identify
836 trends that are outside the normal practice patterns of a
837 provider’s professional peers or the national guidelines of a
838 provider’s professional association. The vendor must be able to
839 provide information and counseling to a provider whose practice
840 patterns are outside the norms, in consultation with the agency,
841 to improve patient care and reduce inappropriate utilization.
842 The agency may mandate prior authorization, drug therapy
843 management, or disease management participation for certain
844 populations of Medicaid beneficiaries, certain drug classes, or
845 particular drugs to prevent fraud, abuse, overuse, and possible
846 dangerous drug interactions. The Pharmaceutical and Therapeutics
847 Committee shall make recommendations to the agency on drugs for
848 which prior authorization is required. The agency shall inform
849 the Pharmaceutical and Therapeutics Committee of its decisions
850 regarding drugs subject to prior authorization. The agency is
851 authorized to limit the entities it contracts with or enrolls as
852 Medicaid providers by developing a provider network through
853 provider credentialing. The agency may competitively bid single
854 source-provider contracts if procurement of goods or services
855 results in demonstrated cost savings to the state without
856 limiting access to care. The agency may limit its network based
857 on the assessment of beneficiary access to care, provider
858 availability, provider quality standards, time and distance
859 standards for access to care, the cultural competence of the
860 provider network, demographic characteristics of Medicaid
861 beneficiaries, practice and provider-to-beneficiary standards,
862 appointment wait times, beneficiary use of services, provider
863 turnover, provider profiling, provider licensure history,
864 previous program integrity investigations and findings, peer
865 review, provider Medicaid policy and billing compliance records,
866 clinical and medical record audits, and other factors. Providers
867 shall not be entitled to enrollment in the Medicaid provider
868 network. The agency shall determine instances in which allowing
869 Medicaid beneficiaries to purchase durable medical equipment and
870 other goods is less expensive to the Medicaid program than long
871 term rental of the equipment or goods. The agency may establish
872 rules to facilitate purchases in lieu of long-term rentals in
873 order to protect against fraud and abuse in the Medicaid program
874 as defined in s. 409.913. The agency may seek federal waivers
875 necessary to administer these policies.
876 (4) The agency may contract with:
877 (b) An entity that is providing comprehensive behavioral
878 health care services to certain Medicaid recipients through a
879 capitated, prepaid arrangement pursuant to the federal waiver
880 provided for by s. 409.905(5). Such entity must be licensed
881 under chapter 624, chapter 636, or chapter 641, or authorized
882 under paragraph (c) or paragraph (d), and must possess the
883 clinical systems and operational competence to manage risk and
884 provide comprehensive behavioral health care to Medicaid
885 recipients. As used in this paragraph, the term “comprehensive
886 behavioral health care services” means covered mental health and
887 substance abuse treatment services that are available to
888 Medicaid recipients. The Secretary of the Department of Children
889 and Family Services shall approve provisions of procurements
890 related to children in the department’s care or custody before
891 enrolling such children in a prepaid behavioral health plan. Any
892 contract awarded under this paragraph must be competitively
893 procured. In developing The behavioral health care prepaid plan
894 procurement document, the agency shall ensure that the
895 procurement document requires the contractor to develop and
896 implement a plan to ensure compliance with s. 394.4574 related
897 to services provided to residents of licensed assisted living
898 facilities that hold a limited mental health license. Except as
899 provided in subparagraph 8., and except in counties where the
900 Medicaid managed care pilot program is authorized pursuant to s.
901 409.91211, the agency shall seek federal approval to contract
902 with a single entity meeting these requirements to provide
903 comprehensive behavioral health care services to all Medicaid
904 recipients not enrolled in a Medicaid managed care plan
905 authorized under s. 409.91211, a provider service network
906 authorized under paragraph (d), or a Medicaid health maintenance
907 organization in an AHCA area. In an AHCA area where the Medicaid
908 managed care pilot program is authorized pursuant to s.
909 409.91211 in one or more counties, the agency may procure a
910 contract with a single entity to serve the remaining counties as
911 an AHCA area or the remaining counties may be included with an
912 adjacent AHCA area and are subject to this paragraph. Each
913 entity must offer a sufficient choice of providers in its
914 network to ensure recipient access to care and the opportunity
915 to select a provider with whom they are satisfied. The network
916 shall include all public mental health hospitals. To ensure
917 unimpaired access to behavioral health care services by Medicaid
918 recipients, all contracts issued pursuant to this paragraph must
919 require 80 percent of the capitation paid to the managed care
920 plan, including health maintenance organizations and capitated
921 provider service networks, to be expended for the provision of
922 behavioral health care services. If the managed care plan
923 expends less than 80 percent of the capitation paid for the
924 provision of behavioral health care services, the difference
925 shall be returned to the agency. The agency shall provide the
926 plan with a certification letter indicating the amount of
927 capitation paid during each calendar year for behavioral health
928 care services pursuant to this section. The agency may reimburse
929 for substance abuse treatment services on a fee-for-service
930 basis until the agency finds that adequate funds are available
931 for capitated, prepaid arrangements.
