Florida Senate - 2020                                    SB 1374
       By Senator Harrell
       25-01225B-20                                          20201374__
    1                        A bill to be entitled                      
    2         An act relating to regional perinatal intensive care
    3         centers; amending s. 383.16, F.S.; defining and
    4         revising terms; amending s. 383.17, F.S.; authorizing
    5         the Department of Health to designate regional
    6         perinatal intensive care centers; amending s. 383.18,
    7         F.S.; providing that designation by the department is
    8         required for participation in the regional perinatal
    9         intensive care centers program; amending s. 383.19,
   10         F.S.; specifying standards that must be included in
   11         department rules relating to the designation,
   12         development, and operation of a regional perinatal
   13         intensive care center; authorizing the department to
   14         designate two regional perinatal intensive care
   15         centers in a district under certain circumstances;
   16         specifying reimbursement parameters for certain
   17         services provided in a regional perinatal intensive
   18         care center setting; providing parameters for removal
   19         of a regional perinatal intensive care center′s
   20         designation; specifying criteria centers must meet for
   21         the department′s selection and designation as regional
   22         perinatal intensive care centers; requiring the
   23         department, in consultation with the agency, to
   24         develop and implement a process by a specified date to
   25         determine levels of maternal care provided by regional
   26         perinatal intensive care centers; revising the
   27         contents of certain annual reports that regional
   28         perinatal intensive care centers are required to
   29         submit to the department; requiring the department to
   30         conduct an onsite review of each center at least once
   31         every 3 years; amending s. 409.908, F.S.; conforming
   32         provisions to changes made by the act; amending s.
   33         409.975, F.S.; conforming a cross-reference; providing
   34         an effective date.
   36  Be It Enacted by the Legislature of the State of Florida:
   38         Section 1. Present subsections (1), (2), and (3) of section
   39  383.16, Florida Statutes, are redesignated as subsections (2),
   40  (4), and (5), respectively, new subsections (1) and (3) are
   41  added to that section, and present subsection (2) of that
   42  section is amended, to read:
   43         383.16 Definitions; ss. 383.15-383.19.—As used in ss.
   44  383.15-383.19, the term:
   45         (1) “Agency” means the Agency for Health Care
   46  Administration.
   47         (3)“District” has the same meaning as in s. 408.032.
   48         (4)(2) “Regional perinatal intensive care center” or
   49  “center” means a unit designated by the department, located
   50  within a hospital, and specifically designed to provide a full
   51  range of perinatal health services to its patients.
   52         Section 2. Section 383.17, Florida Statutes, is amended to
   53  read:
   54         383.17 Regional perinatal intensive care centers program;
   55  authority.—The department may designate and contract with health
   56  care providers in establishing and maintaining centers in
   57  accordance with ss. 383.15-383.19. The cost of administering the
   58  regional perinatal intensive care centers program shall be paid
   59  by the department from funds appropriated for this purpose.
   60         Section 3. Section 383.18, Florida Statutes, is amended to
   61  read:
   62         383.18 Designations; contracts; conditions.—Participation
   63  in the regional perinatal intensive care centers program under
   64  ss. 383.15-383.19 is contingent upon the department designating
   65  and entering into a contract with a provider. The contract must
   66  shall provide that patients will receive services from the
   67  center and that parents or guardians of patients who participate
   68  in the program and who are in compliance with Medicaid
   69  eligibility requirements as determined by the department are not
   70  additionally charged for treatment and care that which has been
   71  contracted for by the department. Financial eligibility for the
   72  program is based on the Medicaid income guidelines for pregnant
   73  women and for children younger than under 1 year of age. Funding
   74  must shall be provided in accordance with ss. 383.19 and
   75  409.908.
   76         Section 4. Section 383.19, Florida Statutes, is amended to
   77  read:
   78         383.19 Standards; funding; ineligibility.—
   79         (1) The department shall adopt rules that specify standards
   80  for designation, development, and operation of a center which
   81  must include, but need not be are not limited to:
   82         (a) The need to provide services through a regional
   83  perinatal intensive care center and the requirements of the
   84  population to be served.
   85         (b) Equipment.
   86         (c) Facilities.
   87         (d) Staffing and qualifications of personnel.
   88         (e) Transportation services.
   89         (f) Data collection.
   90         (g)Levels of care.
   91         (h)Educational outreach.
   92         (i)Access to consultative specialist services.
   93         (j)Participation in quality collaborations, both within
   94  and outside of the center’s district.
