Florida Senate - 2022                             CS for SB 1770
       By the Committee on Appropriations; and Senators Book and
       576-03380-22                                          20221770c1
    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; requiring the agency to adopt rules;
    8         authorizing the agency to seek federal approval;
    9         amending s. 409.908, F.S.; adding donor human milk
   10         bank services to the list of Medicaid services
   11         authorized for reimbursement on a fee-for-service
   12         basis; amending s. 409.973, F.S.; adding donor human
   13         milk bank services to the list of minimum benefits
   14         required to be covered by Medicaid managed care plans;
   15         providing an effective date.
   17  Be It Enacted by the Legislature of the State of Florida:
   19         Section 1. Subsection (28) is added to section 409.906,
   20  Florida Statutes, to read:
   21         409.906 Optional Medicaid services.—Subject to specific
   22  appropriations, the agency may make payments for services which
   23  are optional to the state under Title XIX of the Social Security
   24  Act and are furnished by Medicaid providers to recipients who
   25  are determined to be eligible on the dates on which the services
   26  were provided. Any optional service that is provided shall be
   27  provided only when medically necessary and in accordance with
   28  state and federal law. Optional services rendered by providers
   29  in mobile units to Medicaid recipients may be restricted or
   30  prohibited by the agency. Nothing in this section shall be
   31  construed to prevent or limit the agency from adjusting fees,
   32  reimbursement rates, lengths of stay, number of visits, or
   33  number of services, or making any other adjustments necessary to
   34  comply with the availability of moneys and any limitations or
   35  directions provided for in the General Appropriations Act or
   36  chapter 216. If necessary to safeguard the state’s systems of
   37  providing services to elderly and disabled persons and subject
   38  to the notice and review provisions of s. 216.177, the Governor
   39  may direct the Agency for Health Care Administration to amend
   40  the Medicaid state plan to delete the optional Medicaid service
   41  known as “Intermediate Care Facilities for the Developmentally
   42  Disabled.” Optional services may include:
   43         (28)DONOR HUMAN MILK BANK SERVICES.—The agency may pay for
   44  the provision of donor human milk and human milk products
   45  derived therefrom for inpatient use, for which a licensed
   46  physician, nurse practitioner, physician assistant, or dietitian
   47  has issued an order for an infant who is medically or physically
   48  unable to receive maternal breast milk or to breastfeed or whose
   49  mother is medically or physically unable to produce maternal
   50  breast milk or breastfeed. Such infant must have a documented
   51  birth weight of 1,800 grams or less; have a congenital or
   52  acquired condition and be at high risk for developing a feeding
   53  intolerance, necrotizing enterocolitis, or an infection; or
   54  otherwise have a medical indication for a human milk diet. The
   55  agency shall adopt rules that include, but are not limited to,
   56  eligible providers of donor human milk and donor human milk
   57  derivates. The agency may seek federal approval necessary to
   58  implement this subsection.
   59         Section 2. Present paragraphs (f) through (t) of subsection
   60  (3) of section 409.908, Florida Statutes, are redesignated as
   61  paragraphs (g) through (u), respectively, and a new paragraph
   62  (f) is added to that subsection, to read:
   63         409.908 Reimbursement of Medicaid providers.—Subject to
   64  specific appropriations, the agency shall reimburse Medicaid
   65  providers, in accordance with state and federal law, according
   66  to methodologies set forth in the rules of the agency and in
   67  policy manuals and handbooks incorporated by reference therein.
   68  These methodologies may include fee schedules, reimbursement
   69  methods based on cost reporting, negotiated fees, competitive
   70  bidding pursuant to s. 287.057, and other mechanisms the agency
   71  considers efficient and effective for purchasing services or
   72  goods on behalf of recipients. If a provider is reimbursed based
   73  on cost reporting and submits a cost report late and that cost
   74  report would have been used to set a lower reimbursement rate
   75  for a rate semester, then the provider’s rate for that semester
   76  shall be retroactively calculated using the new cost report, and
   77  full payment at the recalculated rate shall be effected
   78  retroactively. Medicare-granted extensions for filing cost
   79  reports, if applicable, shall also apply to Medicaid cost
   80  reports. Payment for Medicaid compensable services made on
   81  behalf of Medicaid-eligible persons is subject to the
   82  availability of moneys and any limitations or directions
   83  provided for in the General Appropriations Act or chapter 216.
   84  Further, nothing in this section shall be construed to prevent
   85  or limit the agency from adjusting fees, reimbursement rates,
   86  lengths of stay, number of visits, or number of services, or
   87  making any other adjustments necessary to comply with the
   88  availability of moneys and any limitations or directions
   89  provided for in the General Appropriations Act, provided the
   90  adjustment is consistent with legislative intent.
   91         (3) Subject to any limitations or directions provided for
   92  in the General Appropriations Act, the following Medicaid
   93  services and goods may be reimbursed on a fee-for-service basis.
   94  For each allowable service or goods furnished in accordance with
   95  Medicaid rules, policy manuals, handbooks, and state and federal
   96  law, the payment shall be the amount billed by the provider, the
   97  provider’s usual and customary charge, or the maximum allowable
   98  fee established by the agency, whichever amount is less, with
   99  the exception of those services or goods for which the agency
  100  makes payment using a methodology based on capitation rates,
  101  average costs, or negotiated fees.
  102         (f)Donor human milk bank services.
  103         Section 3. Present paragraphs (e) through (bb) of
  104  subsection (1) of section 409.973, Florida Statutes, are
  105  redesignated as paragraphs (f) through (cc), respectively, and a
  106  new paragraph (e) is added to that subsection, to read:
  107         409.973 Benefits.—
  108         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
  109  minimum, the following services:
  110         (e)Donor human milk bank services.
  111         Section 4. This act shall take effect July 1, 2022.