932 1. By January 1, 2001, The agency shall modify the
933 contracts with the entities providing comprehensive inpatient
934 and outpatient mental health care services to Medicaid
935 recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
936 Counties, to include substance abuse treatment services.
937 2. By July 1, 2003, the agency and the Department of
938 Children and Family Services shall execute a written agreement
939 that requires collaboration and joint development of all policy,
940 budgets, procurement documents, contracts, and monitoring plans
941 that have an impact on the state and Medicaid community mental
942 health and targeted case management programs.
943 3. Except as provided in subparagraph 8., by July 1, 2006,
944 the agency and the Department of Children and Family Services
945 shall contract with managed care entities in each AHCA area
946 except area 6 or arrange to provide comprehensive inpatient and
947 outpatient mental health and substance abuse services through
948 capitated prepaid arrangements to all Medicaid recipients who
949 are eligible to participate in such plans under federal law and
950 regulation. In AHCA areas where eligible individuals number less
951 than 150,000, the agency shall contract with a single managed
952 care plan to provide comprehensive behavioral health services to
953 all recipients who are not enrolled in a Medicaid health
954 maintenance organization, a provider service network authorized
955 under paragraph (d), or a Medicaid capitated managed care plan
956 authorized under s. 409.91211. The agency may contract with more
957 than one comprehensive behavioral health provider to provide
958 care to recipients who are not enrolled in a Medicaid capitated
959 managed care plan authorized under s. 409.91211, a provider
960 service network authorized under paragraph (d), or a Medicaid
961 health maintenance organization in AHCA areas where the eligible
962 population exceeds 150,000. In an AHCA area where the Medicaid
963 managed care pilot program is authorized pursuant to s.
964 409.91211 in one or more counties, the agency may procure a
965 contract with a single entity to serve the remaining counties as
966 an AHCA area or the remaining counties may be included with an
967 adjacent AHCA area and shall be subject to this paragraph.
968 Contracts for comprehensive behavioral health providers awarded
969 pursuant to this section shall be competitively procured. Both
970 for-profit and not-for-profit corporations are eligible to
971 compete. Managed care plans contracting with the agency under
972 subsection (3) or paragraph (d), shall provide and receive
973 payment for the same comprehensive behavioral health benefits as
974 provided in AHCA rules, including handbooks incorporated by
975 reference. In AHCA area 11, the agency shall contract with at
976 least two comprehensive behavioral health care providers to
977 provide behavioral health care to recipients in that area who
978 are enrolled in, or assigned to, the MediPass program. One of
979 the behavioral health care contracts must be with the existing
980 provider service network pilot project, as described in
981 paragraph (d), for the purpose of demonstrating the cost
982 effectiveness of the provision of quality mental health services
983 through a public hospital-operated managed care model. Payment
984 shall be at an agreed-upon capitated rate to ensure cost
985 savings. Of the recipients in area 11 who are assigned to
986 MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those
987 MediPass-enrolled recipients shall be assigned to the existing
988 provider service network in area 11 for their behavioral care.
989 4. By October 1, 2003, the agency and the department shall
990 submit a plan to the Governor, the President of the Senate, and
991 the Speaker of the House of Representatives which provides for
992 the full implementation of capitated prepaid behavioral health
993 care in all areas of the state.
994 a. Implementation shall begin in 2003 in those AHCA areas
995 of the state where the agency is able to establish sufficient
996 capitation rates.
997 b. If the agency determines that the proposed capitation
998 rate in any area is insufficient to provide appropriate
999 services, the agency may adjust the capitation rate to ensure
1000 that care will be available. The agency and the department may
1001 use existing general revenue to address any additional required
1002 match but may not over-obligate existing funds on an annualized
1003 basis.
1004 c. Subject to any limitations provided in the General
1005 Appropriations Act, the agency, in compliance with appropriate
1006 federal authorization, shall develop policies and procedures
1007 that allow for certification of local and state funds.
1008 5. Children residing in a statewide inpatient psychiatric
1009 program, or in a Department of Juvenile Justice or a Department
1010 of Children and Family Services residential program approved as
1011 a Medicaid behavioral health overlay services provider may not
1012 be included in a behavioral health care prepaid health plan or
1013 any other Medicaid managed care plan pursuant to this paragraph.
1014 6. In converting to a prepaid system of delivery, the
1015 agency shall in its procurement document require an entity
1016 providing only comprehensive behavioral health care services to
1017 prevent the displacement of indigent care patients by enrollees
1018 in the Medicaid prepaid health plan providing behavioral health
1019 care services from facilities receiving state funding to provide
1020 indigent behavioral health care, to facilities licensed under
1021 chapter 395 which do not receive state funding for indigent
1022 behavioral health care, or reimburse the unsubsidized facility
1023 for the cost of behavioral health care provided to the displaced
1024 indigent care patient.
1025 7. Traditional community mental health providers under
1026 contract with the Department of Children and Family Services
1027 pursuant to part IV of chapter 394, child welfare providers
1028 under contract with the Department of Children and Family
1029 Services in areas 1 and 6, and inpatient mental health providers
1030 licensed pursuant to chapter 395 must be offered an opportunity
1031 to accept or decline a contract to participate in any provider
1032 network for prepaid behavioral health services.
