House Bill 4045e1
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CS/HB 4045, 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3 repealed provisions of law; repealing various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6 purpose, or have been impliedly repealed or
7 superseded; repealing s. 154.013, F.S.,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 cross
10 reference, to conform; repealing s. 154.12(2),
11 F.S., relating to the legal status of county
12 public health trusts with respect to a repealed
13 provision of law relating to the filing of
14 caveats; repealing s. 381.0408, F.S., relating
15 to the Public Health Partnership Council on
16 Stroke; repealing s. 408.0014, F.S., the
17 Florida Health Access Corporation Act; amending
18 ss. 20.42 and 409.9117, F.S.; deleting
19 references, to conform; repealing s. 408.004,
20 F.S., relating to the Florida Health Plan;
21 repealing ss. 408.002, 408.005, and 408.006,
22 F.S., relating to legislative findings and
23 intent and to development goals and strategies,
24 to conform; amending ss. 408.061, 408.15,
25 408.301, and 408.704, F.S.; deleting
26 references, to conform; repealing s. 408.01,
27 F.S., relating to the voluntary private health
28 insurance coverage and insurance cost
29 containment program; repealing s. 408.02(9),
30 F.S., relating to a demonstration project on
31 the effectiveness of practice parameters with
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CS/HB 4045, First Engrossed
1 respect to the costs of defensive medicine and
2 professional liability insurance; repealing s.
3 408.062(1)(g), F.S., relating to development of
4 an alternative uniform system of financial
5 reporting of gross revenues per adjusted
6 admission; repealing s. 408.30, F.S., relating
7 to an obsolete rule-saving clause for the
8 Health Care Cost Containment Board; repealing
9 s. 408.7071, F.S., relating to development of a
10 standardized claim form for insurers and health
11 care providers licensed in this state and to
12 the committee appointed for such purpose;
13 repealing s. 409.908(12)(c) and (22), F.S.,
14 relating to a report on the effect of the
15 resource-based relative value scale fee
16 schedule on utilization of Medicaid services
17 and to implementation of changes in the
18 Medicaid reimbursement methodology for
19 facilities formerly known as ICF/DD facilities;
20 amending s. 409.912, F.S., and repealing
21 paragraph (35)(f), relating to applicability of
22 provisions authorizing a 1997-1998 outpatient
23 specialty services pilot project; deleting an
24 obsolete date and provision relating to
25 requirements under which federally qualified
26 health centers can be Medicaid prepaid plan
27 providers; repealing s. 514.081, F.S., relating
28 to a saving clause applicable to provisions
29 governing construction, modification, and
30 operation of public swimming pools and bathing
31 facilities; amending s. 636.045, F.S.; deleting
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CS/HB 4045, First Engrossed
1 obsolete provisions relating to minimum surplus
2 requirements for prepaid limited health service
3 organizations; repealing s. 859.03, F.S.,
4 relating to wrapping and labeling requirements
5 applicable to the sale of morphine; repealing
6 s. 859.05, F.S., relating to a prohibition on
7 the sale or other disposition of narcotics
8 except by prescription; repealing s. 35, ch.
9 93-129, Laws of Florida, relating to a work
10 group on rural health care; repealing s. 19,
11 ch. 96-403, Laws of Florida, relating to a task
12 force on the organization and structure of
13 state health programs; repealing s. 3, ch.
14 98-21, Laws of Florida, relating to a rural
15 hospital redefinition study group; repealing s.
16 1, ch. 98-305, Laws of Florida, relating to the
17 Prostate Cancer Task Force; repealing s. 4, ch.
18 99-214, Laws of Florida, relating to a school
19 nurse training study group; repealing s. 6, ch.
20 99-393, Laws of Florida, relating to an
21 advisory group on submission and payment of
22 health claims; repealing s. 192, ch. 99-397,
23 Laws of Florida, relating to the task force on
24 the funding of the Public Medical Assistance
25 Trust Fund; amending ch. 99-226, Laws of
26 Florida, relating to the Medicaid Formulary
27 study panel; providing an effective date.
