Florida Senate - 2023                                    SB 1548
       
       
        
       By Senator Bradley
       
       
       
       
       
       6-01476B-23                                           20231548__
    1                        A bill to be entitled                      
    2         An act relating to the Children’s Medical Services
    3         program; amending s. 383.14, F.S.; deleting a
    4         requirement that the Department of Health consult with
    5         the Department of Education before prescribing certain
    6         newborn testing and screening requirements;
    7         authorizing the release of certain newborn screening
    8         results to licensed genetic counselors; requiring that
    9         newborns have a blood specimen collected for newborn
   10         screenings before they reach a specified age; deleting
   11         a requirement that newborns be subjected to a certain
   12         test; conforming provisions to changes made by the
   13         act; revising requirements related to a certain
   14         assessment for hospitals and birth centers; deleting a
   15         requirement that the department submit a certain
   16         annual cost certification as part of its annual
   17         legislative budget request; requiring certain health
   18         care practitioners and health care providers to
   19         prepare and send all newborn screening specimen cards
   20         to the State Public Health Laboratory; amending s.
   21         383.145, F.S.; defining the term “toddler”; revising
   22         newborn screening requirements for licensed birth
   23         centers; requiring that a certain referral for newborn
   24         screening be made before the newborn reaches a
   25         specified age; requiring early childhood programs and
   26         entities that screen for hearing loss to report the
   27         screening results to the department within a specified
   28         timeframe; amending s. 391.016, F.S.; revising the
   29         purposes and functions of the Children’s Medical
   30         Services program; amending s. 391.021, F.S.; revising
   31         definitions; amending s. 391.025, F.S.; revising the
   32         scope of the program; amending s. 391.026, F.S.;
   33         revising the powers and duties of the Department of
   34         Health to conform to changes made by the act; amending
   35         s. 391.028, F.S.; revising activities within the
   36         purview of the program; deleting a requirement that
   37         every office of the program be under the direction of
   38         a licensed physician; amending s. 391.029, F.S.;
   39         revising program eligibility requirements; amending s.
   40         391.0315, F.S.; conforming provisions to changes made
   41         by the act; repealing s. 391.035, F.S., relating to
   42         provider qualifications; amending s. 391.045, F.S.;
   43         conforming provisions to changes made by the act;
   44         amending s. 391.055, F.S.; conforming provisions to
   45         changes made by the act; deleting specifications for
   46         the components of the program; deleting certain
   47         requirements for newborns referred to the program
   48         through the newborn screening program; amending s.
   49         391.097, F.S.; conforming a provision to changes made
   50         by the act; repealing part II of chapter 391, F.S.,
   51         relating to Children’s Medical Services councils and
   52         panels; providing legislative findings and intent;
   53         transferring operation of the Children’s Medical
   54         Services Managed Care Plan from the department to the
   55         Agency for Health Care Administration, effective on a
   56         specified date; providing construction as to judicial
   57         and administrative actions pending as of a specified
   58         date and time; requiring the department’s Children’s
   59         Medical Services program to collaborate with and
   60         assist the agency in specified activities; requiring
   61         the department to conduct certain clinical eligibility
   62         screenings; requiring the agency and the department to
   63         submit a report to the Legislature by a specified
   64         date; providing requirements for the report; amending
   65         s. 409.974, F.S.; requiring the agency to
   66         competitively procure one or more vendors to provide
   67         services for certain children with special health care
   68         needs; requiring the department’s Children’s Medical
   69         Services program to assist the agency in developing
   70         certain specifications for the vendor contract;
   71         requiring the department to conduct clinical
   72         eligibility screenings for services for such children
   73         and collaborate with the agency in the care of such
   74         children; conforming a provision to changes made by
   75         the act; amending ss. 409.166, 409.811, 409.813,
   76         409.8134, 409.814, 409.815, 409.8177, 409.818,
   77         409.912, 409.9126, 409.9131, 409.920, and 409.962,
   78         F.S.; conforming provisions to changes made by the
   79         act; providing effective dates.
   80          
   81  Be It Enacted by the Legislature of the State of Florida:
   82  
   83         Section 1. Section 383.14, Florida Statutes, is amended to
   84  read:
   85         383.14 Screening for metabolic disorders, other hereditary
   86  and congenital disorders, and environmental risk factors.—
   87         (1) SCREENING REQUIREMENTS.—To help ensure access to the
   88  maternal and child health care system, the Department of Health
   89  shall promote the screening of all newborns born in Florida for
   90  metabolic, hereditary, and congenital disorders known to result
   91  in significant impairment of health or intellect, as screening
   92  programs accepted by current medical practice become available
   93  and practical in the judgment of the department. The department
   94  shall also promote the identification and screening of all
   95  newborns in this state and their families for environmental risk
   96  factors such as low income, poor education, maternal and family
   97  stress, emotional instability, substance abuse, and other high
   98  risk conditions associated with increased risk of infant
   99  mortality and morbidity to provide early intervention,
  100  remediation, and prevention services, including, but not limited
  101  to, parent support and training programs, home visitation, and
  102  case management. Identification, perinatal screening, and
  103  intervention efforts shall begin prior to and immediately
  104  following the birth of the child by the attending health care
  105  provider. Such efforts shall be conducted in hospitals,
  106  perinatal centers, county health departments, school health
  107  programs that provide prenatal care, and birthing centers, and
  108  reported to the Office of Vital Statistics.
  109         (a) Prenatal screening.—The department shall develop a
  110  multilevel screening process that includes a risk assessment
  111  instrument to identify women at risk for a preterm birth or
  112  other high-risk condition. The primary health care provider
  113  shall complete the risk assessment instrument and report the
  114  results to the Office of Vital Statistics so that the woman may
  115  immediately be notified and referred to appropriate health,
  116  education, and social services.
  117         (b) Postnatal screening.—A risk factor analysis using the
  118  department’s designated risk assessment instrument shall also be
  119  conducted as part of the medical screening process upon the
  120  birth of a child and submitted to the department’s Office of
  121  Vital Statistics for recording and other purposes provided for
  122  in this chapter. The department’s screening process for risk
  123  assessment shall include a scoring mechanism and procedures that
  124  establish thresholds for notification, further assessment,
  125  referral, and eligibility for services by professionals or
  126  paraprofessionals consistent with the level of risk. Procedures
  127  for developing and using the screening instrument, notification,
  128  referral, and care coordination services, reporting
  129  requirements, management information, and maintenance of a
  130  computer-driven registry in the Office of Vital Statistics which
  131  ensures privacy safeguards must be consistent with the
  132  provisions and plans established under chapter 411, Pub. L. No.
