SENATE AMENDMENT
Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
CHAMBER ACTION
Senate House
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11 Senator Silver moved the following amendment to amendment
12 (791604):
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14 Senate Amendment (with title amendment)
15 On page 287, between lines 19 and 20,
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17 insert:
18 Section 144. Section 409.905, Florida Statutes, is
19 amended to read:
20 409.905 Mandatory Medicaid services.--The agency may
21 make payments for the following services, which are required
22 of the state by Title XIX of the Social Security Act,
23 furnished by Medicaid providers to recipients who are
24 determined to be eligible on the dates on which the services
25 were provided. Any service under this section shall be
26 provided only when medically necessary and in accordance with
27 state and federal law. Mandatory services rendered by
28 providers in mobile units to Medicaid recipients may be
29 restricted by the agency. Nothing in this section shall be
30 construed to prevent or limit the agency from adjusting fees,
31 reimbursement rates, lengths of stay, number of visits, number
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 of services, or any other adjustments necessary to comply with
2 the availability of moneys and any limitations or directions
3 provided for in the General Appropriations Act or chapter 216.
4 (1) ADVANCED REGISTERED NURSE PRACTITIONER
5 SERVICES.--The agency shall pay for services provided to a
6 recipient by a licensed advanced registered nurse practitioner
7 who has a valid collaboration agreement with a licensed
8 physician on file with the Department of Health or who
9 provides anesthesia services in accordance with established
10 protocol required by state law and approved by the medical
11 staff of the facility in which the anesthetic service is
12 performed. Reimbursement for such services must be provided in
13 an amount that equals not less than 80 percent of the
14 reimbursement to a physician who provides the same services,
15 unless otherwise provided for in the General Appropriations
16 Act.
17 (2) EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND
18 TREATMENT SERVICES.--The agency shall pay for early and
19 periodic screening and diagnosis of a recipient under age 21
20 to ascertain physical and mental problems and conditions and
21 provide treatment to correct or ameliorate these problems and
22 conditions. These services include all services determined by
23 the agency to be medically necessary for the treatment,
24 correction, or amelioration of these problems, including
25 personal care, private duty nursing, durable medical
26 equipment, physical therapy, occupational therapy, speech
27 therapy, respiratory therapy, and immunizations.
28 (3) FAMILY PLANNING SERVICES.--The agency shall pay
29 for services necessary to enable a recipient voluntarily to
30 plan family size or to space children. These services include
31 information; education; counseling regarding the availability,
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SENATE AMENDMENT
Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 benefits, and risks of each method of pregnancy prevention;
2 drugs and supplies; and necessary medical care and followup.
3 Each recipient participating in the family planning portion of
4 the Medicaid program must be provided freedom to choose any
5 alternative method of family planning, as required by federal
6 law.
7 (4) HOME HEALTH CARE SERVICES.--The agency shall pay
8 for nursing and home health aide services, supplies,
9 appliances, and durable medical equipment, necessary to assist
10 a recipient living at home. An entity that provides services
11 pursuant to this subsection shall be licensed under part IV of
12 chapter 400 or part II of chapter 499, if appropriate. These
13 services, equipment, and supplies, or reimbursement therefor,
14 may be limited as provided in the General Appropriations Act
15 and do not include services, equipment, or supplies provided
16 to a person residing in a hospital or nursing facility. In
17 providing home health care services, the agency may require
18 prior authorization of care based on diagnosis.
19 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
20 for all covered services provided for the medical care and
21 treatment of a recipient who is admitted as an inpatient by a
22 licensed physician or dentist to a hospital licensed under
23 part I of chapter 395. However, the agency shall limit the
24 payment for inpatient hospital services for a Medicaid
25 recipient 21 years of age or older to 45 days or the number of
26 days necessary to comply with the General Appropriations Act.
27 (a) The agency is authorized to implement
28 reimbursement and utilization management reforms in order to
29 comply with any limitations or directions in the General
30 Appropriations Act, which may include, but are not limited to:
31 prior authorization for inpatient psychiatric days; enhanced
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SENATE AMENDMENT
Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 utilization and concurrent review programs for highly utilized
2 services; reduction or elimination of covered days of service;
3 adjusting reimbursement ceilings for variable costs; adjusting
4 reimbursement ceilings for fixed and property costs; and
5 implementing target rates of increase.
