Senate Bill sb1178e1
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1 A bill to be entitled
2 An act relating to minority health care;
3 creating s. 381.736, F.S.; providing for the
4 Department of Health to monitor and report on
5 Florida's status regarding the Healthy People
6 2010 goals and objectives currently tracked by
7 the department; requiring an annual report to
8 the Legislature; requiring the department to
9 work with various groups to educate health care
10 professionals on racial and ethnic issues in
11 health, to recruit and train health care
12 professionals from minority backgrounds, and to
13 promote certain research; amending s. 409.901,
14 F.S.; defining the term "minority physician
15 network"; amending s. 409.912, F.S.; requiring
16 the Agency for Health Care Administration to
17 contract for a Medicaid minority physician
18 network; providing guidelines for the operation
19 of the network; defining the term
20 "cost-effective"; requiring the agency to
21 conduct actuarially sound audits; providing an
22 effective date.
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24 Be It Enacted by the Legislature of the State of Florida:
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26 Section 1. Section 381.736, Florida Statutes, is
27 created to read:
28 381.736 Florida Healthy People 2010 Program.--
29 (1) The Department of Health shall, using existing
30 resources, monitor and report Florida's status on the Healthy
31 People 2010 goals and objectives currently tracked and
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1 available to the department. The federal Healthy People 2010
2 goals and objectives are designed to measure and help to
3 improve the health of all Americans by advancing the following
4 goals:
5 (a) Increase the quality and years of healthy life.
6 (b) Eliminate health disparities among different
7 segments of the population.
8 (2) The department shall report to the Legislature by
9 December 31 of each year on the status of disparities in
10 health among minorities and nonminorities, using health
11 indicators currently available that are consistent with those
12 identified by the federal Healthy People 2010 goals and
13 objectives.
14 (3) To reduce negative health consequences that result
15 from ignoring racial and ethnic cultures, the department shall
16 work with minority physician networks to develop programs to
17 educate health care professionals about the importance of
18 culture in health status. These programs shall include, but
19 need not be limited to:
20 (a) The education of health care providers about the
21 prevalence of specific health conditions among certain
22 minority groups.
23 (b) The training of clinicians to be sensitive to
24 cultural diversity among patients and to recognize that
25 inherent biases can lead to disparate treatments.
26 (c) The creation of initiatives that educate
27 private-sector health care and managed care organizations
28 about the importance of cross-cultural training of health care
29 professionals and the effect of such training on the
30 professional-patient relationship.
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1 (d) The fostering of increased use of interpreter
2 services in health care settings.
3 (4) The department shall work with and promote the
4 establishment of public and private partnerships with
5 charitable organizations, hospitals, and minority physician
6 networks to increase the proportion of health care
7 professionals from minority backgrounds.
8 (5) The department shall promote research on methods
9 by which to reduce disparities in health care at colleges and
10 universities that have historically large minority
11 enrollments, including centers of excellence in this state
12 identified by the National Center on Minority Health and
13 Health Disparities, by working with those colleges and
14 universities and with community representatives to encourage
15 local minority students to pursue professions in health care.
16 Section 2. Subsections (23), (24), (25), and (26) of
17 section 409.901, Florida Statutes, are renumbered as
18 subsections (24), (25), (26), and (27), respectively, and a
19 new subsection (23) is added to that section, to read:
20 409.901 Definitions; ss. 409.901-409.920.--As used in
21 ss. 409.901-409.920, except as otherwise specifically
22 provided, the term:
23 (23) "Minority physician network" means a network of
24 primary care physicians with experience managing Medicaid or
25 Medicare recipients that is predominantly owned by minorities
26 as defined in s. 288.703, which may have a collaborative
27 partnership with a public college or university and a
28 tax-exempt charitable corporation.
29 Section 3. Subsection (45) is added to section
30 409.912, Florida Statutes, to read:
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1 409.912 Cost-effective purchasing of health care.--The
2 agency shall purchase goods and services for Medicaid
3 recipients in the most cost-effective manner consistent with
4 the delivery of quality medical care. The agency shall
5 maximize the use of prepaid per capita and prepaid aggregate
6 fixed-sum basis services when appropriate and other
7 alternative service delivery and reimbursement methodologies,
8 including competitive bidding pursuant to s. 287.057, designed
9 to facilitate the cost-effective purchase of a case-managed
10 continuum of care. The agency shall also require providers to
11 minimize the exposure of recipients to the need for acute
12 inpatient, custodial, and other institutional care and the
13 inappropriate or unnecessary use of high-cost services. The
14 agency may establish prior authorization requirements for
15 certain populations of Medicaid beneficiaries, certain drug
16 classes, or particular drugs to prevent fraud, abuse, overuse,
17 and possible dangerous drug interactions. The Pharmaceutical
18 and Therapeutics Committee shall make recommendations to the
19 agency on drugs for which prior authorization is required. The
20 agency shall inform the Pharmaceutical and Therapeutics
21 Committee of its decisions regarding drugs subject to prior
22 authorization.
23 (45) The agency shall contract with an established
24 minority physician network that provides services to
25 historically underserved minority patients. The network must
26 provide cost-effective Medicaid services, comply with the
27 requirements to be a MediPass provider, and provide its
28 primary care physicians with access to data and other
29 management tools necessary to assist them in ensuring the
30 appropriate use of services, including inpatient hospital
31 services and pharmaceuticals.
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1 (a) The agency shall provide for the development and
2 expansion of minority physician networks in each service area
3 to provide services to Medicaid recipients who are eligible to
4 participate under federal law and rules.
5 (b) The agency shall reimburse the minority physician
6 network as a fee-for-service provider, including the case
7 management fee for primary care, or as a capitated rate
8 provider for Medicaid services. Any savings shall be shared
9 with the minority physician network pursuant to the contract.
10 (c) For purposes of this subsection, the term
11 "cost-effective" means that a network's per-member, per-month
12 costs to the state, including, but not limited to,
13 fee-for-service costs, administrative costs, and
14 case-management fees, must be no greater than the state's
15 costs associated with contracts for Medicaid services
16 established under subsection (3), which shall be actuarially
17 adjusted for case mix, model, and service area. The agency
18 shall conduct actuarially sound audits adjusted for case mix
19 and model in order to ensure such cost-effectiveness and shall
20 publish the audit results on its Internet website and submit
21 the audit results annually to the Governor, the President of
22 the Senate, and the Speaker of the House of Representatives no
23 later than December 31. Contracts established pursuant to this
24 subsection which are not cost-effective may not be renewed.
25 (d) The agency may apply for any federal waivers
26 needed to implement this paragraph.
27 Section 4. This act shall take effect July 1, 2004.
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