   95         (k)Support of rural hospitals, as defined in s. 395.602.
   96         (l)(g) Definitions of terms.
   97         (2) The department shall designate at least one center to
   98  serve a geographic area representing each district region of the
   99  state, and one additional center may be designated in any
  100  district in which at least 20,000 resident 10,000 live births
  101  occur per year, as reported by the department’s Bureau of Vital
  102  Statistics, but in no case may there be more than 22 11 regional
  103  perinatal intensive care centers established unless specifically
  104  authorized in the General Appropriations Act or in this
  105  subsection.
  106         (3) Medicaid reimbursement must shall be made for services
  107  provided to patients who are Medicaid recipients. Medicaid
  108  reimbursement for in-center and outpatient obstetrical and
  109  neonatal physician services must be paid as follows:
  110         (a)Reimbursement for such services provided at centers to
  111  members of a managed care plan as defined in s. 409.962 must be
  112  paid in accordance with the provider payment provisions of part
  113  IV of chapter 409; or
  114         (b)Reimbursement for such services provided at centers on
  115  a fee-for-service basis must shall be based upon the obstetrical
  116  care group payment system or. Medicaid reimbursement for in
  117  center neonatal physician services shall be based upon the
  118  neonatal care group payment system, as applicable. These
  119  prospective payment systems, developed by the department, must
  120  place patients into homogeneous groups based on clinical
  121  factors, severity of illness, and intensity of care. Outpatient
  122  obstetrical services and other Related services provided on a
  123  fee-for-service basis, such as consultations, must shall be
  124  reimbursed based on the usual Medicaid method of fee-for-service
  125  payment for such outpatient medical services.
  126         (4)(3) Failure to comply with any standard the standards
  127  established under this section, department rules, or the terms
  128  of the contract between the department and a center constitutes
  129  grounds for terminating the contract and removal of the centers
  130  designation.
  131         (5)(4) The department shall select and designate centers
  132  that do all of the following: give priority to establishing
  133  centers in hospitals that
  134         (a) Demonstrate an interest in perinatal intensive care by
  135  meeting program standards established in this section and by the
  136  department.
  137         (b) Demonstrate a commitment to improving access to health
  138  services, including the timely use of personal health services
  139  to achieve the best health outcomes.
  140         (c) Maintain a facility birth volume of at least 3,000 live
  141  births per year.
  142         (d) Actively participate in one or more perinatal quality
  143  collaborations as defined by department rule.
  144         (6) No later than July 1, 2023, the department, in
  145  consultation with the agency, shall develop and implement a
  146  statewide process to engage perinatal stakeholders for the
  147  purpose of determining appropriate and efficacious levels of
  148  maternal care provided by centers. The statewide process must
  149  seek to standardize the centers’ internal assessments of levels
  150  of maternal care guided by methodologies and tools developed by
  151  the federal Centers for Disease Control and Prevention.
  152         (7)(5) A private, for-profit hospital that does not accept
  153  county, state, or federal funds or indigent patients is not
  154  eligible to participate under ss. 383.15-383.19.
  155         (8)(6) Each hospital that is designated by and contracts
  156  with the department to provide services under the terms of ss.
  157  383.15-383.19 shall prepare and submit to the department an
  158  annual report that includes, but is not limited to, the number
  159  of clients served, quality improvement measures and projects
  160  that the center has engaged in, and the costs of services in the
  161  center. The department shall annually conduct a programmatic and
  162  financial evaluation of each center and shall conduct an onsite
  163  review of each center at least once every 3 years.
  164         Section 5. Paragraph (c) of subsection (12) of section
  165  409.908, Florida Statutes, is amended to read:
  166         409.908 Reimbursement of Medicaid providers.—Subject to
  167  specific appropriations, the agency shall reimburse Medicaid
  168  providers, in accordance with state and federal law, according
  169  to methodologies set forth in the rules of the agency and in
  170  policy manuals and handbooks incorporated by reference therein.
  171  These methodologies may include fee schedules, reimbursement
  172  methods based on cost reporting, negotiated fees, competitive
  173  bidding pursuant to s. 287.057, and other mechanisms the agency
  174  considers efficient and effective for purchasing services or
  175  goods on behalf of recipients. If a provider is reimbursed based
  176  on cost reporting and submits a cost report late and that cost
  177  report would have been used to set a lower reimbursement rate
  178  for a rate semester, then the provider’s rate for that semester
  179  shall be retroactively calculated using the new cost report, and
  180  full payment at the recalculated rate shall be effected
  181  retroactively. Medicare-granted extensions for filing cost
  182  reports, if applicable, shall also apply to Medicaid cost
  183  reports. Payment for Medicaid compensable services made on
  184  behalf of Medicaid eligible persons is subject to the
  185  availability of moneys and any limitations or directions
  186  provided for in the General Appropriations Act or chapter 216.
