HB 0017

1	A bill to be entitled
2	An act relating to developmental disabilities; amending s.
3	409.912, F.S.; requiring the Agency for Health Care
4	Administration to develop a model waiver program to serve
5	children with specified disorders; requiring the agency to
6	seek federal waiver approval and implement the approved
7	waiver subject to availability of funds and certain
8	limitations; authorizing rules; providing an effective
9	date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Subsection (50) is added to section 409.912,
14	Florida Statutes, to read:
15	409.912  Cost-effective purchasing of health care.--The
16	agency shall purchase goods and services for Medicaid recipients
17	in the most cost-effective manner consistent with the delivery
18	of quality medical care. To ensure that medical services are
19	effectively utilized, the agency may, in any case, require a
20	confirmation or second physician's opinion of the correct
21	diagnosis for purposes of authorizing future services under the
22	Medicaid program. This section does not restrict access to
23	emergency services or poststabilization care services as defined
24	in 42 C.F.R. part 438.114. Such confirmation or second opinion
25	shall be rendered in a manner approved by the agency. The agency
26	shall maximize the use of prepaid per capita and prepaid
27	aggregate fixed-sum basis services when appropriate and other
28	alternative service delivery and reimbursement methodologies,
29	including competitive bidding pursuant to s. 287.057, designed
30	to facilitate the cost-effective purchase of a case-managed
31	continuum of care. The agency shall also require providers to
32	minimize the exposure of recipients to the need for acute
33	inpatient, custodial, and other institutional care and the
34	inappropriate or unnecessary use of high-cost services. The
35	agency may mandate prior authorization, drug therapy management,
36	or disease management participation for certain populations of
37	Medicaid beneficiaries, certain drug classes, or particular
38	drugs to prevent fraud, abuse, overuse, and possible dangerous
39	drug interactions. The Pharmaceutical and Therapeutics Committee
40	shall make recommendations to the agency on drugs for which
41	prior authorization is required. The agency shall inform the
42	Pharmaceutical and Therapeutics Committee of its decisions
43	regarding drugs subject to prior authorization. The agency is
44	authorized to limit the entities it contracts with or enrolls as
45	Medicaid providers by developing a provider network through
46	provider credentialing. The agency may limit its network based
47	on the assessment of beneficiary access to care, provider
48	availability, provider quality standards, time and distance
49	standards for access to care, the cultural competence of the
50	provider network, demographic characteristics of Medicaid
51	beneficiaries, practice and provider-to-beneficiary standards,
52	appointment wait times, beneficiary use of services, provider
53	turnover, provider profiling, provider licensure history,
54	previous program integrity investigations and findings, peer
55	review, provider Medicaid policy and billing compliance records,
56	clinical and medical record audits, and other factors. Providers
57	shall not be entitled to enrollment in the Medicaid provider
58	network. The agency is authorized to seek federal waivers
59	necessary to implement this policy.
60	(50)  The agency shall work with the Department of Children
61	and Family Services to develop a model home and community-based
62	waiver to serve children who are diagnosed with familial
63	dysautonomia or Riley-Day syndrome caused by a mutation of the
64	IKBKAP gene on chromosome 9. The agency shall seek federal
65	waiver approval and implement the approved waiver subject to the
66	availability of funds and any limitations provided in the
67	General Appropriations Act. The agency may adopt rules to
68	implement this waiver program.
69	Section 2.  This act shall take effect July 1, 2005.

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