Florida Senate - 2022                                    SB 1770
       By Senator Book
       32-00150-22                                           20221770__
    1                        A bill to be entitled                      
    2         An act relating to donor human milk bank services;
    3         amending s. 409.906, F.S.; authorizing the Agency for
    4         Health Care Administration to pay for donor human milk
    5         bank services as an optional Medicaid service if
    6         certain conditions are met; specifying coverage
    7         requirements; amending s. 409.908, F.S.; adding donor
    8         human milk bank services to the list of Medicaid
    9         services authorized for reimbursement on a fee-for
   10         service basis; amending s. 409.973, F.S.; adding donor
   11         human milk bank services to the list of minimum
   12         benefits required to be covered by Medicaid managed
   13         care plans; providing an effective date.
   15  Be It Enacted by the Legislature of the State of Florida:
   17         Section 1. Subsection (28) is added to section 409.906,
   18  Florida Statutes, to read:
   19         409.906 Optional Medicaid services.—Subject to specific
   20  appropriations, the agency may make payments for services which
   21  are optional to the state under Title XIX of the Social Security
   22  Act and are furnished by Medicaid providers to recipients who
   23  are determined to be eligible on the dates on which the services
   24  were provided. Any optional service that is provided shall be
   25  provided only when medically necessary and in accordance with
   26  state and federal law. Optional services rendered by providers
   27  in mobile units to Medicaid recipients may be restricted or
   28  prohibited by the agency. Nothing in this section shall be
   29  construed to prevent or limit the agency from adjusting fees,
   30  reimbursement rates, lengths of stay, number of visits, or
   31  number of services, or making any other adjustments necessary to
   32  comply with the availability of moneys and any limitations or
   33  directions provided for in the General Appropriations Act or
   34  chapter 216. If necessary to safeguard the state’s systems of
   35  providing services to elderly and disabled persons and subject
   36  to the notice and review provisions of s. 216.177, the Governor
   37  may direct the Agency for Health Care Administration to amend
   38  the Medicaid state plan to delete the optional Medicaid service
   39  known as “Intermediate Care Facilities for the Developmentally
   40  Disabled.” Optional services may include:
   41         (28)DONOR HUMAN MILK BANK SERVICES.—The agency may pay for
   42  the cost of donor human milk, for home and inpatient use, for
   43  which a licensed physician or nurse practitioner has issued an
   44  order for an infant who is medically or physically unable to
   45  receive maternal breast milk or breastfeed or whose mother is
   46  medically or physically unable to produce maternal breast milk
   47  or breastfeed. Such infant must have a documented birth weight
   48  of 1,500 grams or less; have a congenital or acquired intestinal
   49  condition and be at high risk for developing a feeding
   50  intolerance, necrotizing enterocolitis, or an infection; or
   51  otherwise require nourishment by breast milk. The donor human
   52  milk must be procured from a nonprofit milk bank certified by
   53  the Human Milk Banking Association of North America (HMBANA).
   54  Coverage for donor human milk may not be less than the
   55  reasonable cost of such milk procured from an HMBANA-certified
   56  milk bank, plus reasonable processing and handling fees.
   57         Section 2. Present paragraphs (f) through (t) of subsection
   58  (3) of section 409.908, Florida Statutes, are redesignated as
   59  paragraphs (g) through (u), respectively, and a new paragraph
   60  (f) is added to that subsection, to read:
   61         409.908 Reimbursement of Medicaid providers.—Subject to
   62  specific appropriations, the agency shall reimburse Medicaid
   63  providers, in accordance with state and federal law, according
   64  to methodologies set forth in the rules of the agency and in
   65  policy manuals and handbooks incorporated by reference therein.
   66  These methodologies may include fee schedules, reimbursement
   67  methods based on cost reporting, negotiated fees, competitive
   68  bidding pursuant to s. 287.057, and other mechanisms the agency
   69  considers efficient and effective for purchasing services or
   70  goods on behalf of recipients. If a provider is reimbursed based
   71  on cost reporting and submits a cost report late and that cost
   72  report would have been used to set a lower reimbursement rate
   73  for a rate semester, then the provider’s rate for that semester
   74  shall be retroactively calculated using the new cost report, and
   75  full payment at the recalculated rate shall be effected
   76  retroactively. Medicare-granted extensions for filing cost
   77  reports, if applicable, shall also apply to Medicaid cost
   78  reports. Payment for Medicaid compensable services made on
   79  behalf of Medicaid-eligible persons is subject to the
   80  availability of moneys and any limitations or directions
   81  provided for in the General Appropriations Act or chapter 216.
   82  Further, nothing in this section shall be construed to prevent
   83  or limit the agency from adjusting fees, reimbursement rates,
   84  lengths of stay, number of visits, or number of services, or
   85  making any other adjustments necessary to comply with the
   86  availability of moneys and any limitations or directions
   87  provided for in the General Appropriations Act, provided the
   88  adjustment is consistent with legislative intent.
   89         (3) Subject to any limitations or directions provided for
   90  in the General Appropriations Act, the following Medicaid
   91  services and goods may be reimbursed on a fee-for-service basis.
   92  For each allowable service or goods furnished in accordance with
   93  Medicaid rules, policy manuals, handbooks, and state and federal
   94  law, the payment shall be the amount billed by the provider, the
   95  provider’s usual and customary charge, or the maximum allowable
   96  fee established by the agency, whichever amount is less, with
   97  the exception of those services or goods for which the agency
   98  makes payment using a methodology based on capitation rates,
   99  average costs, or negotiated fees.
  100         (f)Donor human milk bank services.
  101         Section 3. Present paragraphs (e) through (bb) of
  102  subsection (1) of section 409.973, Florida Statutes, are
  103  redesignated as paragraphs (f) through (cc), respectively, and a
  104  new paragraph (e) is added to that subsection, to read:
  105         409.973 Benefits.—
  106         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
  107  minimum, the following services:
  108         (e)Donor human milk bank services.
  109         Section 4. This act shall take effect July 1, 2022.