  187  Further, nothing in this section shall be construed to prevent
  188  or limit the agency from adjusting fees, reimbursement rates,
  189  lengths of stay, number of visits, or number of services, or
  190  making any other adjustments necessary to comply with the
  191  availability of moneys and any limitations or directions
  192  provided for in the General Appropriations Act, provided the
  193  adjustment is consistent with legislative intent.
  194         (12)
  195         (c) Notwithstanding paragraph (b), reimbursement fees to
  196  physicians for providing total obstetrical services to Medicaid
  197  recipients, which include prenatal, delivery, and postpartum
  198  care, shall be at least $1,500 per delivery for a pregnant woman
  199  with low medical risk and at least $2,000 per delivery for a
  200  pregnant woman with high medical risk. However, reimbursement to
  201  physicians working in regional perinatal intensive care centers
  202  designated pursuant to chapter 383, for services to certain
  203  pregnant Medicaid recipients with a high medical risk, must may
  204  be made according to s. 383.19(3) obstetrical care and neonatal
  205  care groupings and rates established by the agency. Nurse
  206  midwives licensed under part I of chapter 464 or midwives
  207  licensed under chapter 467 shall be reimbursed at no less than
  208  80 percent of the low medical risk fee. The agency shall by rule
  209  determine, for the purpose of this paragraph, what constitutes a
  210  high or low medical risk pregnant woman and shall not pay more
  211  based solely on the fact that a caesarean section was performed,
  212  rather than a vaginal delivery. The agency shall by rule
  213  determine a prorated payment for obstetrical services in cases
  214  where only part of the total prenatal, delivery, or postpartum
  215  care was performed. The Department of Health shall adopt rules
  216  for appropriate insurance coverage for midwives licensed under
  217  chapter 467. Prior to the issuance and renewal of an active
  218  license, or reactivation of an inactive license for midwives
  219  licensed under chapter 467, such licensees shall submit proof of
  220  coverage with each application.
  221         Section 6. Paragraph (b) of subsection (1) of section
  222  409.975, Florida Statutes, is amended to read:
  223         409.975 Managed care plan accountability.—In addition to
  224  the requirements of s. 409.967, plans and providers
  225  participating in the managed medical assistance program shall
  226  comply with the requirements of this section.
  227         (1) PROVIDER NETWORKS.—Managed care plans must develop and
  228  maintain provider networks that meet the medical needs of their
  229  enrollees in accordance with standards established pursuant to
  230  s. 409.967(2)(c). Except as provided in this section, managed
  231  care plans may limit the providers in their networks based on
  232  credentials, quality indicators, and price.
  233         (b) Certain providers are statewide resources and essential
  234  providers for all managed care plans in all regions. All managed
  235  care plans must include these essential providers in their
  236  networks. Statewide essential providers include:
  237         1. Faculty plans of Florida medical schools.
  238         2. Regional perinatal intensive care centers as defined in
  239  s. 383.16(4) s. 383.16(2).
  240         3. Hospitals licensed as specialty children’s hospitals as
  241  defined in s. 395.002(27).
  242         4. Accredited and integrated systems serving medically
  243  complex children which comprise separately licensed, but
  244  commonly owned, health care providers delivering at least the
  245  following services: medical group home, in-home and outpatient
  246  nursing care and therapies, pharmacy services, durable medical
  247  equipment, and Prescribed Pediatric Extended Care.
  249  Managed care plans that have not contracted with all statewide
  250  essential providers in all regions as of the first date of
  251  recipient enrollment must continue to negotiate in good faith.
  252  Payments to physicians on the faculty of nonparticipating
  253  Florida medical schools shall be made at the applicable Medicaid
  254  rate. Payments for services rendered by regional perinatal
  255  intensive care centers shall be made at the applicable Medicaid
  256  rate as of the first day of the contract between the agency and
  257  the plan. Except for payments for emergency services, payments
  258  to nonparticipating specialty children’s hospitals shall equal
  259  the highest rate established by contract between that provider
  260  and any other Medicaid managed care plan.
  261         Section 7. This act shall take effect July 1, 2020.