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)
    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, 2017 2014.
   73         (b) Notwithstanding paragraph (a) and for the 2012-2013
   74  fiscal 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, the
   88  agency may not limit dental services to prepaid plans and must
   89  allow qualified dental providers to provide dental services
   90  under Medicaid on a fee-for-service reimbursement methodology.
   91  The agency may seek any necessary revisions or amendments to the
   92  state plan or federal waivers in order to implement this
   93  paragraph. The agency shall terminate existing contracts as
   94  needed to implement this paragraph. This paragraph expires July
   95  1, 2013.
   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.;