Senate Bill sb0428

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    Florida Senate - 2005                                   SB 428

    By Senator Rich





    34-435-05                                            See HB 17

  1                      A bill to be entitled

  2         An act relating to developmental disabilities;

  3         amending s. 409.912, F.S.; requiring the Agency

  4         for Health Care Administration to develop a

  5         model waiver program to serve children with

  6         specified disorders; requiring the agency to

  7         seek federal waiver approval and implement the

  8         approved waiver subject to availability of

  9         funds and certain limitations; authorizing

10         rules; providing an effective date.

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

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

15  409.912, Florida Statutes, to read:

16         409.912  Cost-effective purchasing of health care.--The

17  agency shall purchase goods and services for Medicaid

18  recipients in the most cost-effective manner consistent with

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

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

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

22  the correct diagnosis for purposes of authorizing future

23  services under the Medicaid program. This section does not

24  restrict access to emergency services or poststabilization

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

26  confirmation or second opinion shall be rendered in a manner

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

28  prepaid per capita and prepaid aggregate fixed-sum basis

29  services when appropriate and other alternative service

30  delivery and reimbursement methodologies, including

31  competitive bidding pursuant to s. 287.057, designed to

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






    Florida Senate - 2005                                   SB 428
    34-435-05                                            See HB 17




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

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

 3  minimize the exposure of recipients to the need for acute

 4  inpatient, custodial, and other institutional care and the

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

 6  agency may mandate prior authorization, drug therapy

 7  management, or disease management participation for certain

 8  populations of Medicaid beneficiaries, certain drug classes,

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

10  possible dangerous drug interactions. The Pharmaceutical and

11  Therapeutics Committee shall make recommendations to the

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

13  agency shall inform the Pharmaceutical and Therapeutics

14  Committee of its decisions regarding drugs subject to prior

15  authorization. The agency is authorized to limit the entities

16  it contracts with or enrolls as Medicaid providers by

17  developing a provider network through provider credentialing.

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

19  beneficiary access to care, provider availability, provider

20  quality standards, time and distance standards for access to

21  care, the cultural competence of the provider network,

22  demographic characteristics of Medicaid beneficiaries,

23  practice and provider-to-beneficiary standards, appointment

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

25  provider profiling, provider licensure history, previous

26  program integrity investigations and findings, peer review,

27  provider Medicaid policy and billing compliance records,

28  clinical and medical record audits, and other factors.

29  Providers shall not be entitled to enrollment in the Medicaid

30  provider network. The agency is authorized to seek federal

31  waivers necessary to implement this policy.

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






    Florida Senate - 2005                                   SB 428
    34-435-05                                            See HB 17




 1         (50)  The agency shall work with the Department of

 2  Children and Family Services to develop a model home and

 3  community-based waiver to serve children who are diagnosed

 4  with familial dysautonomia or Riley-Day syndrome caused by a

 5  mutation of the IKBKAP gene on chromosome 9. The agency shall

 6  seek federal waiver approval and implement the approved waiver

 7  subject to the availability of funds and any limitations

 8  provided in the General Appropriations Act. The agency may

 9  adopt rules to implement this waiver program.

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

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