CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. CS for SB's 1414 and 2520, 1st Eng.
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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11 Representative(s) Sanderson offered the following:
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13 Amendment to Amendment (441261) (with title amendment)
14 On page 1, between lines 16 & 17, of the amendment
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17 Section 1. Subsection (13) of section 409.912, Florida
18 Statutes, 1998 Supplement, is amended 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 04/29/99
hci0001 08:33 am 01414-0091-135691
HOUSE AMENDMENT
Bill No. CS for SB's 1414 and 2520, 1st Eng.
Amendment No. (for drafter's use only)
1 (13)(a) The agency shall identify health care
2 utilization and price patterns within the Medicaid program
3 which are not cost-effective or medically appropriate and
4 assess the effectiveness of new or alternate methods of
5 providing and monitoring service, and may implement such
6 methods as it considers appropriate. Such methods may include
7 disease management initiatives, an integrated and systematic
8 approach for managing the health care needs of recipients who
9 are at risk of or diagnosed with a specific disease by using
10 best practices, prevention strategies, clinical-practice
11 improvement, clinical interventions and protocols, outcomes
12 research, information technology, and other tools and
13 resources to reduce overall costs and improve measurable
14 outcomes.
15 (b) The responsibility of the agency under this
16 subsection shall include the development of capabilities to
17 identify actual and optimal practice patterns; patient and
18 provider educational initiatives; methods for determining
19 patient compliance with prescribed treatments; fraud, waste,
20 and abuse prevention and detection programs; and beneficiary
21 case management programs.
22 1. The practice pattern identification program shall
23 evaluate practitioner prescribing patterns based on national
24 and regional practice guidelines, comparing practitioners to
25 their peer groups. The agency and its Drug Utilization Review
26 Board shall consult with a panel of practicing health care
27 professionals consisting of the following: the Speaker of the
28 House of Representatives and the President of the Senate shall
29 each appoint three physicians licensed under ch. 458 or ch.
30 459; and the Governor shall appoint two pharmacists licensed
31 under ch. 465 and one dentist licensed under ch. 466 who is an
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hci0001 08:33 am 01414-0091-135691
HOUSE AMENDMENT
Bill No. CS for SB's 1414 and 2520, 1st Eng.
Amendment No. (for drafter's use only)
1 oral surgeon. Terms of the panel members shall expire at the
2 discretion of the appointing official. The panel shall begin
3 its work by August 1, 1999, regardless of the number of
4 appointments made by that date. The advisory panel shall be
5 responsible for evaluating treatment guidelines and
6 recommending ways to incorporate their use in the practice
7 pattern identification program. Practitioners who are
8 prescribing inappropriately or inefficiently, as determined by
9 the agency, may have their prescribing of certain drugs
10 subject to prior authorization.
11 2. The agency shall also develop educational
12 interventions designed to promote the proper use of
13 medications by providers and beneficiaries.
14 3. The agency shall implement a pharmacy fraud, waste,
15 and abuse initiative that may include a surety bond or letter
16 of credit requirement for participating pharmacies, enhanced
17 provider auditing practices, the use of additional fraud and
18 abuse software, recipient management programs for
19 beneficiaries inappropriately using their benefits, and other
20 steps that will eliminate provider and recipient fraud, waste,
21 and abuse. The initiative shall address enforcement efforts to
22 reduce the number and use of counterfeit prescriptions.
23 4. The agency may apply for any federal waivers needed
24 to implement this paragraph.
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28 And the title is amended as follows:
29 On page 8, line 4, of the amendment
30 remove: all of said line
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hci0001 08:33 am 01414-0091-135691
HOUSE AMENDMENT
Bill No. CS for SB's 1414 and 2520, 1st Eng.
Amendment No. (for drafter's use only)
1 and insert in lieu thereof:
2 An act relating to health care; amending s.
3 409.912, F.S., relating to purchase of goods
4 and services for Medicaid recipients; requiring
5 the Agency for Health Care Administration to
6 develop certain programs and initiatives
7 relating to the prescribing, use, and
8 dispensing of drugs; providing for an advisory
9 panel on prescription practice patterns;
10 amending
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File original & 9 copies 04/29/99
hci0001 08:33 am 01414-0091-135691