6 (b) A licensed hospital maintained primarily for the
7 care and treatment of patients having mental disorders or
8 mental diseases is not eligible to participate in the hospital
9 inpatient portion of the Medicaid program except as provided
10 in federal law. However, the department shall apply for a
11 waiver, within 9 months after June 5, 1991, designed to
12 provide hospitalization services for mental health reasons to
13 children and adults in the most cost-effective and lowest cost
14 setting possible. Such waiver shall include a request for the
15 opportunity to pay for care in hospitals known under federal
16 law as "institutions for mental disease" or "IMD's." The
17 waiver proposal shall propose no additional aggregate cost to
18 the state or Federal Government, and shall be conducted in
19 Hillsborough County, Highlands County, Hardee County, Manatee
20 County, and Polk County. The waiver proposal may incorporate
21 competitive bidding for hospital services, comprehensive
22 brokering, prepaid capitated arrangements, or other mechanisms
23 deemed by the department to show promise in reducing the cost
24 of acute care and increasing the effectiveness of preventive
25 care. When developing the waiver proposal, the department
26 shall take into account price, quality, accessibility,
27 linkages of the hospital to community services and family
28 support programs, plans of the hospital to ensure the earliest
29 discharge possible, and the comprehensiveness of the mental
30 health and other health care services offered by participating
31 providers.
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 (c) Agency for Health Care Administration shall adjust
2 a hospital's current inpatient per diem rate to reflect the
3 cost of serving the Medicaid population at that institution
4 if:
5 1. The hospital experiences an increase in Medicaid
6 caseload by more than 25 percent in any year, primarily
7 resulting from the closure of a hospital in the same service
8 area occurring after July 1, 1995; or
9 2. The hospital's Medicaid per diem rate is at least
10 25 percent below the Medicaid per patient cost for that year.
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12 No later than November 1, 2000, the agency must provide
13 estimated costs for any adjustment in a hospital inpatient per
14 diem pursuant to this paragraph to the Executive Office of the
15 Governor, the House of Representatives General Appropriations
16 Committee, and the Senate Budget Committee. Before the agency
17 implements a change in a hospital's inpatient per diem rate
18 pursuant to this paragraph, the Legislature must have
19 specifically appropriated sufficient funds in the 2001-2002
20 General Appropriations Act to support the increase in cost as
21 estimated by the agency. This paragraph is repealed on July 1,
22 2001.
23 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
24 pay for preventive, diagnostic, therapeutic, or palliative
25 care and other services provided to a recipient in the
26 outpatient portion of a hospital licensed under part I of
27 chapter 395, and provided under the direction of a licensed
28 physician or licensed dentist, except that payment for such
29 care and services is limited to $1,500 per state fiscal year
30 per recipient, unless an exception has been made by the
31 agency, and with the exception of a Medicaid recipient under
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 age 21, in which case the only limitation is medical
2 necessity.
3 (7) INDEPENDENT LABORATORY SERVICES.--The agency shall
4 pay for medically necessary diagnostic laboratory procedures
5 ordered by a licensed physician or other licensed practitioner
6 of the healing arts which are provided for a recipient in a
7 laboratory that meets the requirements for Medicare
8 participation and is licensed under chapter 483, if required.
9 (8) NURSING FACILITY SERVICES.--The agency shall pay
10 for 24-hour-a-day nursing and rehabilitative services for a
11 recipient in a nursing facility licensed under part II of
12 chapter 400 or in a rural hospital, as defined in s. 395.602,
13 or in a Medicare certified skilled nursing facility operated
14 by a hospital, as defined by s. 395.002(11), that is licensed
15 under part I of chapter 395, and in accordance with provisions
16 set forth in s. 409.908(2)(a), which services are ordered by
17 and provided under the direction of a licensed physician.
18 However, if a nursing facility has been destroyed or otherwise
19 made uninhabitable by natural disaster or other emergency and
20 another nursing facility is not available, the agency must pay
21 for similar services temporarily in a hospital licensed under
22 part I of chapter 395 provided federal funding is approved and
23 available.
