Senate Bill sb2110c1
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Florida Senate - 2001 CS for SB 2110
By the Committee on Health, Aging and Long-Term Care; and
Senators Silver and Sanderson
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1 A bill to be entitled
2 An act relating to Medicaid; amending s.
3 409.906, F.S.; providing that the agency may
4 restrict or prohibit the provision of services
5 by mobile providers; providing that Medicaid
6 will not provide reimbursement for dental
7 services provided in mobile dental units,
8 except for certain units; providing an
9 effective date.
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11 Be It Enacted by the Legislature of the State of Florida:
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13 Section 1. Section 409.906, Florida Statutes, is
14 amended to read:
15 409.906 Optional Medicaid services.--Subject to
16 specific appropriations, the agency may make payments for
17 services which are optional to the state under Title XIX of
18 the Social Security Act and are furnished by Medicaid
19 providers to recipients who are determined to be eligible on
20 the dates on which the services were provided. Any optional
21 service that is provided shall be provided only when medically
22 necessary and in accordance with state and federal law.
23 Optional services rendered by providers in mobile units to
24 Medicaid recipients may be restricted or prohibited by the
25 agency. Nothing in this section shall be construed to prevent
26 or limit the agency from adjusting fees, reimbursement rates,
27 lengths of stay, number of visits, or number of services, or
28 making any other adjustments necessary to comply with the
29 availability of moneys and any limitations or directions
30 provided for in the General Appropriations Act or chapter 216.
31 If necessary to safeguard the state's systems of providing
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1 services to elderly and disabled persons and subject to the
2 notice and review provisions of s. 216.177, the Governor may
3 direct the Agency for Health Care Administration to amend the
4 Medicaid state plan to delete the optional Medicaid service
5 known as "Intermediate Care Facilities for the Developmentally
6 Disabled." Optional services may include:
7 (1) ADULT DENTURE SERVICES.--The agency may pay for
8 dentures, the procedures required to seat dentures, and the
9 repair and reline of dentures, provided by or under the
10 direction of a licensed dentist, for a recipient who is age 21
11 or older. However, Medicaid will not provide reimbursement for
12 dental services provided in a mobile dental unit, except for a
13 mobile dental unit:
14 (a) Owned or operated by the Department of Health, in
15 compliance with the Medicaid County Health Department Clinic
16 Services program specifications as a County Health Department
17 provider.
18 (b) Owned or operated by or under contract with a
19 Federally Qualified Health Center, in compliance with the
20 Medicaid Federally Qualified Health Center specifications as a
21 Federally Qualified Health Center provider.
22 (c) That provides dental services to Medicaid
23 recipients, age 21 and over, at a nursing facility.
24 (2) ADULT HEALTH SCREENING SERVICES.--The agency may
25 pay for an annual routine physical examination, conducted by
26 or under the direction of a licensed physician, for a
27 recipient age 21 or older, without regard to medical
28 necessity, in order to detect and prevent disease, disability,
29 or other health condition or its progression.
30 (3) AMBULATORY SURGICAL CENTER SERVICES.--The agency
31 may pay for services provided to a recipient in an ambulatory
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1 surgical center licensed under part I of chapter 395, by or
2 under the direction of a licensed physician or dentist.
3 (4) BIRTH CENTER SERVICES.--The agency may pay for
4 examinations and delivery, recovery, and newborn assessment,
5 and related services, provided in a licensed birth center
6 staffed with licensed physicians, certified nurse midwives,
7 and midwives licensed in accordance with chapter 467, to a
8 recipient expected to experience a low-risk pregnancy and
9 delivery.
10 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
11 primary care case management services rendered to a recipient
12 pursuant to a federally approved waiver, and targeted case
13 management services for specific groups of targeted
14 recipients, for which funding has been provided and which are
15 rendered pursuant to federal guidelines. The agency is
16 authorized to limit reimbursement for targeted case management
17 services in order to comply with any limitations or directions
18 provided for in the General Appropriations Act.
19 Notwithstanding s. 216.292, the Department of Children and
20 Family Services may transfer general funds to the Agency for
21 Health Care Administration to fund state match requirements
22 exceeding the amount specified in the General Appropriations
23 Act for targeted case management services.
24 (6) CHILDREN'S DENTAL SERVICES.--The agency may pay
25 for diagnostic, preventive, or corrective procedures,
26 including orthodontia in severe cases, provided to a recipient
27 under age 21, by or under the supervision of a licensed
28 dentist. Services provided under this program include
29 treatment of the teeth and associated structures of the oral
30 cavity, as well as treatment of disease, injury, or impairment
31 that may affect the oral or general health of the individual.
