Florida Senate - 2019 SB 756 By Senator Book 32-00824A-19 2019756__ 1 A bill to be entitled 2 An act relating to donor human milk bank services; 3 amending s. 409.906, F.S.; authorizing the Agency for 4 Health Care Administration to pay for donor human milk 5 bank services as an optional Medicaid service under 6 certain conditions; specifying eligibility criteria; 7 amending s. 409.908, F.S.; adding donor human milk 8 bank services to the list of Medicaid services 9 authorized for reimbursement on a fee-for-service 10 basis; amending s. 409.973, F.S.; adding donor human 11 milk bank services to the list of services covered by 12 managed care plans; providing an effective date. 13 14 Be It Enacted by the Legislature of the State of Florida: 15 16 Section 1. Subsection (28) is added to section 409.906, 17 Florida Statutes, to read: 18 409.906 Optional Medicaid services.—Subject to specific 19 appropriations, the agency may make payments for services which 20 are optional to the state under Title XIX of the Social Security 21 Act and are furnished by Medicaid providers to recipients who 22 are determined to be eligible on the dates on which the services 23 were provided. Any optional service that is provided shall be 24 provided only when medically necessary and in accordance with 25 state and federal law. Optional services rendered by providers 26 in mobile units to Medicaid recipients may be restricted or 27 prohibited by the agency. Nothing in this section shall be 28 construed to prevent or limit the agency from adjusting fees, 29 reimbursement rates, lengths of stay, number of visits, or 30 number of services, or making any other adjustments necessary to 31 comply with the availability of moneys and any limitations or 32 directions provided for in the General Appropriations Act or 33 chapter 216. If necessary to safeguard the state’s systems of 34 providing services to elderly and disabled persons and subject 35 to the notice and review provisions of s. 216.177, the Governor 36 may direct the Agency for Health Care Administration to amend 37 the Medicaid state plan to delete the optional Medicaid service 38 known as “Intermediate Care Facilities for the Developmentally 39 Disabled.” Optional services may include: 40 (28) DONOR HUMAN MILK BANK SERVICES.—The agency may pay for 41 the cost of donor human milk, for home and inpatient use, for 42 which a licensed physician or nurse practitioner has issued an 43 order for an infant who is medically or physically unable to 44 receive maternal breast milk or breastfeed or whose mother is 45 medically or physically unable to produce maternal breast milk 46 or breastfeed. Such infant must have a documented birth weight 47 of 1,500 grams or less; a congenital or acquired intestinal 48 condition and be at high risk for developing a feeding 49 intolerance, necrotizing enterocolitis, or an infection; or 50 otherwise require nourishment by breast milk. The donor human 51 milk must be procured from a nonprofit milk bank certified by 52 the Human Milk Banking Association of North America (HMBANA). 53 Coverage for donor human milk may not be less than the 54 reasonable cost of such milk procured from an HMBANA-certified 55 milk bank, plus reasonable processing and handling fees. 56 Section 2. Present paragraphs (f) through (t) of subsection 57 (3) of section 409.908, Florida Statutes, are redesignated as 58 paragraphs (g) through (u), respectively, and a new paragraph 59 (f) is added to that subsection, to read: 60 409.908 Reimbursement of Medicaid providers.—Subject to 61 specific appropriations, the agency shall reimburse Medicaid 62 providers, in accordance with state and federal law, according 63 to methodologies set forth in the rules of the agency and in 64 policy manuals and handbooks incorporated by reference therein. 65 These methodologies may include fee schedules, reimbursement 66 methods based on cost reporting, negotiated fees, competitive 67 bidding pursuant to s. 287.057, and other mechanisms the agency 68 considers efficient and effective for purchasing services or 69 goods on behalf of recipients. If a provider is reimbursed based 70 on cost reporting and submits a cost report late and that cost 71 report would have been used to set a lower reimbursement rate 72 for a rate semester, then the provider’s rate for that semester 73 shall be retroactively calculated using the new cost report, and 74 full payment at the recalculated rate shall be effected 75 retroactively. Medicare-granted extensions for filing cost 76 reports, if applicable, shall also apply to Medicaid cost 77 reports. Payment for Medicaid compensable services made on 78 behalf of Medicaid eligible persons is subject to the 79 availability of moneys and any limitations or directions 80 provided for in the General Appropriations Act or chapter 216. 81 Further, nothing in this section shall be construed to prevent 82 or limit the agency from adjusting fees, reimbursement rates, 83 lengths of stay, number of visits, or number of services, or 84 making any other adjustments necessary to comply with the 85 availability of moneys and any limitations or directions 86 provided for in the General Appropriations Act, provided the 87 adjustment is consistent with legislative intent. 88 (3) Subject to any limitations or directions provided for 89 in the General Appropriations Act, the following Medicaid 90 services and goods may be reimbursed on a fee-for-service basis. 91 For each allowable service or goods furnished in accordance with 92 Medicaid rules, policy manuals, handbooks, and state and federal 93 law, the payment shall be the amount billed by the provider, the 94 provider’s usual and customary charge, or the maximum allowable 95 fee established by the agency, whichever amount is less, with 96 the exception of those services or goods for which the agency 97 makes payment using a methodology based on capitation rates, 98 average costs, or negotiated fees. 99 (f) Donor human milk bank services. 100 Section 3. Present paragraphs (e) through (bb) of 101 subsection (1) of section 409.973, Florida Statutes, are 102 redesignated as paragraphs (f) through (cc), respectively, and a 103 new paragraph (e) is added to that subsection, to read: 104 409.973 Benefits.— 105 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a 106 minimum, the following services: 107 (e) Donor human milk bank services. 108 Section 4. This act shall take effect July 1, 2019.