24 (9) PHYSICIAN SERVICES.--The agency shall pay for
25 covered services and procedures rendered to a recipient by, or
26 under the personal supervision of, a person licensed under
27 state law to practice medicine or osteopathic medicine. These
28 services may be furnished in the physician's office, the
29 Medicaid recipient's home, a hospital, a nursing facility, or
30 elsewhere, but shall be medically necessary for the treatment
31 of an injury, illness, or disease within the scope of the
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 practice of medicine or osteopathic medicine as defined by
2 state law. The agency shall not pay for services that are
3 clinically unproven, experimental, or for purely cosmetic
4 purposes.
5 (10) PORTABLE X-RAY SERVICES.--The agency shall pay
6 for professional and technical portable radiological services
7 ordered by a licensed physician or other licensed practitioner
8 of the healing arts which are provided by a licensed
9 professional in a setting other than a hospital, clinic, or
10 office of a physician or practitioner of the healing arts, on
11 behalf of a recipient.
12 (11) RURAL HEALTH CLINIC SERVICES.--The agency shall
13 pay for outpatient primary health care services for a
14 recipient provided by a clinic certified by and participating
15 in the Medicare program which is located in a federally
16 designated, rural, medically underserved area and has on its
17 staff one or more licensed primary care nurse practitioners or
18 physician assistants, and a licensed staff supervising
19 physician or a consulting supervising physician.
20 (12) TRANSPORTATION SERVICES.--The agency shall ensure
21 that appropriate transportation services are available for a
22 Medicaid recipient in need of transport to a qualified
23 Medicaid provider for medically necessary and
24 Medicaid-compensable services, provided a client's ability to
25 choose a specific transportation provider shall be limited to
26 those options resulting from policies established by the
27 agency to meet the fiscal limitations of the General
28 Appropriations Act. The agency may pay for transportation and
29 other related travel expenses as necessary only if these
30 services are not otherwise available.
31 Section 145. Section 409.906, Florida Statutes, is
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 amended to read:
2 409.906 Optional Medicaid services.--Subject to
3 specific appropriations, the agency may make payments for
4 services which are optional to the state under Title XIX of
5 the Social Security Act and are furnished by Medicaid
6 providers to recipients who are determined to be eligible on
7 the dates on which the services were provided. Any optional
8 service that is provided shall be provided only when medically
9 necessary and in accordance with state and federal law.
10 Optional services rendered by providers in mobile units to
11 Medicaid recipients may be restricted or prohibited by the
12 agency. Nothing in this section shall be construed to prevent
13 or limit the agency from adjusting fees, reimbursement rates,
14 lengths of stay, number of visits, or number of services, or
15 making any other adjustments necessary to comply with the
16 availability of moneys and any limitations or directions
17 provided for in the General Appropriations Act or chapter 216.
18 If necessary to safeguard the state's systems of providing
19 services to elderly and disabled persons and subject to the
20 notice and review provisions of s. 216.177, the Governor may
21 direct the Agency for Health Care Administration to amend the
22 Medicaid state plan to delete the optional Medicaid service
23 known as "Intermediate Care Facilities for the Developmentally
24 Disabled." Optional services may include:
25 (1) ADULT DENTURE SERVICES.--The agency may pay for
26 dentures, the procedures required to seat dentures, and the
27 repair and reline of dentures, provided by or under the
28 direction of a licensed dentist, for a recipient who is age 21
29 or older. However, Medicaid will not provide reimbursement for
30 dental services provided in a mobile dental unit, except for a
31 mobile dental unit:
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 (a) Owned by, operated by, or having a contractual
2 agreement with the Department of Health and complying with
3 Medicaid's county health department clinic services program
4 specifications as a county health department clinic services
5 provider.
6 (b) Owned by, operated by, or having a contractual
7 arrangement with a federally qualified health center and
8 complying with Medicaid's federally qualified health center
9 specifications as a federally qualified health center
10 provider.
11 (c) Rendering dental services to Medicaid recipients,
12 21 years of age and older, at nursing facilities.