1033 8. All Medicaid-eligible children, except children in area
1034 1 and children in Highlands County, Hardee County, Polk County,
1035 or Manatee County of area 6, that are open for child welfare
1036 services in the HomeSafeNet system, shall receive their
1037 behavioral health care services through a specialty prepaid plan
1038 operated by community-based lead agencies through a single
1039 agency or formal agreements among several agencies. The agency
1040 shall work with the specialty plan to develop clinically
1041 effective, evidence-based alternatives as a downward
1042 substitution for the statewide inpatient psychiatric program and
1043 similar residential care and institutional services. The
1044 specialty prepaid plan must result in savings to the state
1045 comparable to savings achieved in other Medicaid managed care
1046 and prepaid programs. Such plan must provide mechanisms to
1047 maximize state and local revenues. The specialty prepaid plan
1048 shall be developed by the agency and the Department of Children
1049 and Family Services. The agency may seek federal waivers to
1050 implement this initiative. Medicaid-eligible children whose
1051 cases are open for child welfare services in the HomeSafeNet
1052 system and who reside in AHCA area 10 are exempt from the
1053 specialty prepaid plan upon the development of a service
1054 delivery mechanism for children who reside in area 10 as
1055 specified in s. 409.91211(3)(dd).
1056 (16)
1057 (b) The responsibility of the agency under this subsection
1058 includes shall include the development of capabilities to
1059 identify actual and optimal practice patterns; patient and
1060 provider educational initiatives; methods for determining
1061 patient compliance with prescribed treatments; fraud, waste, and
1062 abuse prevention and detection programs; and beneficiary case
1063 management programs.
1064 1. The practice pattern identification program shall
1065 evaluate practitioner prescribing patterns based on national and
1066 regional practice guidelines, comparing practitioners to their
1067 peer groups. The agency and its Drug Utilization Review Board
1068 shall consult with the Department of Health and a panel of
1069 practicing health care professionals consisting of the
1070 following: the Speaker of the House of Representatives and the
1071 President of the Senate shall each appoint three physicians
1072 licensed under chapter 458 or chapter 459; and the Governor
1073 shall appoint two pharmacists licensed under chapter 465 and one
1074 dentist licensed under chapter 466 who is an oral surgeon. Terms
1075 of the panel members shall expire at the discretion of the
1076 appointing official. The advisory panel shall be responsible for
1077 evaluating treatment guidelines and recommending ways to
1078 incorporate their use in the practice pattern identification
1079 program. Practitioners who are prescribing inappropriately or
1080 inefficiently, as determined by the agency, may have their
1081 prescribing of certain drugs subject to prior authorization or
1082 may be terminated from all participation in the Medicaid
1083 program.
1084 2. The agency shall also develop educational interventions
1085 designed to promote the proper use of medications by providers
1086 and beneficiaries.
1087 3. The agency shall implement a pharmacy fraud, waste, and
1088 abuse initiative that may include a surety bond or letter of
1089 credit requirement for participating pharmacies, enhanced
1090 provider auditing practices, the use of additional fraud and
1091 abuse software, recipient management programs for beneficiaries
1092 inappropriately using their benefits, and other steps that will
1093 eliminate provider and recipient fraud, waste, and abuse. The
1094 initiative shall address enforcement efforts to reduce the
1095 number and use of counterfeit prescriptions.
1096 4. By September 30, 2002, The agency may shall contract
1097 with an entity in the state to provide Medicaid providers with
1098 electronic access to Medicaid prescription refill data and
1099 information relating to the Medicaid preferred drug list
1100 implement a wireless handheld clinical pharmacology drug
1101 information database for practitioners. The initiative shall be
1102 designed to enhance the agency’s efforts to reduce fraud, abuse,
1103 and errors in the prescription drug benefit program and to
1104 otherwise further the intent of this paragraph.
1105 5. By April 1, 2006, The agency shall contract with an
1106 entity to design a database of clinical utilization information
1107 or electronic medical records for Medicaid providers. The
1108 database This system must be web-based and allow providers to
1109 review on a real-time basis the utilization of Medicaid
1110 services, including, but not limited to, physician office
1111 visits, inpatient and outpatient hospitalizations, laboratory
1112 and pathology services, radiological and other imaging services,
1113 dental care, and patterns of dispensing prescription drugs in
1114 order to coordinate care and identify potential fraud and abuse.
1115 6. The agency may apply for any federal waivers needed to
1116 administer this paragraph.
