CODING: Words stricken are deletions; words underlined are additions.





                                                   HOUSE AMENDMENT

                              Bill No. CS/HBs 1927 & 961, 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 Senate Amendment (875086) (with title

14  amendment) 

15         On page 24, between lines 13 & 14, of the amendment

16

17  insert:

18         Section 16.  Subsection (13) of section 409.912,

19  Florida Statutes, 1998 Supplement, is amended to read:

20         409.912  Cost-effective purchasing of health care.--The

21  agency shall purchase goods and services for Medicaid

22  recipients in the most cost-effective manner consistent with

23  the delivery of quality medical care.  The agency shall

24  maximize the use of prepaid per capita and prepaid aggregate

25  fixed-sum basis services when appropriate and other

26  alternative service delivery and reimbursement methodologies,

27  including competitive bidding pursuant to s. 287.057, designed

28  to facilitate the cost-effective purchase of a case-managed

29  continuum of care. The agency shall also require providers to

30  minimize the exposure of recipients to the need for acute

31  inpatient, custodial, and other institutional care and the

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    File original & 9 copies    04/29/99
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                                                   HOUSE AMENDMENT

                              Bill No. CS/HBs 1927 & 961, 1st Eng.

    Amendment No.     (for drafter's use only)





 1  inappropriate or unnecessary use of high-cost services.

 2         (13)(a)  The agency shall identify health care

 3  utilization and price patterns within the Medicaid program

 4  which are not cost-effective or medically appropriate and

 5  assess the effectiveness of new or alternate methods of

 6  providing and monitoring service, and may implement such

 7  methods as it considers appropriate. Such methods may include

 8  disease management initiatives, an integrated and systematic

 9  approach for managing the health care needs of recipients who

10  are at risk of or diagnosed with a specific disease by using

11  best practices, prevention strategies, clinical-practice

12  improvement, clinical interventions and protocols, outcomes

13  research, information technology, and other tools and

14  resources to reduce overall costs and improve measurable

15  outcomes.

16         (b)  The responsibility of the agency under this

17  subsection shall include the development of capabilities to

18  identify actual and optimal practice patterns; patient and

19  provider educational initiatives; methods for determining

20  patient compliance with prescribed treatments; fraud, waste,

21  and abuse prevention and detection programs; and beneficiary

22  case management programs.

23         1.  The practice pattern identification program shall

24  evaluate practitioner prescribing patterns based on national

25  and regional practice guidelines, comparing practitioners to

26  their peer groups. The agency and its Drug Utilization Review

27  Board shall consult with a panel of practicing health care

28  professionals consisting of the following:  the Speaker of the

29  House of Representatives and the President of the Senate shall

30  each appoint three physicians licensed under ch. 458 or ch.

31  459; and the Governor shall appoint two pharmacists licensed

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    File original & 9 copies    04/29/99
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                                                   HOUSE AMENDMENT

                              Bill No. CS/HBs 1927 & 961, 1st Eng.

    Amendment No.     (for drafter's use only)





 1  under ch. 465 and one dentist licensed under ch. 466 who is an

 2  oral surgeon. Terms of the panel members shall expire at the

 3  discretion of the appointing official. The panel shall begin

 4  its work by August 1, 1999, regardless of the number of

 5  appointments made by that date.  The advisory panel shall be

 6  responsible for evaluating treatment guidelines and

 7  recommending ways to incorporate their use in the practice

 8  pattern identification program. Practitioners who are

 9  prescribing inappropriately or inefficiently, as determined by

10  the agency, may have their prescribing of certain drugs

11  subject to prior authorization.

12         2.  The agency shall also develop educational

13  interventions designed to promote the proper use of

14  medications by providers and beneficiaries.

15         3.  The agency shall implement a pharmacy fraud, waste,

16  and abuse initiative that may include a surety bond or letter

17  of credit requirement for participating pharmacies, enhanced

18  provider auditing practices, the use of additional fraud and

19  abuse software, recipient management programs for

20  beneficiaries inappropriately using their benefits, and other

21  steps that will eliminate provider and recipient fraud, waste,

22  and abuse. The initiative shall address enforcement efforts to

23  reduce the number and use of counterfeit prescriptions.

24         4.  The agency may apply for any federal waivers needed

25  to implement this paragraph.

26

27

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

29  And the title is amended as follows:

30         On page 27, line 14, of the amendment

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                                                   HOUSE AMENDMENT

                              Bill No. CS/HBs 1927 & 961, 1st Eng.

    Amendment No.     (for drafter's use only)





 1  insert after the semicolon:

 2         amending s. 409.912, F.S., relating to purchase

 3         of goods and services for Medicaid recipients;

 4         requiring the Agency for Health Care

 5         Administration to develop certain programs and

 6         initiatives relating to the prescribing, use,

 7         and dispensing of drugs; providing for an

 8         advisory panel on prescription practice

 9         patterns;

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    File original & 9 copies    04/29/99
    hci0001                     08:38 am         01927-0091-082629