The Florida Senate

381.0407  Managed care and publicly funded primary care program coordination.--

(1)  SHORT TITLE.--This section may be cited as the "Managed Care and Publicly Funded Primary Care Program Coordination Act."

(2)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature finds that it is in the public interest for publicly funded health providers to be reimbursed by managed care plans when certain health care services are provided that are needed to protect and improve public health. The Legislature also finds that the use of publicly funded perinatal programs should be encouraged, but not required, to make advantageous use of the system of public health services.

(3)  DEFINITIONS.--As used in this section the term:

(a)  "Managed care plan" or "plan" means an entity that contracts with the Agency for Health Care Administration on a prepaid or fixed-sum basis for the provision of Medicaid services pursuant to s. 409.912

(b)  "Publicly funded primary care provider" or "public provider" means a county health department or a migrant health center funded under s. 329 of the Public Health Services Act or a community health center funded under s. 330 of the Public Health Services Act.

(4)  REIMBURSEMENT REQUIRED.--Without prior authorization, managed care plans, and the MediPass program as administered by the Agency for Health Care Administration, shall pay claims initiated by any public provider, to the extent the managed care plan or MediPass program provides coverage, for:

(a)  The diagnosis and treatment of sexually transmitted diseases and other communicable diseases such as tuberculosis and human immunodeficiency virus infection.

(b)  The provision of immunizations.

(c)  Family planning services and related pharmaceuticals.

(d)  School health services listed in paragraphs (a), (b), and (c) and services rendered on an urgent basis. Services rendered on an urgent basis are health care services needed to immediately relieve pain or distress for medical problems such as injuries, nausea, and fever, and to treat infectious diseases and other similar conditions.

Public providers shall attempt to contact managed care plans before providing health care services to their subscribers. Public providers shall provide managed care plans with the results of the office visit, including test results, and shall be reimbursed by managed care plans at the rate negotiated between the managed care plan and the public provider or, if a rate has not been negotiated, at the lesser of either the rate charged by the public provider or the Medicaid fee-for-service reimbursement rate.

(5)  EMERGENCY SHELTER MEDICAL SCREENING REIMBURSEMENT.--County health departments shall be reimbursed by managed care plans, and the MediPass program as administered by the Agency for Health Care Administration, for clients of the Department of Children and Family Services who receive emergency shelter medical screenings.

(6)  MATERNAL AND CHILD HEALTH SERVICES.--The Agency for Health Care Administration, in consultation with the Department of Health, shall encourage agreements between Medicaid-financed managed care plans and public providers for the authorization of and payment for the following services:

(a)  Maternity case management.

(b)  Well-child care.

(c)  Prenatal care.

(7)  VACCINE-PREVENTABLE DISEASE EMERGENCIES.--In the event that a vaccine-preventable disease emergency is declared by the State Health Officer or a county health department director or administrator, managed care plans, the MediPass program as administered by the Agency for Health Care Administration, and health maintenance organizations and prepaid health clinics licensed under chapter 641 shall reimburse county health departments for the cost of the administration of vaccines to persons covered by these entities, provided such action is necessary to end the emergency. Reimbursement shall be at the rate negotiated between the entity and the county health department or, if a rate has not been negotiated, at the lesser of either the rate charged by the county health department or the Medicaid fee-for-service reimbursement rate. No charge shall be made by the county health department for the actual cost of the vaccine or for services not covered under the policy or contract of the entity.

History.--s. 1, ch. 96-199; s. 185, ch. 97-101; s. 28, ch. 97-237.