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29 Be It Enacted by the Legislature of the State of Florida:
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CS/HB 4045, 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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CS/HB 4045, First Engrossed
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 381.0408, Florida Statutes, is
11 repealed.
12 Section 5. Section 408.0014, Florida Statutes, is
13 repealed.
14 Section 6. Paragraphs (b) and (c) of subsection (2) of
15 section 20.42, Florida Statutes, are amended to read:
16 20.42 Agency for Health Care Administration.--There is
17 created the Agency for Health Care Administration within the
18 Department of Business and Professional Regulation. The agency
19 shall be a separate budget entity, and the director of the
20 agency shall be the agency head for all purposes. The agency
21 shall not be subject to control, supervision, or direction by
22 the Department of Business and Professional Regulation in any
23 manner, including, but not limited to, personnel, purchasing,
24 transactions involving real or personal property, and
25 budgetary matters.
26 (2) ORGANIZATION OF THE AGENCY.--The agency shall be
27 organized as follows:
28 (b) The Division of Health Policy and Cost Control,
29 which shall be responsible for health policy, the State Center
30 for Health Statistics, the development of The Florida Health
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1 Plan, certificate of need, state and local health planning
2 under s. 408.033, and research and analysis.
3 (c) The Division of State Health Purchasing shall be
4 responsible for the Medicaid program. The division shall also
5 administer the contracts with the Florida Health Access
6 Corporation program and the Florida Health Care Purchasing
7 Cooperative and the Florida Healthy Kids Corporation.
8 Section 7. Paragraph (h) of subsection (2) of section
9 409.9117, Florida Statutes, is amended to read:
10 409.9117 Primary care disproportionate share
11 program.--
12 (2) In the establishment and funding of this program,
13 the agency shall use the following criteria in addition to
14 those specified in s. 409.911, payments may not be made to a
15 hospital unless the hospital agrees to:
16 (h) Work with the Florida Healthy Kids Corporation,
17 the Florida Health Care Purchasing Cooperative, the Florida
18 Health Access Corporation, and business health coalitions, as
19 appropriate, to develop a feasibility study and plan to
20 provide a low-cost comprehensive health insurance plan to
21 persons who reside within the area and who do not have access
22 to such a plan.
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24 Any hospital that fails to comply with any of the provisions
25 of this subsection, or any other contractual condition, may
26 not receive payments under this section until full compliance
27 is achieved.
28 Section 8. Sections 408.002, 408.004, 408.005, and
29 408.006, Florida Statutes, are repealed.
30 Section 9. Paragraph (a) of subsection (4) of section
31 408.061, Florida Statutes, is amended to read:
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CS/HB 4045, First Engrossed
1 408.061 Data collection; uniform systems of financial
2 reporting; information relating to physician charges;
3 confidentiality of patient records; immunity.--
4 (4)(a) Within 120 days after the end of its fiscal
5 year, each health care facility shall file with the agency, on
6 forms adopted by the agency and based on the uniform system of
7 financial reporting, its actual financial experience for that
8 fiscal year, including expenditures, revenues, and statistical
9 measures. Such data may be based on internal financial
10 reports which are certified to be complete and accurate by the
11 provider. However, hospitals' actual financial experience
12 shall be their audited actual experience. Nursing homes that
13 do not participate in the Medicare or Medicaid programs shall
14 also submit audited actual experience. Every nursing home
15 shall submit to the agency, in a format designated by the
16 agency, a statistical profile of the nursing home residents.
17 The agency, in conjunction with the Department of Elderly
18 Affairs and the Department of Health, shall review these
19 statistical profiles and develop recommendations for the types
20 of residents who might more appropriately be placed in their
21 homes or other noninstitutional settings. The agency shall
22 include its findings in the final Florida Health Plan which
23 must be submitted to the Legislature by December 31, 1993.
24 Included in the findings shall be outcome data and cost
25 differential data as part of patient profiles.
