SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
CHAMBER ACTION
Senate House
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11 Senator Silver moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 1, line 12,
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16 insert:
17 Section 1. Section 409.905, Florida Statutes, is
18 amended to read:
19 409.905 Mandatory Medicaid services.--The agency may
20 make payments for the following services, which are required
21 of the state by Title XIX of the Social Security Act,
22 furnished by Medicaid providers to recipients who are
23 determined to be eligible on the dates on which the services
24 were provided. Any service under this section shall be
25 provided only when medically necessary and in accordance with
26 state and federal law. Mandatory services rendered by
27 providers in mobile units to Medicaid recipients may be
28 restricted by the agency. Nothing in this section shall be
29 construed to prevent or limit the agency from adjusting fees,
30 reimbursement rates, lengths of stay, number of visits, number
31 of services, or any other adjustments necessary to comply with
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SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
1 the availability of moneys and any limitations or directions
2 provided for in the General Appropriations Act or chapter 216.
3 (1) ADVANCED REGISTERED NURSE PRACTITIONER
4 SERVICES.--The agency shall pay for services provided to a
5 recipient by a licensed advanced registered nurse practitioner
6 who has a valid collaboration agreement with a licensed
7 physician on file with the Department of Health or who
8 provides anesthesia services in accordance with established
9 protocol required by state law and approved by the medical
10 staff of the facility in which the anesthetic service is
11 performed. Reimbursement for such services must be provided in
12 an amount that equals not less than 80 percent of the
13 reimbursement to a physician who provides the same services,
14 unless otherwise provided for in the General Appropriations
15 Act.
16 (2) EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND
17 TREATMENT SERVICES.--The agency shall pay for early and
18 periodic screening and diagnosis of a recipient under age 21
19 to ascertain physical and mental problems and conditions and
20 provide treatment to correct or ameliorate these problems and
21 conditions. These services include all services determined by
22 the agency to be medically necessary for the treatment,
23 correction, or amelioration of these problems, including
24 personal care, private duty nursing, durable medical
25 equipment, physical therapy, occupational therapy, speech
26 therapy, respiratory therapy, and immunizations.
27 (3) FAMILY PLANNING SERVICES.--The agency shall pay
28 for services necessary to enable a recipient voluntarily to
29 plan family size or to space children. These services include
30 information; education; counseling regarding the availability,
31 benefits, and risks of each method of pregnancy prevention;
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SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
1 drugs and supplies; and necessary medical care and followup.
2 Each recipient participating in the family planning portion of
3 the Medicaid program must be provided freedom to choose any
4 alternative method of family planning, as required by federal
5 law.
6 (4) HOME HEALTH CARE SERVICES.--The agency shall pay
7 for nursing and home health aide services, supplies,
8 appliances, and durable medical equipment, necessary to assist
9 a recipient living at home. An entity that provides services
10 pursuant to this subsection shall be licensed under part IV of
11 chapter 400 or part II of chapter 499, if appropriate. These
12 services, equipment, and supplies, or reimbursement therefor,
13 may be limited as provided in the General Appropriations Act
14 and do not include services, equipment, or supplies provided
15 to a person residing in a hospital or nursing facility. In
16 providing home health care services, the agency may require
17 prior authorization of care based on diagnosis.
18 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
19 for all covered services provided for the medical care and
20 treatment of a recipient who is admitted as an inpatient by a
21 licensed physician or dentist to a hospital licensed under
22 part I of chapter 395. However, the agency shall limit the
23 payment for inpatient hospital services for a Medicaid
24 recipient 21 years of age or older to 45 days or the number of
25 days necessary to comply with the General Appropriations Act.
26 (a) The agency is authorized to implement
27 reimbursement and utilization management reforms in order to
28 comply with any limitations or directions in the General
29 Appropriations Act, which may include, but are not limited to:
30 prior authorization for inpatient psychiatric days; enhanced
31 utilization and concurrent review programs for highly utilized
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SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
1 services; reduction or elimination of covered days of service;
2 adjusting reimbursement ceilings for variable costs; adjusting
3 reimbursement ceilings for fixed and property costs; and
4 implementing target rates of increase.
5 (b) A licensed hospital maintained primarily for the
6 care and treatment of patients having mental disorders or
7 mental diseases is not eligible to participate in the hospital
8 inpatient portion of the Medicaid program except as provided
9 in federal law. However, the department shall apply for a
10 waiver, within 9 months after June 5, 1991, designed to
11 provide hospitalization services for mental health reasons to
12 children and adults in the most cost-effective and lowest cost
13 setting possible. Such waiver shall include a request for the
14 opportunity to pay for care in hospitals known under federal
15 law as "institutions for mental disease" or "IMD's." The
16 waiver proposal shall propose no additional aggregate cost to
17 the state or Federal Government, and shall be conducted in
18 Hillsborough County, Highlands County, Hardee County, Manatee
19 County, and Polk County. The waiver proposal may incorporate
20 competitive bidding for hospital services, comprehensive
21 brokering, prepaid capitated arrangements, or other mechanisms
22 deemed by the department to show promise in reducing the cost
23 of acute care and increasing the effectiveness of preventive
24 care. When developing the waiver proposal, the department
25 shall take into account price, quality, accessibility,
26 linkages of the hospital to community services and family
27 support programs, plans of the hospital to ensure the earliest
28 discharge possible, and the comprehensiveness of the mental
29 health and other health care services offered by participating
30 providers.
