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

       The Committee on Health Policy (Bean) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete lines 1235 - 1285
    4  and insert:
    5         Section 34. Effective upon becoming a law and applying
    6  retroactively, paragraph (a) of subsection (5) of section
    7  409.905, Florida Statutes, is amended to read:
    8         409.905 Mandatory Medicaid services.—The agency may make
    9  payments for the following services, which are required of the
   10  state by Title XIX of the Social Security Act, furnished by
   11  Medicaid providers to recipients who are determined to be
   12  eligible on the dates on which the services were provided. Any
   13  service under this section shall be provided only when medically
   14  necessary and in accordance with state and federal law.
   15  Mandatory services rendered by providers in mobile units to
   16  Medicaid recipients may be restricted by the agency. Nothing in
   17  this section shall be construed to prevent or limit the agency
   18  from adjusting fees, reimbursement rates, lengths of stay,
   19  number of visits, number of services, or any other adjustments
   20  necessary to comply with the availability of moneys and any
   21  limitations or directions provided for in the General
   22  Appropriations Act or chapter 216.
   23         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
   24  all covered services provided for the medical care and treatment
   25  of a recipient who is admitted as an inpatient by a licensed
   26  physician or dentist to a hospital licensed under part I of
   27  chapter 395. However, the agency shall limit the payment for
   28  inpatient hospital services for a Medicaid recipient 21 years of
   29  age or older to 45 days or the number of days necessary to
   30  comply with the General Appropriations Act.
   31         (a) The agency may implement reimbursement and utilization
   32  management reforms in order to comply with any limitations or
   33  directions in the General Appropriations Act, which may include,
   34  but are not limited to: prior authorization for inpatient
   35  psychiatric days; prior authorization for nonemergency hospital
   36  inpatient admissions for individuals 21 years of age and older;
   37  authorization of emergency and urgent-care admissions within 24
   38  hours after admission; enhanced utilization and concurrent
   39  review programs for highly utilized services; reduction or
   40  elimination of covered days of service; adjusting reimbursement
   41  ceilings for variable costs; adjusting reimbursement ceilings
   42  for fixed and property costs; and implementing target rates of
   43  increase. The agency may limit prior authorization for hospital
   44  inpatient services to selected diagnosis-related groups, based
   45  on an analysis of the cost and potential for unnecessary
   46  hospitalizations represented by certain diagnoses. Admissions
   47  for normal delivery and newborns are exempt from requirements
   48  for prior authorization. In implementing the provisions of this
   49  section related to prior authorization, the agency shall ensure
   50  that the process for authorization is accessible 24 hours per
   51  day, 7 days per week and authorization is automatically granted
   52  when not denied within 4 hours after the request. Authorization
   53  procedures must include steps for review of denials. The agency
   54  may conduct, or contract with or otherwise delegate another
   55  entity to conduct, reviews, investigations, analyses, or audits,
   56  or any combination thereof, to determine whether fraud, abuse,
   57  overpayment, or recipient neglect is occurring in the Medicaid
   58  program Upon implementing the prior authorization program for
   59  hospital inpatient services, the agency shall discontinue its
   60  hospital retrospective review program.
   61         Section 35. The amendment to s. 409.905, Florida Statutes,
   62  is considered a legislative interpretation of the original
   63  statute rather than a substantive change to the statute to
   64  address the court’s decision in Lee Memorial Health System Gulf
   65  Coast Medical Center v. Agency for Health Care Administration,
   66  Case No. 1D16-1969 (Fla. 1st DCA Feb. 27, 2019), which is
   67  inconsistent with the intent of the statutory text.
   68         Section 36. Subsection (1) of section 409.967, Florida
   69  Statutes, is amended to read:
   70         409.967 Managed care plan accountability.—
   71         (1) Beginning with the contract procurement process
   72  initiated during the 2023 calendar year, the agency shall
   73  establish a 6-year 5-year contract with each managed care plan
   74  selected through the procurement process described in s.
   75  409.966. A plan contract may not be renewed; however, the agency
   76  may extend the term of a plan contract to cover any delays
   77  during the transition to a new plan. The agency shall extend
   78  until December 31, 2024, the term of existing plan contracts
   79  awarded pursuant to the invitation to negotiate published in
   80  July 2017.
   82  ================= T I T L E  A M E N D M E N T ================
   83  And the title is amended as follows:
   84         Delete lines 84 - 87
   85  and insert:
   86         review program under certain circumstances; providing
   87         legislative intent and clarifying language; amending
   88         s. 409.967, F.S.; revising the length of managed care
   89         plan contracts procured by the agency beginning during
   90         a specified timeframe; requiring the agency to extend
   91         the term of certain existing managed care plan
   92         contracts until a specified date; amending s. 409.913,
   93         F.S.; revising the due date for a certain annual
   94         report; deleting the requirement that certain agencies
   95         submit their annual reports jointly; specifying that
   96         the agency and its contractors are entitled to recover
   97         all investigative and legal costs and other expenses
   98         incurred as a result of an audit, investigation, or
   99         enforcement action; amending