Florida Senate - 2007 SENATOR AMENDMENT
Bill No. HB 1155, 2nd Eng.
Barcode 190244
CHAMBER ACTION
Senate House
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05/02/2007 05:01 PM .
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11 Senator Saunders moved the following amendment to amendment
12 (461802):
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14 Senate Amendment (with title amendment)
15 On page 7, between lines 22 and 23,
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17 insert:
18 Section 4. Section (53) is added to section 409.912,
19 Florida Statutes, to read:
20 409.912 Cost-effective purchasing of health care.--The
21 agency shall purchase goods and services for Medicaid
22 recipients in the most cost-effective manner consistent with
23 the delivery of quality medical care. To ensure that medical
24 services are effectively utilized, the agency may, in any
25 case, require a confirmation or second physician's opinion of
26 the correct diagnosis for purposes of authorizing future
27 services under the Medicaid program. This section does not
28 restrict access to emergency services or poststabilization
29 care services as defined in 42 C.F.R. part 438.114. Such
30 confirmation or second opinion shall be rendered in a manner
31 approved by the agency. The agency shall maximize the use of
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Florida Senate - 2007 SENATOR AMENDMENT
Bill No. HB 1155, 2nd Eng.
Barcode 190244
1 prepaid per capita and prepaid aggregate fixed-sum basis
2 services when appropriate and other alternative service
3 delivery and reimbursement methodologies, including
4 competitive bidding pursuant to s. 287.057, designed to
5 facilitate the cost-effective purchase of a case-managed
6 continuum of care. The agency shall also require providers to
7 minimize the exposure of recipients to the need for acute
8 inpatient, custodial, and other institutional care and the
9 inappropriate or unnecessary use of high-cost services. The
10 agency shall contract with a vendor to monitor and evaluate
11 the clinical practice patterns of providers in order to
12 identify trends that are outside the normal practice patterns
13 of a provider's professional peers or the national guidelines
14 of a provider's professional association. The vendor must be
15 able to provide information and counseling to a provider whose
16 practice patterns are outside the norms, in consultation with
17 the agency, to improve patient care and reduce inappropriate
18 utilization. The agency may mandate prior authorization, drug
19 therapy management, or disease management participation for
20 certain populations of Medicaid beneficiaries, certain drug
21 classes, or particular drugs to prevent fraud, abuse, overuse,
22 and possible dangerous drug interactions. The Pharmaceutical
23 and Therapeutics Committee shall make recommendations to the
24 agency on drugs for which prior authorization is required. The
25 agency shall inform the Pharmaceutical and Therapeutics
26 Committee of its decisions regarding drugs subject to prior
27 authorization. The agency is authorized to limit the entities
28 it contracts with or enrolls as Medicaid providers by
29 developing a provider network through provider credentialing.
30 The agency may competitively bid single-source-provider
31 contracts if procurement of goods or services results in
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Florida Senate - 2007 SENATOR AMENDMENT
Bill No. HB 1155, 2nd Eng.
Barcode 190244
1 demonstrated cost savings to the state without limiting access
2 to care. The agency may limit its network based on the
3 assessment of beneficiary access to care, provider
4 availability, provider quality standards, time and distance
5 standards for access to care, the cultural competence of the
6 provider network, demographic characteristics of Medicaid
7 beneficiaries, practice and provider-to-beneficiary standards,
8 appointment wait times, beneficiary use of services, provider
9 turnover, provider profiling, provider licensure history,
10 previous program integrity investigations and findings, peer
11 review, provider Medicaid policy and billing compliance
12 records, clinical and medical record audits, and other
13 factors. Providers shall not be entitled to enrollment in the
14 Medicaid provider network. The agency shall determine
15 instances in which allowing Medicaid beneficiaries to purchase
16 durable medical equipment and other goods is less expensive to
17 the Medicaid program than long-term rental of the equipment or
18 goods. The agency may establish rules to facilitate purchases
19 in lieu of long-term rentals in order to protect against fraud
20 and abuse in the Medicaid program as defined in s. 409.913.
21 The agency may seek federal waivers necessary to administer
22 these policies.
23 (53)(a) A pharmacist may not dispense a drug for
24 immunosuppressive therapy following transplant unless the drug
25 is the specific formulation and manufactured by the specific
26 manufacturer as prescribed by the patient's physician.
27 (b) A pharmacist may substitute a drug product that is
28 generically equivalent for immunosuppressive therapy following
29 transplant only if, before making the substitution, the
30 pharmacist obtains a signed authorization from the prescribing
31 physician.
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Florida Senate - 2007 SENATOR AMENDMENT
Bill No. HB 1155, 2nd Eng.
Barcode 190244
1 (c) This subsection does not apply to generic
2 equivalents for immunosuppressive drugs currently on the
3 Medicaid preferred drug list, generic equivalents for
4 immunosuppressive drugs currently under review by the
5 Pharmaceutical and Therapeutics Committee and the agency, or
6 to any patient enrolled in the Medicaid program that is
7 currently receiving generically equivalent immunosuppressive
8 drugs.
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10 (Redesignate subsequent sections.)
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13 ================ T I T L E A M E N D M E N T ===============
14 And the title is amended as follows:
15 On page 9, line 26, after the semicolon,
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17 insert:
18 amending s. 409.912, F.S.; providing
19 limitations on the dispensing of certain drugs
20 following transplants;
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