  133  99-457, and this chapter. Procedures established for reporting
  134  information and maintaining a confidential registry must include
  135  a mechanism for a centralized information depository at the
  136  state and county levels. The department shall coordinate with
  137  existing risk assessment systems and information registries. The
  138  department must ensure, to the maximum extent possible, that the
  139  screening information registry is integrated with the
  140  department’s automated data systems, including the Florida On
  141  line Recipient Integrated Data Access (FLORIDA) system. Tests
  142  and screenings must be performed by the State Public Health
  143  Laboratory, in coordination with Children’s Medical Services, at
  144  such times and in such manner as is prescribed by the department
  145  after consultation with the Genetics and Newborn Screening
  146  Advisory Council and the Department of Education.
  147         (c) Release of screening results.—Notwithstanding any law
  148  to the contrary, the State Public Health Laboratory may release,
  149  directly or through the Children’s Medical Services program, the
  150  results of a newborn’s hearing and metabolic tests or screenings
  151  to the newborn’s health care practitioner, the newborn’s parent
  152  or legal guardian, the newborn’s personal representative, or a
  153  person designated by the newborn’s parent or legal guardian. As
  154  used in this paragraph, the term “health care practitioner”
  155  means a physician or physician assistant licensed under chapter
  156  458; an osteopathic physician or physician assistant licensed
  157  under chapter 459; an advanced practice registered nurse,
  158  registered nurse, or licensed practical nurse licensed under
  159  part I of chapter 464; a midwife licensed under chapter 467; a
  160  speech-language pathologist or audiologist licensed under part I
  161  of chapter 468; or a dietician or nutritionist licensed under
  162  part X of chapter 468; or a genetic counselor licensed under
  163  part III of chapter 483.
  164         (2) RULES.—
  165         (a) After consultation with the Genetics and Newborn
  166  Screening Advisory Council, the department shall adopt and
  167  enforce rules requiring that every newborn in this state must
  168  shall:
  169         1. Before becoming 1 week of age, have a blood specimen
  170  collected for newborn screenings be subjected to a test for
  171  phenylketonuria;
  172         2. Be tested for any condition included on the federal
  173  Recommended Uniform Screening Panel which the council advises
  174  the department should be included under the state’s screening
  175  program. After the council recommends that a condition be
  176  included, the department shall submit a legislative budget
  177  request to seek an appropriation to add testing of the condition
  178  to the newborn screening program. The department shall expand
  179  statewide screening of newborns to include screening for such
  180  conditions within 18 months after the council renders such
  181  advice, if a test approved by the United States Food and Drug
  182  Administration or a test offered by an alternative vendor is
  183  available. If such a test is not available within 18 months
  184  after the council makes its recommendation, the department shall
  185  implement such screening as soon as a test offered by the United
  186  States Food and Drug Administration or by an alternative vendor
  187  is available; and
  188         3. At the appropriate age, be tested for such other
  189  metabolic diseases and hereditary or congenital disorders as the
  190  department may deem necessary from time to time.
  191         (b) After consultation with the Department of Education,
  192  the department shall adopt and enforce rules requiring every
  193  newborn in this state to be screened for environmental risk
  194  factors that place children and their families at risk for
  195  increased morbidity, mortality, and other negative outcomes.
  196         (c) The department shall adopt such additional rules as are
  197  found necessary for the administration of this section and s.
  198  383.145, including rules providing definitions of terms, rules
  199  relating to the methods used and time or times for testing as
  200  accepted medical practice indicates, rules relating to charging
  201  and collecting fees for the administration of the newborn
  202  screening program authorized by this section, rules for
  203  processing requests and releasing test and screening results,
  204  and rules requiring mandatory reporting of the results of tests
  205  and screenings for these conditions to the department.
  206         (3) DEPARTMENT OF HEALTH; POWERS AND DUTIES.—The department
  207  shall administer and provide certain services to implement the
  208  provisions of this section and shall:
  209         (a) Assure the availability and quality of the necessary
  210  laboratory tests and materials.
  211         (b) Furnish all physicians, county health departments,
  212  perinatal centers, birthing centers, and hospitals forms on
  213  which environmental screening and the results of tests for
  214  phenylketonuria and such other disorders for which testing may
  215  be required from time to time shall be reported to the
  216  department.
  217         (c) Promote education of the public about the prevention
  218  and management of metabolic, hereditary, and congenital
  219  disorders and dangers associated with environmental risk
  220  factors.
  221         (d) Maintain a confidential registry of cases, including
  222  information of importance for the purpose of follow-up followup
  223  services to prevent intellectual disabilities, to correct or
  224  ameliorate physical disabilities, and for epidemiologic studies,
  225  if indicated. Such registry shall be exempt from the provisions
  226  of s. 119.07(1).
  227         (e) Supply the necessary dietary treatment products where
  228  practicable for diagnosed cases of phenylketonuria and other
  229  metabolic diseases for as long as medically indicated when the
  230  products are not otherwise available. Provide nutrition
  231  education and supplemental foods to those families eligible for
  232  the Special Supplemental Nutrition Program for Women, Infants,
  233  and Children as provided in s. 383.011.
  234         (f) Promote the availability of genetic studies, services,
  235  and counseling in order that the parents, siblings, and affected
  236  newborns may benefit from detection and available knowledge of
  237  the condition.
  238         (g) Have the authority to charge and collect fees for the
  239  administration of the newborn screening program. authorized in
  240  this section, as follows:
  241         1. A fee not to exceed $15 will be charged for each live
  242  birth, as recorded by the Office of Vital Statistics, occurring
  243  in a hospital licensed under part I of chapter 395 or a birth
  244  center licensed under s. 383.305 per year. The department shall
  245  calculate the annual assessment for each hospital and birth
  246  center, and this assessment must be paid in equal amounts
  247  quarterly. Quarterly, The department shall generate and send
  248  mail to each hospital and birth center a statement of the amount
  249  due.
  250         2. As part of the department’s legislative budget request
  251  prepared pursuant to chapter 216, the department shall submit a
  252  certification by the department’s inspector general, or the
  253  director of auditing within the inspector general’s office, of
  254  the annual costs of the uniform testing and reporting procedures
  255  of the newborn screening program. In certifying the annual
  256  costs, the department’s inspector general or the director of
  257  auditing within the inspector general’s office shall calculate
  258  the direct costs of the uniform testing and reporting
  259  procedures, including applicable administrative costs.
  260  Administrative costs shall be limited to those department costs
  261  which are reasonably and directly associated with the
  262  administration of the uniform testing and reporting procedures
  263  of the newborn screening program.
  264         (h) Have the authority to bill third-party payors for
  265  newborn screening tests.
  266         (i) Create and make available electronically a pamphlet
  267  with information on screening for, and the treatment of,
  268  preventable infant and childhood eye and vision disorders,
  269  including, but not limited to, retinoblastoma and amblyopia.
  270  
  271  All provisions of this subsection must be coordinated with the
  272  provisions and plans established under this chapter, chapter
  273  411, and Pub. L. No. 99-457.
  274         (4) OBJECTIONS OF PARENT OR GUARDIAN.—The provisions of
  275  this section shall not apply when the parent or guardian of the
  276  child objects thereto. A written statement of such objection
  277  shall be presented to the physician or other person whose duty
  278  it is to administer and report tests and screenings under this
  279  section.
  280         (5) SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS.—Any
  281  physician, advanced practice registered nurse, licensed midwife,
  282  or other licensed health care practitioner or other health care
  283  provider whose duty it is to administer screenings under this
  284  section shall prepare and send all newborn screening specimen
  285  cards to the State Public Health Laboratory in accordance with
  286  rules adopted under this section.