1117 (39)(a) The agency shall implement a Medicaid prescribed
1118 drug spending-control program that includes the following
1119 components:
1120 1. A Medicaid preferred drug list, which shall be a listing
1121 of cost-effective therapeutic options recommended by the
1122 Medicaid Pharmacy and Therapeutics Committee established
1123 pursuant to s. 409.91195 and adopted by the agency for each
1124 therapeutic class on the preferred drug list. At the discretion
1125 of the committee, and when feasible, the preferred drug list
1126 should include at least two products in a therapeutic class. The
1127 agency may post the preferred drug list and updates to the
1128 preferred drug list on an Internet website without following the
1129 rulemaking procedures of chapter 120. Antiretroviral agents are
1130 excluded from the preferred drug list. The agency shall also
1131 limit the amount of a prescribed drug dispensed to no more than
1132 a 34-day supply unless the drug products’ smallest marketed
1133 package is greater than a 34-day supply, or the drug is
1134 determined by the agency to be a maintenance drug in which case
1135 a 100-day maximum supply may be authorized. The agency may is
1136 authorized to seek any federal waivers necessary to implement
1137 these cost-control programs and to continue participation in the
1138 federal Medicaid rebate program, or alternatively to negotiate
1139 state-only manufacturer rebates. The agency may adopt rules to
1140 administer implement this subparagraph. The agency shall
1141 continue to provide unlimited contraceptive drugs and items. The
1142 agency must establish procedures to ensure that:
1143 a. There is a response to a request for prior consultation
1144 by telephone or other telecommunication device within 24 hours
1145 after receipt of a request for prior consultation; and
1146 b. A 72-hour supply of the drug prescribed is provided in
1147 an emergency or when the agency does not provide a response
1148 within 24 hours as required by sub-subparagraph a.
1149 2. Reimbursement to pharmacies for Medicaid prescribed
1150 drugs shall be set at the lowest lesser of: the average
1151 wholesale price (AWP) minus 16.4 percent, the wholesaler
1152 acquisition cost (WAC) plus 1.5 4.75 percent, the federal upper
1153 limit (FUL), the state maximum allowable cost (SMAC), or the
1154 usual and customary (UAC) charge billed by the provider.
1155 3. The agency shall develop and implement a process for
1156 managing the drug therapies of Medicaid recipients who are using
1157 significant numbers of prescribed drugs each month. The
1158 management process may include, but is not limited to,
1159 comprehensive, physician-directed medical-record reviews, claims
1160 analyses, and case evaluations to determine the medical
1161 necessity and appropriateness of a patient’s treatment plan and
1162 drug therapies. The agency may contract with a private
1163 organization to provide drug-program-management services. The
1164 Medicaid drug benefit management program shall include
1165 initiatives to manage drug therapies for HIV/AIDS patients,
1166 patients using 20 or more unique prescriptions in a 180-day
1167 period, and the top 1,000 patients in annual spending. The
1168 agency shall enroll any Medicaid recipient in the drug benefit
1169 management program if he or she meets the specifications of this
1170 provision and is not enrolled in a Medicaid health maintenance
1171 organization.
1172 4. The agency may limit the size of its pharmacy network
1173 based on need, competitive bidding, price negotiations,
1174 credentialing, or similar criteria. The agency shall give
1175 special consideration to rural areas in determining the size and
1176 location of pharmacies included in the Medicaid pharmacy
1177 network. A pharmacy credentialing process may include criteria
1178 such as a pharmacy’s full-service status, location, size,
1179 patient educational programs, patient consultation, disease
1180 management services, and other characteristics. The agency may
1181 impose a moratorium on Medicaid pharmacy enrollment if when it
1182 is determined that it has a sufficient number of Medicaid
1183 participating providers. The agency must allow dispensing
1184 practitioners to participate as a part of the Medicaid pharmacy
1185 network regardless of the practitioner’s proximity to any other
1186 entity that is dispensing prescription drugs under the Medicaid
1187 program. A dispensing practitioner must meet all credentialing
1188 requirements applicable to his or her practice, as determined by
1189 the agency.
1190 5. The agency shall develop and implement a program that
1191 requires Medicaid practitioners who prescribe drugs to use a
1192 counterfeit-proof prescription pad for Medicaid prescriptions.
1193 The agency shall require the use of standardized counterfeit
1194 proof prescription pads by Medicaid-participating prescribers or
1195 prescribers who write prescriptions for Medicaid recipients. The
1196 agency may implement the program in targeted geographic areas or
1197 statewide.
1198 6. The agency may enter into arrangements that require
1199 manufacturers of generic drugs prescribed to Medicaid recipients
1200 to provide rebates of at least 15.1 percent of the average
1201 manufacturer price for the manufacturer’s generic products.
1202 These arrangements shall require that if a generic-drug
1203 manufacturer pays federal rebates for Medicaid-reimbursed drugs
1204 at a level below 15.1 percent, the manufacturer must provide a
1205 supplemental rebate to the state in an amount necessary to
1206 achieve a 15.1-percent rebate level.