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1 However, Medicaid will not provide reimbursement for dental
2 services provided in a mobile dental unit, except for a mobile
3 dental unit:
4 (a) Owned or operated by the Department of Health, in
5 compliance with the Medicaid County Health Department Clinic
6 Services program specifications as a County Health Department
7 provider.
8 (b) Owned or operated by or under contract with a
9 Federally Qualified Health Center, in compliance with the
10 Medicaid Federally Qualified Health Center specifications as a
11 Federally Qualified Health Center provider.
12 (c) That provides dental services to Medicaid
13 recipients, age 21 and over, at a nursing facility.
14 (7) CHIROPRACTIC SERVICES.--The agency may pay for
15 manual manipulation of the spine and initial services,
16 screening, and X rays provided to a recipient by a licensed
17 chiropractic physician.
18 (8) COMMUNITY MENTAL HEALTH SERVICES.--The agency may
19 pay for rehabilitative services provided to a recipient by a
20 mental health or substance abuse provider licensed by the
21 agency and under contract with the agency or the Department of
22 Children and Family Services to provide such services. Those
23 services which are psychiatric in nature shall be rendered or
24 recommended by a psychiatrist, and those services which are
25 medical in nature shall be rendered or recommended by a
26 physician or psychiatrist. The agency must develop a provider
27 enrollment process for community mental health providers which
28 bases provider enrollment on an assessment of service need.
29 The provider enrollment process shall be designed to control
30 costs, prevent fraud and abuse, consider provider expertise
31 and capacity, and assess provider success in managing
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1 utilization of care and measuring treatment outcomes.
2 Providers will be selected through a competitive procurement
3 or selective contracting process. In addition to other
4 community mental health providers, the agency shall consider
5 for enrollment mental health programs licensed under chapter
6 395 and group practices licensed under chapter 458, chapter
7 459, chapter 490, or chapter 491. The agency is also
8 authorized to continue operation of its behavioral health
9 utilization management program and may develop new services if
10 these actions are necessary to ensure savings from the
11 implementation of the utilization management system. The
12 agency shall coordinate the implementation of this enrollment
13 process with the Department of Children and Family Services
14 and the Department of Juvenile Justice. The agency is
15 authorized to utilize diagnostic criteria in setting
16 reimbursement rates, to preauthorize certain high-cost or
17 highly utilized services, to limit or eliminate coverage for
18 certain services, or to make any other adjustments necessary
19 to comply with any limitations or directions provided for in
20 the General Appropriations Act.
21 (9) DIALYSIS FACILITY SERVICES.--Subject to specific
22 appropriations being provided for this purpose, the agency may
23 pay a dialysis facility that is approved as a dialysis
24 facility in accordance with Title XVIII of the Social Security
25 Act, for dialysis services that are provided to a Medicaid
26 recipient under the direction of a physician licensed to
27 practice medicine or osteopathic medicine in this state,
28 including dialysis services provided in the recipient's home
29 by a hospital-based or freestanding dialysis facility.
30 (10) DURABLE MEDICAL EQUIPMENT.--The agency may
31 authorize and pay for certain durable medical equipment and
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1 supplies provided to a Medicaid recipient as medically
2 necessary.
3 (11) HEALTHY START SERVICES.--The agency may pay for a
4 continuum of risk-appropriate medical and psychosocial
5 services for the Healthy Start program in accordance with a
6 federal waiver. The agency may not implement the federal
7 waiver unless the waiver permits the state to limit enrollment
8 or the amount, duration, and scope of services to ensure that
9 expenditures will not exceed funds appropriated by the
10 Legislature or available from local sources. If the Health
11 Care Financing Administration does not approve a federal
12 waiver for Healthy Start services, the agency, in consultation
13 with the Department of Health and the Florida Association of
14 Healthy Start Coalitions, is authorized to establish a
15 Medicaid certified-match program for Healthy Start services.
16 Participation in the Healthy Start certified-match program
17 shall be voluntary, and reimbursement shall be limited to the
18 federal Medicaid share to Medicaid-enrolled Healthy Start
19 coalitions for services provided to Medicaid recipients. The
20 agency shall take no action to implement a certified-match
21 program without ensuring that the amendment and review
22 requirements of ss. 216.177 and 216.181 have been met.
23 (12) HEARING SERVICES.--The agency may pay for hearing
24 and related services, including hearing evaluations, hearing
25 aid devices, dispensing of the hearing aid, and related
26 repairs, if provided to a recipient by a licensed hearing aid
27 specialist, otolaryngologist, otologist, audiologist, or
28 physician.
29 (13) HOME AND COMMUNITY-BASED SERVICES.--The agency
30 may pay for home-based or community-based services that are
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1 rendered to a recipient in accordance with a federally
2 approved waiver program.
