HOUSE AMENDMENT
Bill No. HB 1753 Barcode 103563
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
.
.
1 .
.
2 .
.
3 .
.
4 ______________________________________________________________
5 ORIGINAL STAMP BELOW
6
7
8
9
10 ______________________________________________________________
11 Representative(s) Maygarden offered the following:
12
13 Substitute Amendment for Amendment (064079) (with title
14 amendment)
15 On page 5, line 12, through page 9, line 24
16 remove from the bill: all of said lines
17
18 and insert in lieu thereof:
19 Section 3. Subsection (1) of section 409.904, Florida
20 Statutes, is amended, and subsection (9) is added to said
21 section, to read:
22 409.904 Optional payments for eligible persons.--The
23 agency may make payments for medical assistance and related
24 services on behalf of the following persons who are determined
25 to be eligible subject to the income, assets, and categorical
26 eligibility tests set forth in federal and state law. Payment
27 on behalf of these Medicaid-eligible persons is subject to the
28 availability of moneys and any limitations established by the
29 General Appropriations Act or chapter 216.
30 (1) A person who is age 65 or older or is determined
31 to be disabled, whose income is at or below 90 100 percent of
1
File original & 9 copies 03/29/01
hap0008 04:50 pm 01753-0002-103563
HOUSE AMENDMENT
Bill No. HB 1753 Barcode 103563
Amendment No. ___ (for drafter's use only)
1 federal poverty level, and whose assets do not exceed
2 established limitations.
3 (9) A Medicaid-eligible individual for the
4 individual's health insurance premiums, if the agency
5 determines that such payments are cost-effective.
6 Section 4. Subsection (5) of section 409.905, Florida
7 Statutes, is amended to read:
8 409.905 Mandatory Medicaid services.--The agency may
9 make payments for the following services, which are required
10 of the state by Title XIX of the Social Security Act,
11 furnished by Medicaid providers to recipients who are
12 determined to be eligible on the dates on which the services
13 were provided. Any service under this section shall be
14 provided only when medically necessary and in accordance with
15 state and federal law. Nothing in this section shall be
16 construed to prevent or limit the agency from adjusting fees,
17 reimbursement rates, lengths of stay, number of visits, number
18 of services, or any other adjustments necessary to comply with
19 the availability of moneys and any limitations or directions
20 provided for in the General Appropriations Act or chapter 216.
21 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
22 for all covered services provided for the medical care and
23 treatment of a recipient who is admitted as an inpatient by a
24 licensed physician or dentist to a hospital licensed under
25 part I of chapter 395. However, the agency shall limit the
26 payment for inpatient hospital services for a Medicaid
27 recipient 21 years of age or older to 45 days or the number of
28 days necessary to comply with the General Appropriations Act.
29 (a) The agency is authorized to implement
30 reimbursement and utilization management reforms in order to
31 comply with any limitations or directions in the General
2
File original & 9 copies 03/29/01
hap0008 04:50 pm 01753-0002-103563
HOUSE AMENDMENT
Bill No. HB 1753 Barcode 103563
Amendment No. ___ (for drafter's use only)
1 Appropriations Act, which may include, but are not limited to:
2 prior authorization for inpatient psychiatric days; prior
3 authorization for nonemergency hospital inpatient admissions;
4 enhanced utilization and concurrent review programs for highly
5 utilized services; reduction or elimination of covered days of
6 service; adjusting reimbursement ceilings for variable costs;
7 adjusting reimbursement ceilings for fixed and property costs;
8 and implementing target rates of increase.
9 (b) A licensed hospital maintained primarily for the
10 care and treatment of patients having mental disorders or
11 mental diseases is not eligible to participate in the hospital
12 inpatient portion of the Medicaid program except as provided
13 under in federal law or pursuant to a federally approved
14 waiver. However, the department shall apply for a waiver,
15 within 9 months after June 5, 1991, designed to provide
16 behavioral health hospitalization services for mental health
17 reasons to children and adults in the most cost-effective and
18 lowest cost setting possible. Such waiver shall include a
19 request for the opportunity to pay for care in hospitals known
20 under federal law as "institutions for mental disease" or
21 "IMD's." The behavioral health waiver proposal shall propose
22 no additional aggregate cost to the state or Federal
23 Government, and shall be conducted in Hillsborough County,
24 Highlands County, Hardee County, Manatee County, and Polk
25 County. Implementation of the behavioral health waiver
26 proposal shall not be the basis for adjusting a hospital's
27 Medicaid inpatient or outpatient rate. The waiver proposal may
28 incorporate competitive bidding for hospital services,
29 comprehensive brokering, prepaid capitated arrangements, or
30 other mechanisms deemed by the department to show promise in
31 reducing the cost of acute care and increasing the
3
File original & 9 copies 03/29/01
hap0008 04:50 pm 01753-0002-103563
HOUSE AMENDMENT
Bill No. HB 1753 Barcode 103563
Amendment No. ___ (for drafter's use only)
1 effectiveness of preventive care. When developing The waiver
2 proposal, the department shall take into account price,
3 quality, accessibility, linkages of the hospital to community
4 services and family support programs, plans of the hospital to
5 ensure the earliest discharge possible, and the
6 comprehensiveness of the mental health and other health care
7 services offered by participating providers.
8 (c) The agency for Health Care Administration shall
9 adjust a hospital's current inpatient per diem rate to reflect
10 the cost of serving the Medicaid population at that
11 institution if:
12 1. The hospital experiences an increase in Medicaid
13 caseload by more than 25 percent in any year, primarily
14 resulting from the closure of a hospital in the same service
15 area occurring after July 1, 1995; or
16 2. The hospital's Medicaid per diem rate is at least
17 25 percent below the Medicaid per patient cost for that year.
18
19 No later than November 1, 2000, the agency must provide
20 estimated costs for any adjustment in a hospital inpatient per
21 diem pursuant to this paragraph to the Executive Office of the
22 Governor, the House of Representatives General Appropriations
23 Committee, and the Senate Budget Committee. Before the agency
24 implements a change in a hospital's inpatient per diem rate
25 pursuant to this paragraph, the Legislature must have
26 specifically appropriated sufficient funds in the 2001-2002
27 General Appropriations Act to support the increase in cost as
28 estimated by the agency. This paragraph is repealed on July 1,
29 2001.
30
31
4
File original & 9 copies 03/29/01
hap0008 04:50 pm 01753-0002-103563
HOUSE AMENDMENT
Bill No. HB 1753 Barcode 103563
Amendment No. ___ (for drafter's use only)
1 ================ T I T L E A M E N D M E N T ===============
2 And the title is amended as follows:
3 On page 1, lines 8-15,
4 remove from the title of the bill: all of said lines
5
6 and insert in lieu thereof:
7 amending s. 409.904, F.S.; revising Medicaid
8 eligibility requirements for certain elderly or
9 disabled persons; authorizing payment for
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
5
File original & 9 copies 03/29/01
hap0008 04:50 pm 01753-0002-103563