Senate Bill 1766e1

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    SB 1766                                        First Engrossed



  1                      A bill to be entitled

  2         An act relating to obsolete, expired, or

  3         repealed provisions of law; repealing various

  4         provisions of law that have become obsolete,

  5         have had their effect, have served their

  6         purpose, or have been impliedly repealed or

  7         superseded; repealing s. 154.013, F.S.,

  8         relating to county primary health care panels;

  9         amending s. 154.011, F.S.; deleting a

10         cross-reference, to conform; repealing s.

11         154.12(2), F.S., relating to the legal status

12         of county public health trusts with respect to

13         a repealed provision of law relating to the

14         filing of caveats; repealing s. 408.30, F.S.,

15         relating to an obsolete rule-saving clause for

16         the Health Care Cost Containment Board;

17         amending s. 409.912, F.S., and repealing

18         paragraph (35)(f), relating to applicability of

19         provisions authorizing a 1997-1998 outpatient

20         specialty services pilot project; deleting an

21         obsolete date and provision relating to

22         requirements under which federally qualified

23         health centers can be Medicaid prepaid plan

24         providers; repealing s. 381.0408, F.S.,

25         relating to the Public Health Partnership

26         Council on Stroke; repealing s. 408.0014, F.S.,

27         the Florida Health Access Corporation Act;

28         amending ss. 20.42 and 409.9117, F.S.; deleting

29         references, to conform; repealing s. 408.004,

30         F.S., relating to the Florida Health Plan;

31         repealing ss. 408.002, 408.005, and 408.006,


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  1         F.S., relating to legislative findings and

  2         intent and to development goals and strategies,

  3         to conform; amending ss. 408.061, 408.15,

  4         408.301, and 408.704, F.S.; deleting

  5         references, to conform; repealing s. 408.01,

  6         F.S., relating to the voluntary private health

  7         insurance coverage and insurance cost

  8         containment program; repealing s. 408.02(9),

  9         F.S., relating to a demonstration project on

10         the effectiveness of practice parameters with

11         respect to the costs of defensive medicine and

12         professional liability insurance; repealing s.

13         408.062(1)(g), F.S., relating to development of

14         an alternative uniform system of financial

15         reporting of gross revenues per adjusted

16         admission; amending s. 408.7071, F.S.; deleting

17         provisions relating to development of a

18         standardized claim form for insurers and health

19         care providers licensed in this state and to

20         the committee appointed for such purpose;

21         repealing s. 409.908(12)(c) and (22), F.S.,

22         relating to a report on the effect of the

23         resource-based relative value scale fee

24         schedule on utilization of Medicaid services

25         and to implementation of changes in the

26         Medicaid reimbursement methodology for

27         facilities formerly known as ICF/DD facilities;

28         repealing s. 514.081, F.S., relating to a

29         saving clause applicable to provisions

30         governing construction, modification, and

31         operation of public swimming pools and bathing


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  1         facilities; amending s. 636.045, F.S.; deleting

  2         obsolete provisions relating to minimum surplus

  3         requirements for prepaid limited health service

  4         organizations; repealing s. 859.03, F.S.,

  5         relating to wrapping and labeling requirements

  6         applicable to the sale of morphine; repealing

  7         s. 859.05, F.S., relating to a prohibition on

  8         the sale or other disposition of narcotics

  9         except by prescription; repealing s. 35, ch.

10         93-129, Laws of Florida, relating to a work

11         group on rural health care; repealing s. 19,

12         ch. 96-403, Laws of Florida, relating to a task

13         force on the organization and structure of

14         state health programs; repealing s. 3, ch.

15         98-21, Laws of Florida, relating to a rural

16         hospital redefinition study group; repealing s.

17         1, ch. 98-305, Laws of Florida, relating to the

18         Prostate Cancer Task Force; repealing s. 4, ch.

19         99-214, Laws of Florida, relating to a school

20         nurse training study group; repealing s. 6, ch.