31 (c) Agency for Health Care Administration shall adjust
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SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
1 a hospital's current inpatient per diem rate to reflect the
2 cost of serving the Medicaid population at that institution
3 if:
4 1. The hospital experiences an increase in Medicaid
5 caseload by more than 25 percent in any year, primarily
6 resulting from the closure of a hospital in the same service
7 area occurring after July 1, 1995; or
8 2. The hospital's Medicaid per diem rate is at least
9 25 percent below the Medicaid per patient cost for that year.
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11 No later than November 1, 2000, the agency must provide
12 estimated costs for any adjustment in a hospital inpatient per
13 diem pursuant to this paragraph to the Executive Office of the
14 Governor, the House of Representatives General Appropriations
15 Committee, and the Senate Budget Committee. Before the agency
16 implements a change in a hospital's inpatient per diem rate
17 pursuant to this paragraph, the Legislature must have
18 specifically appropriated sufficient funds in the 2001-2002
19 General Appropriations Act to support the increase in cost as
20 estimated by the agency. This paragraph is repealed on July 1,
21 2001.
22 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
23 pay for preventive, diagnostic, therapeutic, or palliative
24 care and other services provided to a recipient in the
25 outpatient portion of a hospital licensed under part I of
26 chapter 395, and provided under the direction of a licensed
27 physician or licensed dentist, except that payment for such
28 care and services is limited to $1,500 per state fiscal year
29 per recipient, unless an exception has been made by the
30 agency, and with the exception of a Medicaid recipient under
31 age 21, in which case the only limitation is medical
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SENATE AMENDMENT
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Amendment No. ___ Barcode 465908
1 necessity.
2 (7) INDEPENDENT LABORATORY SERVICES.--The agency shall
3 pay for medically necessary diagnostic laboratory procedures
4 ordered by a licensed physician or other licensed practitioner
5 of the healing arts which are provided for a recipient in a
6 laboratory that meets the requirements for Medicare
7 participation and is licensed under chapter 483, if required.
8 (8) NURSING FACILITY SERVICES.--The agency shall pay
9 for 24-hour-a-day nursing and rehabilitative services for a
10 recipient in a nursing facility licensed under part II of
11 chapter 400 or in a rural hospital, as defined in s. 395.602,
12 or in a Medicare certified skilled nursing facility operated
13 by a hospital, as defined by s. 395.002(11), that is licensed
14 under part I of chapter 395, and in accordance with provisions
15 set forth in s. 409.908(2)(a), which services are ordered by
16 and provided under the direction of a licensed physician.
17 However, if a nursing facility has been destroyed or otherwise
18 made uninhabitable by natural disaster or other emergency and
19 another nursing facility is not available, the agency must pay
20 for similar services temporarily in a hospital licensed under
21 part I of chapter 395 provided federal funding is approved and
22 available.
23 (9) PHYSICIAN SERVICES.--The agency shall pay for
24 covered services and procedures rendered to a recipient by, or
25 under the personal supervision of, a person licensed under
26 state law to practice medicine or osteopathic medicine. These
27 services may be furnished in the physician's office, the
28 Medicaid recipient's home, a hospital, a nursing facility, or
29 elsewhere, but shall be medically necessary for the treatment
30 of an injury, illness, or disease within the scope of the
31 practice of medicine or osteopathic medicine as defined by
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SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
1 state law. The agency shall not pay for services that are
2 clinically unproven, experimental, or for purely cosmetic
3 purposes.
4 (10) PORTABLE X-RAY SERVICES.--The agency shall pay
5 for professional and technical portable radiological services
6 ordered by a licensed physician or other licensed practitioner
7 of the healing arts which are provided by a licensed
8 professional in a setting other than a hospital, clinic, or
9 office of a physician or practitioner of the healing arts, on
10 behalf of a recipient.
11 (11) RURAL HEALTH CLINIC SERVICES.--The agency shall
12 pay for outpatient primary health care services for a
13 recipient provided by a clinic certified by and participating
14 in the Medicare program which is located in a federally
15 designated, rural, medically underserved area and has on its
16 staff one or more licensed primary care nurse practitioners or
17 physician assistants, and a licensed staff supervising
18 physician or a consulting supervising physician.
19 (12) TRANSPORTATION SERVICES.--The agency shall ensure
20 that appropriate transportation services are available for a
21 Medicaid recipient in need of transport to a qualified
22 Medicaid provider for medically necessary and
23 Medicaid-compensable services, provided a client's ability to
24 choose a specific transportation provider shall be limited to
25 those options resulting from policies established by the
26 agency to meet the fiscal limitations of the General
27 Appropriations Act. The agency may pay for transportation and
28 other related travel expenses as necessary only if these
29 services are not otherwise available.
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31 (Redesignate subsequent sections.)
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SENATE AMENDMENT
Bill No. CS for SB 2110
Amendment No. ___ Barcode 465908
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, line 2, delete that line
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5 and insert:
6 An act relating to Medicaid services; amending
7 s. 409.905, F.S.; providing that the Agency for
8 Health Care Administration may restrict the
9 provision of mandatory services by mobile
10 providers; amending s.
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