SENATE AMENDMENT
    Bill No. CS for SB 2110
    Amendment No. ___   Barcode 465908
                            CHAMBER ACTION
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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; 2 1:36 PM 04/17/01 s2110c1c-38j01
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 3 1:36 PM 04/17/01 s2110c1c-38j01
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 4 1:36 PM 04/17/01 s2110c1c-38j01
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. 10 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 5 1:36 PM 04/17/01 s2110c1c-38j01
SENATE AMENDMENT Bill No. CS for SB 2110 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 6 1:36 PM 04/17/01 s2110c1c-38j01
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. 30 31 (Redesignate subsequent sections.) 7 1:36 PM 04/17/01 s2110c1c-38j01
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 4 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. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 8 1:36 PM 04/17/01 s2110c1c-38j01