Florida Senate - 2009 SENATOR AMENDMENT
Bill No. CS for CS for CS for SB 1986
Barcode 131462
LEGISLATIVE ACTION
Senate . House
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Floor: 5/AD/2R .
04/23/2009 05:23 PM .
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Senator Gaetz moved the following:
1 Senate Amendment (with title amendment)
2
3 Between lines 830 and 831
4 insert:
5 Section 13. Section 409.91207, Florida Statutes, is created
6 to read:
7 409.91207 — Medical Home Pilot Project.
8 (1) The agency shall develop a plan to implement a medical
9 home pilot project that utilizes primary care case management
10 enhanced by medical home networks to provide coordinated and
11 cost-effective care that is reimbursed on a fee-for-service
12 basis and to compare the performance of the medical home
13 networks with other existing Medicaid managed care models. The
14 agency is authorized to seek a federal Medicaid waiver or an
15 amendment to any existing Medicaid waiver, except for the
16 current 1115 Medicaid waiver authorized in s. 409.91211, as
17 needed, to develop the pilot project created in this section but
18 must obtain approval of the Legislature prior to implementing
19 the pilot project.
20 (2) Each medical home network shall:
21 (a) Provide Medicaid recipients primary care, coordinated
22 services to control chronic illness, pharmacy services,
23 specialty physician services, and hospital outpatient and
24 inpatient services.
25 (b) Coordinate with other health care providers, as
26 necessary, to ensure that Medicaid recipients receive efficient
27 and effective access to other needed medical services,
28 consistent with the scope of services provided to Medipass
29 recipients.
30 (c) Consist of primary care physicians, federally qualified
31 health centers, clinics affiliated with Florida medical schools
32 or teaching hospitals, programs serving children with special
33 health care needs, medical school faculty, statutory teaching
34 hospitals, and other hospitals that agree to participate in the
35 network. A managed care organization is eligible to be
36 designated as a medical home network if it documents policies
37 and procedures consistent with subsection (3).
38 (3) The medical home pilot project developed by the agency
39 must be designed to modify the processes and patterns of health
40 care service delivery in the Medicaid program by requiring a
41 medical home network to:
42 (a) Assign a personal medical provider to lead an
43 interdisciplinary team of professionals who share the
44 responsibility for ongoing care to a specific panel of patients.
45 (b) Require the personal medical provider to identify the
46 patient’s health care needs and respond to those needs either
47 directly or through arrangements with other qualified providers.
48 (c) Coordinate or integrate care across all parts of the
49 health care delivery system.
50 (d) Integrate information technology into the health care
51 delivery system to enhance clinical performance and monitor
52 patient outcomes.
53 (4) The agency shall have the following duties, and
54 responsibilities with respect to the development of the medical
55 home pilot project:
56 (a) To develop and recommend a medical home pilot project
57 in at least two geographic regions in the state that will
58 facilitate access to specialty services in the state’s medical
59 schools and teaching hospitals.
60 (b) To develop and recommend funding strategies that
61 maximize available state and federal funds, including:
62 1. Enhanced primary care case management fees to
63 participating federally qualified health centers and primary
64 care clinics owned or operated by a medical school or teaching
65 hospital.
66 2. Enhanced payments to participating medical schools
67 through the supplemental physician payment program using
68 certified funds.
69 3. Reimbursement for facility costs, in addition to medical
70 services, for participating outpatient primary or specialty
71 clinics.
72 4. Supplemental Medicaid payments through the low-income
73 pool and exempt fee-for-service rates for participating
74 hospitals.
75 5. Enhanced capitation rates for managed care organizations
76 designated as medical home networks to reflect enhanced fee-for
77 service payments to medical home network providers.
78 (c) To develop and recommend criteria to designate medical
79 home networks as eligible to participate in the pilot program
80 and recommend incentives for medical home networks to
81 participate in the medical home pilot project, including bonus
82 payments and shared saving arrangements.
83 (d) To develop a comprehensive fiscal estimate of the
84 medical home pilot project that includes, but is not limited to,
85 anticipated savings to the Medicaid program and any anticipated
86 administrative costs.
87 (e) To develop and recommend which medical services the
88 medical home network would be responsible for providing to
89 enrolled Medicaid recipients.
90 (f) To develop and recommend methodologies to measure the
91 performance of the medical home pilot project including patient
92 outcomes, cost-effectiveness, provider participation, recipient
93 satisfaction, and accountability to ensure the quality of the
94 medical care provided to Medicaid recipients enrolled in the
95 pilot.
96 (g) To recommend policies and procedures for the medical
97 home pilot project administration including, but not limited to:
98 an implementation timeline, the Medicaid recipient enrollment
99 process, recruitment and enrollment of Medicaid providers, and
100 the reimbursement methodologies for participating Medicaid
101 providers.
102 (h) To determine and recommend methods to evaluate the
103 medical home pilot project including but not limited to the
104 comparison of the Medicaid fee-for service system, Medipass
105 system, and other Medicaid managed care programs.
106 (i) To develop and recommend standards and designation
107 requirements for a medical home network that include, but are
108 not limited to: medical care provided by the network, referral
109 arrangements, medical record requirements, health information
110 technology standards, follow-up care processes, and data
111 collection requirements.
112 (5) The Secretary of Health Care Administration shall
113 appoint a task force by August 1, 2009, to assist the agency in
114 the development and implementation of the medical home pilot
115 project. The task force must include, but is not limited to,
116 representatives of providers who could potentially participate
117 in a medical home network, Medicaid recipients, and existing
118 Medipass and managed care providers. Members of the task force
119 shall serve without compensation but are entitled to
120 reimbursement for per diem and travel expenses as provided in s.
121 112.061.
122 (6) The agency shall submit an implementation plan for the
123 medical home pilot project authorized in this section to the
124 Speaker of the House of Representatives, the President of the
125 Senate, and the Governor by February 1, 2010. The implementation
126 plan must include any approved waivers, waiver applications, or
127 state plan amendments necessary to implement the medical home
128 pilot project.
129 (a) The agency shall post any waiver applications, or
130 waiver amendments, authorized under this section on its Internet
131 website 15 days before submitting the applications to the United
132 States Centers for Medicare and Medicaid Services.
133 (b) The implementation of the medical home pilot project,
134 including any Medicaid waivers authorized in this section, is
135 contingent upon review and approval by the Legislature.
136 (c) Upon legislative approval to implement the medical home
137 pilot project, the agency may initiate the adoption of
138 administrative rules to implement and administer the medical
139 home pilot project created in this section.
140
141 ================= T I T L E A M E N D M E N T ================
142 And the title is amended as follows:
143 Delete line 53
144 and insert:
145 the overutilization of Medicaid services; creating s. 409.91207;
146 requiring the agency to develop a plan to create a medical home
147 pilot project; providing waiver authority for the agency;
148 providing an exception; requiring each medical home network to
149 provide specified services; providing responsibilities of the
150 agency; requiring the Secretary of the agency to appoint a task
151 force; requiring the agency to submit a medical home
152 implementation plan; specifying that implementation of the
153 medical home pilot project is contingent upon legislative
154 approval; authorizing the agency to develop rules; amending s.