HOUSE AMENDMENT Bill No. SB 1252
1	CHAMBER ACTION
2	Senate House
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12	Representatives Green, Gelber, and Goodlette offered the
13	following:
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15	Amendment (with title amendment)
16	On page 29, lines 14-18,
17	remove: all of said lines
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19	and insert:
20	Administration to implement section 13 of this act during the
21	2002-2003 fiscal year. This section takes effect May 1, 2003.
22	Section 15. Section 430.83, Florida Statutes, is created
23	to read:
24	430.83 Sunshine for Seniors Program.--
25	(1) POPULAR NAME.--This section shall be known by the
26	popular name "The Sunshine for Seniors Act."
27	(2) DEFINITIONS.--As used in this section, the term:
28	(a) "Application assistance organization" means any
29	private organization that assists individuals with obtaining
30	prescription drugs through manufacturers’ pharmaceutical
31	assistance programs.
32	(b) "Eligible individual" means any individual who is 60
33	years of age or older who lacks adequate pharmaceutical
34	insurance coverage.
35	(c) "Manufacturers’ pharmaceutical assistance program"
36	means any program offered by a pharmaceutical manufacturer that
37	provides low-income individuals with prescription drugs free or
38	at reduced prices, including, but not limited to, senior
39	discount card programs and patient assistance programs.
40	(3) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
41	finds that the pharmaceutical manufacturers, seeing a need, have
42	created charitable programs to aid low-income seniors with the
43	cost of prescription drugs. The Legislature also finds that many
44	low-income seniors are unaware of such programs or either do not
45	know how to apply for or need assistance in completing the
46	applications for such programs. Therefore, it is the intent of
47	the Legislature that the Department of Elderly Affairs, in
48	consultation with the Agency for Health Care Administration,
49	implement and oversee the Sunshine for Seniors Program to help
50	seniors in accessing manufacturers’ pharmaceutical assistance
51	programs.
52	(4) SUNSHINE FOR SENIORS PROGRAM.--There is established a
53	program to assist low-income seniors with obtaining prescription
54	drugs from manufacturers’ pharmaceutical assistance programs,
55	which shall be known as the "Sunshine for Seniors Program."
56	Implementation of the program is subject to the availability of
57	funding and any limitations or directions provided for by the
58	General Appropriations Act or chapter 216.
59	(5) IMPLEMENTATION AND OVERSIGHT DUTIES.--In implementing
60	and overseeing the Sunshine for Seniors Program, the Department
61	of Elderly Affairs:
62	(a) Shall promote the availability of manufacturers’
63	pharmaceutical assistance programs to eligible individuals with
64	various outreach initiatives.
65	(b) Shall, working cooperatively with pharmaceutical
66	manufacturers and consumer advocates, develop a uniform
67	application form, which shall be available in English, Spanish,
68	and Creole, to be completed by seniors who wish to participate
69	in the Sunshine for Seniors Program.
70	(c) May request proposals from application assistance
71	organizations to assist eligible individuals with obtaining
72	prescription drugs through manufacturers’ pharmaceutical
73	assistance programs.
74	(d) Shall train volunteers to help eligible individuals
75	fill out applications for the manufacturers’ pharmaceutical
76	assistance programs.
77	(e) Shall train volunteers to determine if applicants are
78	available for other state programs.
79	(f) Shall seek federal funds to help fund the Sunshine for
80	Seniors Program.
81	(g) May seek federal waivers to help fund the Sunshine for
82	Seniors Program.
83	(6) COMMUNITY PARTNERSHIPS.--The Department of Elderly
84	Affairs may build private-sector and public-sector partnerships
85	with corporations, hospitals, physicians, pharmacists,
86	foundations, volunteers, state agencies, community groups, area
87	agencies on aging, and any other entities that will further the
88	intent of this section. These community partnerships may also be
89	used to facilitate other pro bono benefits for eligible
90	individuals, including, but not limited to, medical, dental, and
91	prescription services.
92	(7) CONTRACTS.--The Department of Elderly Affairs may
93	select and contract with application assistance organizations to
94	assist eligible individuals in obtaining their prescription
95	drugs through the manufacturers’ pharmaceutical assistance
96	programs. If the department contracts with an application
97	assistance organization, the department shall evaluate quarterly
98	the performance of the application assistance organization to
99	ensure compliance with the contract and the quality of service
100	provided to eligible individuals.
