Senate Bill sb2892

    Florida Senate - 2007                                  SB 2892

    By Senator Dawson





    29-1744-07

  1                      A bill to be entitled

  2         An act relating to health care; amending s.

  3         409.912, F.S.; providing a deadline for the

  4         Agency for Health Care Administration to

  5         develop and expand the minority physician

  6         networks in each service area to provide

  7         services to Medicaid recipients who are

  8         eligible to participate under federal law and

  9         rules; amending s. 381.736, F.S.; requiring

10         that the Department of Health work with

11         provider service networks and Medicaid health

12         maintenance organizations to increase the

13         proportion of health care professionals from

14         minority backgrounds; providing an effective

15         date.

16  

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

18  

19         Section 1.  Paragraph (a) of subsection (49) of section

20  409.912, Florida Statutes, is amended to read:

21         409.912  Cost-effective purchasing of health care.--The

22  agency shall purchase goods and services for Medicaid

23  recipients in the most cost-effective manner consistent with

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

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

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

27  the correct diagnosis for purposes of authorizing future

28  services under the Medicaid program. This section does not

29  restrict access to emergency services or poststabilization

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

31  confirmation or second opinion shall be rendered in a manner

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    Florida Senate - 2007                                  SB 2892
    29-1744-07




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

 2  prepaid per capita and prepaid aggregate fixed-sum basis

 3  services when appropriate and other alternative service

 4  delivery and reimbursement methodologies, including

 5  competitive bidding pursuant to s. 287.057, designed to

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

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

 8  minimize the exposure of recipients to the need for acute

 9  inpatient, custodial, and other institutional care and the

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

11  agency shall contract with a vendor to monitor and evaluate

12  the clinical practice patterns of providers in order to

13  identify trends that are outside the normal practice patterns

14  of a provider's professional peers or the national guidelines

15  of a provider's professional association. The vendor must be

16  able to provide information and counseling to a provider whose

17  practice patterns are outside the norms, in consultation with

18  the agency, to improve patient care and reduce inappropriate

19  utilization. The agency may mandate prior authorization, drug

20  therapy management, or disease management participation for

21  certain populations of Medicaid beneficiaries, certain drug

22  classes, or particular drugs to prevent fraud, abuse, overuse,

23  and possible dangerous drug interactions. The Pharmaceutical

24  and Therapeutics Committee shall make recommendations to the

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

26  agency shall inform the Pharmaceutical and Therapeutics

27  Committee of its decisions regarding drugs subject to prior

28  authorization. The agency is authorized to limit the entities

29  it contracts with or enrolls as Medicaid providers by

30  developing a provider network through provider credentialing.

31  The agency may competitively bid single-source-provider

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    Florida Senate - 2007                                  SB 2892
    29-1744-07




 1  contracts if procurement of goods or services results in

 2  demonstrated cost savings to the state without limiting access

 3  to care. The agency may limit its network based on the

 4  assessment of beneficiary access to care, provider

 5  availability, provider quality standards, time and distance

 6  standards for access to care, the cultural competence of the

 7  provider network, demographic characteristics of Medicaid

 8  beneficiaries, practice and provider-to-beneficiary standards,

 9  appointment wait times, beneficiary use of services, provider

10  turnover, provider profiling, provider licensure history,

11  previous program integrity investigations and findings, peer

12  review, provider Medicaid policy and billing compliance

13  records, clinical and medical record audits, and other

14  factors. Providers shall not be entitled to enrollment in the

15  Medicaid provider network. The agency shall determine

16  instances in which allowing Medicaid beneficiaries to purchase

17  durable medical equipment and other goods is less expensive to

18  the Medicaid program than long-term rental of the equipment or

19  goods. The agency may establish rules to facilitate purchases

20  in lieu of long-term rentals in order to protect against fraud

21  and abuse in the Medicaid program as defined in s. 409.913.

22  The agency may seek federal waivers necessary to administer

23  these policies.

24         (49)  The agency shall contract with established

25  minority physician networks that provide services to

26  historically underserved minority patients. The networks must

27  provide cost-effective Medicaid services, comply with the

28  requirements to be a MediPass provider, and provide their

29  primary care physicians with access to data and other

30  management tools necessary to assist them in ensuring the

31  

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    Florida Senate - 2007                                  SB 2892
    29-1744-07




 1  appropriate use of services, including inpatient hospital

 2  services and pharmaceuticals.

 3         (a)  The agency shall provide for the development and

 4  expansion of minority physician networks in each service area

 5  by July 1, 2007, to provide services to Medicaid recipients

 6  who are eligible to participate under federal law and rules.

 7         Section 2.  Subsection (4) of section 381.736, Florida

 8  Statutes, is amended to read:

 9         381.736  Florida Healthy People 2010 Program.--

10         (4)  The department shall work with and promote the

11  establishment of public and private partnerships with

12  charitable organizations, hospitals, provider service

13  networks, Medicaid health maintenance organizations, and

14  minority physician networks to increase the proportion of

15  health care professionals from minority backgrounds.

16         Section 3.  This act shall take effect upon becoming a

17  law.

18  

19            *****************************************

20                          SENATE SUMMARY

21    Provides a deadline for the Agency for Health Care
      Administration to develop and expand the minority
22    physician networks in each service area to provide
      services to Medicaid recipients who are eligible to
23    participate. Requires that the Department of Health work
      with provider service networks and Medicaid health
24    maintenance organizations to increase the proportion of
      health care professionals from minority backgrounds.
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