13 (d) Owned by, operated by, or having a contractual
14 agreement with a state-approved dental educational
15 institution.
16 (2) ADULT HEALTH SCREENING SERVICES.--The agency may
17 pay for an annual routine physical examination, conducted by
18 or under the direction of a licensed physician, for a
19 recipient age 21 or older, without regard to medical
20 necessity, in order to detect and prevent disease, disability,
21 or other health condition or its progression.
22 (3) AMBULATORY SURGICAL CENTER SERVICES.--The agency
23 may pay for services provided to a recipient in an ambulatory
24 surgical center licensed under part I of chapter 395, by or
25 under the direction of a licensed physician or dentist.
26 (4) BIRTH CENTER SERVICES.--The agency may pay for
27 examinations and delivery, recovery, and newborn assessment,
28 and related services, provided in a licensed birth center
29 staffed with licensed physicians, certified nurse midwives,
30 and midwives licensed in accordance with chapter 467, to a
31 recipient expected to experience a low-risk pregnancy and
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 delivery.
2 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
3 primary care case management services rendered to a recipient
4 pursuant to a federally approved waiver, and targeted case
5 management services for specific groups of targeted
6 recipients, for which funding has been provided and which are
7 rendered pursuant to federal guidelines. The agency is
8 authorized to limit reimbursement for targeted case management
9 services in order to comply with any limitations or directions
10 provided for in the General Appropriations Act.
11 Notwithstanding s. 216.292, the Department of Children and
12 Family Services may transfer general funds to the Agency for
13 Health Care Administration to fund state match requirements
14 exceeding the amount specified in the General Appropriations
15 Act for targeted case management services.
16 (6) CHILDREN'S DENTAL SERVICES.--The agency may pay
17 for diagnostic, preventive, or corrective procedures,
18 including orthodontia in severe cases, provided to a recipient
19 under age 21, by or under the supervision of a licensed
20 dentist. Services provided under this program include
21 treatment of the teeth and associated structures of the oral
22 cavity, as well as treatment of disease, injury, or impairment
23 that may affect the oral or general health of the individual.
24 However, Medicaid will not provide reimbursement for dental
25 services provided in a mobile dental unit, except for a mobile
26 dental unit:
27 (a) Owned by, operated by, or having a contractual
28 agreement with the Department of Health and complying with
29 Medicaid's county health department clinic services program
30 specifications as a county health department clinic services
31 provider.
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Bill No. CS for SB 1558, 1st Eng.
Amendment No. ___ Barcode 742036
1 (b) Owned by, operated by, or having a contractual
2 arrangement with a federally qualified health center and
3 complying with Medicaid's federally qualified health center
4 specifications as a federally qualified health center
5 provider.
6 (c) Rendering dental services to Medicaid recipients,
7 21 years of age and older, at nursing facilities.
8 (d) Owned by, operated by, or having a contractual
9 agreement with a state-approved dental educational
10 institution.
11 (7) CHIROPRACTIC SERVICES.--The agency may pay for
12 manual manipulation of the spine and initial services,
13 screening, and X rays provided to a recipient by a licensed
14 chiropractic physician.
15 (8) COMMUNITY MENTAL HEALTH SERVICES.--The agency may
16 pay for rehabilitative services provided to a recipient by a
17 mental health or substance abuse provider licensed by the
18 agency and under contract with the agency or the Department of
19 Children and Family Services to provide such services. Those
20 services which are psychiatric in nature shall be rendered or
21 recommended by a psychiatrist, and those services which are
22 medical in nature shall be rendered or recommended by a
23 physician or psychiatrist. The agency must develop a provider
24 enrollment process for community mental health providers which
25 bases provider enrollment on an assessment of service need.
26 The provider enrollment process shall be designed to control
27 costs, prevent fraud and abuse, consider provider expertise
28 and capacity, and assess provider success in managing
29 utilization of care and measuring treatment outcomes.
