HOUSE AMENDMENT
dhs-21 Bill No. HB 1753 Barcode 242285
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
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11 Representative(s) Maygarden offered the following:
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13 Amendment (with title amendment)
14 On page 5, line 12, through page 9, line 24,
15 remove from the bill: all of said lines
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17 and insert in lieu thereof:
18 Section 3. Subsection (1) of section 409.904, Florida
19 Statutes, is amended, and subsection (9) is added to said
20 section, to read:
21 409.904 Optional payments for eligible persons.--The
22 agency may make payments for medical assistance and related
23 services on behalf of the following persons who are determined
24 to be eligible subject to the income, assets, and categorical
25 eligibility tests set forth in federal and state law. Payment
26 on behalf of these Medicaid-eligible persons is subject to the
27 availability of moneys and any limitations established by the
28 General Appropriations Act or chapter 216.
29 (1) A person who is age 65 or older or is determined
30 to be disabled, whose income is at or below 90 100 percent of
31 federal poverty level, and whose assets do not exceed
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HOUSE AMENDMENT
dhs-21 Bill No. HB 1753 Barcode 242285
Amendment No. ___ (for drafter's use only)
1 established limitations.
2 (9) A Medicaid-eligible individual for the
3 individual's health insurance premiums, if the agency
4 determines that such payments are cost-effective.
5 Section 4. Subsection (5) of section 409.905, Florida
6 Statutes, is amended to read:
7 409.905 Mandatory Medicaid services.--The agency may
8 make payments for the following services, which are required
9 of the state by Title XIX of the Social Security Act,
10 furnished by Medicaid providers to recipients who are
11 determined to be eligible on the dates on which the services
12 were provided. Any service under this section shall be
13 provided only when medically necessary and in accordance with
14 state and federal law. Nothing in this section shall be
15 construed to prevent or limit the agency from adjusting fees,
16 reimbursement rates, lengths of stay, number of visits, number
17 of services, or any other adjustments necessary to comply with
18 the availability of moneys and any limitations or directions
19 provided for in the General Appropriations Act or chapter 216.
20 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
21 for all covered services provided for the medical care and
22 treatment of a recipient who is admitted as an inpatient by a
23 licensed physician or dentist to a hospital licensed under
24 part I of chapter 395. However, the agency shall limit the
25 payment for inpatient hospital services for a Medicaid
26 recipient 21 years of age or older to 45 days or the number of
27 days necessary to comply with the General Appropriations Act.
28 (a) The agency is authorized to implement
29 reimbursement and utilization management reforms in order to
30 comply with any limitations or directions in the General
31 Appropriations Act, which may include, but are not limited to:
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HOUSE AMENDMENT
dhs-21 Bill No. HB 1753 Barcode 242285
Amendment No. ___ (for drafter's use only)
1 prior authorization for inpatient psychiatric days; prior
2 authorization for nonemergency hospital inpatient admissions;
3 enhanced utilization and concurrent review programs for highly
4 utilized services; reduction or elimination of covered days of
5 service; adjusting reimbursement ceilings for variable costs;
6 adjusting reimbursement ceilings for fixed and property costs;
7 and implementing target rates of increase.
8 (b) A licensed hospital maintained primarily for the
9 care and treatment of patients having mental disorders or
10 mental diseases is not eligible to participate in the hospital
11 inpatient portion of the Medicaid program except as provided
12 under in federal law or pursuant to a federally approved
13 waiver. However, the department shall apply for a waiver,
14 within 9 months after June 5, 1991, designed to provide
15 behavioral health hospitalization services for mental health
16 reasons to children and adults in the most cost-effective and
17 lowest cost setting possible. Such waiver shall include a
18 request for the opportunity to pay for care in hospitals known
19 under federal law as "institutions for mental disease" or
20 "IMD's." The behavioral health waiver proposal shall propose
21 no additional aggregate cost to the state or Federal
22 Government, and shall be conducted in Hillsborough County,
23 Highlands County, Hardee County, Manatee County, and Polk
24 County. Implementation of the behavioral health waiver
25 proposal shall not be the basis for adjusting a hospital's
26 Medicaid inpatient or outpatient rate. The waiver proposal may
27 incorporate competitive bidding for hospital services,
28 comprehensive brokering, prepaid capitated arrangements, or
29 other mechanisms deemed by the department to show promise in
30 reducing the cost of acute care and increasing the
31 effectiveness of preventive care. When developing The waiver
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hbd0011 05:14 pm 01753-0002-242285
HOUSE AMENDMENT
dhs-21 Bill No. HB 1753 Barcode 242285
Amendment No. ___ (for drafter's use only)
1 proposal, the department shall take into account price,
2 quality, accessibility, linkages of the hospital to community
3 services and family support programs, plans of the hospital to
4 ensure the earliest discharge possible, and the
5 comprehensiveness of the mental health and other health care
6 services offered by participating providers.
7 (c) The agency for Health Care Administration shall
8 adjust a hospital's current inpatient per diem rate to reflect
9 the cost of serving the Medicaid population at that
10 institution if:
11 1. The hospital experiences an increase in Medicaid
12 caseload by more than 25 percent in any year, primarily
13 resulting from the closure of a hospital in the same service
14 area occurring after July 1, 1995; or
15 2. The hospital's Medicaid per diem rate is at least
16 25 percent below the Medicaid per patient cost for that year.
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18 No later than November 1, 2000, the agency must provide
19 estimated costs for any adjustment in a hospital inpatient per
20 diem pursuant to this paragraph to the Executive Office of the
21 Governor, the House of Representatives General Appropriations
22 Committee, and the Senate Budget Committee. Before the agency
23 implements a change in a hospital's inpatient per diem rate
24 pursuant to this paragraph, the Legislature must have
25 specifically appropriated sufficient funds in the 2001-2002
26 General Appropriations Act to support the increase in cost as
27 estimated by the agency. This paragraph is repealed on July 1,
28 2001.
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HOUSE AMENDMENT
dhs-21 Bill No. HB 1753 Barcode 242285
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
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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
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File original & 9 copies 03/26/01
hbd0011 05:14 pm 01753-0002-242285