  287         (6) ADVISORY COUNCIL.—There is established a Genetics and
  288  Newborn Screening Advisory Council made up of 15 members
  289  appointed by the State Surgeon General. The council shall be
  290  composed of two consumer members, three practicing
  291  pediatricians, at least one of whom must be a pediatric
  292  hematologist, a representative from each of four medical schools
  293  in this state, the State Surgeon General or his or her designee,
  294  one representative from the Department of Health representing
  295  Children’s Medical Services, one representative from the Florida
  296  Hospital Association, one individual with experience in newborn
  297  screening programs, one individual representing audiologists,
  298  and one representative from the Agency for Persons with
  299  Disabilities. All appointments shall be for a term of 4 years.
  300  The chairperson of the council shall be elected from the
  301  membership of the council and shall serve for a period of 2
  302  years. The council shall meet at least semiannually or upon the
  303  call of the chairperson. The council may establish ad hoc or
  304  temporary technical advisory groups to assist the council with
  305  specific topics which come before the council. Council members
  306  shall serve without pay. Pursuant to the provisions of s.
  307  112.061, the council members are entitled to be reimbursed for
  308  per diem and travel expenses. It is the purpose of the council
  309  to advise the department about:
  310         (a) Conditions for which testing should be included under
  311  the screening program and the genetics program. Within 1 year
  312  after a condition is added to the federal Recommended Uniform
  313  Screening Panel, the council shall consider whether the
  314  condition should be included under the state’s screening
  315  program.
  316         (b) Procedures for collection and transmission of specimens
  317  and recording of results.
  318         (c) Methods whereby screening programs and genetics
  319  services for children now provided or proposed to be offered in
  320  the state may be more effectively evaluated, coordinated, and
  321  consolidated.
  322         Section 2. Section 383.145, Florida Statutes, is amended to
  323  read:
  324         383.145 Newborn, and infant, and toddler hearing
  325  screening.—
  326         (1) LEGISLATIVE INTENT.—It is the intent of the Legislature
  327  to provide a statewide comprehensive and coordinated
  328  interdisciplinary program of early hearing loss screening,
  329  identification, and follow-up care for newborns. The goal is to
  330  screen all newborns for hearing loss in order to alleviate the
  331  adverse effects of hearing loss on speech and language
  332  development, academic performance, and cognitive development. It
  333  is further the intent of the Legislature that this section only
  334  be implemented to the extent that funds are specifically
  335  included in the General Appropriations Act for carrying out the
  336  purposes of this section.
  337         (2) DEFINITIONS.—As used in this section, the term:
  338         (a) “Audiologist” means a person licensed under part I of
  339  chapter 468 to practice audiology.
  340         (b) “Department” means the Department of Health.
  341         (c) “Hearing loss” means a hearing loss of 30 dB HL or
  342  greater in the frequency region important for speech recognition
  343  and comprehension in one or both ears, approximately 500 through
  344  4,000 hertz.
  345         (d) “Hospital” means a facility as defined in s.
  346  395.002(13) and licensed under chapter 395 and part II of
  347  chapter 408.
  348         (e) “Infant” means an age range from 30 days through 12
  349  months.
  350         (f) “Licensed health care provider” means a physician or
  351  physician assistant licensed under chapter 458; an osteopathic
  352  physician or physician assistant licensed under chapter 459; an
  353  advanced practice registered nurse, a registered nurse, or a
  354  licensed practical nurse licensed under part I of chapter 464; a
  355  midwife licensed under chapter 467; or a speech-language
  356  pathologist or an audiologist licensed under part I of chapter
  357  468.
  358         (g) “Management” means the habilitation of the child with
  359  hearing loss.
  360         (h) “Newborn” means an age range from birth through 29
  361  days.
  362         (i) “Physician” means a person licensed under chapter 458
  363  to practice medicine or chapter 459 to practice osteopathic
  364  medicine.
  365         (j) “Screening” means a test or battery of tests
  366  administered to determine the need for an in-depth hearing
  367  diagnostic evaluation.
  368         (k) “Toddler” means a child from 12 months to 36 months of
  369  age.
  370         (3) REQUIREMENTS FOR SCREENING OF NEWBORNS, INFANTS, AND
  371  TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES.—
  372         (a) Each hospital or other state-licensed birthing facility
  373  that provides maternity and newborn care services shall ensure
  374  that all newborns are, before discharge, screened for the
  375  detection of hearing loss to prevent the consequences of
  376  unidentified disorders. If a newborn fails the screening for the
  377  detection of hearing loss, the hospital or other state-licensed
  378  birthing facility must administer a test approved by the United
  379  States Food and Drug Administration or another diagnostically
  380  equivalent test on the newborn to screen for congenital
  381  cytomegalovirus before the newborn becomes 21 days of age or
  382  before discharge, whichever occurs earlier.
  383         (b) Each licensed birth center that provides maternity and
  384  newborn care services shall ensure that all newborns are, before
  385  discharge, screened for the detection of hearing loss. The
  386  licensed birth center must ensure that all newborns who do not
  387  pass the hearing screening are referred to an audiologist, a
  388  hospital, or another newborn hearing screening provider for a
  389  test to screen for congenital cytomegalovirus before the newborn
  390  becomes 21 days of age screening for the detection of hearing
  391  loss to prevent the consequences of unidentified disorders. The
  392  referral for appointment must be made within 7 days after
  393  discharge. Written documentation of the referral must be placed
  394  in the newborn’s medical chart.
  395         (c) If the parent or legal guardian of the newborn objects
  396  to the screening, the screening must not be completed. In such
  397  case, the physician, midwife, or other person attending the
  398  newborn shall maintain a record that the screening has not been
  399  performed and attach a written objection that must be signed by
  400  the parent or guardian.
  401         (d) For home births, the health care provider in attendance
  402  is responsible for coordination and referral to an audiologist,
  403  a hospital, or another newborn hearing screening provider. The
  404  health care provider in attendance must make the referral for
  405  appointment within 7 days after the birth. In cases in which the
  406  home birth is not attended by a health care provider, the
  407  newborn’s primary health care provider is responsible for
  408  coordinating the referral.
  409         (e) For home births and births in a licensed birth center,
  410  if a newborn is referred to a newborn hearing screening provider
  411  and the newborn fails the screening for the detection of hearing
  412  loss, the newborn’s primary health care provider must refer the
  413  newborn for administration of a test approved by the United
  414  States Food and Drug Administration or another diagnostically
  415  equivalent test on the newborn to screen for congenital
  416  cytomegalovirus before the newborn becomes 21 days of age.
  417         (f) All newborn and infant hearing screenings must be
  418  conducted by an audiologist, a physician, or an appropriately
  419  supervised individual who has completed documented training
  420  specifically for newborn hearing screening. Every hospital that
  421  provides maternity or newborn care services shall obtain the
  422  services of an audiologist, a physician, or another newborn
  423  hearing screening provider, through employment or contract or
  424  written memorandum of understanding, for the purposes of
  425  appropriate staff training, screening program supervision,
  426  monitoring the scoring and interpretation of test results,
  427  rendering of appropriate recommendations, and coordination of
  428  appropriate follow-up services. Appropriate documentation of the
  429  screening completion, results, interpretation, and
  430  recommendations must be placed in the medical record within 24
  431  hours after completion of the screening procedure.
  432         (g) The screening of a newborn’s hearing must be completed
  433  before the newborn is discharged from the hospital. However, if
  434  the screening is not completed before discharge due to
  435  scheduling or temporary staffing limitations, the screening must
  436  be completed within 21 days after the birth. Screenings
  437  completed after discharge or performed because of initial
  438  screening failure must be completed by an audiologist, a
  439  physician, a hospital, or another newborn hearing screening
  440  provider.
