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.
   14  Be It Enacted by the Legislature of the State of Florida:
   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.