Florida Senate - 2020 SB 42 By Senator Book 32-00054-20 202042__ 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 if 6 certain conditions are met; specifying coverage 7 requirements; amending s. 409.908, F.S.; adding donor 8 human milk bank services to the list of Medicaid 9 services authorized for reimbursement on a fee-for 10 service basis; amending s. 409.973, F.S.; adding donor 11 human milk bank services to the list of minimum 12 benefits required to be covered by managed care plans; 13 providing an effective date. 14 15 Be It Enacted by the Legislature of the State of Florida: 16 17 Section 1. Subsection (28) is added to section 409.906, 18 Florida Statutes, to read: 19 409.906 Optional Medicaid services.—Subject to specific 20 appropriations, the agency may make payments for services which 21 are optional to the state under Title XIX of the Social Security 22 Act and are furnished by Medicaid providers to recipients who 23 are determined to be eligible on the dates on which the services 24 were provided. Any optional service that is provided shall be 25 provided only when medically necessary and in accordance with 26 state and federal law. Optional services rendered by providers 27 in mobile units to Medicaid recipients may be restricted or 28 prohibited by the agency. Nothing in this section shall be 29 construed to prevent or limit the agency from adjusting fees, 30 reimbursement rates, lengths of stay, number of visits, or 31 number of services, or making any other adjustments necessary to 32 comply with the availability of moneys and any limitations or 33 directions provided for in the General Appropriations Act or 34 chapter 216. If necessary to safeguard the state’s systems of 35 providing services to elderly and disabled persons and subject 36 to the notice and review provisions of s. 216.177, the Governor 37 may direct the Agency for Health Care Administration to amend 38 the Medicaid state plan to delete the optional Medicaid service 39 known as “Intermediate Care Facilities for the Developmentally 40 Disabled.” Optional services may include: 41 (28) DONOR HUMAN MILK BANK SERVICES.—The agency may pay for 42 the cost of donor human milk, for home and inpatient use, for 43 which a licensed physician or nurse practitioner has issued an 44 order for an infant who is medically or physically unable to 45 receive maternal breast milk or breastfeed or whose mother is 46 medically or physically unable to produce maternal breast milk 47 or breastfeed. Such infant must have a documented birth weight 48 of 1,500 grams or less; have a congenital or acquired intestinal 49 condition and be at high risk for developing a feeding 50 intolerance, necrotizing enterocolitis, or an infection; or 51 otherwise require nourishment by breast milk. The donor human 52 milk must be procured from a nonprofit milk bank certified by 53 the Human Milk Banking Association of North America (HMBANA). 54 Coverage for donor human milk may not be less than the 55 reasonable cost of such milk procured from an HMBANA-certified 56 milk bank, plus reasonable processing and handling fees. 57 Section 2. Present paragraphs (f) through (t) of subsection 58 (3) of section 409.908, Florida Statutes, are redesignated as 59 paragraphs (g) through (u), respectively, and a new paragraph 60 (f) is added to that subsection, to read: 61 409.908 Reimbursement of Medicaid providers.—Subject to 62 specific appropriations, the agency shall reimburse Medicaid 63 providers, in accordance with state and federal law, according 64 to methodologies set forth in the rules of the agency and in 65 policy manuals and handbooks incorporated by reference therein. 66 These methodologies may include fee schedules, reimbursement 67 methods based on cost reporting, negotiated fees, competitive 68 bidding pursuant to s. 287.057, and other mechanisms the agency 69 considers efficient and effective for purchasing services or 70 goods on behalf of recipients. If a provider is reimbursed based 71 on cost reporting and submits a cost report late and that cost 72 report would have been used to set a lower reimbursement rate 73 for a rate semester, then the provider’s rate for that semester 74 shall be retroactively calculated using the new cost report, and 75 full payment at the recalculated rate shall be effected 76 retroactively. Medicare-granted extensions for filing cost 77 reports, if applicable, shall also apply to Medicaid cost 78 reports. Payment for Medicaid compensable services made on 79 behalf of Medicaid eligible persons is subject to the 80 availability of moneys and any limitations or directions 81 provided for in the General Appropriations Act or chapter 216. 82 Further, nothing in this section shall be construed to prevent 83 or limit the agency from adjusting fees, reimbursement rates, 84 lengths of stay, number of visits, or number of services, or 85 making any other adjustments necessary to comply with the 86 availability of moneys and any limitations or directions 87 provided for in the General Appropriations Act, provided the 88 adjustment is consistent with legislative intent. 89 (3) Subject to any limitations or directions provided for 90 in the General Appropriations Act, the following Medicaid 91 services and goods may be reimbursed on a fee-for-service basis. 92 For each allowable service or goods furnished in accordance with 93 Medicaid rules, policy manuals, handbooks, and state and federal 94 law, the payment shall be the amount billed by the provider, the 95 provider’s usual and customary charge, or the maximum allowable 96 fee established by the agency, whichever amount is less, with 97 the exception of those services or goods for which the agency 98 makes payment using a methodology based on capitation rates, 99 average costs, or negotiated fees. 100 (f) Donor human milk bank services. 101 Section 3. Present paragraphs (e) through (bb) of 102 subsection (1) of section 409.973, Florida Statutes, are 103 redesignated as paragraphs (f) through (cc), respectively, and a 104 new paragraph (e) is added to that subsection, to read: 105 409.973 Benefits.— 106 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a 107 minimum, the following services: 108 (e) Donor human milk bank services. 109 Section 4. This act shall take effect July 1, 2020.