HB 17

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, in coordination with the Agency for
5	Persons with Disabilities, to develop a model waiver
6	program to serve children with specified disorders;
7	requiring the Agency for Health Care Administration to
8	seek federal waiver approval and implement the approved
9	waiver subject to availability of funds and certain
10	limitations; authorizing rules; providing an
11	appropriation; providing an effective date.
12
13	Be It Enacted by the Legislature of the State of Florida:
14
15	Section 1.  Subsection (50) is added to section 409.912,
16	Florida Statutes, to read:
17	409.912  Cost-effective purchasing of health care.--The
18	agency shall purchase goods and services for Medicaid recipients
19	in the most cost-effective manner consistent with the delivery
20	of quality medical care. To ensure that medical services are
21	effectively utilized, the agency may, in any case, require a
22	confirmation or second physician's opinion of the correct
23	diagnosis for purposes of authorizing future services under the
24	Medicaid program. This section does not restrict access to
25	emergency services or poststabilization care services as defined
26	in 42 C.F.R. part 438.114. Such confirmation or second opinion
27	shall be rendered in a manner approved by the agency. The agency
28	shall maximize the use of prepaid per capita and prepaid
29	aggregate fixed-sum basis services when appropriate and other
30	alternative service delivery and reimbursement methodologies,
31	including competitive bidding pursuant to s. 287.057, designed
32	to facilitate the cost-effective purchase of a case-managed
33	continuum of care. The agency shall also require providers to
34	minimize the exposure of recipients to the need for acute
35	inpatient, custodial, and other institutional care and the
36	inappropriate or unnecessary use of high-cost services. The
37	agency may mandate prior authorization, drug therapy management,
38	or disease management participation for certain populations of
39	Medicaid beneficiaries, certain drug classes, or particular
40	drugs to prevent fraud, abuse, overuse, and possible dangerous
41	drug interactions. The Pharmaceutical and Therapeutics Committee
42	shall make recommendations to the agency on drugs for which
43	prior authorization is required. The agency shall inform the
44	Pharmaceutical and Therapeutics Committee of its decisions
45	regarding drugs subject to prior authorization. The agency is
46	authorized to limit the entities it contracts with or enrolls as
47	Medicaid providers by developing a provider network through
48	provider credentialing. The agency may limit its network based
49	on the assessment of beneficiary access to care, provider
50	availability, provider quality standards, time and distance
51	standards for access to care, the cultural competence of the
52	provider network, demographic characteristics of Medicaid
53	beneficiaries, practice and provider-to-beneficiary standards,
54	appointment wait times, beneficiary use of services, provider
55	turnover, provider profiling, provider licensure history,
56	previous program integrity investigations and findings, peer
57	review, provider Medicaid policy and billing compliance records,
58	clinical and medical record audits, and other factors. Providers
59	shall not be entitled to enrollment in the Medicaid provider
60	network. The agency is authorized to seek federal waivers
61	necessary to implement this policy.
62	(50)  The agency shall work with the Agency for Persons
63	with Disabilities to develop a model home and community-based
64	waiver to serve children who are diagnosed with familial
65	dysautonomia or Riley-Day syndrome caused by a mutation of the
66	IKBKAP gene on chromosome 9. The agency shall seek federal
67	waiver approval and implement the approved waiver subject to the
68	availability of funds and any limitations provided in the
69	General Appropriations Act. The agency may adopt rules to
70	implement this waiver program.
71	Section 2.  The sums of $171,840 from the General Revenue
72	Fund and $246,160 from the Medical Care Trust Fund are
73	appropriated to the Agency for Health Care Administration for
74	the purpose of implementing this act during the 2005-2006 fiscal
75	year.
76	Section 3.  This act shall take effect July 1, 2005.

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