  441         (h) Each hospital shall formally designate a lead physician
  442  responsible for programmatic oversight for newborn hearing
  443  screening. Each birth center shall designate a licensed health
  444  care provider to provide such programmatic oversight and to
  445  ensure that the appropriate referrals are being completed.
  446         (i) When ordered by the treating physician, the hearing
  447  screening of a newborn, infant, or toddler newborn’s hearing
  448  must include auditory brainstem responses, or evoked otoacoustic
  449  emissions, or appropriate technology as approved by the United
  450  States Food and Drug Administration.
  451         (j) Early childhood programs or entities screening infants
  452  and toddlers for hearing loss must report screening results to
  453  the department within 7 days after completing the screening in
  454  an effort to identify late-onset hearing loss not identified
  455  during the newborn hearing screening process.
  456         (k) The results of any test conducted pursuant to this
  457  section, including, but not limited to, newborn hearing loss
  458  screening, congenital cytomegalovirus testing, and any related
  459  diagnostic testing, must be reported to the department within 7
  460  days after receipt of such results.
  461         (l)(k) The initial procedure for screening the hearing of
  462  the newborn or infant and any medically necessary follow-up
  463  reevaluations leading to diagnosis shall be a covered benefit
  464  for Medicaid patients covered by a fee-for-service program. For
  465  Medicaid patients enrolled in HMOs, providers shall be
  466  reimbursed directly by the Medicaid Program Office at the
  467  Medicaid rate. This service may not be considered a covered
  468  service for the purposes of establishing the payment rate for
  469  Medicaid HMOs. All health insurance policies and health
  470  maintenance organizations as provided under ss. 627.6416,
  471  627.6579, and 641.31(30), except for supplemental policies that
  472  only provide coverage for specific diseases, hospital indemnity,
  473  or Medicare supplement, or to the supplemental policies, shall
  474  compensate providers for the covered benefit at the contracted
  475  rate. Nonhospital-based providers are eligible to bill Medicaid
  476  for the professional and technical component of each procedure
  477  code.
  478         (m)(l) A child who is diagnosed as having permanent hearing
  479  loss must be referred to the primary care physician for medical
  480  management, treatment, and follow-up services. Furthermore, in
  481  accordance with Part C of the Individuals with Disabilities
  482  Education Act, Pub. L. No. 108-446, Infants and Toddlers with
  483  Disabilities, any child from birth to 36 months of age who is
  484  diagnosed as having hearing loss that requires ongoing special
  485  hearing services must be referred to the Children’s Medical
  486  Services Early Intervention Program serving the geographical
  487  area in which the child resides.
  488         Section 3. Subsection (1) of section 391.016, Florida
  489  Statutes, is amended to read:
  490         391.016 Purposes and functions.—The Children’s Medical
  491  Services program is established for the following purposes and
  492  authorized to perform the following functions:
  493         (1) Provide to children and youth with special health care
  494  needs a family-centered, comprehensive, and coordinated
  495  statewide managed system of care that links community-based
  496  health care with multidisciplinary, regional, and tertiary
  497  pediatric specialty care. The program shall coordinate and
  498  maintain a consistent medical home for participating children.
  499         Section 4. Subsections (1), (2), and (4) of section
  500  391.021, Florida Statutes, are amended to read:
  501         391.021 Definitions.—When used in this act, the term:
  502         (2)(1) “Children’s Medical Services Managed Care Plan
  503  network” or “plan network” means a statewide managed care
  504  service system that includes health care providers, as defined
  505  in this section.
  506         (1)(2) “Children and youth with special health care needs”
  507  means those children younger than 21 years of age who have
  508  chronic and serious physical, developmental, behavioral, or
  509  emotional conditions and who require health care and related
  510  services of a type or amount beyond that which is generally
  511  required by children.
  512         (4) “Eligible individual” means a child or youth with a
  513  special health care need or a female with a high-risk pregnancy,
  514  who meets the financial and medical eligibility standards
  515  established in s. 391.029.
  516         Section 5. Subsection (1) of section 391.025, Florida
  517  Statutes, is amended to read:
  518         391.025 Applicability and scope.—
  519         (1) The Children’s Medical Services program consists of the
  520  following components:
  521         (a) The newborn screening program established in s. 383.14
  522  and the newborn, infant, and toddler hearing screening program
  523  established in s. 383.145.
  524         (b) The regional perinatal intensive care centers program
  525  established in ss. 383.15-383.19.
  526         (c) The developmental evaluation and intervention program,
  527  including the Early Steps Program established in ss. 391.301
  528  391.308.
  529         (d) The Children’s Medical Services Managed Care Plan
  530  network.
  531         (e)The Children’s Multidisciplinary Assessment Team.
  532         (f) The Medical Foster Care Program.
  533         (g)The Title V program for children and youth with special
  534  health care needs.
  535         (h)The Safety Net Program.
  536         (i)The Networks for Access and Quality.
  537         (j)Child Protection Teams and sexual abuse treatment
  538  programs established under s. 39.303.
  539         (k)The State Child Abuse Death Review Committee and local
  540  child abuse death review committees established in s. 383.402.
  541         Section 6. Section 391.026, Florida Statutes, is amended to
  542  read:
  543         391.026 Powers and duties of the department.—The department
  544  shall have the following powers, duties, and responsibilities:
  545         (1) To provide or contract for the provision of health
  546  services to eligible individuals.
  547         (2) To provide services to abused and neglected children
  548  through Child Protection Teams pursuant to s. 39.303.
  549         (3) To determine the medical and financial eligibility of
  550  individuals seeking health services from the program.
  551         (4) To coordinate a comprehensive delivery system for
  552  eligible individuals to take maximum advantage of all available
  553  funds.
  554         (5) To coordinate with programs relating to children’s
  555  medical services in cooperation with other public and private
  556  agencies.
  557         (6) To initiate and coordinate applications to federal
  558  agencies and private organizations for funds, services, or
  559  commodities relating to children’s medical programs.
  560         (7) To sponsor or promote grants for projects, programs,
  561  education, or research in the field of children and youth with
  562  special health care needs, with an emphasis on early diagnosis
  563  and treatment.
  564         (8) To oversee and operate the Children’s Medical Services
  565  Managed Care Plan network.
  566         (9) To establish reimbursement mechanisms for the
  567  Children’s Medical Services Managed Care Plan network.
  568         (10) To establish Children’s Medical Services Managed Care
  569  Plan network standards and, if applicable, credentialing
  570  requirements for health care providers and health care services.
  571         (11) To serve as a provider and principal case manager for
  572  children with special health care needs under Titles XIX and XXI
  573  of the Social Security Act.
  574         (12) To monitor the provision of health services in the
  575  program, including the utilization and quality of health
  576  services.
  577         (12)(13) To administer the Children and Youth with Special
  578  Health Care Needs program in accordance with Title V of the
  579  Social Security Act.
  580         (13)(14) To establish and operate a grievance resolution
  581  process for participants and health care providers.