21         99-393, Laws of Florida, relating to an

22         advisory group on submission and payment of

23         health claims; repealing s. 192, ch. 99-397,

24         Laws of Florida, relating to the task force on

25         the funding of the Public Medical Assistance

26         Trust Fund; amending ch. 99-226, Laws of

27         Florida, relating to the Medicaid Formulary

28         study panel; providing an effective date.

29

30  Be It Enacted by the Legislature of the State of Florida:

31


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    SB 1766                                        First Engrossed



  1         Section 1.  Section 154.013, Florida Statutes, is

  2  repealed.

  3         Section 2.  Subsection (1) of section 154.011, Florida

  4  Statutes, is amended to read:

  5         154.011  Primary care services.--

  6         (1)  It is the intent of the Legislature that all 67

  7  counties offer primary care services through contracts, as

  8  required by s. 154.01(3), for Medicaid recipients and other

  9  qualified low-income persons.  Therefore, beginning July 1,

10  1987, the Department of Health is directed, to the extent that

11  funds are appropriated, to develop a plan to implement a

12  program in cooperation with each county.  The department shall

13  coordinate with the county's primary care panel, as created by

14  s. 154.013, or with the county's governing body if no primary

15  care panel is appointed.  Such primary care programs shall be

16  phased-in and made operational as additional resources are

17  appropriated, and shall be subject to the following:

18         (a)  The department shall enter into contracts with the

19  county governing body for the purpose of expanding primary

20  care coverage.  The county governing body shall have the

21  option of organizing the primary care programs through county

22  health departments or through county public hospitals owned

23  and operated directly by the county.  The department shall, as

24  its first priority, maximize the number of counties

25  participating in the primary care programs under this section,

26  but shall establish priorities for funding based on need and

27  the willingness of counties to participate.  The department

28  shall select counties for programs through a formal

29  request-for-proposal process that requires compliance with

30  program standards for cost-effective quality care and seeks to

31  maximize access throughout the county.


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  1         (b)  Each county's primary care program may utilize any

  2  or all of the following options of providing services:

  3  offering services directly through the county health

  4  departments; contracting with individual or group

  5  practitioners for all or part of the service; or developing

  6  service delivery models which are organized through the county

  7  health departments but which utilize other service or delivery

  8  systems available, such as federal primary care programs or

  9  prepaid health plans.  In addition, counties shall have the

10  option of pooling resources and joining with neighboring

11  counties in order to fulfill the intent of this section.

12         (c)  Each primary care program shall conform to the

13  requirements and specifications of the department, and shall

14  at a minimum:

15         1.  Adopt a minimum eligibility standard of at least

16  100 percent of the federal nonfarm poverty level.

17         2.  Provide a comprehensive mix of preventive and

18  illness care services.

19         3.  Be family oriented and be easily accessible

20  regardless of income, physical status, or geographical

21  location.

22         4.  Ensure 24-hour telephone access and offer evening

23  and weekend clinic services.

24         5.  Offer continuity of care over time.

25         6.  Make maximum use of existing providers and closely

26  coordinate its services and funding with existing federal

27  primary care programs, especially in rural counties, to ensure

28  efficient use of resources.

29         7.  Have a sliding fee schedule based on income for

30  eligible persons above 100 percent of the federal nonfarm

31  poverty level.


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  1         8.  Include quality assurance provisions and procedures

  2  for evaluation.

  3         9.  Provide early periodic screening diagnostic and

  4  treatment services for Medicaid-eligible children.

  5         10.  Fully utilize and coordinate with rural hospitals

  6  for outpatient services, including contracting for services

  7  when advisable in terms of cost-effectiveness and feasibility.

  8         Section 3.  Subsection (2) of section 154.12, Florida

  9  Statutes, is repealed.

10         Section 4.  Section 408.30, Florida Statutes, is

11  repealed.

