Florida Senate - 2023                                    SB 1352
       
       
        
       By Senator Rouson
       
       
       
       
       
       16-01044-23                                           20231352__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid enrollees with sickle cell
    3         disease; creating s. 409.9129, F.S.; requiring the
    4         Agency for Health Care Administration to conduct a
    5         biennial review of Medicaid enrollees with sickle cell
    6         disease to determine if the available covered
    7         medications, treatment, and services are adequate to
    8         meet their needs; providing minimum requirements for
    9         the review; requiring the agency to submit a report of
   10         its findings to the Governor, the Legislature, the
   11         Office of Minority Health and Health Equity, and the
   12         Rare Disease Advisory Council by a specified date
   13         every 2 years; requiring the agency to publish the
   14         report on its website in an easily accessible manner;
   15         requiring the agency to develop its review and report
   16         in consultation with a certain dedicated sickle cell
   17         disease medical treatment and research center;
   18         providing an effective date.
   19          
   20  Be It Enacted by the Legislature of the State of Florida:
   21  
   22         Section 1. Section 409.9129, Florida Statutes, is created
   23  to read:
   24         409.9129 Biennial review of Medicaid enrollees with sickle
   25  cell disease.—
   26         (1) Every two years, the agency shall conduct a review of
   27  Medicaid enrollees to determine if the available covered
   28  medications, treatment, and services are adequate to meet the
   29  needs of enrollees who are diagnosed with sickle cell disease
   30  and whether the agency should seek coverage of additional
   31  medications, treatment, or services to adequately meet their
   32  needs.
   33         (2) Using data collected under the Medicaid program from
   34  the preceding 2-year period, the agency’s review must provide
   35  for all of the following, at a minimum:
   36         (a) The total number of Medicaid enrollees diagnosed with
   37  sickle cell disease.
   38         (b) The age and other demographic characteristics of
   39  Medicaid enrollees diagnosed with sickle cell disease.
   40         (c) Health care utilization patterns and total
   41  expenditures, both pharmaceutical and medical, for services
   42  provided by the Medicaid program for all enrollees diagnosed
   43  with sickle cell disease.
   44         (d) Of the enrollees diagnosed with sickle cell disease,
   45  the number of enrollees who experienced two or more emergency
   46  room visits or two or more hospital inpatient admissions in a
   47  12-month period, including the length of stay and the total
   48  related expenditures, both medical and pharmaceutical, for those
   49  enrollees.
   50         (e) The number of clinical treatment programs available for
   51  the care of Medicaid enrollees which are specifically designed
   52  or certified to provide health care coordination and health care
   53  access for individuals with sickle cell disease and the number
   54  of those clinical treatment programs contracted, per region,
   55  with managed care plans.
   56         (f) An assessment of the agency’s existing payment
   57  methodologies for approved treatment or drug products for the
   58  treatment of sickle cell disease in the inpatient setting and
   59  whether such payment methodologies result in barriers to access.
   60  If barriers to access are identified, an assessment of whether
   61  such methodologies may be modified or improved through the
   62  adoption of revised or new policies.
   63         (3) By November 1, 2024, and every 2 years thereafter, the
   64  agency shall submit a report of its findings and recommendations
   65  from the preceding 2-year review to the Governor, the President
   66  of the Senate, the Speaker of the House of Representatives, the
   67  Office of Minority Health and Health Equity, and the Rare
   68  Disease Advisory Council. The agency shall also publish the
   69  report on its website in a manner easily accessible by the
   70  public.
   71         (4) The agency shall develop its review and report in
   72  consultation with a dedicated sickle cell disease medical
   73  treatment and research center that maintains a sickle cell
   74  patient database and tracks sickle cell disease outcome
   75  measures.
   76         Section 2. This act shall take effect July 1, 2023.