  582         (14)(15) To maintain program integrity in the Children’s
  583  Medical Services program.
  584         (15)(16) To receive and manage health care premiums,
  585  capitation payments, and funds from federal, state, local, and
  586  private entities for the program. The department may contract
  587  with a third-party administrator for processing claims,
  588  monitoring medical expenses, and other related services
  589  necessary to the efficient and cost-effective operation of the
  590  Children’s Medical Services Managed Care Plan network. The
  591  department is authorized to maintain a minimum reserve for the
  592  Children’s Medical Services Managed Care Plan network in an
  593  amount that is the greater of:
  594         (a) Ten percent of total projected expenditures for Title
  595  XIX-funded and Title XXI-funded children; or
  596         (b) Two percent of total annualized payments from the
  597  Agency for Health Care Administration for Title XIX and Title
  598  XXI of the Social Security Act.
  599         (16)(17) To provide or contract for peer review and other
  600  quality-improvement activities.
  601         (17)(18) To adopt rules pursuant to ss. 120.536(1) and
  602  120.54 to administer the Children’s Medical Services Act.
  603         (18)(19) To serve as the lead agency in administering the
  604  Early Steps Program pursuant to part C of the federal
  605  Individuals with Disabilities Education Act and part III of this
  606  chapter.
  607         (19)To administer the Medical Foster Care Program,
  608  including all of the following:
  609         (a)Recruitment, training, assessment, and monitoring for
  610  the Medical Foster Care Program.
  611         (b)Monitoring access and facilitating admissions of
  612  eligible children and youth to the program and designated
  613  medical foster care homes.
  614         (c)Coordination with the Department of Children and
  615  Families and the Agency for Health Care Administration or their
  616  designees.
  617         Section 7. Section 391.028, Florida Statutes, is amended to
  618  read:
  619         391.028 Administration.—
  620         (1) The Director of Children’s Medical Services must be a
  621  physician licensed under chapter 458 or chapter 459 who has
  622  specialized training and experience in the provision of health
  623  care to children and youth and who has recognized skills in
  624  leadership and the promotion of children’s health programs. The
  625  director shall be the deputy secretary and the Deputy State
  626  Health Officer for Children’s Medical Services and is appointed
  627  by and reports to the State Surgeon General. The director may
  628  appoint such other staff as necessary for the operation of the
  629  program subject to the approval of the State Surgeon General.
  630         (2) The director shall provide for an operational system
  631  using such department staff and contract providers as necessary.
  632  The program shall implement all of the following program
  633  activities under physician supervision on a statewide basis:
  634         (a) Case management services for network participants;
  635         (b) Management and oversight of statewide local program
  636  activities.;
  637         (b)(c) Medical and financial eligibility determination for
  638  the program in accordance with s. 391.029.;
  639         (c)(d) Determination of a level of care and medical
  640  complexity for long-term care services.;
  641         (d)(e) Authorizing services in the program and developing
  642  spending plans.;
  643         (f) Development of treatment plans; and
  644         (e)(g) Resolution of complaints and grievances from
  645  participants and health care providers.
  646         (3) Each Children’s Medical Services area office shall be
  647  directed by a physician licensed under chapter 458 or chapter
  648  459 who has specialized training and experience in the provision
  649  of health care to children. The director of a Children’s Medical
  650  Services area office shall be appointed by the director from the
  651  active panel of Children’s Medical Services physician
  652  consultants.
  653         Section 8. Subsections (2) and (3) of section 391.029,
  654  Florida Statutes, are amended to read:
  655         391.029 Program eligibility.—
  656         (2) The following individuals are eligible to receive
  657  services through the program:
  658         (a) Related to the regional perinatal intensive care
  659  centers, a high-risk pregnant female who is enrolled in
  660  Medicaid.
  661         (b) Children and youth with serious special health care
  662  needs from birth to 21 years of age who are enrolled in
  663  Medicaid.
  664         (c) Children and youth with serious special health care
  665  needs from birth to 19 years of age who are enrolled in a
  666  program under Title XXI of the Social Security Act.
  667         (3) Subject to the availability of funds, the following
  668  individuals may receive services through the program:
  669         (a) Children and youth with serious special health care
  670  needs from birth to 21 years of age who do not qualify for
  671  Medicaid or Title XXI of the Social Security Act but who are
  672  unable to access, due to lack of providers or lack of financial
  673  resources, specialized services that are medically necessary or
  674  essential family support services. Families shall participate
  675  financially in the cost of care based on a sliding fee scale
  676  established by the department.
  677         (b) Children and youth with special health care needs from
  678  birth to 21 years of age, as provided in Title V of the Social
  679  Security Act.
  680         (c) An infant who receives an award of compensation under
  681  s. 766.31(1). The Florida Birth-Related Neurological Injury
  682  Compensation Association shall reimburse the Children’s Medical
  683  Services Managed Care Plan Network the state’s share of funding,
  684  which must thereafter be used to obtain matching federal funds
  685  under Title XXI of the Social Security Act.
  686         Section 9. Section 391.0315, Florida Statutes, is amended
  687  to read:
  688         391.0315 Benefits.—Benefits provided under the Children’s
  689  Medical Services Managed Care Plan program for children with
  690  special health care needs shall be equivalent to benefits
  691  provided to children as specified in ss. 409.905 and 409.906.
  692  The department may offer additional benefits through Children’s
  693  Medical Services programs for early intervention services,
  694  respite services, genetic testing, genetic and nutritional
  695  counseling, and parent support services, if such services are
  696  determined to be medically necessary.
  697         Section 10. Section 391.035, Florida Statutes, is repealed.
  698         Section 11. Section 391.045, Florida Statutes, is amended
  699  to read:
  700         391.045 Reimbursement.—
  701         (1) The department shall reimburse health care providers
  702  for services rendered through the Children’s Medical Services
  703  Managed Care Plan network using cost-effective methods,
  704  including, but not limited to, capitation, discounted fee-for
  705  service, unit costs, and cost reimbursement. Medicaid
  706  reimbursement rates shall be utilized to the maximum extent
  707  possible, where applicable.
  708         (2) Reimbursement to the Children’s Medical Services
  709  program for services provided to children and youth with special
  710  health care needs who participate in the Florida Kidcare program
  711  and who are not Medicaid recipients shall be on a capitated
  712  basis.
  713         Section 12. Section 391.055, Florida Statutes, is amended
  714  to read:
  715         391.055 Service delivery systems.—
  716         (1) The program shall apply managed care methods to ensure
  717  the efficient operation of the Children’s Medical Services
  718  Managed Care Plan network. Such methods include, but are not
  719  limited to, capitation payments, utilization management and
  720  review, prior authorization, and case management.
  721         (2) The components of the network are:
  722         (a) Qualified primary care physicians who shall serve as
  723  the gatekeepers and who shall be responsible for the provision
  724  or authorization of health services to an eligible individual
  725  who is enrolled in the Children’s Medical Services network.
  726         (b) Comprehensive Specialty care arrangements that meet the
  727  requirements of s. 391.035 to provide acute care, specialty
  728  care, long-term care, and chronic disease management for
  729  eligible individuals.
  730         (c) Case management services.
  731         (3) The Children’s Medical Services Managed Care Plan
  732  network may contract with school districts participating in the
  733  certified school match program pursuant to ss. 409.908(21) and
  734  1011.70 for the provision of school-based services, as provided
  735  for in s. 409.9071, for Medicaid-eligible children who are
  736  enrolled in the Children’s Medical Services Managed Care Plan
  737  network.
  738         (4) If a newborn has an abnormal screening result for
  739  metabolic or other hereditary and congenital disorders which is
  740  identified through the newborn screening program pursuant to s.