101	(8) REPORTS AND EVALUATIONS.--By January 1 of each year,
102	while the Sunshine for Seniors Program is operating, the
103	Department of Elderly Affairs shall report to the Legislature
104	regarding the implementation and operation of the Sunshine for
105	Seniors Program.
106	(9) NONENTITLEMENT.--The Sunshine for Seniors Program
107	established by this section is not an entitlement. If funds are
108	insufficient to assist all eligible individuals, the Department
109	of Elderly Affairs may develop a waiting list prioritized by
110	application date.
111	Section 16. Section 409.9065, Florida Statutes, is amended
112	to read:
113	409.9065 Pharmaceutical expense assistance.--
114	(1) PROGRAM ESTABLISHED.--There is established a program
115	to provide pharmaceutical expense assistance to eligiblecertain
116	low-income elderly individuals, which shall be known as the "Ron
117	Silver Senior Drug Program" and may be referred to as the
118	"Silver Lifesaver Program."
119	(2) ELIGIBILITY.--Eligibility for the program is limited
120	to those individuals who qualify for limited assistance under
121	the Florida Medicaid program as a result of being dually
122	eligible for both Medicare and Medicaid, but whose limited
123	assistance or Medicare coverage does not include any pharmacy
124	benefit. To the extent funds are appropriated, specifically
125	eligible individuals are individuals who:
126	(a) Are Florida residents age 65 and over;
127	(b) Have an income equal to or less than 200 percent of
128	the federal poverty level;:
129	1. Between 88 and 120 percent of the federal poverty
130	level;
131	2. Between 88 and 150 percent of the federal poverty level
132	if the Federal Government increases the federal Medicaid match
133	for persons between 100 and 150 percent of the federal poverty
134	level; or
135	3. Between 88 percent of the federal poverty level and a
136	level that can be supported with funds provided in the General
137	Appropriations Act for the program offered under this section
138	along with federal matching funds approved by the Federal
139	Government under a s. 1115 waiver. The agency is authorized to
140	submit and implement a federal waiver pursuant to this
141	subparagraph. The agency shall design a pharmacy benefit that
142	includes annual per-member benefit limits and cost-sharing
143	provisions and limits enrollment to available appropriations and
144	matching federal funds. Prior to implementing this program, the
145	agency must submit a budget amendment pursuant to chapter 216;
146	(c) Are eligible for both Medicare and Medicaid;
147	(d) Have exhausted pharmacy benefits under Medicare,
148	Medicaid, or any other insurance planAre not enrolled in a
149	Medicare health maintenance organization that provides a
150	pharmacy benefit; and
151	(e) Request to be enrolled in the program.
152	(3) BENEFITS.--Eligible individuals shall receive a
153	discount for prescription drugsMedications covered under the
154	pharmaceutical expense assistance program are those covered
155	under the Medicaid program in s. 409.906(20)(19). Monthly
156	benefit payments shall be limited to $80 per program
157	participant. Participants are required to make a 10-percent
158	coinsurance payment for each prescription purchased through this
159	program.
160	(a) Eligible individuals with incomes equal to or less
161	than 120 percent of the federal poverty level shall receive a
162	discount of 100 percent for the first $160 worth of prescription
163	drugs they receive each month, subject to copayments that the
164	agency requires on these benefits. For all other prescription
165	drugs received each month, eligible individuals shall receive a
166	discount of 50 percent.
167	(b) Eligible individuals with incomes of more than 120
168	percent but not more than 150 percent of the federal poverty
169	level shall receive a discount of 50 percent.
170	(c) Eligible individuals with incomes of more than 150
171	percent but not more than 175 percent of the federal poverty
172	level shall receive a discount of 41 percent.
173	(d) Eligible individuals with incomes of more than 175
174	percent but not more than 200 percent of the federal poverty
175	level shall receive a discount of 37 percent.
176	(4) ADMINISTRATION.--The pharmaceutical expense assistance
177	program shall be administered by the agency for Health Care
178	Administration, in collaborationconsultationwith the
179	Department of Elderly Affairs and the Department of Children and
180	Family Services.
181	(a) The Agency for Health Care Administration and the
182	Department of Elderly Affairs shall develop a single-page
183	application for the pharmaceutical expense assistance program.
184	(a)(b) The agency for Health Care Administrationshall, by
185	rule, establish for the pharmaceutical expense assistance
186	program eligibility requirements;, limits on participation;,
187	benefit limitations, including copayments;a requirement for
188	generic drug substitution;,and other program parameters
189	comparable to those of the Medicaid program. However, there
190	shall be no monetary limit on prescription drugs purchased with
191	discounts of less than 51 percent unless the agency determines
192	there is a risk of a funding shortfall in the program. If the
193	agency determines there is a risk of a funding shortfall, the
194	agency may establish monetary limits on prescription drugs which
195	shall not be less than $160 worth of prescription drugs per
196	month.