1207 7. The agency may establish a preferred drug list as
1208 described in this subsection, and, pursuant to the establishment
1209 of such preferred drug list, it is authorized to negotiate
1210 supplemental rebates from manufacturers that are in addition to
1211 those required by Title XIX of the Social Security Act and at no
1212 less than 14 percent of the average manufacturer price as
1213 defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
1214 the federal or supplemental rebate, or both, equals or exceeds
1215 29 percent. There is no upper limit on the supplemental rebates
1216 the agency may negotiate. The agency may determine that specific
1217 products, brand-name or generic, are competitive at lower rebate
1218 percentages. Agreement to pay the minimum supplemental rebate
1219 percentage will guarantee a manufacturer that the Medicaid
1220 Pharmaceutical and Therapeutics Committee will consider a
1221 product for inclusion on the preferred drug list. However, a
1222 pharmaceutical manufacturer is not guaranteed placement on the
1223 preferred drug list by simply paying the minimum supplemental
1224 rebate. Agency decisions will be made on the clinical efficacy
1225 of a drug and recommendations of the Medicaid Pharmaceutical and
1226 Therapeutics Committee, as well as the price of competing
1227 products minus federal and state rebates. The agency may is
1228 authorized to contract with an outside agency or contractor to
1229 conduct negotiations for supplemental rebates. For the purposes
1230 of this section, the term “supplemental rebates” means cash
1231 rebates. Effective July 1, 2004, Value-added programs as a
1232 substitution for supplemental rebates are prohibited. The agency
1233 may is authorized to seek any federal waivers to implement this
1234 initiative.
1235 8. The agency for Health Care Administration shall expand
1236 home delivery of pharmacy products. The agency may amend the
1237 state plan and issue a procurement, as necessary, in order to
1238 implement this program. The procurements must include agreements
1239 with a pharmacy or pharmacies located in the state to provide
1240 mail order delivery services at no cost to the recipients who
1241 elect to receive home delivery of pharmacy products. The
1242 procurement must focus on serving recipients with chronic
1243 diseases for which pharmacy expenditures represent a significant
1244 portion of Medicaid pharmacy expenditures or which impact a
1245 significant portion of the Medicaid population. To assist
1246 Medicaid patients in securing their prescriptions and reduce
1247 program costs, the agency shall expand its current mail-order
1248 pharmacy diabetes-supply program to include all generic and
1249 brand-name drugs used by Medicaid patients with diabetes.
1250 Medicaid recipients in the current program may obtain
1251 nondiabetes drugs on a voluntary basis. This initiative is
1252 limited to the geographic area covered by the current contract.
1253 The agency may seek and implement any federal waivers necessary
1254 to implement this subparagraph.
1255 9. The agency shall limit to one dose per month any drug
1256 prescribed to treat erectile dysfunction.
1257 10.a. The agency may implement a Medicaid behavioral drug
1258 management system. The agency may contract with a vendor that
1259 has experience in operating behavioral drug management systems
1260 to implement this program. The agency may is authorized to seek
1261 federal waivers to implement this program.
1262 b. The agency, in conjunction with the Department of
1263 Children and Family Services, may implement the Medicaid
1264 behavioral drug management system that is designed to improve
1265 the quality of care and behavioral health prescribing practices
1266 based on best practice guidelines, improve patient adherence to
1267 medication plans, reduce clinical risk, and lower prescribed
1268 drug costs and the rate of inappropriate spending on Medicaid
1269 behavioral drugs. The program may include the following
1270 elements:
1271 (I) Provide for the development and adoption of best
1272 practice guidelines for behavioral health-related drugs such as
1273 antipsychotics, antidepressants, and medications for treating
1274 bipolar disorders and other behavioral conditions; translate
1275 them into practice; review behavioral health prescribers and
1276 compare their prescribing patterns to a number of indicators
1277 that are based on national standards; and determine deviations
1278 from best practice guidelines.
1279 (II) Implement processes for providing feedback to and
1280 educating prescribers using best practice educational materials
1281 and peer-to-peer consultation.
1282 (III) Assess Medicaid beneficiaries who are outliers in
1283 their use of behavioral health drugs with regard to the numbers
1284 and types of drugs taken, drug dosages, combination drug
1285 therapies, and other indicators of improper use of behavioral
1286 health drugs.
1287 (IV) Alert prescribers to patients who fail to refill
1288 prescriptions in a timely fashion, are prescribed multiple same
1289 class behavioral health drugs, and may have other potential
1290 medication problems.
1291 (V) Track spending trends for behavioral health drugs and
1292 deviation from best practice guidelines.
1293 (VI) Use educational and technological approaches to
1294 promote best practices, educate consumers, and train prescribers
1295 in the use of practice guidelines.
1296 (VII) Disseminate electronic and published materials.
1297 (VIII) Hold statewide and regional conferences.
1298 (IX) Implement a disease management program with a model
1299 quality-based medication component for severely mentally ill
1300 individuals and emotionally disturbed children who are high
1301 users of care.
1302 11.a. The agency shall implement a Medicaid prescription
1303 drug management system.
1304 a. The agency may contract with a vendor that has
1305 experience in operating prescription drug management systems in
1306 order to implement this system. Any management system that is
1307 implemented in accordance with this subparagraph must rely on
1308 cooperation between physicians and pharmacists to determine
1309 appropriate practice patterns and clinical guidelines to improve
1310 the prescribing, dispensing, and use of drugs in the Medicaid
1311 program. The agency may seek federal waivers to implement this
1312 program.