12         Section 5.  Paragraph (f) of subsection (35) of section

13  409.912, Florida Statutes, is repealed, and paragraph (c) of

14  subsection (3) of said section is amended to read:

15         409.912  Cost-effective purchasing of health care.--The

16  agency shall purchase goods and services for Medicaid

17  recipients in the most cost-effective manner consistent with

18  the delivery of quality medical care.  The agency shall

19  maximize the use of prepaid per capita and prepaid aggregate

20  fixed-sum basis services when appropriate and other

21  alternative service delivery and reimbursement methodologies,

22  including competitive bidding pursuant to s. 287.057, designed

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

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

25  minimize the exposure of recipients to the need for acute

26  inpatient, custodial, and other institutional care and the

27  inappropriate or unnecessary use of high-cost services.

28         (3)  The agency may contract with:

29         (c)1.  A federally qualified health center or an entity

30  owned by one or more federally qualified health centers or an

31  entity owned by other migrant and community health centers


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  1  receiving non-Medicaid financial support from the Federal

  2  Government to provide health care services on a prepaid or

  3  fixed-sum basis to recipients.  Such prepaid health care

  4  services entity must be licensed under parts I and III of

  5  chapter 641 by January 1, 1998, but shall be prohibited from

  6  serving Medicaid recipients on a prepaid basis, until such

  7  licensure has been obtained.  However, such an entity is

  8  exempt from s. 641.225 if the entity meets the requirements

  9  specified in subsections (14) and (15).

10         2.  Until March 1, 2000, only, the licensure

11  requirements under parts I and III of chapter 641 shall not

12  apply to a federally qualified health center, an entity owned

13  by one or more federally qualified health centers, or an

14  entity owned by other migrant and community health centers

15  receiving non-Medicaid financial support from the Federal

16  Government to provide health care services on a prepaid or

17  fixed-sum basis to recipients. These entities are not

18  prohibited from serving Medicaid recipients on a prepaid

19  basis. This subparagraph expires March 1, 2000.

20         Section 6.  Section 381.0408, Florida Statutes, is

21  repealed.

22         Section 7.  Section 408.0014, Florida Statutes, is

23  repealed.

24         Section 8.  Paragraphs (b) and (c) of subsection (2) of

25  section 20.42, Florida Statutes, are amended to read:

26         20.42  Agency for Health Care Administration.--There is

27  created the Agency for Health Care Administration within the

28  Department of Business and Professional Regulation. The agency

29  shall be a separate budget entity, and the director of the

30  agency shall be the agency head for all purposes. The agency

31  shall not be subject to control, supervision, or direction by


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  1  the Department of Business and Professional Regulation in any

  2  manner, including, but not limited to, personnel, purchasing,

  3  transactions involving real or personal property, and

  4  budgetary matters.

  5         (2)  ORGANIZATION OF THE AGENCY.--The agency shall be

  6  organized as follows:

  7         (b)  The Division of Health Policy and Cost Control,

  8  which shall be responsible for health policy, the State Center

  9  for Health Statistics, the development of The Florida Health

10  Plan, certificate of need, state and local health planning

11  under s. 408.033, and research and analysis.

12         (c)  The Division of State Health Purchasing shall be

13  responsible for the Medicaid program. The division shall also

14  administer the contracts with the Florida Health Access

15  Corporation program and the Florida Health Care Purchasing

16  Cooperative and the Florida Healthy Kids Corporation.

17         Section 9.  Paragraph (h) of subsection (2) of section

18  409.9117, Florida Statutes, is amended to read:

19         409.9117  Primary care disproportionate share

20  program.--

21         (2)  In the establishment and funding of this program,

22  the agency shall use the following criteria in addition to

23  those specified in s. 409.911, payments may not be made to a

24  hospital unless the hospital agrees to:

25         (h)  Work with the Florida Healthy Kids Corporation,

26  the Florida Health Care Purchasing Cooperative, the Florida

27  Health Access Corporation, and business health coalitions, as

28  appropriate, to develop a feasibility study and plan to

29  provide a low-cost comprehensive health insurance plan to

30  persons who reside within the area and who do not have access

31  to such a plan.