  741  383.14, the newborn shall be referred to the Children’s Medical
  742  Services program for additional testing, medical management,
  743  early intervention services, or medical referral.
  744         Section 13. Section 391.097, Florida Statutes, is amended
  745  to read:
  746         391.097 Research and evaluation.—
  747         (1) The department may initiate, fund, and conduct research
  748  and evaluation projects to improve the delivery of children’s
  749  medical services. The department may cooperate with public and
  750  private agencies engaged in work of a similar nature.
  751         (2) The Children’s Medical Services Managed Care Plan
  752  network shall be included in any evaluation conducted in
  753  accordance with the provisions of Title XXI of the Social
  754  Security Act as enacted by the Legislature.
  755         Section 14. Part II of chapter 391, Florida Statutes,
  756  consisting of ss. 391.221 and 391.223, Florida Statutes, is
  757  repealed, and part III of that chapter is redesignated as part
  758  II.
  759         Section 15. Legislative findings and intent.—
  760         (1)The Legislature finds that:
  761         (a)In August 2014, the Department of Health’s Children’s
  762  Medical Services Network, which was a fee-for-service program
  763  serving children with special health care needs who were
  764  enrolled in Medicaid under Title XIX of the Social Security Act
  765  and children with special health care needs who were enrolled in
  766  the Children’s Health Insurance Program under Title XXI of the
  767  Social Security Act, was transitioned to the Children’s Medical
  768  Services Managed Care Plan.
  769         (b)The Agency for Health Care Administration serves as the
  770  lead agency for Statewide Medicaid Managed Care for the state of
  771  Florida, and the Agency for Health Care Administration contracts
  772  with the Department of Health to provide Medicaid services
  773  through the Children’s Medical Services Managed Care Plan.
  774         (c)The Department of Health subcontracts with a private
  775  provider to operate various components of the Children’s Medical
  776  Services Managed Care Plan, including services for children with
  777  special health care needs enrolled in Medicaid and children with
  778  special health care needs enrolled in the Children’s Health
  779  Insurance Program.
  780         (d)The administrative requirements of this intermediary
  781  relationship can be addressed by transitioning the operations of
  782  the Children’s Medical Services Managed Care Plan to the Agency
  783  for Health Care Administration. This transition shall include
  784  children with special health care needs enrolled in Medicaid and
  785  children with special health care needs enrolled in the
  786  Children’s Health Insurance Program.
  787         (e)The Department of Health’s Children’s Medical Services
  788  program has a longstanding history of successfully and
  789  compassionately caring for children with special health care
  790  needs and their families. This knowledge, skill, and ability can
  791  be used to collaborate with the Agency for Health Care
  792  Administration in the care of children with special health care
  793  needs.
  794         (2)It is the intent of the Legislature that the Agency for
  795  Health Care Administration shall, in consultation with the
  796  Department of Health, competitively procure and operate one or
  797  more specialty plan contracts for children and youth with
  798  special health care needs beginning with the 2024-2025 plan
  799  year.
  800         Section 16. Transfer of operation of the Children’s Medical
  801  Services Managed Care Plan.
  802         (1)Effective October 1, 2024, all statutory powers,
  803  duties, functions, records, personnel, pending issues, existing
  804  contracts, administrative authority, administrative rules, and
  805  unexpended balances of appropriations, allocations, and other
  806  funds for the operation of the Department of Health’s Children’s
  807  Medical Services Managed Care Plan, except those powers, duties,
  808  and personnel retained by the Department of Health in chapter
  809  391, Florida Statutes, are transferred to the Agency for Health
  810  Care Administration.
  811         (2)The transfer of operations of the Children’s Medical
  812  Services Managed Care Plan does not affect the validity of any
  813  judicial or administrative action pending as of 11:59 p.m. on
  814  the day before the effective date of the transfer to which the
  815  Department of Health’s Children’s Medical Services Managed Care
  816  Plan is at that time a party, and the Agency for Health Care
  817  Administration shall be substituted as a party in interest in
  818  any such action.
  819         (3)The Department of Health’s Children’s Medical Services
  820  program shall use its knowledge, skill, and ability to
  821  collaborate with the Agency for Health Care Administration in
  822  the care of children with special health care needs. The
  823  Department of Health’s Children’s Medical Services program shall
  824  do all of the following:
  825         (a)Assist the agency in developing specifications for use
  826  in the procurement of vendors and the model contract, including
  827  provisions relating to referral, enrollment, disenrollment,
  828  access, quality-of-care, network adequacy, care coordination,
  829  and service integration.
  830         (b)Conduct clinical eligibility screening for children
  831  with special health care needs who are eligible for or enrolled
  832  in Medicaid or the Children’s Health Insurance Program.
  833         (c)Collaborate with the agency in the care of children
  834  with special health care needs.
  835         Section 17. By November 1, 2023, the Agency for Health Care
  836  Administration and the Department of Health shall submit to each
  837  substantive and fiscal committee of the Legislature having
  838  jurisdiction a report specifying any legislative and
  839  administrative changes needed to effectively transfer operations
  840  of the Children’s Medical Services Managed Care Plan from the
  841  department to the agency.
  842         Section 18. Subsection (4) of section 409.974, Florida
  843  Statutes, is amended to read:
  844         409.974 Eligible plans.—
  845         (4) CHILDREN’S MEDICAL SERVICES NETWORK.—The Agency for
  846  Health Care Administration shall competitively procure one or
  847  more vendors to provide services for children with special
  848  health care needs who are enrolled in Medicaid and children with
  849  special health care needs who are enrolled in the Children’s
  850  Health Insurance Program for the 2024-2025 plan year. The
  851  Department of Health’s Children’s Medical Services program shall
  852  do all of the following:
  853         (a)Assist the agency in developing specifications for use
  854  in the procurement of vendors and the model contract, including
  855  provisions relating to referral, enrollment, disenrollment,
  856  access, quality-of-care, network adequacy, care coordination,
  857  and service integration.
  858         (b)Conduct clinical eligibility screening for children
  859  with special health care needs who are eligible for or are
  860  enrolled in Medicaid or the Children’s Health Insurance Program.
  861         (c)Collaborate with the agency in the care of children
  862  with special health care needs Participation by the Children’s
  863  Medical Services Network shall be pursuant to a single,
  864  statewide contract with the agency that is not subject to the
  865  procurement requirements or regional plan number limits of this
  866  section. The Children’s Medical Services Network must meet all
  867  other plan requirements for the managed medical assistance
  868  program.
  869         Section 19. Effective October 1, 2024, paragraph (f) of
  870  subsection (4) and paragraph (b) of subsection (5) of section
  871  409.166, Florida Statutes, are amended to read:
  872         409.166 Children within the child welfare system; adoption
  873  assistance program.—
  874         (4) ADOPTION ASSISTANCE.—
  875         (f) The department may provide adoption assistance to the
  876  adoptive parents, subject to specific appropriation, for medical
  877  assistance initiated after the adoption of the child for
  878  medical, surgical, hospital, and related services needed as a
  879  result of a physical or mental condition of the child which
  880  existed before the adoption and is not covered by Medicaid,
  881  Children’s Medical Services, or Children’s Mental Health
  882  Services. Such assistance may be initiated at any time but must
  883  shall terminate on or before the child’s 18th birthday.
