| 1 | Representative(s) Bogdanoff offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | On page 1, between line(s) 23 and 24, insert: |
| 5 | Section 2. Subsection (43) of section 409.912, Florida |
| 6 | Statutes, is amended to read: |
| 7 | 409.912 Cost-effective purchasing of health care.--The |
| 8 | agency shall purchase goods and services for Medicaid recipients |
| 9 | in the most cost-effective manner consistent with the delivery |
| 10 | of quality medical care. To ensure that medical services are |
| 11 | effectively utilized, the agency may, in any case, require a |
| 12 | confirmation or second physician's opinion of the correct |
| 13 | diagnosis for purposes of authorizing future services under the |
| 14 | Medicaid program. This section does not restrict access to |
| 15 | emergency services or poststabilization care services as defined |
| 16 | in 42 C.F.R. part 438.114. Such confirmation or second opinion |
| 17 | shall be rendered in a manner approved by the agency. The agency |
| 18 | shall maximize the use of prepaid per capita and prepaid |
| 19 | aggregate fixed-sum basis services when appropriate and other |
| 20 | alternative service delivery and reimbursement methodologies, |
| 21 | including competitive bidding pursuant to s. 287.057, designed |
| 22 | to facilitate the cost-effective purchase of a case-managed |
| 23 | continuum of care. The agency shall also require providers to |
| 24 | minimize the exposure of recipients to the need for acute |
| 25 | inpatient, custodial, and other institutional care and the |
| 26 | inappropriate or unnecessary use of high-cost services. The |
| 27 | agency may mandate prior authorization, drug therapy management, |
| 28 | or disease management participation for certain populations of |
| 29 | Medicaid beneficiaries, certain drug classes, or particular |
| 30 | drugs to prevent fraud, abuse, overuse, and possible dangerous |
| 31 | drug interactions. The Pharmaceutical and Therapeutics Committee |
| 32 | shall make recommendations to the agency on drugs for which |
| 33 | prior authorization is required. The agency shall inform the |
| 34 | Pharmaceutical and Therapeutics Committee of its decisions |
| 35 | regarding drugs subject to prior authorization. The agency is |
| 36 | authorized to limit the entities it contracts with or enrolls as |
| 37 | Medicaid providers by developing a provider network through |
| 38 | provider credentialing. The agency may limit its network based |
| 39 | on the assessment of beneficiary access to care, provider |
| 40 | availability, provider quality standards, time and distance |
| 41 | standards for access to care, the cultural competence of the |
| 42 | provider network, demographic characteristics of Medicaid |
| 43 | beneficiaries, practice and provider-to-beneficiary standards, |
| 44 | appointment wait times, beneficiary use of services, provider |
| 45 | turnover, provider profiling, provider licensure history, |
| 46 | previous program integrity investigations and findings, peer |
| 47 | review, provider Medicaid policy and billing compliance records, |
| 48 | clinical and medical record audits, and other factors. Providers |
| 49 | shall not be entitled to enrollment in the Medicaid provider |
| 50 | network. The agency is authorized to seek federal waivers |
| 51 | necessary to implement this policy. |
| 52 | (43)(a) The agency may contract on a prepaid or fixed-sum |
| 53 | basis with appropriately licensed prepaid dental health plans to |
| 54 | provide dental services. |
| 55 | (b) The agency shall submit for approval an amended waiver |
| 56 | application to the Legislature during the regular legislative |
| 57 | session, or to the Legislative Budget Commission when the |
| 58 | Legislature is not in session, to implement the managed care |
| 59 | program for dental care in areas 9 and 10. The agency shall post |
| 60 | the amended waiver application for this managed care program on |
| 61 | its Internet website 60 days before submitting the amended |
| 62 | waiver application to the United States Center for Medicare and |
| 63 | Medicaid Services. All waivers submitted to and approved by the |
| 64 | United States Centers for Medicare and Medicaid Services must be |
| 65 | submitted to the appropriate committees of the Senate and the |
| 66 | House of Representatives in order to obtain authority for |
| 67 | implementation as required in s. 409.912(11) before program |
| 68 | implementation. |
| 69 |
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| 70 | ================= T I T L E A M E N D M E N T ================= |
| 71 | On page 1, line(s) 8, |
| 72 | remove: all of said line |
| 73 |
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| 74 | and insert: recipients; requiring the agency to submit an |
| 75 | amended waiver application to the Legislature or the Legislative |
| 76 | Budget Commission to implement a managed care program for dental |
| 77 | care in specified areas; providing an appropriation; |