26 Section 10. Subsections (6) and (7) of section 408.15,
27 Florida Statutes, are amended to read:
28 408.15 Powers of the agency.--In addition to the
29 powers granted to the agency elsewhere in this chapter, the
30 agency is authorized to:
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1 (6) Apply for and receive and accept grants, gifts,
2 and other payments, including property and services, from any
3 governmental or other public and private entity or person and
4 make arrangements as to the use of same, including undertaking
5 special studies and other projects related to The Florida
6 Health Plan. Funds obtained under this subsection may be used
7 as matching funds for public or private grants.
8 (7) Seek federal statutory changes and any waivers of
9 federal laws or regulations that will aid in implementing The
10 Florida Health Plan and related health care reforms. This may
11 include seeking amendments to:
12 (a) The Employee Retirement and Income Security Act of
13 1974 to permit greater state regulation of employer insurance
14 plans.
15 (b) The Medicaid program to permit alternative
16 organizational alignments, elimination of all program
17 eligibility requirements except income, and a moratorium on
18 further federal mandates.
19 (c) The Medicare program to seek state administration
20 of benefits, provider payments, or case management of
21 beneficiaries.
22 (d) Federal tax laws to permit a 100-percent tax
23 deduction for all private health insurance plans, including
24 those of self-employed persons and unincorporated employers,
25 and reform of the flexible sharing account requirements to
26 maximize pretax health care expenditures.
27 (e) Other federal programs to permit full
28 implementation of The Florida Health Plan and related state
29 health care reforms.
30 Section 11. Section 408.301, Florida Statutes, is
31 amended to read:
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CS/HB 4045, First Engrossed
1 408.301 Legislative findings.--The Legislature has
2 found that access to quality, affordable, health care for all
3 Floridians is an important goal for the state. The
4 Legislature has charged the Agency for Health Care
5 Administration with the responsibility of developing the
6 Florida Health Plan for assuring access to health care for all
7 Floridians. At the same time, The Legislature recognizes that
8 there are Floridians with special health care and social needs
9 which require particular attention. The people served by the
10 Department of Children and Family Services and the Department
11 of Health are examples of citizens with special needs. The
12 Legislature further recognizes that the Medicaid program is an
13 intricate part of the service delivery system for the special
14 needs citizens served by or through the Department of Children
15 and Family Services and the Department of Health. The Agency
16 for Health Care Administration is not a service provider and
17 does not develop or direct programs for the special needs
18 citizens served by or through the Department of Children and
19 Family Services and the Department of Health. Therefore, it is
20 the intent of the Legislature that the Agency for Health Care
21 Administration work closely with the Department of Children
22 and Family Services and the Department of Health in developing
23 plans for assuring access to all Floridians in order to assure
24 that the needs of special citizens are met.
25 Section 12. Paragraph (b) of subsection (5) of section
26 408.704, Florida Statutes, is amended to read:
27 408.704 Agency duties and responsibilities related to
28 community health purchasing alliances.--The agency shall
29 assist in developing a statewide system of community health
30 purchasing alliances. To this end, the agency is responsible
31 for:
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CS/HB 4045, First Engrossed
1 (5) Establishing a data system for accountable health
2 partnerships.
3 (b) The advisory data committee shall issue a report
4 and recommendations on each of the following subjects as each
5 is completed. A final report covering all subjects must be
6 included in the final Florida Health Plan to be submitted to
7 the Legislature on December 31, 1993. The report shall
8 include recommendations regarding:
9 1. Types of data to be collected. Careful
10 consideration shall be given to other data collection projects
11 and standards for electronic data interchanges already in
12 process in this state and nationally, to evaluating and
13 recommending the feasibility and cost-effectiveness of various
14 data collection activities, and to ensuring that data
15 reporting is necessary to support the evaluation of providers
16 with respect to cost containment, access, quality, control of
17 expensive technologies, and customer satisfaction analysis.
18 Data elements to be collected from providers include prices,
19 utilization, patient outcomes, quality, and patient
20 satisfaction. The completion of this task is the first
21 priority of the advisory data committee. The agency shall
22 begin implementing these data collection activities
23 immediately upon receipt of the recommendations, but no later
24 than January 1, 1994. The data shall be submitted by
25 hospitals, other licensed health care facilities, pharmacists,
26 and group practices as defined in s. 455.654(3)(f).
