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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 5                                           ORIGINAL STAMP BELOW

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10                                                                

11  Representative(s) Sanderson offered the following:

12

13         Amendment to Amendment (441261) (with title amendment) 

14         On page 1, between lines 16 & 17, of the amendment

15

16  insert:

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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    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  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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26

27  ================ T I T L E   A M E N D M E N T ===============

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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    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  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