3 (14) HOSPICE CARE SERVICES.--The agency may pay for
4 all reasonable and necessary services for the palliation or
5 management of a recipient's terminal illness, if the services
6 are provided by a hospice that is licensed under part VI of
7 chapter 400 and meets Medicare certification requirements.
8 (15) INTERMEDIATE CARE FACILITY FOR THE
9 DEVELOPMENTALLY DISABLED SERVICES.--The agency may pay for
10 health-related care and services provided on a 24-hour-a-day
11 basis by a facility licensed and certified as a Medicaid
12 Intermediate Care Facility for the Developmentally Disabled,
13 for a recipient who needs such care because of a developmental
14 disability.
15 (16) INTERMEDIATE CARE SERVICES.--The agency may pay
16 for 24-hour-a-day intermediate care nursing and rehabilitation
17 services rendered to a recipient in a nursing facility
18 licensed under part II of chapter 400, if the services are
19 ordered by and provided under the direction of a physician.
20 (17) OPTOMETRIC SERVICES.--The agency may pay for
21 services provided to a recipient, including examination,
22 diagnosis, treatment, and management, related to ocular
23 pathology, if the services are provided by a licensed
24 optometrist or physician.
25 (18) PHYSICIAN ASSISTANT SERVICES.--The agency may pay
26 for all services provided to a recipient by a physician
27 assistant licensed under s. 458.347 or s. 459.022.
28 Reimbursement for such services must be not less than 80
29 percent of the reimbursement that would be paid to a physician
30 who provided the same services.
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1 (19) PODIATRIC SERVICES.--The agency may pay for
2 services, including diagnosis and medical, surgical,
3 palliative, and mechanical treatment, related to ailments of
4 the human foot and lower leg, if provided to a recipient by a
5 podiatric physician licensed under state law.
6 (20) PRESCRIBED DRUG SERVICES.--The agency may pay for
7 medications that are prescribed for a recipient by a physician
8 or other licensed practitioner of the healing arts authorized
9 to prescribe medications and that are dispensed to the
10 recipient by a licensed pharmacist or physician in accordance
11 with applicable state and federal law.
12 (21) REGISTERED NURSE FIRST ASSISTANT SERVICES.--The
13 agency may pay for all services provided to a recipient by a
14 registered nurse first assistant as described in s. 464.027.
15 Reimbursement for such services may not be less than 80
16 percent of the reimbursement that would be paid to a physician
17 providing the same services.
18 (22) STATE HOSPITAL SERVICES.--The agency may pay for
19 all-inclusive psychiatric inpatient hospital care provided to
20 a recipient age 65 or older in a state mental hospital.
21 (23) VISUAL SERVICES.--The agency may pay for visual
22 examinations, eyeglasses, and eyeglass repairs for a
23 recipient, if they are prescribed by a licensed physician
24 specializing in diseases of the eye or by a licensed
25 optometrist.
26 (24) CHILD-WELFARE-TARGETED CASE MANAGEMENT.--The
27 Agency for Health Care Administration, in consultation with
28 the Department of Children and Family Services, may establish
29 a targeted case-management pilot project in those counties
30 identified by the Department of Children and Family Services
31 and for the community-based child welfare project in Sarasota
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1 and Manatee counties, as authorized under s. 409.1671. These
2 projects shall be established for the purpose of determining
3 the impact of targeted case management on the child welfare
4 program and the earnings from the child welfare program.
5 Results of the pilot projects shall be reported to the Child
6 Welfare Estimating Conference and the Social Services
7 Estimating Conference established under s. 216.136. The number
8 of projects may not be increased until requested by the
9 Department of Children and Family Services, recommended by the
10 Child Welfare Estimating Conference and the Social Services
11 Estimating Conference, and approved by the Legislature. The
12 covered group of individuals who are eligible to receive
13 targeted case management include children who are eligible for
14 Medicaid; who are between the ages of birth through 21; and
15 who are under protective supervision or postplacement
16 supervision, under foster-care supervision, or in shelter care
17 or foster care. The number of individuals who are eligible to
18 receive targeted case management shall be limited to the
19 number for whom the Department of Children and Family Services
20 has available matching funds to cover the costs. The general
21 revenue funds required to match the funds for services
22 provided by the community-based child welfare projects are
23 limited to funds available for services described under s.
24 409.1671. The Department of Children and Family Services may
25 transfer the general revenue matching funds as billed by the
26 Agency for Health Care Administration.
27 Section 2. This act shall take effect July 1, 2001.
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Florida Senate - 2001 CS for SB 2110
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 2110
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4 The Committee Substitute authorizes the Agency for Health Care
Administration to restrict or prohibit reimbursement for
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units.
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