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  1

  2  Any hospital that fails to comply with any of the provisions

  3  of this subsection, or any other contractual condition, may

  4  not receive payments under this section until full compliance

  5  is achieved.

  6         Section 10.  Sections 408.002, 408.004, 408.005, and

  7  408.006, Florida Statutes, are repealed.

  8         Section 11.  Paragraph (a) of subsection (4) of section

  9  408.061, Florida Statutes, is amended to read:

10         408.061  Data collection; uniform systems of financial

11  reporting; information relating to physician charges;

12  confidentiality of patient records; immunity.--

13         (4)(a)  Within 120 days after the end of its fiscal

14  year, each health care facility shall file with the agency, on

15  forms adopted by the agency and based on the uniform system of

16  financial reporting, its actual financial experience for that

17  fiscal year, including expenditures, revenues, and statistical

18  measures.  Such data may be based on internal financial

19  reports which are certified to be complete and accurate by the

20  provider.  However, hospitals' actual financial experience

21  shall be their audited actual experience. Nursing homes that

22  do not participate in the Medicare or Medicaid programs shall

23  also submit audited actual experience. Every nursing home

24  shall submit to the agency, in a format designated by the

25  agency, a statistical profile of the nursing home residents.

26  The agency, in conjunction with the Department of Elderly

27  Affairs and the Department of Health, shall review these

28  statistical profiles and develop recommendations for the types

29  of residents who might more appropriately be placed in their

30  homes or other noninstitutional settings. The agency shall

31  include its findings in the final Florida Health Plan which


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  1  must be submitted to the Legislature by December 31, 1993.

  2  Included in the findings shall be outcome data and cost

  3  differential data as part of patient profiles.

  4         Section 12.  Subsections (6) and (7) of section 408.15,

  5  Florida Statutes, are amended to read:

  6         408.15  Powers of the agency.--In addition to the

  7  powers granted to the agency elsewhere in this chapter, the

  8  agency is authorized to:

  9         (6)  Apply for and receive and accept grants, gifts,

10  and other payments, including property and services, from any

11  governmental or other public and private entity or person and

12  make arrangements as to the use of same, including undertaking

13  special studies and other projects related to The Florida

14  Health Plan. Funds obtained under this subsection may be used

15  as matching funds for public or private grants.

16         (7)  Seek federal statutory changes and any waivers of

17  federal laws or regulations that will aid in implementing The

18  Florida Health Plan and related health care reforms.  This may

19  include seeking amendments to:

20         (a)  The Employee Retirement and Income Security Act of

21  1974 to permit greater state regulation of employer insurance

22  plans.

23         (b)  The Medicaid program to permit alternative

24  organizational alignments, elimination of all program

25  eligibility requirements except income, and a moratorium on

26  further federal mandates.

27         (c)  The Medicare program to seek state administration

28  of benefits, provider payments, or case management of

29  beneficiaries.

30         (d)  Federal tax laws to permit a 100-percent tax

31  deduction for all private health insurance plans, including


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    SB 1766                                        First Engrossed



  1  those of self-employed persons and unincorporated employers,

  2  and reform of the flexible sharing account requirements to

  3  maximize pretax health care expenditures.

  4         (e)  Other federal programs to permit full

  5  implementation of The Florida Health Plan and related state

  6  health care reforms.