1313 b. The drug management system must be designed to improve
1314 the quality of care and prescribing practices based on best
1315 practice guidelines, improve patient adherence to medication
1316 plans, reduce clinical risk, and lower prescribed drug costs and
1317 the rate of inappropriate spending on Medicaid prescription
1318 drugs. The program must:
1319 (I) Provide for the development and adoption of best
1320 practice guidelines for the prescribing and use of drugs in the
1321 Medicaid program, including translating best practice guidelines
1322 into practice; reviewing prescriber patterns and comparing them
1323 to indicators that are based on national standards and practice
1324 patterns of clinical peers in their community, statewide, and
1325 nationally; and determine deviations from best practice
1326 guidelines.
1327 (II) Implement processes for providing feedback to and
1328 educating prescribers using best practice educational materials
1329 and peer-to-peer consultation.
1330 (III) Assess Medicaid recipients who are outliers in their
1331 use of a single or multiple prescription drugs with regard to
1332 the numbers and types of drugs taken, drug dosages, combination
1333 drug therapies, and other indicators of improper use of
1334 prescription drugs.
1335 (IV) Alert prescribers to recipients patients who fail to
1336 refill prescriptions in a timely fashion, are prescribed
1337 multiple drugs that may be redundant or contraindicated, or may
1338 have other potential medication problems.
1339 (V) Track spending trends for prescription drugs and
1340 deviation from best practice guidelines.
1341 (VI) Use educational and technological approaches to
1342 promote best practices, educate consumers, and train prescribers
1343 in the use of practice guidelines.
1344 (VII) Disseminate electronic and published materials.
1345 (VIII) Hold statewide and regional conferences.
1346 (IX) Implement disease management programs in cooperation
1347 with physicians and pharmacists, along with a model quality
1348 based medication component for individuals having chronic
1349 medical conditions.
1350 12. The agency may is authorized to contract for drug
1351 rebate administration, including, but not limited to,
1352 calculating rebate amounts, invoicing manufacturers, negotiating
1353 disputes with manufacturers, and maintaining a database of
1354 rebate collections.
1355 13. The agency may specify the preferred daily dosing form
1356 or strength for the purpose of promoting best practices with
1357 regard to the prescribing of certain drugs as specified in the
1358 General Appropriations Act and ensuring cost-effective
1359 prescribing practices.
1360 14. The agency may require prior authorization for
1361 Medicaid-covered prescribed drugs. The agency may, but is not
1362 required to, prior-authorize the use of a product:
1363 a. For an indication not approved in labeling;
1364 b. To comply with certain clinical guidelines; or
1365 c. If the product has the potential for overuse, misuse, or
1366 abuse.
1367
1368 The agency may require the prescribing professional to provide
1369 information about the rationale and supporting medical evidence
1370 for the use of a drug. The agency may post prior authorization
1371 criteria and protocol and updates to the list of drugs that are
1372 subject to prior authorization on an Internet website without
1373 amending its rule or engaging in additional rulemaking.
1374 15. The agency, in conjunction with the Pharmaceutical and
1375 Therapeutics Committee, may require age-related prior
1376 authorizations for certain prescribed drugs. The agency may
1377 preauthorize the use of a drug for a recipient who may not meet
1378 the age requirement or may exceed the length of therapy for use
1379 of this product as recommended by the manufacturer and approved
1380 by the Food and Drug Administration. Prior authorization may
1381 require the prescribing professional to provide information
1382 about the rationale and supporting medical evidence for the use
1383 of a drug.
1384 16. The agency shall implement a step-therapy prior
1385 authorization approval process for medications excluded from the
1386 preferred drug list. Medications listed on the preferred drug
1387 list must be used within the previous 12 months before prior to
1388 the alternative medications that are not listed. The step
1389 therapy prior authorization may require the prescriber to use
1390 the medications of a similar drug class or for a similar medical
1391 indication unless contraindicated in the Food and Drug
1392 Administration labeling. The trial period between the specified
1393 steps may vary according to the medical indication. The step
1394 therapy approval process shall be developed in accordance with
1395 the committee as stated in s. 409.91195(7) and (8). A drug
1396 product may be approved without meeting the step-therapy prior
1397 authorization criteria if the prescribing physician provides the
1398 agency with additional written medical or clinical documentation
1399 that the product is medically necessary because:
1400 a. There is not a drug on the preferred drug list to treat
1401 the disease or medical condition which is an acceptable clinical
1402 alternative;
1403 b. The alternatives have been ineffective in the treatment
1404 of the beneficiary’s disease; or
1405 c. Based on historic evidence and known characteristics of
1406 the patient and the drug, the drug is likely to be ineffective,
1407 or the number of doses have been ineffective.
1408
1409 The agency shall work with the physician to determine the best
1410 alternative for the patient. The agency may adopt rules waiving
1411 the requirements for written clinical documentation for specific
1412 drugs in limited clinical situations.
