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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11 Representative(s) Sanderson offered the following:
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13 Amendment to Senate Amendment (875086) (with title
14 amendment)
15 On page 24, between lines 13 & 14, of the amendment
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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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hci0001 08:38 am 01927-0091-082629
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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hci0001 08:38 am 01927-0091-082629
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.
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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