  7         Section 13.  Section 408.301, Florida Statutes, is

  8  amended to read:

  9         408.301  Legislative findings.--The Legislature has

10  found that access to quality, affordable, health care for all

11  Floridians is an important goal for the state.  The

12  Legislature has charged the Agency for Health Care

13  Administration with the responsibility of developing the

14  Florida Health Plan for assuring access to health care for all

15  Floridians. At the same time, The Legislature recognizes that

16  there are Floridians with special health care and social needs

17  which require particular attention. The people served by the

18  Department of Children and Family Services and the Department

19  of Health are examples of citizens with special needs.  The

20  Legislature further recognizes that the Medicaid program is an

21  intricate part of the service delivery system for the special

22  needs citizens served by or through the Department of Children

23  and Family Services and the Department of Health.  The Agency

24  for Health Care Administration is not a service provider and

25  does not develop or direct programs for the special needs

26  citizens served by or through the Department of Children and

27  Family Services and the Department of Health. Therefore, it is

28  the intent of the Legislature that the Agency for Health Care

29  Administration work closely with the Department of Children

30  and Family Services and the Department of Health in developing

31


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    SB 1766                                        First Engrossed



  1  plans for assuring access to all Floridians in order to assure

  2  that the needs of special citizens are met.

  3         Section 14.  Paragraph (b) of subsection (5) of section

  4  408.704, Florida Statutes, is amended to read:

  5         408.704  Agency duties and responsibilities related to

  6  community health purchasing alliances.--The agency shall

  7  assist in developing a statewide system of community health

  8  purchasing alliances.  To this end, the agency is responsible

  9  for:

10         (5)  Establishing a data system for accountable health

11  partnerships.

12         (b)  The advisory data committee shall issue a report

13  and recommendations on each of the following subjects as each

14  is completed.  A final report covering all subjects must be

15  included in the final Florida Health Plan to be submitted to

16  the Legislature on December 31, 1993.  The report shall

17  include recommendations regarding:

18         1.  Types of data to be collected.  Careful

19  consideration shall be given to other data collection projects

20  and standards for electronic data interchanges already in

21  process in this state and nationally, to evaluating and

22  recommending the feasibility and cost-effectiveness of various

23  data collection activities, and to ensuring that data

24  reporting is necessary to support the evaluation of providers

25  with respect to cost containment, access, quality, control of

26  expensive technologies, and customer satisfaction analysis.

27  Data elements to be collected from providers include prices,

28  utilization, patient outcomes, quality, and patient

29  satisfaction.  The completion of this task is the first

30  priority of the advisory data committee. The agency shall

31  begin implementing these data collection activities


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  1  immediately upon receipt of the recommendations, but no later

  2  than January 1, 1994.  The data shall be submitted by

  3  hospitals, other licensed health care facilities, pharmacists,

  4  and group practices as defined in s. 455.654(3)(f).

  5         2.  A standard data set, a standard cost-effective

  6  format for collecting the data, and a standard methodology for

  7  reporting the data to the agency, or its designee, and to the

  8  alliances.  The reporting mechanisms must be designed to

  9  minimize the administrative burden and cost to health care

10  providers and carriers.  A methodology shall be developed for

11  aggregating data in a standardized format for making

12  comparisons between accountable health partnerships which

13  takes advantage of national models and activities.

14         3.  Methods by which the agency should collect,

15  process, analyze, and distribute the data.

16         4.  Standards for data interpretation.  The advisory

17  data committee shall actively solicit broad input from the

18  provider community, carriers, the business community, and the

19  general public.

20         5.  Structuring the data collection process to:

21         a.  Incorporate safeguards to ensure that the health

22  care services utilization data collected is reviewed by

23  experienced, practicing physicians licensed to practice

24  medicine in this state;

25         b.  Require that carrier customer satisfaction data

26  conclusions are validated by the agency;

27         c.  Protect the confidentiality of medical information

28  to protect the patient's identity and to protect the privacy

29  of individual physicians and patients.  Proprietary data

30  submitted by insurers, providers, and purchasers are

31  confidential pursuant to s. 408.061; and


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  1         d.  Afford all interested professional medical and

  2  hospital associations and carriers a minimum of 60 days to

  3  review and comment before data is released to the public.

