Senate Bill sb1618

    Florida Senate - 2005                                  SB 1618

    By Senator Atwater





    25-1335-05                                              See HB

  1                      A bill to be entitled

  2         An act relating to the Autism Spectrum Disorder

  3         Medicaid Waiver Program; amending s. 409.912,

  4         F.S.; requiring the Agency for Health Care

  5         Administration to work with the Agency for

  6         Persons with Disabilities to develop a Medicaid

  7         waiver program for children with Autism

  8         Spectrum Disorder; providing a definition;

  9         providing for implementation subject to the

10         availability of funds; authorizing the agency

11         to adopt rules; providing an effective date.

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

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15         Section 1.  Subsection (50) is added to section

16  409.912, Florida Statutes, to read:

17         409.912  Cost-effective purchasing of health care.--The

18  agency shall purchase goods and services for Medicaid

19  recipients in the most cost-effective manner consistent with

20  the delivery of quality medical care. To ensure that medical

21  services are effectively utilized, the agency may, in any

22  case, require a confirmation or second physician's opinion of

23  the correct diagnosis for purposes of authorizing future

24  services under the Medicaid program. This section does not

25  restrict access to emergency services or poststabilization

26  care services as defined in 42 C.F.R. part 438.114. Such

27  confirmation or second opinion shall be rendered in a manner

28  approved by the agency. The agency shall maximize the use of

29  prepaid per capita and prepaid aggregate fixed-sum basis

30  services when appropriate and other alternative service

31  delivery and reimbursement methodologies, including

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






    Florida Senate - 2005                                  SB 1618
    25-1335-05                                              See HB




 1  competitive bidding pursuant to s. 287.057, designed to

 2  facilitate the cost-effective purchase of a case-managed

 3  continuum of care. The agency shall also require providers to

 4  minimize the exposure of recipients to the need for acute

 5  inpatient, custodial, and other institutional care and the

 6  inappropriate or unnecessary use of high-cost services. The

 7  agency may mandate prior authorization, drug therapy

 8  management, or disease management participation for certain

 9  populations of Medicaid beneficiaries, certain drug classes,

10  or particular drugs to prevent fraud, abuse, overuse, and

11  possible dangerous drug interactions. The Pharmaceutical and

12  Therapeutics Committee shall make recommendations to the

13  agency on drugs for which prior authorization is required. The

14  agency shall inform the Pharmaceutical and Therapeutics

15  Committee of its decisions regarding drugs subject to prior

16  authorization. The agency is authorized to limit the entities

17  it contracts with or enrolls as Medicaid providers by

18  developing a provider network through provider credentialing.

19  The agency may limit its network based on the assessment of

20  beneficiary access to care, provider availability, provider

21  quality standards, time and distance standards for access to

22  care, the cultural competence of the provider network,

23  demographic characteristics of Medicaid beneficiaries,

24  practice and provider-to-beneficiary standards, appointment

25  wait times, beneficiary use of services, provider turnover,

26  provider profiling, provider licensure history, previous

27  program integrity investigations and findings, peer review,

28  provider Medicaid policy and billing compliance records,

29  clinical and medical record audits, and other factors.

30  Providers shall not be entitled to enrollment in the Medicaid

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






    Florida Senate - 2005                                  SB 1618
    25-1335-05                                              See HB




 1  provider network. The agency is authorized to seek federal

 2  waivers necessary to implement this policy.

 3         (50)  The Agency for Health Care Administration shall

 4  work with the Agency for Persons with Disabilities to develop

 5  a home and community-based waiver program to provide personal

 6  care assistance, respite, and applied behavioral analysis for

 7  children who are diagnosed with Autism Spectrum Disorder. For

 8  the purposes of this subsection, "Autism Spectrum Disorder"

 9  means a neurological disorder that affects reasoning, social

10  interaction, and communication, may affect the functioning of

11  the brain, and is usually evident before a child is 3 years of

12  age. The Agency for Health Care Administration shall seek

13  federal waiver approval and implement the approved waiver

14  subject to the availability of funds and any limitations

15  provided in the General Appropriations Act. The Agency for

16  Health Care Administration may adopt rules to implement this

17  waiver program.

18         Section 2.  This act shall take effect July 1, 2005.

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