Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. SB 1726
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Health Policy (Bean) recommended the following:
    1         Senate Substitute for Amendment (942012) (with title
    2  amendment)
    4         Delete lines 1235 - 1285
    5  and insert:
    6         Section 34. Effective upon becoming a law, paragraph (a) of
    7  subsection (5) of section 409.905, Florida Statutes, is amended
    8  to read:
    9         409.905 Mandatory Medicaid services.—The agency may make
   10  payments for the following services, which are required of the
   11  state by Title XIX of the Social Security Act, furnished by
   12  Medicaid providers to recipients who are determined to be
   13  eligible on the dates on which the services were provided. Any
   14  service under this section shall be provided only when medically
   15  necessary and in accordance with state and federal law.
   16  Mandatory services rendered by providers in mobile units to
   17  Medicaid recipients may be restricted by the agency. Nothing in
   18  this section shall be construed to prevent or limit the agency
   19  from adjusting fees, reimbursement rates, lengths of stay,
   20  number of visits, number of services, or any other adjustments
   21  necessary to comply with the availability of moneys and any
   22  limitations or directions provided for in the General
   23  Appropriations Act or chapter 216.
   24         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
   25  all covered services provided for the medical care and treatment
   26  of a recipient who is admitted as an inpatient by a licensed
   27  physician or dentist to a hospital licensed under part I of
   28  chapter 395. However, the agency shall limit the payment for
   29  inpatient hospital services for a Medicaid recipient 21 years of
   30  age or older to 45 days or the number of days necessary to
   31  comply with the General Appropriations Act.
   32         (a)1. The agency may implement reimbursement and
   33  utilization management reforms in order to comply with any
   34  limitations or directions in the General Appropriations Act,
   35  which may include, but are not limited to: prior authorization
   36  for inpatient psychiatric days; prior authorization for
   37  nonemergency hospital inpatient admissions for individuals 21
   38  years of age and older; authorization of emergency and urgent
   39  care admissions within 24 hours after admission; enhanced
   40  utilization and concurrent review programs for highly utilized
   41  services; reduction or elimination of covered days of service;
   42  adjusting reimbursement ceilings for variable costs; adjusting
   43  reimbursement ceilings for fixed and property costs; and
   44  implementing target rates of increase.
   45         2. The agency may limit prior authorization for hospital
   46  inpatient services to selected diagnosis-related groups, based
   47  on an analysis of the cost and potential for unnecessary
   48  hospitalizations represented by certain diagnoses. Admissions
   49  for normal delivery and newborns are exempt from requirements
   50  for prior authorization.
   51         3. In implementing the provisions of this section related
   52  to prior authorization, the agency shall ensure that the process
   53  for authorization is accessible 24 hours per day, 7 days per
   54  week and authorization is automatically granted when not denied
   55  within 4 hours after the request. Authorization procedures must
   56  include steps for review of denials.
   57         4. Upon implementing the prior authorization program for
   58  hospital inpatient services, the agency shall discontinue its
   59  hospital retrospective review program. However, this
   60  subparagraph may not be construed to prevent the agency from
   61  conducting retrospective reviews under s. 409.913.
   62         Section 35. It is the intent of the Legislature that
   63  section 409.905(5)(a), Florida Statutes, as amended by this act,
   64  confirm and clarify existing law.
   65         Section 36. Subsection (1) of section 409.967, Florida
   66  Statutes, is amended to read:
   67         409.967 Managed care plan accountability.—
   68         (1) Beginning with the contract procurement process
   69  initiated during the 2023 calendar year, the agency shall
   70  establish a 6-year 5-year contract with each managed care plan
   71  selected through the procurement process described in s.
   72  409.966. A plan contract may not be renewed; however, the agency
   73  may extend the term of a plan contract to cover any delays
   74  during the transition to a new plan. The agency shall extend
   75  until December 31, 2024, the term of existing plan contracts
   76  awarded pursuant to the invitation to negotiate published in
   77  July 2017.
   79  ================= T I T L E  A M E N D M E N T ================
   80  And the title is amended as follows:
   81         Delete lines 82 - 84
   82  and insert:
   83         amending s. 409.905, F.S.; providing construction for
   84         a provision that requires the agency to discontinue
   85         its hospital retrospective review program under
   86         certain circumstances; providing legislative intent;
   87         amending s. 409.967, F.S.; revising the length of
   88         managed care plan contracts procured by the agency
   89         beginning during a specified timeframe; requiring the
   90         agency to extend the term of certain existing managed
   91         care plan contracts until a specified date; amending