  4         6.  Developing a data collection implementation

  5  schedule, based on the data collection capabilities of

  6  carriers and providers.

  7         Section 15.  Section 408.01, Florida Statutes, is

  8  repealed.

  9         Section 16.  Subsection (9) of section 408.02, Florida

10  Statutes, is repealed.

11         Section 17.  Paragraph (g) of subsection (1) of section

12  408.062, Florida Statutes, is repealed.

13         Section 18.  Section 408.7071, Florida Statutes, is

14  amended to read:

15         408.7071  Standardized claim form.--

16         (1)  The Agency for Health Care Administration shall

17  develop a standardized claim claims form to be used by

18  insurers and health care providers licensed in this state.

19         (2)  In order to develop the standardized claim form,

20  the agency shall appoint a 15-person committee.  The committee

21  shall consist of:

22         (a)  The director of the Agency for Health Care

23  Administration, or the director's designee.

24         (b)  The Insurance Commissioner, or the commissioner's

25  designee.

26         (c)  Two representatives of hospitals.

27         (d)  Five representatives of physicians: two licensed

28  under chapter 458, one licensed under chapter 459, one

29  licensed under chapter 460, and one licensed under chapter

30  461.

31         (e)  Two representatives of health insurers.


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  1         (f)  Two representatives of health maintenance

  2  organizations.

  3         (g)  Two representatives of consumers.

  4         (3)  The committee shall issue a draft of the

  5  standardized claims form to the Agency for Health Care

  6  Administration by October 1, 1993.  The agency may return the

  7  form to the committee for modification on a schedule that

  8  allows the agency to include the standardized claim form in

  9  the final Florida Health Plan, which must be submitted to the

10  Legislature by December 1, 1993.

11         Section 19.  Paragraph (c) of subsection (12) and

12  subsection (22) of section 409.908, Florida Statutes, are

13  repealed.

14         Section 20.  Section 514.081, Florida Statutes, is

15  repealed.

16         Section 21.  Section 636.045, Florida Statutes, is

17  amended to read:

18         636.045  Minimum surplus requirements.--

19         (1)  Except as provided in subsection (2), Each prepaid

20  limited health service organization must at all times maintain

21  a minimum surplus in an amount which is the greater of

22  $150,000 or 10 percent of total liabilities. Any prepaid

23  limited health service organization which had a valid

24  certificate of authority issued pursuant to part I, part II,

25  or part III of chapter 637, or chapter 638, before October 1,

26  1993, must maintain the surplus required on September 30,

27  1993, until the following dates, and then shall increase its

28  surplus as follows:

29

30  Date                                                    Amount

31  January 1, 1994.................................The greater of


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  1                                           $100,000 or 6 percent

  2                                           of total liabilities,

  3                                           whichever is greater.

  4  January 1, 1995.................................The greater of

  5                                           $125,000 or 8 percent

  6                                           of total liabilities,

  7                                           whichever is greater.

  8  January 1, 1996.................................The greater of

  9                                          $150,000 or 10 percent

10                                           of total liabilities,

11                                           whichever is greater.

12

13         (2)  The department may not issue a certificate of

14  authority on or after October 1, 1993, unless the prepaid

15  limited health service organization has a minimum surplus in

16  an amount of $150,000 or 10 percent of liabilities, whichever

17  is the greater amount.

18         Section 22.  Section 859.03, Florida Statutes, is

19  repealed.

20         Section 23.  Section 859.05, Florida Statutes, is

21  repealed.