  884         (5) ELIGIBILITY FOR SERVICES.—
  885         (b) A child who is handicapped at the time of adoption is
  886  shall be eligible for services through a specialty plan under
  887  contract with the agency to serve children with special heath
  888  care needs the Children’s Medical Services network established
  889  under part I of chapter 391 if the child was eligible for such
  890  services before prior to the adoption.
  891         Section 20. Subsection (7) of section 409.811, Florida
  892  Statutes, is amended to read:
  893         409.811 Definitions relating to Florida Kidcare Act.—As
  894  used in ss. 409.810-409.821, the term:
  895         (7) “Children’s Medical Services Managed Care Plan Network”
  896  or “plan network” means a statewide managed care service system
  897  as defined in s. 391.021 s. 391.021(1).
  898         Section 21. Effective October 1, 2024, subsection (1) of
  899  section 409.813, Florida Statutes, is amended to read:
  900         409.813 Health benefits coverage; program components;
  901  entitlement and nonentitlement.—
  902         (1) The Florida Kidcare program includes health benefits
  903  coverage provided to children through the following program
  904  components, which shall be marketed as the Florida Kidcare
  905  program:
  906         (a) Medicaid;
  907         (b) Medikids as created in s. 409.8132;
  908         (c) The Florida Healthy Kids Corporation as created in s.
  909  624.91;
  910         (d) Employer-sponsored group health insurance plans
  911  approved under ss. 409.810-409.821; and
  912         (e) A specialty plan under contract with the agency to
  913  serve children with special health care needs The Children’s
  914  Medical Services network established in chapter 391.
  915         Section 22. Effective October 1, 2024, subsection (3) of
  916  section 409.8134, Florida Statutes, is amended to read:
  917         409.8134 Program expenditure ceiling; enrollment.—
  918         (3) Upon determination by the Social Services Estimating
  919  Conference that there are insufficient funds to finance the
  920  current enrollment in the Florida Kidcare program within current
  921  appropriations, the program shall initiate disenrollment
  922  procedures to remove enrollees, except those children enrolled
  923  in a specialty plan under contract with the agency to serve
  924  children with special health care needs the Children’s Medical
  925  Services Network, on a last-in, first-out basis until the
  926  expenditure and appropriation levels are balanced.
  927         Section 23. Subsection (3) and paragraph (c) of subsection
  928  (10) of section 409.814, Florida Statutes, are amended to read:
  929         409.814 Eligibility.—A child who has not reached 19 years
  930  of age whose family income is equal to or below 200 percent of
  931  the federal poverty level is eligible for the Florida Kidcare
  932  program as provided in this section. If an enrolled individual
  933  is determined to be ineligible for coverage, he or she must be
  934  immediately disenrolled from the respective Florida Kidcare
  935  program component.
  936         (3) A Title XXI-funded child who is eligible for the
  937  Florida Kidcare program who is a child with special health care
  938  needs, as determined through a medical or behavioral screening
  939  instrument, is eligible for health benefits coverage from and
  940  shall be assigned to and may opt out of the Children’s Medical
  941  Services Managed Care Plan Network.
  942         (10) In determining the eligibility of a child, an assets
  943  test is not required. Each applicant shall provide documentation
  944  during the application process and the redetermination process,
  945  including, but not limited to, the following:
  946         (c) To enroll in the Children’s Medical Services Managed
  947  Care Plan Network, a completed application, including a clinical
  948  screening.
  949         Section 24. Effective October 1, 2024, paragraph (t) of
  950  subsection (2) of section 409.815, Florida Statutes, is amended
  951  to read:
  952         409.815 Health benefits coverage; limitations.—
  953         (2) BENCHMARK BENEFITS.—In order for health benefits
  954  coverage to qualify for premium assistance payments for an
  955  eligible child under ss. 409.810-409.821, the health benefits
  956  coverage, except for coverage under Medicaid and Medikids, must
  957  include the following minimum benefits, as medically necessary.
  958         (t) Enhancements to minimum requirements.—
  959         1. This section sets the minimum benefits that must be
  960  included in any health benefits coverage, other than Medicaid or
  961  Medikids coverage, offered under ss. 409.810-409.821. Health
  962  benefits coverage may include additional benefits not included
  963  under this subsection, but may not include benefits excluded
  964  under paragraph (r).
  965         2. Health benefits coverage may extend any limitations
  966  beyond the minimum benefits described in this section.
  967  
  968  Except for a specialty plan under contract with the agency to
  969  serve children with special health care needs the Children’s
  970  Medical Services Network, the agency may not increase the
  971  premium assistance payment for either additional benefits
  972  provided beyond the minimum benefits described in this section
  973  or the imposition of less restrictive service limitations.
  974         Section 25. Effective October 1, 2024, paragraph (i) of
  975  subsection (1) of section 409.8177, Florida Statutes, is amended
  976  to read:
  977         409.8177 Program evaluation.—
  978         (1) The agency, in consultation with the Department of
  979  Health, the Department of Children and Families, and the Florida
  980  Healthy Kids Corporation, shall contract for an evaluation of
  981  the Florida Kidcare program and shall by January 1 of each year
  982  submit to the Governor, the President of the Senate, and the
  983  Speaker of the House of Representatives a report of the program.
  984  In addition to the items specified under s. 2108 of Title XXI of
  985  the Social Security Act, the report shall include an assessment
  986  of crowd-out and access to health care, as well as the
  987  following:
  988         (i) An assessment of the effectiveness of the Florida
  989  Kidcare program, including Medicaid, the Florida Healthy Kids
  990  program, Medikids, and the specialty plans under contract with
  991  the agency to serve children with special health care needs
  992  Children’s Medical Services network, and other public and
  993  private programs in the state in increasing the availability of
  994  affordable quality health insurance and health care for
  995  children.
  996         Section 26. Effective October 1, 2024, subsection (4) of
  997  section 409.818, Florida Statutes, is amended to read:
  998         409.818 Administration.—In order to implement ss. 409.810
  999  409.821, the following agencies shall have the following duties:
 1000         (4) The Office of Insurance Regulation shall certify that
 1001  health benefits coverage plans that seek to provide services
 1002  under the Florida Kidcare program, except those offered through
 1003  the Florida Healthy Kids Corporation or the Children’s Medical
 1004  Services Network, meet, exceed, or are actuarially equivalent to
 1005  the benchmark benefit plan and that health insurance plans will
 1006  be offered at an approved rate. In determining actuarial
 1007  equivalence of benefits coverage, the Office of Insurance
 1008  Regulation and health insurance plans must comply with the
 1009  requirements of s. 2103 of Title XXI of the Social Security Act.
 1010  The department shall adopt rules necessary for certifying health
 1011  benefits coverage plans.
