House Bill 2227
CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 1999 HB 2227
By the Committee on Health & Human Services Appropriations
and Representative Sanderson
1 A bill to be entitled
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 providing an effective date.
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12 Be It Enacted by the Legislature of the State of Florida:
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14 Section 1. Subsection (13) of section 409.912, Florida
15 Statutes, 1998 Supplement, is amended to read:
16 409.912 Cost-effective purchasing of health care.--The
17 agency shall purchase goods and services for Medicaid
18 recipients in the most cost-effective manner consistent with
19 the delivery of quality medical care. The agency shall
20 maximize the use of prepaid per capita and prepaid aggregate
21 fixed-sum basis services when appropriate and other
22 alternative service delivery and reimbursement methodologies,
23 including competitive bidding pursuant to s. 287.057, designed
24 to facilitate the cost-effective purchase of a case-managed
25 continuum of care. The agency shall also require providers to
26 minimize the exposure of recipients to the need for acute
27 inpatient, custodial, and other institutional care and the
28 inappropriate or unnecessary use of high-cost services.
29 (13)(a) The agency shall identify health care
30 utilization and price patterns within the Medicaid program
31 which are not cost-effective or medically appropriate and
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Florida House of Representatives - 1999 HB 2227
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1 assess the effectiveness of new or alternate methods of
2 providing and monitoring service, and may implement such
3 methods as it considers appropriate. Such methods may include
4 disease management initiatives, an integrated and systematic
5 approach for managing the health care needs of recipients who
6 are at risk of or diagnosed with a specific disease by using
7 best practices, prevention strategies, clinical-practice
8 improvement, clinical interventions and protocols, outcomes
9 research, information technology, and other tools and
10 resources to reduce overall costs and improve measurable
11 outcomes.
12 (b) The responsibility of the agency under this
13 subsection shall include the development of capabilities to
14 identify actual and optimal practice patterns; patient and
15 provider educational initiatives; methods for determining
16 patient compliance with prescribed treatments; fraud, waste,
17 and abuse prevention and detection programs; and beneficiary
18 case management programs.
19 1. The practice pattern identification program shall
20 evaluate practitioner prescribing patterns based on national
21 and regional practice guidelines, comparing practitioners to
22 their peer groups. The agency and its Drug Utilization Review
23 Board shall consult with a panel of practicing health care
24 professionals appointed by the director of the agency,
25 consisting of six physicians licensed under chapter 458,
26 chapter 459, or chapter 461, two pharmacists licensed under
27 chapter 465, and one dentist licensed under chapter 466 who is
28 an oral and maxillofacial surgeon. The advisory panel shall be
29 responsible for evaluating treatment guidelines and
30 recommending ways to incorporate their use in the practice
31 pattern identification program. Practitioners who are
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CODING: Words stricken are deletions; words underlined are additions.
Florida House of Representatives - 1999 HB 2227
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1 prescribing inappropriately or inefficiently, as determined by
2 the agency, may have their prescribing of certain drugs
3 subject to prior authorization.
4 2. The agency shall also develop educational
5 interventions designed to promote the proper use of
6 medications by providers and beneficiaries.
7 3. The agency shall implement a pharmacy fraud, waste,
8 and abuse initiative that may include a surety bond or letter
9 of credit requirement for participating pharmacies, enhanced
10 provider auditing practices, the use of additional fraud and
11 abuse software, recipient management programs for
12 beneficiaries inappropriately using their benefits, and other
13 steps that will eliminate provider and recipient fraud, waste,
14 and abuse. The initiative shall address enforcement efforts to
15 reduce the number and use of counterfeit prescriptions.
16 4. The agency may apply for any federal waivers needed
17 to implement this paragraph.
18 Section 2. This act shall take effect July 1, 1999.
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21 HOUSE SUMMARY
22
Amends provisions relating to the purchase of goods and
23 services for Medicaid recipients, to require the Agency
for Health Care Administration to develop certain
24 programs and initiatives relating to the prescribing,
use, and dispensing of drugs. Provides for appointment
25 and duties of an advisory panel on prescription practice
patterns. See bill for details.
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