27 2. A standard data set, a standard cost-effective
28 format for collecting the data, and a standard methodology for
29 reporting the data to the agency, or its designee, and to the
30 alliances. The reporting mechanisms must be designed to
31 minimize the administrative burden and cost to health care
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1 providers and carriers. A methodology shall be developed for
2 aggregating data in a standardized format for making
3 comparisons between accountable health partnerships which
4 takes advantage of national models and activities.
5 3. Methods by which the agency should collect,
6 process, analyze, and distribute the data.
7 4. Standards for data interpretation. The advisory
8 data committee shall actively solicit broad input from the
9 provider community, carriers, the business community, and the
10 general public.
11 5. Structuring the data collection process to:
12 a. Incorporate safeguards to ensure that the health
13 care services utilization data collected is reviewed by
14 experienced, practicing physicians licensed to practice
15 medicine in this state;
16 b. Require that carrier customer satisfaction data
17 conclusions are validated by the agency;
18 c. Protect the confidentiality of medical information
19 to protect the patient's identity and to protect the privacy
20 of individual physicians and patients. Proprietary data
21 submitted by insurers, providers, and purchasers are
22 confidential pursuant to s. 408.061; and
23 d. Afford all interested professional medical and
24 hospital associations and carriers a minimum of 60 days to
25 review and comment before data is released to the public.
26 6. Developing a data collection implementation
27 schedule, based on the data collection capabilities of
28 carriers and providers.
29 Section 13. Section 408.01, Florida Statutes, is
30 repealed.
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CS/HB 4045, First Engrossed
1 Section 14. Subsection (9) of section 408.02, Florida
2 Statutes, is repealed.
3 Section 15. Paragraph (g) of subsection (1) of section
4 408.062, Florida Statutes, is repealed.
5 Section 16. Section 408.30, Florida Statutes, is
6 repealed.
7 Section 17. Section 408.7071, Florida Statutes, is
8 repealed.
9 Section 18. Paragraph (c) of subsection (12) and
10 subsection (22) of section 409.908, Florida Statutes, are
11 repealed.
12 Section 19. Paragraph (f) of subsection (35) of
13 section 409.912, Florida Statutes, is repealed, and paragraph
14 (c) of 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 20. Section 514.081, Florida Statutes, is
21 repealed.
22 Section 21. Section 636.045, Florida Statutes, is
23 amended to read:
24 636.045 Minimum surplus requirements.--
25 (1) Except as provided in subsection (2), Each prepaid
26 limited health service organization must at all times maintain
27 a minimum surplus in an amount which is the greater of
28 $150,000 or 10 percent of total liabilities. Any prepaid
29 limited health service organization which had a valid
30 certificate of authority issued pursuant to part I, part II,
31 or part III of chapter 637, or chapter 638, before October 1,
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1 1993, must maintain the surplus required on September 30,
2 1993, until the following dates, and then shall increase its
3 surplus as follows:
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5 Date Amount
6 January 1, 1994.................................The greater of
7 $100,000 or 6 percent
8 of total liabilities,
9 whichever is greater.
10 January 1, 1995.................................The greater of
11 $125,000 or 8 percent
12 of total liabilities,
13 whichever is greater.
14 January 1, 1996.................................The greater of
15 $150,000 or 10 percent
16 of total liabilities,
17 whichever is greater.
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19 (2) The department may not issue a certificate of
20 authority on or after October 1, 1993, unless the prepaid
21 limited health service organization has a minimum surplus in
22 an amount of $150,000 or 10 percent of liabilities, whichever
23 is the greater amount.
24 Section 22. Section 859.03, Florida Statutes, is
25 repealed.
26 Section 23. Section 859.05, Florida Statutes, is
27 repealed.