 1012         Section 27. Effective October 1, 2024, subsection (11) of
 1013  section 409.912, Florida Statutes, is amended to read:
 1014         409.912 Cost-effective purchasing of health care.—The
 1015  agency shall purchase goods and services for Medicaid recipients
 1016  in the most cost-effective manner consistent with the delivery
 1017  of quality medical care. To ensure that medical services are
 1018  effectively utilized, the agency may, in any case, require a
 1019  confirmation or second physician’s opinion of the correct
 1020  diagnosis for purposes of authorizing future services under the
 1021  Medicaid program. This section does not restrict access to
 1022  emergency services or poststabilization care services as defined
 1023  in 42 C.F.R. s. 438.114. Such confirmation or second opinion
 1024  shall be rendered in a manner approved by the agency. The agency
 1025  shall maximize the use of prepaid per capita and prepaid
 1026  aggregate fixed-sum basis services when appropriate and other
 1027  alternative service delivery and reimbursement methodologies,
 1028  including competitive bidding pursuant to s. 287.057, designed
 1029  to facilitate the cost-effective purchase of a case-managed
 1030  continuum of care. The agency shall also require providers to
 1031  minimize the exposure of recipients to the need for acute
 1032  inpatient, custodial, and other institutional care and the
 1033  inappropriate or unnecessary use of high-cost services. The
 1034  agency shall contract with a vendor to monitor and evaluate the
 1035  clinical practice patterns of providers in order to identify
 1036  trends that are outside the normal practice patterns of a
 1037  provider’s professional peers or the national guidelines of a
 1038  provider’s professional association. The vendor must be able to
 1039  provide information and counseling to a provider whose practice
 1040  patterns are outside the norms, in consultation with the agency,
 1041  to improve patient care and reduce inappropriate utilization.
 1042  The agency may mandate prior authorization, drug therapy
 1043  management, or disease management participation for certain
 1044  populations of Medicaid beneficiaries, certain drug classes, or
 1045  particular drugs to prevent fraud, abuse, overuse, and possible
 1046  dangerous drug interactions. The Pharmaceutical and Therapeutics
 1047  Committee shall make recommendations to the agency on drugs for
 1048  which prior authorization is required. The agency shall inform
 1049  the Pharmaceutical and Therapeutics Committee of its decisions
 1050  regarding drugs subject to prior authorization. The agency is
 1051  authorized to limit the entities it contracts with or enrolls as
 1052  Medicaid providers by developing a provider network through
 1053  provider credentialing. The agency may competitively bid single
 1054  source-provider contracts if procurement of goods or services
 1055  results in demonstrated cost savings to the state without
 1056  limiting access to care. The agency may limit its network based
 1057  on the assessment of beneficiary access to care, provider
 1058  availability, provider quality standards, time and distance
 1059  standards for access to care, the cultural competence of the
 1060  provider network, demographic characteristics of Medicaid
 1061  beneficiaries, practice and provider-to-beneficiary standards,
 1062  appointment wait times, beneficiary use of services, provider
 1063  turnover, provider profiling, provider licensure history,
 1064  previous program integrity investigations and findings, peer
 1065  review, provider Medicaid policy and billing compliance records,
 1066  clinical and medical record audits, and other factors. Providers
 1067  are not entitled to enrollment in the Medicaid provider network.
 1068  The agency shall determine instances in which allowing Medicaid
 1069  beneficiaries to purchase durable medical equipment and other
 1070  goods is less expensive to the Medicaid program than long-term
 1071  rental of the equipment or goods. The agency may establish rules
 1072  to facilitate purchases in lieu of long-term rentals in order to
 1073  protect against fraud and abuse in the Medicaid program as
 1074  defined in s. 409.913. The agency may seek federal waivers
 1075  necessary to administer these policies.
 1076         (11) The agency shall implement a program of all-inclusive
 1077  care for children. The program of all-inclusive care for
 1078  children shall be established to provide in-home hospice-like
 1079  support services to children diagnosed with a life-threatening
 1080  illness and enrolled in the Children’s Medical Services network
 1081  to reduce hospitalizations as appropriate. The agency, in
 1082  consultation with the Department of Health, may implement the
 1083  program of all-inclusive care for children after obtaining
 1084  approval from the Centers for Medicare and Medicaid Services.
 1085         Section 28. Effective October 1, 2024, subsection (1) of
 1086  section 409.9126, Florida Statutes, is amended to read:
 1087         409.9126 Children with special health care needs.—
 1088         (1) Except as provided in subsection (4), children eligible
 1089  for Children’s Medical Services who receive Medicaid benefits,
 1090  and other Medicaid-eligible children with special health care
 1091  needs, are shall be exempt from the provisions of s. 409.9122
 1092  and shall be served through the Children’s Medical Services
 1093  network established in chapter 391.
 1094         Section 29. Effective October 1, 2024, paragraph (a) of
 1095  subsection (5) of section 409.9131, Florida Statutes, is amended
 1096  to read:
 1097         409.9131 Special provisions relating to integrity of the
 1098  Medicaid program.—
 1099         (5) DETERMINATIONS OF OVERPAYMENT.—In making a
 1100  determination of overpayment to a physician, the agency must:
 1101         (a) Use accepted and valid auditing, accounting,
 1102  analytical, statistical, or peer-review methods, or combinations
 1103  thereof. Appropriate statistical methods may include, but are
 1104  not limited to, sampling and extension to the population,
 1105  parametric and nonparametric statistics, tests of hypotheses,
 1106  other generally accepted statistical methods, review of medical
 1107  records, and a consideration of the physician’s client case mix.
 1108  Before performing a review of the physician’s Medicaid records,
 1109  however, the agency shall make every effort to consider the
 1110  physician’s patient case mix, including, but not limited to,
 1111  patient age and whether individual patients are clients of the
 1112  Children’s Medical Services Network established in chapter 391.
 1113  In meeting its burden of proof in any administrative or court
 1114  proceeding, the agency may introduce the results of such
 1115  statistical methods and its other audit findings as evidence of
 1116  overpayment.
 1117         Section 30. Effective October 1, 2024, paragraph (e) of
 1118  subsection (1) of section 409.920, Florida Statutes, is amended
 1119  to read:
 1120         409.920 Medicaid provider fraud.—
 1121         (1) For the purposes of this section, the term:
 1122         (e) “Managed care plans” means a health insurer authorized
 1123  under chapter 624, an exclusive provider organization authorized
 1124  under chapter 627, a health maintenance organization authorized
 1125  under chapter 641, the Children’s Medical Services Network
 1126  authorized under chapter 391, a prepaid health plan authorized
 1127  under this chapter, a provider service network authorized under
 1128  this chapter, a minority physician network authorized under this
 1129  chapter, and an emergency department diversion program
 1130  authorized under this chapter or the General Appropriations Act,
 1131  providing health care services pursuant to a contract with the
 1132  Medicaid program.
 1133         Section 31. Effective October 1, 2024, subsection (7) of
 1134  section 409.962, Florida Statutes, is amended to read:
 1135         409.962 Definitions.—As used in this part, except as
 1136  otherwise specifically provided, the term:
 1137         (7) “Eligible plan” means a health insurer authorized under
 1138  chapter 624, an exclusive provider organization authorized under
 1139  chapter 627, a health maintenance organization authorized under
 1140  chapter 641, or a provider service network authorized under s.
 1141  409.912(1) or an accountable care organization authorized under
 1142  federal law. For purposes of the managed medical assistance
 1143  program, the term also includes the Children’s Medical Services
 1144  Network authorized under chapter 391 and entities qualified
 1145  under 42 C.F.R. part 422 as Medicare Advantage Preferred
 1146  Provider Organizations, Medicare Advantage Provider-sponsored
 1147  Organizations, Medicare Advantage Health Maintenance
 1148  Organizations, Medicare Advantage Coordinated Care Plans, and
 1149  Medicare Advantage Special Needs Plans, and the Program of All
 1150  inclusive Care for the Elderly.
 1151         Section 32. Except as otherwise expressly provided in this
 1152  act, this act shall take effect July 1, 2023.