1413 17. The agency shall implement a return and reuse program
1414 for drugs dispensed by pharmacies to institutional recipients,
1415 which includes payment of a $5 restocking fee for the
1416 implementation and operation of the program. The return and
1417 reuse program shall be implemented electronically and in a
1418 manner that promotes efficiency. The program must permit a
1419 pharmacy to exclude drugs from the program if it is not
1420 practical or cost-effective for the drug to be included and must
1421 provide for the return to inventory of drugs that cannot be
1422 credited or returned in a cost-effective manner. The agency
1423 shall determine if the program has reduced the amount of
1424 Medicaid prescription drugs which are destroyed on an annual
1425 basis and if there are additional ways to ensure more
1426 prescription drugs are not destroyed which could safely be
1427 reused. The agency’s conclusion and recommendations shall be
1428 reported to the Legislature by December 1, 2005.
1429 Section 13. Paragraph (m) is added to subsection (2) and
1430 subsection (15) is added to section 409.9122, Florida Statutes,
1431 to read:
1432 409.9122 Mandatory Medicaid managed care enrollment;
1433 programs and procedures.—
1434 (2)
1435 (m) If the Medicaid recipient is diagnosed with HIV/AIDS
1436 and resides in Broward, Miami-Dade, or Palm Beach counties, the
1437 agency shall assign the recipient to a managed care plan that is
1438 a health maintenance organization authorized under Chapter 641,
1439 under contract with the agency on July 1, 2011, and which offers
1440 a delivery system through a university-based teaching and
1441 research-oriented organization that specializes in providing
1442 health care services and treatment for individuals diagnosed
1443 with HIV/AIDS.
1444 (15) The agency shall contract with a single provider
1445 service network to function as a managing entity for the
1446 MediPass program in all counties with fewer than two prepaid
1447 plans. The contractor shall be responsible for implementing
1448 preauthorization procedures, case management programs, and
1449 utilization management initiatives in order to improve care
1450 coordination and patient outcomes while reducing costs. The
1451 contractor may earn an administrative fee if the fee is less
1452 than any savings as determined by the reconciliation process
1453 under s. 409.912(4)(d)1.
1454 Section 14. Section 636.0145, Florida Statutes, is amended
1455 to read:
1456 636.0145 Certain entities contracting with Medicaid.
1457 Notwithstanding the requirements of s. 409.912(4)(b), an entity
1458 that is providing comprehensive inpatient and outpatient mental
1459 health care services to certain Medicaid recipients in
1460 Hillsborough, Highlands, Hardee, Manatee, and Polk Counties
1461 through a capitated, prepaid arrangement pursuant to the federal
1462 waiver provided for in s. 409.905(5) must become licensed under
1463 chapter 636 by December 31, 1998. Any entity licensed under this
1464 chapter which provides services solely to Medicaid recipients
1465 under a contract with Medicaid is shall be exempt from ss.
1466 636.017, 636.018, 636.022, 636.028, and 636.034, and 636.066(1).
1467 Section 15. The amendments to s. 636.0145, Florida
1468 Statutes, under this act shall operate prospectively and do not
1469 provide a basis for relief from or assessment of taxes not paid,
1470 or for determining any denial of or right to a refund of taxes
1471 paid before the effective date of the act.
1472 Section 16. (1) The Legislature finds that hundreds of
1473 millions of dollars appropriated annually in support of the
1474 state’s Medicaid program and other critical health programs come
1475 directly from revenues resulting from the settlement in State of
1476 Florida v. American Tobacco Co., No. 95-1466AH (Fla. 15th Cir.
1477 Ct.), that maintaining those revenues is critical to the health
1478 of this state’s residents, that s. 569.23(3), Florida Statutes,
1479 protects the continued receipt of those revenues, that the
1480 sunset of s. 569.23(3), Florida Statutes, will undermine
1481 financial support for the state’s Medicaid and other critical
1482 health programs, and that the sunset of that subsection should
1483 therefore be repealed.
1484 (2) Paragraph (f) of subsection (3) of section 569.23,
1485 Florida Statutes, is repealed.
1486 Section 17. Notwithstanding s. 430.707, Florida Statutes,
1487 and subject to federal approval of the application to be a site
1488 for the Program of All-inclusive Care for the Elderly, the
1489 Agency for Health Care Administration shall contract with one
1490 private health care organization, the sole member of which is a
1491 private, not-for-profit corporation that owns and manages health
1492 care organizations which provide comprehensive long-term care
1493 services, including nursing home, assisted living, independent
1494 housing, home care, adult day care, and care management, with a
1495 board-certified, trained geriatrician as the medical director.
1496 This organization shall provide these services to frail and
1497 elderly persons who reside in Palm Beach County. The
1498 organization is exempt from the requirements of chapter 641,
1499 Florida Statutes. The agency, in consultation with the
1500 Department of Elderly Affairs and subject to an appropriation,
1501 shall approve up to 150 initial enrollees in the Program of All
1502 inclusive Care for the Elderly established by this organization
1503 to serve elderly persons who reside in Palm Beach County.
