996013
Florida Senate - 2010
SB7084
The Committee on Health and Human Services Appropriations (Haridopolos and
Gaetz) recommended the following amendment:
Section: 03
On Page: 005
Spec App: 176
| EXPLANATION:
Revises the proviso immediately preceeding Specific
Appropration 176 related to the implementation of
patient centered medical home networks.
|
NET IMPACT ON: Total Funds General Revenue Trust Funds
Recurring - 0 0 0
Non-Recurring - 0 0 0
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Positions & Amounts Positions & Amounts
DELETE INSERT
AGENCY FOR HEALTH CARE ADMINISTRATION
Program: Health Care Services
Medicaid Services To Individuals 68501400
In Section 03 On Page 005
176 Special Categories 100062
Adult Vision And Hearing Services IOEE
DELETE the proviso immediately preceeding Specific Appropriation 176:
From the funds in Specific Appropriations 176 through 213, the agency
shall implement patient centered medical home networks in Agency for
Health Care Administration Areas 1 and 2 by October 1, 2010. The
projects shall utilize primary care case management centrally managed by
a primary care physician, and enhanced by medical home networks that use
coordinated evidence based medicine and health information technology
for data management and ongoing quality improvement. The medical home
network shall consist of a provider service network that contracts with
the agency to provide medical services to Medicaid patients on a
capitated and risk basis that is managed and delivered by primary care
physicians, healthcare providers, federally qualified health centers,
and hospitals. The provider service network shall be majority owned by
one or more of these healthcare providers. No less than 85% of the
capitated rate paid to the provider service network by the agency shall
be expended for direct patient care. Direct patient care shall mean
payments to health care providers for the provision of direct medical
services to a patient. Providers within the network shall be paid on a
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fee for service basis and shall be eligible to receive an enhanced case
management fee and other incentives to encourage care coordination. Any
provider service network is eligible to be designated as a medical home
network if it meets the above referenced criteria. The agency shall
transition the existing Medipass patients in Areas 1 and 2 into the
medical home network provider service networks within 60 days of giving
the patients advance notice of the pending transition. The agency is
authorized to seek any necessary state plan amendment or federal waiver
to implement this provision. The agency shall evaluate these networks
and report on the following measures: the savings to the Medicaid
program realized by the capitated payment scheme, provider
participation, patient satisfaction, the percent of the capitation
payment spent on direct patient care, and the quality of the medical
care provided to Medicaid patients enrolled in the networks. The agency
shall issue a report on these measures to the Legislature and the public
prior to October 1, 2011, and a final assessment shall be submitted by
October 1, 2013.
Insert proviso immediately preceeding Specific Appropriation 176:
From the funds in Specific Appropriation 176 through 213, the agency
shall implement patient centered medical home networks in Agency for
Health Care Administration Areas 1 and 2 by October 1, 2010. The
projects shall utilize primary care case management centrally managed by
a primary care physician, and enhanced by medical home networks that use
coordinated evidence based medicine and health information technology
for data management and ongoing quality improvement. Each medical home
network shall consist of a provider service network; health maintenance
organization licensed under chapter 641 Florida Statutes, or other
managed care entity authorized by Florida law to assume risk; or a
partnership of health providers such as hospitals, county health
departments, physicians, federally qualified health centers, and other
health care providers in partnership with a managed care entity
authorized by Florida law to assume risk, that contracts with the
agency to provide medical services to Medicaid patients. No less than
85% of the capitated rate paid to the network by the agency shall be
expended for direct patient care and the network shall be required to
save the state at least 8 percent compared to the existing fee for
service delivery system in agency Areas 1 and 2. Direct patient care
shall mean payments to health care providers for the provision of direct
medical services to a patient. Providers within the network shall be
eligible to receive an enhanced case management fee and other incentives
to encourage care coordination. The agency shall transition the
existing Medipass patients in Areas 1 and 2 into the medical home
networks, as approved by the federal Centers for Medicare and Medicaid
Services, within 60 days of giving the patients advance notice of the
pending transition. The agency is authorized to seek any necessary
state plan amendment or federal waiver to implement this provision. The
agency shall evaluate these networks and report on the following
measures: the savings to the Medicaid Program, provider participation,
996013 Log:0035 CSK/CSK 03/17/10 08:55:03 PM Senate Page: 2
patient satisfaction, and the percent of the capitation payment spent on
direct patient care, and the quality of the medical care provided to
Medicaid patients enrolled in the networks. The agency shall issue a
report on these measures to the Legislature and the public prior to
October 1, 2011, and a final assessment shall be submitted by October 1,
2012.
| Line item amendments are accepted as part of the amendatory process. However, due to the necessity of using computerized systems this may entail a different placement within a budget entity or the renumbering of the specific appropriation items. Items printed in italics are computer codes and are not a part of the official text of this amendment. |
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