197	(b)(c) By January 1 of each year, the agency for Health
198	Care Administrationshall report to the Legislature on the
199	operation of the program. The report shall include information
200	on the number of individuals served, use rates, and expenditures
201	under the program. The report shall also address the impact of
202	the program on reducing unmet pharmaceutical drug needs among
203	the elderly and recommend programmatic changes.
204	(5) NONENTITLEMENT.--The pharmaceutical expense assistance
205	program established by this section is not an entitlement.
206	Enrollment levels are limited to those authorized by the
207	Legislature in the annual General Appropriations Act. If, after
208	establishing monetary limits as required by paragraph (4)(a),
209	funds are insufficient to serve all eligible individuals
210	eligible under subsection (2) andseeking coverage, the agency
211	may develop a waiting list based on application dates to use in
212	enrolling individuals in unfilled enrollment slots.
213	(6) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In order
214	for a drug product to be covered under Medicaid or this program,
215	the product's manufacturer shall:
216	(a) Provide a rebate to the state equal to the rebate
217	required by the Medicaid program; and
218	(b) Make the drug product available to the program for the
219	best price that the manufacturer makes the drug product
220	available in the Medicaid program.
221	(7) REIMBURSEMENT.--Totalreimbursements to pharmacies
222	participating in the pharmaceutical expense assistance program
223	established under this section shall be equivalent to
224	reimbursements under the Medicaid program.
225	(8) FEDERAL APPROVAL.--The benefits provided in this
226	section are limited to those approved by the Federal Government
227	pursuant to a Medicaid waiver or an amendment to the state
228	Medicaid plan.
229	Section 17. Subsections (7), (8), and (9) are added to
230	section 430.502, Florida Statutes, to read:
231	430.502 Alzheimer's disease; memory disorder clinics and
232	day care and respite care programs.--
233	(7) The Agency for Health Care Administration and the
234	department shall seek a federal waiver to implement a Medicaid
235	home and community-based waiver targeted to persons with
236	Alzheimer's disease to test the effectiveness of Alzheimer’s
237	specific interventions to delay or to avoid institutional
238	placement.
239	(8) The department will implement the waiver program
240	specified in subsection (7). The agency and the department shall
241	ensure that providers are selected that have a history of
242	successfully serving persons with Alzheimer's disease. The
243	department and the agency shall develop specialized standards
244	for providers and services tailored to persons in the early,
245	middle, and late stages of Alzheimer's disease and designate a
246	level of care determination process and standard that is most
247	appropriate to this population. The department and the agency
248	shall include in the waiver services designed to assist the
249	caregiver in continuing to provide in-home care. The department
250	shall implement this waiver program subject to a specific
251	appropriation or as provided in the General Appropriations Act.
252	The department and the agency shall submit their program design
253	to the President of the Senate and the Speaker of the House of
254	Representatives for consultation during the development process.
255	(9) Authority to continue the waiver program specified in
256	subsection (7) shall be automatically eliminated at the close of
257	the 2008 Regular Session of the Legislature unless further
258	legislative action is taken to continue it prior to such time.
259	Section 18. Except as otherwise expressly provided, this
260	act shall take effect July 1, 2003, but if it becomes a law
261	after May 1, 2003, sections 13 and 14 of this act shall
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263	================= T I T L E A M E N D M E N T =================
264	On page 1, line 2,
265	remove: all of said line
266
267	and insert:
268	An act relating to health care; creating s. 430.83, F.S.;
269	providing a popular name; providing definitions; providing
270	legislative findings and intent; creating the Sunshine for
271	Seniors Program to assist low-income seniors with
272	obtaining prescription drugs from manufacturers’
273	pharmaceutical assistance programs; providing
274	implementation and oversight duties of the Department of
275	Elderly Affairs; providing for community partnerships;
276	providing for contracts; requiring annual evaluation
277	reports on the program; specifying that the program is not
278	an entitlement; amending s. 409.9065, F.S.; revising the
279	pharmaceutical expense assistance program for low-income
280	elderly individuals; adding eligibility groups; providing
281	benefits; requiring the Agency for Health Care
282	Administration, in administering the program, to
283	collaborate with both the Department of Elderly Affairs
284	and the Department of Children and Family Services;
285	requiring federal approval of benefits; amending s.
286	430.502, F.S.; requiring the Agency for Health Care
287	Administration and the Department of Health to seek and
288	implement a Medicaid home and community-based waiver for
289	persons with Alzheimer's disease; requiring the
290	development of waiver program standards; providing for
291	consultation with the presiding officers of the
292	Legislature; providing for a contingent future repeal of
293	such waiver program;