1504 Section 18. This act shall take effect July 1, 2011.
1505
1506 ================= T I T L E A M E N D M E N T ================
1507 And the title is amended as follows:
1508 Delete everything before the enacting clause
1509 and insert:
1510 A bill to be entitled
1511 An act relating to Medicaid; amending s. 400.23, F.S.;
1512 revising the minimum staffing requirements for nursing
1513 homes; amending s. 408.815, F.S.; requiring that the
1514 Agency for Health Care Administration deny an
1515 application for a license or license renewal of an
1516 applicant, a controlling interest of the applicant, or
1517 any entity in which a controlling interest of the
1518 applicant was an owner or officer during the
1519 occurrence of certain actions; authorizing the agency
1520 to consider certain mitigating circumstances;
1521 authorizing the agency to extend a license expiration
1522 date under certain circumstances; amending s. 409.904,
1523 F.S.; repealing the sunset of provisions authorizing
1524 the federal waiver for certain persons age 65 and
1525 older or who have a disability; repealing the sunset
1526 of provisions authorizing a specified medically needy
1527 program; eliminating the limit to services placed on
1528 the medically needy program for pregnant women and
1529 children younger than age 21; amending s. 409.905,
1530 F.S.; deleting provisions requiring that the agency
1531 implement hospitalist programs; amending s. 409.908,
1532 F.S.; revising the factors that are excluded from the
1533 direct care subcomponent of the long-term care
1534 reimbursement plan for nursing home care; revising the
1535 factors for calculating the maximum allowable fee for
1536 pharmaceutical ingredient costs; continuing the
1537 requirement that the Agency for Health Care
1538 Administration set certain institutional provider
1539 reimbursement rates in a manner that results in no
1540 automatic cost-based statewide expenditure increase;
1541 deleting an obsolete requirement to establish
1542 workgroups to evaluate alternate reimbursement and
1543 payment methods; eliminating the repeal date of the
1544 suspension of the use of cost data to set certain
1545 institutional provider reimbursement rates; amending
1546 s. 409.9082, F.S.; revising the aggregated amount of
1547 the quality assessment for nursing home facilities;
1548 exempting certain nursing home facilities from the
1549 quality assessment; amending s. 409.9083, F.S.;
1550 eliminating the repeal date of the quality assessment
1551 on privately operated intermediate care facilities for
1552 the developmentally disabled; amending s. 409.911,
1553 F.S.; updating references to data to be used for the
1554 disproportionate share program; providing that certain
1555 hospitals eligible for payments remain eligible for
1556 payments during the next fiscal year; amending s.
1557 409.9112, F.S.; extending the prohibition against
1558 distributing moneys under the regional perinatal
1559 intensive care centers disproportionate share program
1560 for another year; amending s. 409.9113, F.S.;
1561 extending the disproportionate share program for
1562 teaching hospitals for another year; amending s.
1563 409.9117, F.S.; extending the prohibition against
1564 distributing moneys under the primary care
1565 disproportionate share program for another year;
1566 amending s. 409.912, F.S.; providing for alternatives
1567 to the statewide inpatient psychiatric program;
1568 allowing the agency to continue to contract for
1569 electronic access to certain pharmacology drug
1570 information; eliminating the requirement to implement
1571 a wireless handheld clinical pharmacology drug
1572 information database for practitioners; revising the
1573 factors for calculating the maximum allowable fee for
1574 pharmaceutical ingredient costs; deleting obsolete
1575 provisions; authorizing the agency to seek federal
1576 approval and to issue a procurement in order to
1577 implement a home delivery of pharmacy products
1578 program; establishing the provisions for the
1579 procurement and the program; eliminating the
1580 requirement for the expansion of the mail-order
1581 pharmacy diabetes-supply program; eliminating certain
1582 provisions of the Medicaid prescription drug
1583 management program; amending s. 409.9122, F.S.;
1584 requiring the agency to assign Medicaid recipients
1585 with HIV/AIDS in certain counties to a certain type of
1586 managed care plan; requiring the agency to contract
1587 with a single provider service network to manage the
1588 MediPass program in certain counties; amending s.
1589 636.0145, F.S.; exempting certain entities providing
1590 services solely to Medicaid recipients under a
1591 Medicaid contract from being subject to the premium
1592 tax imposed on premiums, contributions, and
1593 assessments received by prepaid limited health service
1594 organizations; providing for prospective operation and
1595 specifying that the act does not provide a basis for
1596 relief from or assessment of taxes not paid, or for
1597 determining any denial of or right to a refund of
1598 taxes paid, before the effective date of the act;
1599 providing legislative intent with respect to the need
1600 to maintain revenues that support critical health
1601 programs; repealing s. 569.23(3)(f), F.S.; abrogating
1602 the repeal of provisions requiring that appellants of
1603 tobacco settlement agreement judgments provide
1604 specified security; authorizing the agency to contract
1605 with an organization to provide certain benefits under
1606 a federal program in Palm Beach County; providing an
1607 exemption from ch. 641, F.S., for the organization;
1608 authorizing, subject to appropriation, enrollment
1609 slots for the Program of All-inclusive Care for the
1610 Elderly in Palm Beach County; providing an effective
1611 date.