Florida Senate - 2020 COMMITTEE AMENDMENT
Bill No. SB 1726
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LEGISLATIVE ACTION
Senate . House
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The Committee on Health Policy (Bean) recommended the following:
1 Senate Substitute for Amendment (942012) (with title
2 amendment)
3
4 Delete lines 1235 - 1285
5 and insert:
6 Section 34. Effective upon becoming a law, paragraph (a) of
7 subsection (5) of section 409.905, Florida Statutes, is amended
8 to read:
9 409.905 Mandatory Medicaid services.—The agency may make
10 payments for the following services, which are required of the
11 state by Title XIX of the Social Security Act, furnished by
12 Medicaid providers to recipients who are determined to be
13 eligible on the dates on which the services were provided. Any
14 service under this section shall be provided only when medically
15 necessary and in accordance with state and federal law.
16 Mandatory services rendered by providers in mobile units to
17 Medicaid recipients may be restricted by the agency. Nothing in
18 this section shall be construed to prevent or limit the agency
19 from adjusting fees, reimbursement rates, lengths of stay,
20 number of visits, number of services, or any other adjustments
21 necessary to comply with the availability of moneys and any
22 limitations or directions provided for in the General
23 Appropriations Act or chapter 216.
24 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
25 all covered services provided for the medical care and treatment
26 of a recipient who is admitted as an inpatient by a licensed
27 physician or dentist to a hospital licensed under part I of
28 chapter 395. However, the agency shall limit the payment for
29 inpatient hospital services for a Medicaid recipient 21 years of
30 age or older to 45 days or the number of days necessary to
31 comply with the General Appropriations Act.
32 (a)1. The agency may implement reimbursement and
33 utilization management reforms in order to comply with any
34 limitations or directions in the General Appropriations Act,
35 which may include, but are not limited to: prior authorization
36 for inpatient psychiatric days; prior authorization for
37 nonemergency hospital inpatient admissions for individuals 21
38 years of age and older; authorization of emergency and urgent
39 care admissions within 24 hours after admission; enhanced
40 utilization and concurrent review programs for highly utilized
41 services; reduction or elimination of covered days of service;
42 adjusting reimbursement ceilings for variable costs; adjusting
43 reimbursement ceilings for fixed and property costs; and
44 implementing target rates of increase.
45 2. The agency may limit prior authorization for hospital
46 inpatient services to selected diagnosis-related groups, based
47 on an analysis of the cost and potential for unnecessary
48 hospitalizations represented by certain diagnoses. Admissions
49 for normal delivery and newborns are exempt from requirements
50 for prior authorization.
51 3. In implementing the provisions of this section related
52 to prior authorization, the agency shall ensure that the process
53 for authorization is accessible 24 hours per day, 7 days per
54 week and authorization is automatically granted when not denied
55 within 4 hours after the request. Authorization procedures must
56 include steps for review of denials.
57 4. Upon implementing the prior authorization program for
58 hospital inpatient services, the agency shall discontinue its
59 hospital retrospective review program. However, this
60 subparagraph may not be construed to prevent the agency from
61 conducting retrospective reviews under s. 409.913.
62 Section 35. It is the intent of the Legislature that
63 section 409.905(5)(a), Florida Statutes, as amended by this act,
64 confirm and clarify existing law.
65 Section 36. Subsection (1) of section 409.967, Florida
66 Statutes, is amended to read:
67 409.967 Managed care plan accountability.—
68 (1) Beginning with the contract procurement process
69 initiated during the 2023 calendar year, the agency shall
70 establish a 6-year 5-year contract with each managed care plan
71 selected through the procurement process described in s.
72 409.966. A plan contract may not be renewed; however, the agency
73 may extend the term of a plan contract to cover any delays
74 during the transition to a new plan. The agency shall extend
75 until December 31, 2024, the term of existing plan contracts
76 awarded pursuant to the invitation to negotiate published in
77 July 2017.
78
79 ================= T I T L E A M E N D M E N T ================
80 And the title is amended as follows:
81 Delete lines 82 - 84
82 and insert:
83 amending s. 409.905, F.S.; providing construction for
84 a provision that requires the agency to discontinue
85 its hospital retrospective review program under
86 certain circumstances; providing legislative intent;
87 amending s. 409.967, F.S.; revising the length of
88 managed care plan contracts procured by the agency
89 beginning during a specified timeframe; requiring the
90 agency to extend the term of certain existing managed
91 care plan contracts until a specified date; amending