Bill Amendment: FL S0966 | 2013 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Health Care
Status: 2013-05-03 - Died on Calendar, companion bill(s) passed, see CS/HB 1071 (Ch. 2013-93), CS/CS/HB 1159 (Ch. 2013-153), SB 1520 (Ch. 2013-48) [S0966 Detail]
Download: Florida-2013-S0966-Senate_Floor_Amendment_601024.html
Bill Title: Health Care
Status: 2013-05-03 - Died on Calendar, companion bill(s) passed, see CS/HB 1071 (Ch. 2013-93), CS/CS/HB 1159 (Ch. 2013-153), SB 1520 (Ch. 2013-48) [S0966 Detail]
Download: Florida-2013-S0966-Senate_Floor_Amendment_601024.html
Florida Senate - 2013 SENATOR AMENDMENT Bill No. CS for CS for SB 966 Barcode 601024 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Garcia moved the following: 1 Senate Amendment (with title amendment) 2 3 Before line 2292 4 insert: 5 Section 55. Subsection (41) of section 409.912, Florida 6 Statutes, is amended to read: 7 409.912 Cost-effective purchasing of health care.—The 8 agency shall purchase goods and services for Medicaid recipients 9 in the most cost-effective manner consistent with the delivery 10 of quality medical care. To ensure that medical services are 11 effectively utilized, the agency may, in any case, require a 12 confirmation or second physician’s opinion of the correct 13 diagnosis for purposes of authorizing future services under the 14 Medicaid program. This section does not restrict access to 15 emergency services or poststabilization care services as defined 16 in 42 C.F.R. part 438.114. Such confirmation or second opinion 17 shall be rendered in a manner approved by the agency. The agency 18 shall maximize the use of prepaid per capita and prepaid 19 aggregate fixed-sum basis services when appropriate and other 20 alternative service delivery and reimbursement methodologies, 21 including competitive bidding pursuant to s. 287.057, designed 22 to facilitate the cost-effective purchase of a case-managed 23 continuum of care. The agency shall also require providers to 24 minimize the exposure of recipients to the need for acute 25 inpatient, custodial, and other institutional care and the 26 inappropriate or unnecessary use of high-cost services. The 27 agency shall contract with a vendor to monitor and evaluate the 28 clinical practice patterns of providers in order to identify 29 trends that are outside the normal practice patterns of a 30 provider’s professional peers or the national guidelines of a 31 provider’s professional association. The vendor must be able to 32 provide information and counseling to a provider whose practice 33 patterns are outside the norms, in consultation with the agency, 34 to improve patient care and reduce inappropriate utilization. 35 The agency may mandate prior authorization, drug therapy 36 management, or disease management participation for certain 37 populations of Medicaid beneficiaries, certain drug classes, or 38 particular drugs to prevent fraud, abuse, overuse, and possible 39 dangerous drug interactions. The Pharmaceutical and Therapeutics 40 Committee shall make recommendations to the agency on drugs for 41 which prior authorization is required. The agency shall inform 42 the Pharmaceutical and Therapeutics Committee of its decisions 43 regarding drugs subject to prior authorization. The agency is 44 authorized to limit the entities it contracts with or enrolls as 45 Medicaid providers by developing a provider network through 46 provider credentialing. The agency may competitively bid single 47 source-provider contracts if procurement of goods or services 48 results in demonstrated cost savings to the state without 49 limiting access to care. The agency may limit its network based 50 on the assessment of beneficiary access to care, provider 51 availability, provider quality standards, time and distance 52 standards for access to care, the cultural competence of the 53 provider network, demographic characteristics of Medicaid 54 beneficiaries, practice and provider-to-beneficiary standards, 55 appointment wait times, beneficiary use of services, provider 56 turnover, provider profiling, provider licensure history, 57 previous program integrity investigations and findings, peer 58 review, provider Medicaid policy and billing compliance records, 59 clinical and medical record audits, and other factors. Providers 60 are not entitled to enrollment in the Medicaid provider network. 61 The agency shall determine instances in which allowing Medicaid 62 beneficiaries to purchase durable medical equipment and other 63 goods is less expensive to the Medicaid program than long-term 64 rental of the equipment or goods. The agency may establish rules 65 to facilitate purchases in lieu of long-term rentals in order to 66 protect against fraud and abuse in the Medicaid program as 67 defined in s. 409.913. The agency may seek federal waivers 68 necessary to administer these policies. 69 (41)(a) Notwithstanding s. 409.961, the agency shall 70 contract on a prepaid or fixed-sum basis with appropriately 71 licensed prepaid dental health plans to provide dental services. 72 This paragraph expires October 1, 20172014. 73 (b) Notwithstanding paragraph (a)and for the 2012-201374fiscal year only, the agency is authorized to provide a Medicaid 75 prepaid dental health program in Miami-Dade County. The agency 76 shall provide an annual report by January 15 to the Governor, 77 the President of the Senate, and the Speaker of the House of 78 Representatives which compares the combined reported annual 79 benefits utilization and encounter data from all contractors, 80 along with the agency’s findings as to projected and budgeted 81 annual program costs, the extent to which each contracting 82 entity is complying with all contract terms and conditions, the 83 effect that each entity’s operation is having on access to care 84 for Medicaid recipients in the contractor’s service area, and 85 the statistical trends associated with indicators of good oral 86 health among all recipients served in comparison with the 87 state’s population as a whole.For all other counties, the88agency may not limit dental services to prepaid plans and must89allow qualified dental providers to provide dental services90under Medicaid on a fee-for-service reimbursement methodology.91The agency may seek any necessary revisions or amendments to the92state plan or federal waivers in order to implement this93paragraph. The agency shall terminate existing contracts as94needed to implement this paragraph. This paragraph expires July951, 2013.96 97 ================= T I T L E A M E N D M E N T ================ 98 And the title is amended as follows: 99 Delete line 199 100 and insert: 101 screening provisions; amending s. 409.912, F.S.; 102 postponing the scheduled repeal of a provision 103 requiring the Agency for Health Care Administration to 104 contract with dental plans for dental services on a 105 prepaid or fixed-sum basis; authorizing the agency to 106 provide a prepaid dental health program in Miami-Dade 107 County on a permanent basis; requiring an annual 108 report to the Governor and Legislature; amending s. 109 409.9122, F.S.;