HOUSE AMENDMENT Bill No. SB 2322
1	CHAMBER ACTION
2	Senate House
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12	Representative Green, Gelber, and Goodlette offered the
13	following:
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15	Amendment (with title amendment)
16	On page 3, line 10, through page 6, line 9,
17	remove: all of said lines
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19	and insert: manufacturers and consumer advocates, develop a
20	uniform application form to be completed by seniors who wish to
21	participate in the Sunshine for Seniors Program.
22	(c) May request proposals from application assistance
23	organizations to assist eligible individuals with obtaining
24	prescription drugs through manufacturers' pharmaceutical
25	assistance programs.
26	(d) Shall train volunteers to help eligible individuals
27	fill out applications for the manufacturers' pharmaceutical
28	assistance programs.
29	(e) Shall train volunteers to determine when applicants
30	may be eligible for other state programs and refer them to the
31	proper entity for eligibility determination for such programs.
32	(f) Shall seek federal funds to help fund the Sunshine for
33	Seniors Program.
34	(g) May seek federal waivers to help fund the Sunshine for
35	Seniors Program.
36	(6) COMMUNITY PARTNERSHIPS.--The Department of Elderly
37	Affairs may build private sector and public sector partnerships
38	with corporations, hospitals, physicians, pharmacists,
39	foundations, volunteers, state agencies, community groups, area
40	agencies on aging, and any other entities that will further the
41	intent of this section. These community partnerships may also be
42	used to facilitate other pro bono benefits for eligible
43	individuals, including, but not limited to, medical, dental, and
44	prescription services.
45	(7) CONTRACTS.--The Department of Elderly Affairs may
46	select and contract with application assistance organizations to
47	assist eligible individuals in obtaining their prescription
48	drugs through the manufacturers' pharmaceutical assistance
49	programs. If the department contracts with an application
50	assistance organization, the department shall evaluate quarterly
51	the performance of the application assistance organization to
52	ensure compliance with the contract and the quality of service
53	provided to eligible individuals.
54	(8) REPORTS AND EVALUATIONS.--By January 1 of each year,
55	while the Sunshine for Seniors Program is operating, the
56	Department of Elderly Affairs shall report to the Legislature
57	regarding the implementation and operation of the Sunshine for
58	Seniors Program.
59	(9) NONENTITLEMENT.--The Sunshine for Seniors Program
60	established by this section is not an entitlement. If funds are
61	insufficient to assist all eligible individuals, the Department
62	of Elderly Affairs may develop a waiting list prioritized by
63	application date.
64	Section 2. The sum of $226,660 is appropriated from the
65	General Revenue Fund to the Department of Elderly Affairs, and
66	one position is authorized, to implement section 1 of this act
67	during the 2003-2004 fiscal year.
68	Section 3. Subsection (2) of section 409.904, Florida
69	Statutes, is amended to read:
70	409.904 Optional payments for eligible persons.--The
71	agency may make payments for medical assistance and related
72	services on behalf of the following persons who are determined
73	to be eligible subject to the income, assets, and categorical
74	eligibility tests set forth in federal and state law. Payment
75	on behalf of these Medicaid eligible persons is subject to the
76	availability of moneys and any limitations established by the
77	General Appropriations Act or chapter 216.
78	(2) A caretaker relative or parent, a pregnant woman, a
79	child under age 19 who would otherwise qualify for Florida
80	Kidcare Medicaid, a child up to age 21 who would otherwise
81	qualify under s. 409.903(1), a person age 65 or over, or a blind
82	or disabled person, who would otherwise be eligible for Florida
83	Medicaid, except that the income or assets of such family or
84	person exceed established limitations. For a family or person in
85	one of these coverage groups, medical expenses are deductible
86	from income in accordance with federal requirements in order to
87	make a determination of eligibility. Expenses used to meet
88	spend-down liability are not reimbursable by Medicaid. Effective
89	JulyMay1, 2003, when determining the eligibility of a pregnant
90	woman, a child, or an aged, blind, or disabled individual, $270
91	shall be deducted from the countable income of the filing unit.
92	When determining the eligibility of the parent or caretaker
93	relative as defined by Title XIX of the Social Security Act, the
94	additional income disregard of $270 does not apply. A family or
95	person eligible under the coverage known as the "medically
96	needy," is eligible to receive the same services as other
97	Medicaid recipients, with the exception of services in skilled
98	nursing facilities and intermediate care facilities for the
99	developmentally disabled.
100	Section 4. The nonrecurring sums of $8,265,777 from the
101	General Revenue Fund, $2,505,224 from the Grants and Donations
102	Trust Fund, and $11,727,287 from the Medical Care Trust Fund are
103	appropriated to the Agency for Health Care Administration to
104	implement section 3 of this act during the 2002-2003 fiscal
105	year.
106	Section 5. Effective July 1, 2003, section 409.9065,
107	Florida Statutes, is amended to read:
108	409.9065 Pharmaceutical expense assistance.--
109	(1) PROGRAM ESTABLISHED.--There is established a program
110	to provide pharmaceutical expense assistance to eligiblecertain
111	low-income elderly individuals, which shall be known as the "Ron
112	Silver Senior Drug Program" and may be referred to as the
113	"Silver Lifesaver Program."
