House Bill hb1577

CODING: Words stricken are deletions; words underlined are additions.




    Florida House of Representatives - 2002                HB 1577

        By Representative Frankel






  1                      A bill to be entitled

  2         An act relating to Medicaid; amending s.

  3         409.904, F.S.; revising standards for

  4         eligibility for certain optional medical

  5         assistance; amending s. 409.906, F.S.; revising

  6         guidelines for payment for certain services;

  7         revising eligibility for certain Medicaid

  8         services; amending s. 409.9065, F.S.; removing

  9         certain limitations on enrollment levels with

10         respect to pharmaceutical expense assistance;

11         amending s. 409.815, F.S.; correcting a cross

12         reference; repealing s. 1 of ch. 2001-377, Laws

13         of Florida, relating to eligibility of

14         specified persons for certain optional medical

15         assistance; providing an effective date.

16  

17  Be It Enacted by the Legislature of the State of Florida:

18  

19         Section 1.  Subsections (1) and (2) of section 409.904,

20  Florida Statutes, are amended 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 100 88 percent of

31  

                                  1

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2002                HB 1577

    115-224-02






  1  federal poverty level, and whose assets do not exceed

  2  established limitations.

  3         (2)  A family, a pregnant woman, a child under age 18,

  4  a person age 65 or over, or a blind or disabled person who

  5  would be eligible under any group listed in s. 409.903(1),

  6  (2), or (3), except that the income or assets of such family

  7  or person exceed established limitations.

  8         (a)  A pregnant woman who would otherwise qualify for

  9  Medicaid under s. 409.903(5) except for her level of income

10  and whose assets fall within the limits established by the

11  Department of Children and Family Services for the medically

12  needy.  A pregnant woman who applies for medically needy

13  eligibility may not be made presumptively eligible.

14         (b)  A child under age 21 who would otherwise qualify

15  for Medicaid or the Florida Kidcare program except for the

16  family's level of income and whose assets fall within the

17  limits established by the Department of Children and Family

18  Services for the medically needy.

19  

20  For a family or person in this group, medical expenses are

21  deductible from income in accordance with federal requirements

22  in order to make a determination of eligibility.  A family or

23  person in this group, which group is known as the "medically

24  needy," is eligible to receive the same services as other

25  Medicaid recipients, with the exception of services in skilled

26  nursing facilities and intermediate care facilities for the

27  developmentally disabled.

28         Section 2.  Subsections (1), (12), and (23) of section

29  409.906, Florida Statutes, are amended to read:

30         409.906  Optional Medicaid services.--Subject to

31  specific appropriations, the agency may make payments for

                                  2

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2002                HB 1577

    115-224-02






  1  services which are optional to the state under Title XIX of

  2  the Social Security Act and are furnished by Medicaid

  3  providers to recipients who are determined to be eligible on

  4  the dates on which the services were provided.  Any optional

  5  service that is provided shall be provided only when medically

  6  necessary and in accordance with state and federal law.

  7  Optional services rendered by providers in mobile units to

  8  Medicaid recipients may be restricted or prohibited by the

  9  agency. Nothing in this section shall be construed to prevent

10  or limit the agency from adjusting fees, reimbursement rates,

11  lengths of stay, number of visits, or number of services, or

12  making any other adjustments necessary to comply with the

13  availability of moneys and any limitations or directions

14  provided for in the General Appropriations Act or chapter 216.

15  If necessary to safeguard the state's systems of providing

16  services to elderly and disabled persons and subject to the

17  notice and review provisions of s. 216.177, the Governor may

18  direct the Agency for Health Care Administration to amend the

19  Medicaid state plan to delete the optional Medicaid service

20  known as "Intermediate Care Facilities for the Developmentally

21  Disabled."  Optional services may include:

22         (1)  ADULT DENTURE SERVICES.--The agency may pay for

23  dentures, the procedures required to seat dentures, and the

24  repair and reline of dentures, provided by or under the

25  direction of a licensed dentist, for a recipient who is age 21

26  or older. However, Medicaid will not provide reimbursement for

27  dental services provided in a mobile dental unit, except for a

28  mobile dental unit:

29         (a)  Owned by, operated by, or having a contractual

30  agreement with the Department of Health and complying with

31  Medicaid's county health department clinic services program

                                  3

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2002                HB 1577

    115-224-02






  1  specifications as a county health department clinic services

  2  provider.

