HB 0645

CS

CHAMBER ACTION

1	The Committee on Appropriations recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to minority health care; creating s.
7	381.736, F.S.; providing for the Department of Health to
8	monitor and report on Florida's status regarding the
9	Healthy People 2010 goals and objectives currently tracked
10	by the department; requiring an annual report to the
11	Legislature; requiring the department to work with various
12	groups to educate health care professionals on racial and
13	ethnic issues in health, to recruit and train health care
14	professionals from minority backgrounds, and to promote
15	certain research; amending s. 409.901, F.S.; defining the
16	term "minority physician network"; amending s. 409.912,
17	F.S.; requiring the Agency for Health Care Administration
18	to contract for a Medicaid minority physician network;
19	providing guidelines for the operation of the network;
20	defining the term "cost-effective"; requiring the agency
21	to conduct actuarially sound audits; providing an
22	effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1.  Section 381.736, Florida Statutes, is created
27	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 Florida
31	Healthy People 2010 goals and objectives currently tracked and
32	available to the department. The federal Healthy People 2010
33	goals and objectives are designed to measure and help to improve
34	the health of all Americans by advancing the following goals:
35	(a)  Increase the quality and years of healthy life.
36	(b)  Eliminate health disparities among different segments
37	of the population.
38	(2)  The department shall report to the Legislature by
39	December 31 of each year on the status of disparities in health
40	among minorities and nonminorities, using health indicators that
41	are consistent with those identified by the federal Healthy
42	People 2010 goals and objectives.
43	(3)  To reduce negative health consequences that result
44	from ignoring racial and ethnic cultures, the department shall
45	work with minority physician networks to develop programs to
46	educate health care professionals about the importance of
47	culture in health status. These programs shall include, but need
48	not be limited to:
49	(a)  The education of health care providers about the
50	prevalence of specific health conditions among certain minority
51	groups.
52	(b)  The training of clinicians to be sensitive to cultural
53	diversity among patients and to recognize that inherent biases
54	can lead to disparate treatments.
55	(c)  The creation of initiatives that educate private-
56	sector health care and managed care organizations about the
57	importance of cross-cultural training of health care
58	professionals and the effect of such training on the
59	professional-patient relationship.
60	(d)  The fostering of increased use of interpreter services
61	in health care settings.
62	(4)  The department shall work with and promote the
63	establishment of public and private partnerships with charitable
64	organizations, hospitals, and minority physician networks to
65	increase the proportion of health care professionals from
66	minority backgrounds.
67	(5)  The department shall work with and promote research on
68	methods by which to reduce disparities in health care at
69	colleges and universities that have historically large minority
70	enrollments, including centers of excellence in this state
71	identified by the National Center on Minority Health and Health
72	Disparities, by working with those colleges, universities, and
73	with community representatives to encourage local minority
74	students to pursue professions in health care.
75	Section 2.  Present subsections (23), (24), (25), and (26)
76	of section 409.901, Florida Statutes, are renumbered as
77	subsections (24), (25), (26), and (27), respectively, and a new
78	subsection (23) is added to that section, to read:
79	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
80	409.901-409.920, except as otherwise specifically provided, the
81	term:
82	(23)  "Minority physician network" means a network of
83	primary care physicians with experience managing Medicaid or
84	Medicare recipients that is predominantly owned by minorities,
85	as defined in s. 288.703(3), which may have a collaborative
86	partnership with a public college or university and a tax-exempt
87	charitable corporation.
88	Section 3.  Subsection (45) is added to section 409.912,
89	Florida Statutes, to read:
90	409.912  Cost-effective purchasing of health care.--The
91	agency shall purchase goods and services for Medicaid recipients
92	in the most cost-effective manner consistent with the delivery
93	of quality medical care.  The agency shall maximize the use of
94	prepaid per capita and prepaid aggregate fixed-sum basis
95	services when appropriate and other alternative service delivery
96	and reimbursement methodologies, including competitive bidding
97	pursuant to s. 287.057, designed to facilitate the cost-
98	effective purchase of a case-managed continuum of care. The
99	agency shall also require providers to minimize the exposure of
100	recipients to the need for acute inpatient, custodial, and other
101	institutional care and the inappropriate or unnecessary use of
102	high-cost services. The agency may establish prior authorization
103	requirements for certain populations of Medicaid beneficiaries,
104	certain drug classes, or particular drugs to prevent fraud,
105	abuse, overuse, and possible dangerous drug interactions. The
106	Pharmaceutical and Therapeutics Committee shall make
107	recommendations to the agency on drugs for which prior
108	authorization is required. The agency shall inform the
109	Pharmaceutical and Therapeutics Committee of its decisions
110	regarding drugs subject to prior authorization.
111	(45)  The agency shall contract with minority physician
112	networks that have a history of providing health care services
113	to historically underserved minorities. The network must provide
114	cost-effective Medicaid services, comply with the requirements
115	of the MediPass program, and provide its primary care physicians
116	with access to data and other management tools necessary to
117	assist them in ensuring the appropriate use of services,
118	including inpatient hospital services and pharmaceuticals. The
119	providers in the network must be enrolled in the MediPass
120	program.
121	(a)  The agency shall provide for the development and
122	expansion of minority physician networks in each service area to
123	provide services to Medicaid recipients who are eligible to
124	participate under federal law and rules.
125	(b)  The agency shall reimburse the minority physician
126	network as a fee-for-service provider, including the case
127	management fee for primary care, or as a capitated rate provider
128	for Medicaid services. Any savings shall be shared with the
129	minority physician network pursuant to the contract.
130	(c)  For purposes of this subsection, the term "cost-
131	effective" means that a network's per-member, per-month costs to
132	the state, including, but not limited to, fee-for-service costs,
133	administrative costs, and case-management fees, must be no
134	greater than the state's costs associated with contracts for
135	Medicaid services established under subsection (3), which shall
136	be actuarially adjusted for case mix, model, and service area.
137	The agency shall conduct actuarially sound audits adjusted for
138	case mix and model in order to ensure such cost-effectiveness
139	and shall publish the audit results on its Internet website and
140	submit the audit results annually to the Governor, the President
141	of the Senate, and the Speaker of the House of Representatives
142	no later than December 31. Contracts established pursuant to
143	this subsection which are not cost-effective may not be renewed.
144	(d)  The agency may apply for any federal waivers needed to
145	implement this paragraph.
146	Section 4.  This act shall take effect July 1, 2004.

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