Florida Senate - 2009 COMMITTEE AMENDMENT
Bill No. PCS (224390) for SB 1986
Barcode 275632
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
03/25/2009 .
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The Committee on Health Regulation (Gaetz) recommended the
following:
1 Senate Amendment
2
3 Delete lines 483 - 554
4 and insert:
5 (b) Terminated for cause, pursuant to the appeals
6 procedures established by the state or federal government, from
7 any state Medicaid program or the federal Medicare program.
8 Section 11. Subsection (4) of section 409.905, Florida
9 Statutes, is amended to read:
10 409.905 Mandatory Medicaid services.—The agency may make
11 payments for the following services, which are required of the
12 state by Title XIX of the Social Security Act, furnished by
13 Medicaid providers to recipients who are determined to be
14 eligible on the dates on which the services were provided. Any
15 service under this section shall be provided only when medically
16 necessary and in accordance with state and federal law.
17 Mandatory services rendered by providers in mobile units to
18 Medicaid recipients may be restricted by the agency. Nothing in
19 this section shall be construed to prevent or limit the agency
20 from adjusting fees, reimbursement rates, lengths of stay,
21 number of visits, number of services, or any other adjustments
22 necessary to comply with the availability of moneys and any
23 limitations or directions provided for in the General
24 Appropriations Act or chapter 216.
25 (4) HOME HEALTH CARE SERVICES.—The agency shall pay for
26 nursing and home health aide services, supplies, appliances, and
27 durable medical equipment, necessary to assist a recipient
28 living at home. An entity that provides services pursuant to
29 this subsection shall be licensed under part III of chapter 400.
30 These services, equipment, and supplies, or reimbursement
31 therefor, may be limited as provided in the General
32 Appropriations Act and do not include services, equipment, or
33 supplies provided to a person residing in a hospital or nursing
34 facility.
35 (a) In providing home health care services, the agency may
36 require prior authorization of care based on diagnosis or
37 utilization rates. The agency shall require prior authorization
38 for visits for home health services that are not associated with
39 a skilled nursing visit when the home health agency utilization
40 rates exceed the state average by 50 percent or more. The home
41 health agency must submit the recipient’s plan of care and
42 documentation that supports the recipient’s diagnosis to the
43 agency when requesting prior authorization.
44 (b) The agency shall implement a comprehensive utilization
45 management program that requires prior authorization of all
46 private duty nursing services, an individualized treatment plan
47 that includes information about medication and treatment orders,
48 treatment goals, methods of care to be used, and plans for care
49 coordination by nurses and other health professionals. The
50 utilization management program shall also include a process for
51 periodically reviewing the ongoing use of private duty nursing
52 services. The assessment of need shall be based on a child’s
53 condition, family support and care supplements, a family’s
54 ability to provide care, and a family’s and child’s schedule
55 regarding work, school, sleep, and care for other family
56 dependents. When implemented, the private duty nursing
57 utilization management program shall replace the current
58 authorization program used by the Agency for Health Care
59 Administration and the Children’s Medical Services program of
60 the Department of Health. The agency may competitively bid on a
61 contract to select a qualified organization to provide
62 utilization management of private duty nursing services. The
63 agency is authorized to seek federal waivers to implement this
64 initiative.
65 (c) The agency may not pay for home health services, unless
66 the services are medically necessary, and:
67 1. The services are ordered by a physician.
68 2. The written prescription for the services is signed and
69 dated by the recipient’s physician before the development of a
70 plan of care and before any request requiring prior
71 authorization.
72 3. The physician ordering the services is not employed,
73 under contract with, or otherwise affiliated with the home
74 health agency rendering the services.
75 4. The physician ordering the services has examined the
76 recipient within the 30 days preceding the initial request for
77 the services and biannually thereafter.
78