30 Providers will be selected through a competitive procurement
31 or selective contracting process. In addition to other
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Amendment No. ___ Barcode 742036
1 community mental health providers, the agency shall consider
2 for enrollment mental health programs licensed under chapter
3 395 and group practices licensed under chapter 458, chapter
4 459, chapter 490, or chapter 491. The agency is also
5 authorized to continue operation of its behavioral health
6 utilization management program and may develop new services if
7 these actions are necessary to ensure savings from the
8 implementation of the utilization management system. The
9 agency shall coordinate the implementation of this enrollment
10 process with the Department of Children and Family Services
11 and the Department of Juvenile Justice. The agency is
12 authorized to utilize diagnostic criteria in setting
13 reimbursement rates, to preauthorize certain high-cost or
14 highly utilized services, to limit or eliminate coverage for
15 certain services, or to make any other adjustments necessary
16 to comply with any limitations or directions provided for in
17 the General Appropriations Act.
18 (9) DIALYSIS FACILITY SERVICES.--Subject to specific
19 appropriations being provided for this purpose, the agency may
20 pay a dialysis facility that is approved as a dialysis
21 facility in accordance with Title XVIII of the Social Security
22 Act, for dialysis services that are provided to a Medicaid
23 recipient under the direction of a physician licensed to
24 practice medicine or osteopathic medicine in this state,
25 including dialysis services provided in the recipient's home
26 by a hospital-based or freestanding dialysis facility.
27 (10) DURABLE MEDICAL EQUIPMENT.--The agency may
28 authorize and pay for certain durable medical equipment and
29 supplies provided to a Medicaid recipient as medically
30 necessary.
31 (11) HEALTHY START SERVICES.--The agency may pay for a
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Amendment No. ___ Barcode 742036
1 continuum of risk-appropriate medical and psychosocial
2 services for the Healthy Start program in accordance with a
3 federal waiver. The agency may not implement the federal
4 waiver unless the waiver permits the state to limit enrollment
5 or the amount, duration, and scope of services to ensure that
6 expenditures will not exceed funds appropriated by the
7 Legislature or available from local sources. If the Health
8 Care Financing Administration does not approve a federal
9 waiver for Healthy Start services, the agency, in consultation
10 with the Department of Health and the Florida Association of
11 Healthy Start Coalitions, is authorized to establish a
12 Medicaid certified-match program for Healthy Start services.
13 Participation in the Healthy Start certified-match program
14 shall be voluntary, and reimbursement shall be limited to the
15 federal Medicaid share to Medicaid-enrolled Healthy Start
16 coalitions for services provided to Medicaid recipients. The
17 agency shall take no action to implement a certified-match
18 program without ensuring that the amendment and review
19 requirements of ss. 216.177 and 216.181 have been met.
20 (12) HEARING SERVICES.--The agency may pay for hearing
21 and related services, including hearing evaluations, hearing
22 aid devices, dispensing of the hearing aid, and related
23 repairs, if provided to a recipient by a licensed hearing aid
24 specialist, otolaryngologist, otologist, audiologist, or
25 physician.
26 (13) HOME AND COMMUNITY-BASED SERVICES.--The agency
27 may pay for home-based or community-based services that are
28 rendered to a recipient in accordance with a federally
29 approved waiver program.
30 (14) HOSPICE CARE SERVICES.--The agency may pay for
31 all reasonable and necessary services for the palliation or
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Amendment No. ___ Barcode 742036
1 management of a recipient's terminal illness, if the services
2 are provided by a hospice that is licensed under part VI of
3 chapter 400 and meets Medicare certification requirements.
4 (15) INTERMEDIATE CARE FACILITY FOR THE
5 DEVELOPMENTALLY DISABLED SERVICES.--The agency may pay for
6 health-related care and services provided on a 24-hour-a-day
7 basis by a facility licensed and certified as a Medicaid
8 Intermediate Care Facility for the Developmentally Disabled,
9 for a recipient who needs such care because of a developmental
10 disability.
11 (16) INTERMEDIATE CARE SERVICES.--The agency may pay
12 for 24-hour-a-day intermediate care nursing and rehabilitation
13 services rendered to a recipient in a nursing facility
14 licensed under part II of chapter 400, if the services are
15 ordered by and provided under the direction of a physician.