  3         (b)  Owned by, operated by, or having a contractual

  4  arrangement with a federally qualified health center and

  5  complying with Medicaid's federally qualified health center

  6  specifications as a federally qualified health center

  7  provider.

  8         (c)  Rendering dental services to Medicaid recipients,

  9  21 years of age and older, at nursing facilities.

10         (d)  Owned by, operated by, or having a contractual

11  agreement with a state-approved dental educational

12  institution.

13         (e)  This subsection is repealed July 1, 2002.

14         (12)  CHILDREN'S HEARING SERVICES.--The agency may pay

15  for hearing and related services, including hearing

16  evaluations, hearing aid devices, dispensing of the hearing

17  aid, and related repairs, if provided to a recipient under age

18  21 by a licensed hearing aid specialist, otolaryngologist,

19  otologist, audiologist, or physician.

20         (13)  HOME AND COMMUNITY-BASED SERVICES.--The agency

21  may pay for home-based or community-based services that are

22  rendered to a recipient in accordance with a federally

23  approved waiver program. The agency may limit or eliminate

24  coverage for certain Project AIDS Care Waiver services,

25  preauthorize high-cost or highly utilized services, or make

26  any other adjustments necessary to comply with any limitations

27  or directions provided for in the General Appropriations Act.

28         (23)  CHILDREN'S VISUAL SERVICES.--The agency may pay

29  for visual examinations, eyeglasses, and eyeglass repairs for

30  a recipient under age 21, if they are prescribed by a licensed

31  

                                  4

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2002                HB 1577

    115-224-02






  1  physician specializing in diseases of the eye or by a licensed

  2  optometrist.

  3         Section 3.  Subsections (3) and (5) of section

  4  409.9065, Florida Statutes, are amended to read:

  5         409.9065  Pharmaceutical expense assistance.--

  6         (3)  BENEFITS.--Medications covered under the

  7  pharmaceutical expense assistance program are those covered

  8  under the Medicaid program in s. 409.906(20)(19). Monthly

  9  benefit payments shall be limited to $80 per program

10  participant. Participants are required to make a 10-percent

11  coinsurance payment for each prescription purchased through

12  this program.

13         (5)  NONENTITLEMENT.--The pharmaceutical expense

14  assistance program established by this section is not an

15  entitlement. Enrollment levels are limited to those authorized

16  by the Legislature in the annual General Appropriations Act.

17  If funds are insufficient to serve all individuals eligible

18  under subsection (2) and seeking coverage, the agency may

19  develop a waiting list based on application dates to use in

20  enrolling individuals in unfilled enrollment slots.

21         Section 4.  Paragraph (q) of subsection (2) of section

22  409.815, Florida Statutes, is amended to read:

23         409.815  Health benefits coverage; limitations.--

24         (2)  BENCHMARK BENEFITS.--In order for health benefits

25  coverage to qualify for premium assistance payments for an

26  eligible child under ss. 409.810-409.820, the health benefits

27  coverage, except for coverage under Medicaid and Medikids,

28  must include the following minimum benefits, as medically

29  necessary.

30         (q)  Dental services.--Subject to a specific

31  appropriation for this benefit, covered services include those

                                  5

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2002                HB 1577

    115-224-02






  1  dental services provided to children by the Florida Medicaid

  2  program under s. 409.906(6)(5).

  3         Section 5.  Section 1 of chapter 2001-377, Laws of

  4  Florida, is repealed.

  5         Section 6.  This act shall take effect upon becoming a

  6  law.

  7  

  8            *****************************************

  9                          HOUSE SUMMARY

10  
      Reverses changes to Medicaid law enacted in Special
11    Session C, 2001, relating to eligibility standards for
      optional medical assistance for certain families and
12    elderly persons, eligibility for specified optional
      Medicaid services, guidelines for payment for certain
13    optional Medicaid services, and limitations on enrollment
      levels for Medicaid pharmaceutical expense assistance.
14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  6

CODING: Words stricken are deletions; words underlined are additions.