CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. CS/HB 3895
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Albright offered the following:
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13 Amendment (with title amendment)
14 On page 10, between lines 18 and 19, of the bill
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17 Section 7. New subsection (33) is added to section
18 409.912, Florida Statutes, to read:
19 409.912 Cost-effective purchasing of health care.--The
20 agency shall purchase goods and services for Medicaid
21 recipients in the most cost-effective manner consistent with
22 the delivery of quality medical care. The agency shall
23 maximize the use of prepaid per capita and prepaid aggregate
24 fixed-sum basis services when appropriate and other
25 alternative service delivery and reimbursement methodologies,
26 including competitive bidding pursuant to s. 287.057, designed
27 to facilitate the cost-effective purchase of a case-managed
28 continuum of care. The agency shall also require providers to
29 minimize the exposure of recipients to the need for acute
30 inpatient, custodial, and other institutional care and the
31 inappropriate or unnecessary use of high-cost services.
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File original & 9 copies 04/07/98
hci0002 06:36 pm 03895-0024-763867
HOUSE AMENDMENT
Bill No. CS/HB 3895
Amendment No. (for drafter's use only)
1 (33) The Agency for Health Care Administration is
2 directed to issue a request for proposal or intent to
3 negotiate to implement on a demonstration basis an outpatient
4 specialty services pilot project in a rural and urban county
5 in the state. As used in this subsection, the term
6 "outpatient specialty services" means clinical laboratory,
7 diagnostic imaging, and specified home medical services to
8 include durable medical equipment, prosthetics and orthotics,
9 and infusion therapy.
10 (a) The entity that is awarded the contract to provide
11 Medicaid managed care outpatient specialty services shall, at
12 a minimum, meet the following criteria:
13 1. The entity shall be licensed by the Department of
14 Insurance under part II of chapter 641.
15 2. The entity shall be experienced in providing
16 outpatient specialty services.
17 3. The entity shall demonstrate to the satisfaction of
18 the agency that it provides high-quality services to its
19 patients.
20 4. The entity shall demonstrate that it has in place a
21 complaints and grievance process to assist Medicaid recipients
22 enrolled in the pilot managed care program to resolve
23 complaints and grievances.
24 (b) The pilot managed care program shall operate for a
25 period of three years. The objective of the pilot program
26 shall be to determine the cost-effectiveness and effects on
27 utilization, access, and quality of providing outpatient
28 specialty services to Medicaid recipients on a prepaid,
29 capitated basis.
30 (c) The agency shall conduct a quality-assurance
31 review of the prepaid limited health service organization each
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hci0002 06:36 pm 03895-0024-763867
HOUSE AMENDMENT
Bill No. CS/HB 3895
Amendment No. (for drafter's use only)
1 year that the demonstration program is in effect. The prepaid
2 limited health service organization is responsible for all
3 expenses incurred by the agency in conducting a quality
4 assurance review.
5 (d) The entity that is awarded the contract to provide
6 outpatient specialty services to Medicaid recipients shall
7 report data required by the agency in a format specified by
8 the agency, for the purpose of conducting the evaluation
9 required in paragraph (e).
10 (e) The agency shall conduct an evaluation of the
11 pilot managed care program and report its findings to the
12 Governor and the Legislature by no later than January 1, 2001.
13 (f) Nothing in this subsection is intended to conflict
14 with the provision of the 1997-98 General Appropriations Act
15 which authorizes competitive bidding for Medicaid home health,
16 clinical laboratory, or x-ray services.
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20 And the title is amended as follows:
21 On page 1, line 24,
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23 insert after the semicolon:
24 amending s. 409.912, F.S., directing the Agency
25 for Health Care Administration to establish an
26 outpatient specialty services pilot project;
27 providing definitions; providing criteria for
28 participation; requiring an evaluation and a
29 report to the Governor and Legislature;
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File original & 9 copies 04/07/98
hci0002 06:36 pm 03895-0024-763867