28 Section 24. Section 35 of chapter 93-129, Laws of
29 Florida, is repealed.
30 Section 25. Section 19 of chapter 96-403, Laws of
31 Florida, is repealed.
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CS/HB 4045, First Engrossed
1 Section 26. Section 3 of chapter 98-21, Laws of
2 Florida, is repealed.
3 Section 27. Section 1 of chapter 98-305, Laws of
4 Florida, is repealed.
5 Section 28. Section 4 of chapter 99-214, Laws of
6 Florida, is repealed.
7 Section 29. Section 6 of chapter 99-393, Laws of
8 Florida, is repealed.
9 Section 30. Section 192 of chapter 99-397, Laws of
10 Florida, is repealed.
11 Section 31. The proviso language following Specific
12 Appropriation 224 of chapter 99-226, Laws of Florida, is
13 amended to read:
14
15 224 SALARIES AND BENEFITS POSITIONS 884
16 FROM GENERAL REVENUE FUND........ 12,856,783
17 FROM ADMINISTRATIVE TRUST FUND........ 22,992,867
18 FROM GRANTS AND DONATIONS TRUST FUND........ 187,973
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20 From the funds in Specific Appropriation 224,
21 the Agency for Health Care Administration in
22 conjunction with the Department of Children and
23 Families shall conduct a feasibility study
24 related to the development and implementation
25 of a system to automate patient applications
26 for nursing home care under the Medicaid
27 program.
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29 The Agency for Health Care Administration and
30 the Department of Children and Families shall
31 evaluate the potential cost effectiveness of
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1 conducting the demonstration project, document
2 potential savings to the state and provide a
3 written report to the chairmen of the Senate
4 Budget Committee and the House Fiscal
5 Responsibility Council and to the Governor no
6 later than February 1, 2000.
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8 From the funds in Specific Appropriation 224
9 and 225B the agency shall provide support for
10 the Medicaid Formulary study panel.
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12 The Medicaid Formulary study panel is created
13 and shall consist of the following nine
14 members: three members appointed by the
15 Governor to include the Director of the Agency
16 for Health Care Administration; three members
17 appointed by the Speaker of the House of
18 Representatives to include a Member of the
19 House of Representatives; and three members
20 appointed by the President of the Senate, to
21 include a Member of the Senate. The Governor
22 shall appoint a chairperson of the panel from
23 among the panel membership. The panel shall be
24 placed for administrative purposes within the
25 Agency for Health Care Administration. Staff
26 support for the panel shall be provided by the
27 Agency for Health Care Administration.
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29 The panel shall prepare recommendations on the
30 advisability, feasibility and cost
31 effectiveness of implementing an appropriate
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1 formulary for the Medicaid program. Included
2 within the recommendations shall be proposals
3 which will ensure quality of care, enhance
4 patient safety, support appropriate
5 utilization, and maximize cost efficiency. In
6 addition, the panel shall when making their
7 recommendations, include studying the pros and
8 cons of an Open Formulary versus a Restricted
9 Formulary, and the impact a formulary will have
10 on the overall Medicaid program.
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12 In addition, the panel must prepare a plan
13 which must include, but is not limited to, the
14 following specific components: recommended time
15 lines for implementation; an appropriate
16 communication plan to providers and Medicaid
17 beneficiaries; a plan to obtain all required
18 waivers from the federal government;
19 identification of cost savings through a
20 combination of changes in prescription drug
21 utilization, enhanced patient compliance, and
22 reduced purchasing costs; development of
23 appropriate clinical protocols and guidelines;
24 identification of administrative resources to
25 support the program; multi-year projections for
26 benchmarks for additional cost savings; and an
27 ongoing evaluation plan that includes cost and
28 quality measures. However, the agency shall not
29 implement a formulary without specific
30 legislative authorization.
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1 Travel and per diem costs of panel members
2 shall be the responsibility of the appointing
3 agency.
4
5 The panel shall present its report to the
6 Governor, the Speaker of the House of
7 Representatives, and the President of the
8 Senate by no later than January 15, 2000.
9 Section 32. This act shall take effect upon becoming a
10 law.
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