114	(2) ELIGIBILITY.--Eligibility for the program is limited
115	to those individuals who qualify for limited assistance under
116	the Florida Medicaid program as a result of being dually
117	eligible for both Medicare and Medicaid, but whose limited
118	assistance or Medicare coverage does not include any pharmacy
119	benefit. To the extent funds are appropriated, specifically
120	eligible individuals are individuals who:
121	(a) Are Florida residents age 65 and over;
122	(b) Have an income equal to or less than 200 percent of
123	the federal poverty level;:
124	1. Between 88 and 120 percent of the federal poverty
125	level;
126	2. Between 88 and 150 percent of the federal poverty level
127	if the Federal Government increases the federal Medicaid match
128	for persons between 100 and 150 percent of the federal poverty
129	level; or
130	3. Between 88 percent of the federal poverty level and a
131	level that can be supported with funds provided in the General
132	Appropriations Act for the program offered under this section
133	along with federal matching funds approved by the Federal
134	Government under a s. 1115 waiver. The agency is authorized to
135	submit and implement a federal waiver pursuant to this
136	subparagraph. The agency shall design a pharmacy benefit that
137	includes annual per-member benefit limits and cost-sharing
138	provisions and limits enrollment to available appropriations and
139	matching federal funds. Prior to implementing this program, the
140	agency must submit a budget amendment pursuant to chapter 216;
141	(c) Are eligible for both Medicare and Medicaid;
142	(d) Have exhausted pharmacy benefits under Medicare,
143	Medicaid, or any other insurance planAre not enrolled in a
144	Medicare health maintenance organization that provides a
145	pharmacy benefit; and
146	(e) Request to be enrolled in the program.
147	(3) BENEFITS.--Eligible individuals shall receive a
148	discount for prescription drugsMedications covered under the
149	pharmaceutical expense assistance program are those covered
150	under the Medicaid program in s. 409.906(20)(19). Monthly
151	benefit payments shall be limited to $80 per program
152	participant. Participants are required to make a 10-percent
153	coinsurance payment for each prescription purchased through this
154	program.
155	(a) Eligible individuals with incomes equal to or less
156	than 120 percent of the federal poverty level shall receive a
157	discount of 100 percent for the first $160 worth of prescription
158	drugs they receive each month, subject to copayments that the
159	agency requires on these benefits. For all other prescription
160	drugs received each month, eligible individuals shall receive a
161	discount of 50 percent.
162	(b) Eligible individuals with incomes of more than 120
163	percent but not more than 150 percent of the federal poverty
164	level shall receive a discount of 50 percent.
165	(c) Eligible individuals with incomes of more than 150
166	percent but not more than 175 percent of the federal poverty
167	level shall receive a discount of 41 percent.
168	(d) Eligible individuals with incomes of more than 175
169	percent but not more than 200 percent of the federal poverty
170	level shall receive a discount of 37 percent.
171	(4) ADMINISTRATION.--The pharmaceutical expense assistance
172	program shall be administered by the agency for Health Care
173	Administration, in collaborationconsultationwith the
174	Department of Elderly Affairs and the Department of Children and
175	Family Services.
176	(a) The Agency for Health Care Administration and the
177	Department of Elderly Affairs shall develop a single-page
178	application for the pharmaceutical expense assistance program.
179	(a)(b) The agency for Health Care Administrationshall, by
180	rule, establish for the pharmaceutical expense assistance
181	program eligibility requirements;, limits on participation;,
182	benefit limitations, including copayments;a requirement for
183	generic drug substitution;,and other program parameters
184	comparable to those of the Medicaid program. However, there
185	shall be no monetary limit on prescription drugs purchased with
186	discounts of less than 51 percent unless the agency determines
187	there is a risk of a funding shortfall in the program. If the
188	agency determines there is a risk of a funding shortfall, the
189	agency may establish monetary limits on prescription drugs which
190	shall not be less than $160 worth of prescription drugs per
191	month.
192	(b)(c) By January 1 of each year, the agency for Health
193	Care Administrationshall report to the Legislature on the
194	operation of the program. The report shall include information
195	on the number of individuals served, use rates, and expenditures
196	under the program. The report shall also address the impact of
197	the program on reducing unmet pharmaceutical drug needs among
198	the elderly and recommend programmatic changes.
199	(5) NONENTITLEMENT.--The pharmaceutical expense assistance
200	program established by this section is not an entitlement.
201	Enrollment levels are limited to those authorized by the
202	Legislature in the annual General Appropriations Act. If, after
203	establishing monetary limits as required by paragraph (4)(a),
204	funds are insufficient to serve all eligible individuals
205	eligible under subsection (2) andseeking coverage, the agency
206	may develop a waiting list based on application dates to use in
207	enrolling individuals in unfilled enrollment slots.
208	(6) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In order
209	for a drug product to be covered under Medicaid or this program,
210	the product's manufacturer shall:
211	(a) Provide a rebate to the state equal to the rebate
212	required by the Medicaid program; and
213	(b) Make the drug product available to the program for the
214	best price that the manufacturer makes the drug product
215	available in the Medicaid program.
216	(7) REIMBURSEMENT.--Totalreimbursements to pharmacies
217	participating in the pharmaceutical expense assistance program
218	established under this section shall be equivalent to
219	reimbursements under the Medicaid program.
220	(8) FEDERAL APPROVAL.--The benefits provided in this
221	section are limited to those approved by the Federal Government
222	pursuant to a Medicaid waiver or an amendment to the state
223	Medicaid plan.
224	Section 6. This act shall take effect upon becoming a law,
225	unless otherwise specified in this act, but if it becomes a law
226	after May 1, 2003, sections 3 and 4 of this act shall operate
227	retroactively to that date.
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229	================= T I T L E A M E N D M E N T =================
230	On page 1, line 23,
231	remove: all of said line
232
233	and insert: application; amending s. 409.9065, F.S.; adding
234	eligibility groups; providing benefits; providing collaboration
235	with the Department of Children and Family Services; requiring
236	federal approval of benefits; providing effective dates.