Florida Senate - 2007 SENATOR AMENDMENT
Bill No. CS for CS for SB 518
Barcode 194570
CHAMBER ACTION
Senate House
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05/02/2007 04:59 PM .
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 8, between lines 15 and 16,
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16 insert:
17 Section 4. Section (53) is added to section 409.912,
18 Florida Statutes, to read:
19 409.912 Cost-effective purchasing of health care.--The
20 agency shall purchase goods and services for Medicaid
21 recipients in the most cost-effective manner consistent with
22 the delivery of quality medical care. To ensure that medical
23 services are effectively utilized, the agency may, in any
24 case, require a confirmation or second physician's opinion of
25 the correct diagnosis for purposes of authorizing future
26 services under the Medicaid program. This section does not
27 restrict access to emergency services or poststabilization
28 care services as defined in 42 C.F.R. part 438.114. Such
29 confirmation or second opinion shall be rendered in a manner
30 approved by the agency. The agency shall maximize the use of
31 prepaid per capita and prepaid aggregate fixed-sum basis
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Florida Senate - 2007 SENATOR AMENDMENT
Bill No. CS for CS for SB 518
Barcode 194570
1 services when appropriate and other alternative service
2 delivery and reimbursement methodologies, including
3 competitive bidding pursuant to s. 287.057, designed to
4 facilitate the cost-effective purchase of a case-managed
5 continuum of care. The agency shall also require providers to
6 minimize the exposure of recipients to the need for acute
7 inpatient, custodial, and other institutional care and the
8 inappropriate or unnecessary use of high-cost services. The
9 agency shall contract with a vendor to monitor and evaluate
10 the clinical practice patterns of providers in order to
11 identify trends that are outside the normal practice patterns
12 of a provider's professional peers or the national guidelines
13 of a provider's professional association. The vendor must be
14 able to provide information and counseling to a provider whose
15 practice patterns are outside the norms, in consultation with
16 the agency, to improve patient care and reduce inappropriate
17 utilization. The agency may mandate prior authorization, drug
18 therapy management, or disease management participation for
19 certain populations of Medicaid beneficiaries, certain drug
20 classes, or particular drugs to prevent fraud, abuse, overuse,
21 and possible dangerous drug interactions. The Pharmaceutical
22 and Therapeutics Committee shall make recommendations to the
23 agency on drugs for which prior authorization is required. The
24 agency shall inform the Pharmaceutical and Therapeutics
25 Committee of its decisions regarding drugs subject to prior
26 authorization. The agency is authorized to limit the entities
27 it contracts with or enrolls as Medicaid providers by
28 developing a provider network through provider credentialing.
29 The agency may competitively bid single-source-provider
30 contracts if procurement of goods or services results in
31 demonstrated cost savings to the state without limiting access
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Florida Senate - 2007 SENATOR AMENDMENT
Bill No. CS for CS for SB 518
Barcode 194570
1 to care. The agency may limit its network based on the
2 assessment of beneficiary access to care, provider
3 availability, provider quality standards, time and distance
4 standards for access to care, the cultural competence of the
5 provider network, demographic characteristics of Medicaid
6 beneficiaries, practice and provider-to-beneficiary standards,
7 appointment wait times, beneficiary use of services, provider
8 turnover, provider profiling, provider licensure history,
9 previous program integrity investigations and findings, peer
10 review, provider Medicaid policy and billing compliance
11 records, clinical and medical record audits, and other
12 factors. Providers shall not be entitled to enrollment in the
13 Medicaid provider network. The agency shall determine
14 instances in which allowing Medicaid beneficiaries to purchase
15 durable medical equipment and other goods is less expensive to
16 the Medicaid program than long-term rental of the equipment or
17 goods. The agency may establish rules to facilitate purchases
18 in lieu of long-term rentals in order to protect against fraud
19 and abuse in the Medicaid program as defined in s. 409.913.
20 The agency may seek federal waivers necessary to administer
21 these policies.
22 (53)(a) A pharmacist may not dispense a drug for
23 immunosuppressive therapy following transplant unless the drug
24 is the specific formulation and manufactured by the specific
25 manufacturer as prescribed by the patient's physician.
26 (b) A pharmacist may substitute a drug product that is
27 generically equivalent for immunosuppressive therapy following
28 transplant only if, before making the substitution, the
29 pharmacist obtains a signed authorization from the prescribing
30 physician.
31 (c) This subsection does not apply to generic
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Florida Senate - 2007 SENATOR AMENDMENT
Bill No. CS for CS for SB 518
Barcode 194570
1 equivalents for immunosuppressive drugs currently on the
2 Medicaid preferred drug list, generic equivalents for
3 immunosuppressive drugs currently under review by the
4 Pharmaceutical and Therapeutics Committee and the agency, or
5 to any patient enrolled in the Medicaid program that is
6 currently receiving generically equivalent immunosuppressive
7 drugs.
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9 (Redesignate subsequent sections.)
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12 ================ T I T L E A M E N D M E N T ===============
13 And the title is amended as follows:
14 On page 1, line 24, after the semicolon,
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16 insert:
17 amending s. 409.912, F.S.; providing
18 limitations on the dispensing of certain drugs
19 following transplants;
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