16 (17) OPTOMETRIC SERVICES.--The agency may pay for
17 services provided to a recipient, including examination,
18 diagnosis, treatment, and management, related to ocular
19 pathology, if the services are provided by a licensed
20 optometrist or physician.
21 (18) PHYSICIAN ASSISTANT SERVICES.--The agency may pay
22 for all services provided to a recipient by a physician
23 assistant licensed under s. 458.347 or s. 459.022.
24 Reimbursement for such services must be not less than 80
25 percent of the reimbursement that would be paid to a physician
26 who provided the same services.
27 (19) PODIATRIC SERVICES.--The agency may pay for
28 services, including diagnosis and medical, surgical,
29 palliative, and mechanical treatment, related to ailments of
30 the human foot and lower leg, if provided to a recipient by a
31 podiatric physician licensed under state law.
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1 (20) PRESCRIBED DRUG SERVICES.--The agency may pay for
2 medications that are prescribed for a recipient by a physician
3 or other licensed practitioner of the healing arts authorized
4 to prescribe medications and that are dispensed to the
5 recipient by a licensed pharmacist or physician in accordance
6 with applicable state and federal law.
7 (21) REGISTERED NURSE FIRST ASSISTANT SERVICES.--The
8 agency may pay for all services provided to a recipient by a
9 registered nurse first assistant as described in s. 464.027.
10 Reimbursement for such services may not be less than 80
11 percent of the reimbursement that would be paid to a physician
12 providing the same services.
13 (22) STATE HOSPITAL SERVICES.--The agency may pay for
14 all-inclusive psychiatric inpatient hospital care provided to
15 a recipient age 65 or older in a state mental hospital.
16 (23) VISUAL SERVICES.--The agency may pay for visual
17 examinations, eyeglasses, and eyeglass repairs for a
18 recipient, if they are prescribed by a licensed physician
19 specializing in diseases of the eye or by a licensed
20 optometrist.
21 (24) CHILD-WELFARE-TARGETED CASE MANAGEMENT.--The
22 Agency for Health Care Administration, in consultation with
23 the Department of Children and Family Services, may establish
24 a targeted case-management pilot project in those counties
25 identified by the Department of Children and Family Services
26 and for the community-based child welfare project in Sarasota
27 and Manatee counties, as authorized under s. 409.1671. These
28 projects shall be established for the purpose of determining
29 the impact of targeted case management on the child welfare
30 program and the earnings from the child welfare program.
31 Results of the pilot projects shall be reported to the Child
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1 Welfare Estimating Conference and the Social Services
2 Estimating Conference established under s. 216.136. The number
3 of projects may not be increased until requested by the
4 Department of Children and Family Services, recommended by the
5 Child Welfare Estimating Conference and the Social Services
6 Estimating Conference, and approved by the Legislature. The
7 covered group of individuals who are eligible to receive
8 targeted case management include children who are eligible for
9 Medicaid; who are between the ages of birth through 21; and
10 who are under protective supervision or postplacement
11 supervision, under foster-care supervision, or in shelter care
12 or foster care. The number of individuals who are eligible to
13 receive targeted case management shall be limited to the
14 number for whom the Department of Children and Family Services
15 has available matching funds to cover the costs. The general
16 revenue funds required to match the funds for services
17 provided by the community-based child welfare projects are
18 limited to funds available for services described under s.
19 409.1671. The Department of Children and Family Services may
20 transfer the general revenue matching funds as billed by the
21 Agency for Health Care Administration.
22
23 (Redesignate subsequent sections.)
24
25
26 ================ T I T L E A M E N D M E N T ===============
27 And the title is amended as follows:
28 On page 300, line 20, following the semicolon
29
30 insert:
31 amending s. 409.905, F.S.; providing that the
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Amendment No. ___ Barcode 742036
1 Agency for Health Care Administration may
2 restrict the provision of mandatory services by
3 mobile providers; amending s. 409.906, F.S.;
4 providing that the agency may restrict or
5 prohibit the provision of services by mobile
6 providers; providing that Medicaid will not
7 provide reimbursement for dental services
8 provided in mobile dental units, except for
9 certain units;
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