22         Section 24.  Section 35 of chapter 93-129, Laws of

23  Florida, is repealed.

24         Section 25.  Section 19 of chapter 96-403, Laws of

25  Florida, is repealed.

26         Section 26.  Section 3 of chapter 98-21, Laws of

27  Florida, is repealed.

28         Section 27.  Section 1 of chapter 98-305, Laws of

29  Florida, is repealed.

30         Section 28.  Section 4 of chapter 99-214, Laws of

31  Florida, is repealed.


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  1         Section 29.  Section 6 of chapter 99-393, Laws of

  2  Florida, is repealed.

  3         Section 30.  Section 192 of chapter 99-397, Laws of

  4  Florida, is repealed.

  5         Section 31.  The proviso language following Specific

  6  Appropriation 224 of chapter 99-226, Laws of Florida, is

  7  amended to read:

  8

  9  224  SALARIES AND BENEFITS      POSITIONS    884

10        FROM GENERAL REVENUE FUND........  12,856,783

11        FROM ADMINISTRATIVE TRUST FUND........        22,992,867

12        FROM GRANTS AND DONATIONS TRUST FUND........     187,973

13

14         From the funds in Specific Appropriation 224,

15         the Agency for Health Care Administration in

16         conjunction with the Department of Children and

17         Families shall conduct a feasibility study

18         related to the development and implementation

19         of a system to automate patient applications

20         for nursing home care under the Medicaid

21         program.

22

23         The Agency for Health Care Administration and

24         the Department of Children and Families shall

25         evaluate the potential cost effectiveness of

26         conducting the demonstration project, document

27         potential savings to the state and provide a

28         written report to the chairmen of the Senate

29         Budget Committee and the House Fiscal

30         Responsibility Council and to the Governor no

31         later than February 1, 2000.


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    SB 1766                                        First Engrossed



  1

  2         From the funds in Specific Appropriation 224

  3         and 225B the agency shall provide support for

  4         the Medicaid Formulary study panel.

  5

  6         The Medicaid Formulary study panel is created

  7         and shall consist of the following nine

  8         members: three members appointed by the

  9         Governor to include the Director of the Agency

10         for Health Care Administration; three members

11         appointed by the Speaker of the House of

12         Representatives to include a Member of the

13         House of Representatives; and three members

14         appointed by the President of the Senate, to

15         include a Member of the Senate. The Governor

16         shall appoint a chairperson of the panel from

17         among the panel membership. The panel shall be

18         placed for administrative purposes within the

19         Agency for Health Care Administration. Staff

20         support for the panel shall be provided by the

21         Agency for Health Care Administration.

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23         The panel shall prepare recommendations on the

24         advisability, feasibility and cost

25         effectiveness of implementing an appropriate

26         formulary for the Medicaid program. Included

27         within the recommendations shall be proposals

28         which will ensure quality of care, enhance

29         patient safety, support appropriate

30         utilization, and maximize cost efficiency. In

31         addition, the panel shall when making their


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    SB 1766                                        First Engrossed



  1         recommendations, include studying the pros and

  2         cons of an Open Formulary versus a Restricted

  3         Formulary, and the impact a formulary will have

  4         on the overall Medicaid program.

  5

  6         In addition, the panel must prepare a plan

  7         which must include, but is not limited to, the

  8         following specific components: recommended time

  9         lines for implementation; an appropriate

10         communication plan to providers and Medicaid

11         beneficiaries; a plan to obtain all required

12         waivers from the federal government;

13         identification of cost savings through a

14         combination of changes in prescription drug

15         utilization, enhanced patient compliance, and

16         reduced purchasing costs; development of

17         appropriate clinical protocols and guidelines;

18         identification of administrative resources to

19         support the program; multi-year projections for

20         benchmarks for additional cost savings; and an

21         ongoing evaluation plan that includes cost and

22         quality measures. However, the agency shall not

23         implement a formulary without specific

24         legislative authorization.

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26         Travel and per diem costs of panel members

27         shall be the responsibility of the appointing

28         agency.

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30         The panel shall present its report to the

31         Governor, the Speaker of the House of


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    SB 1766                                        First Engrossed



  1         Representatives, and the President of the

  2         Senate by no later than January 15, 2000.

  3         Section 32.  This act shall take effect upon becoming a

  4  law.

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