November 14, 2019
Print This PagePrint This Page

  *
Session:
Bill #:
Session:
Chamber: View Search Tips
Search Term:
Year: View Search Tips
Search Term:
_h5301__
HB 5301

1
A bill to be entitled
2An act relating to Medicaid services; amending s. 400.141,
3F.S.; conforming a cross-reference to changes made by the
4act; amending s. 400.23, F.S.; providing for flexibility
5in how to meet the minimum staffing requirements for
6nursing home facilities; amending s. 409.903, F.S.;
7eliminating eligibility and coverage for women during
8pregnancy and the postpartum period who live in a family
9that has an income at or below a specified percentage of
10the federal poverty level; amending s. 409.904, F.S.;
11revising the expiration date of provisions authorizing the
12federal waiver for certain persons age 65 and over or who
13have a disability; revising the expiration date of
14provisions authorizing a specified medically needy
15program; amending s. 409.906, F.S.; eliminating optional
16adult Medicaid coverage for chiropractic services for
17adult recipients; amending s. 409.908, F.S.; updating the
18formula used for calculating reimbursements to providers
19of prescribed drugs; amending s. 409.9082, F.S.; revising
20the purpose of the use of the nursing home facility
21quality assessment and federal matching funds; amending s.
22409.9083, F.S.; revising the purpose of the use of the
23privately operated intermediate care facilities for the
24developmentally disabled quality assessment and federal
25matching funds; amending s. 409.911, F.S.; updating the
26data to be used in calculating disproportionate share;
27revising the formula used to pay disproportionate share
28dollars to provider service network hospitals; amending s.
29409.9112, F.S.; continuing the prohibition against
30distributing moneys under the perinatal intensive care
31centers disproportionate share program; amending s.
32409.9113, F.S.; continuing authorization for the
33distribution of moneys to teaching hospitals under the
34disproportionate share program; amending s. 409.9117,
35F.S.; continuing the prohibition against distributing
36moneys under the primary care disproportionate share
37program; amending s. 409.912, F.S.; updating the formula
38used for calculating reimbursements to providers of
39prescribed drugs; amending s. 430.707, F.S.; permitting
40the Agency for Health Care Administration, in consultation
41with the Department of Elderly Affairs, to accept and
42forward an application for expansion of service capacity
43to the Centers for Medicare and Medicaid Services for a
44specified entity that provides benefits under the Program
45of All-inclusive Care for the Elderly; providing an
46effective date.
47
48Be It Enacted by the Legislature of the State of Florida:
49
50     Section 1.  Paragraph (o) of subsection (1) of section
51400.141, Florida Statutes, is amended to read:
52     400.141  Administration and management of nursing home
53facilities.-
54     (1)  Every licensed facility shall comply with all
55applicable standards and rules of the agency and shall:
56     (o)1.  Submit semiannually to the agency, or more
57frequently if requested by the agency, information regarding
58facility staff-to-resident ratios, staff turnover, and staff
59stability, including information regarding certified nursing
60assistants, licensed nurses, the director of nursing, and the
61facility administrator. For purposes of this reporting:
62     a.  Staff-to-resident ratios must be reported in the
63categories specified in s. 400.23(3)(a) and applicable rules.
64The ratio must be reported as an average for the most recent
65calendar quarter.
66     b.  Staff turnover must be reported for the most recent 12-
67month period ending on the last workday of the most recent
68calendar quarter prior to the date the information is submitted.
69The turnover rate must be computed quarterly, with the annual
70rate being the cumulative sum of the quarterly rates. The
71turnover rate is the total number of terminations or separations
72experienced during the quarter, excluding any employee
73terminated during a probationary period of 3 months or less,
74divided by the total number of staff employed at the end of the
75period for which the rate is computed, and expressed as a
76percentage.
77     c.  The formula for determining staff stability is the
78total number of employees that have been employed for more than
7912 months, divided by the total number of employees employed at
80the end of the most recent calendar quarter, and expressed as a
81percentage.
82     d.  A nursing facility that has failed to comply with state
83minimum-staffing requirements for 2 consecutive days is
84prohibited from accepting new admissions until the facility has
85achieved the minimum-staffing requirements for a period of 6
86consecutive days. For the purposes of this sub-subparagraph, any
87person who was a resident of the facility and was absent from
88the facility for the purpose of receiving medical care at a
89separate location or was on a leave of absence is not considered
90a new admission. Failure to impose such an admissions moratorium
91constitutes a class II deficiency.
92     e.  A nursing facility which does not have a conditional
93license may be cited for failure to comply with the standards in
94s. 400.23(3)(a)1.b. and c. s. 400.23(3)(a)1.a. only if it has
95failed to meet those standards on 2 consecutive days or if it
96has failed to meet at least 97 percent of those standards on any
97one day.
98     f.  A facility which has a conditional license must be in
99compliance with the standards in s. 400.23(3)(a) at all times.
100     2.  This paragraph does not limit the agency's ability to
101impose a deficiency or take other actions if a facility does not
102have enough staff to meet the residents' needs.
103     Section 2.  Paragraph (a) of subsection (3) of section
104400.23, Florida Statutes, is amended to read:
105     400.23  Rules; evaluation and deficiencies; licensure
106status.-
107     (3)(a)1.  The agency shall adopt rules providing minimum
108staffing requirements for nursing homes. These requirements
109shall include, for each nursing home facility:
110     a.  A minimum weekly average of certified nursing assistant
111and licensed nursing staffing combined of 3.9 hours of direct
112care per resident per day. As used in this sub-subparagraph, a
113week is defined as Sunday through Saturday.
114     b.  A minimum certified nursing assistant staffing of 2.7
115hours of direct care per resident per day. A facility may not
116staff below one certified nursing assistant per 20 residents.
117     c.  A minimum licensed nursing staffing of 1.0 hour of
118direct care per resident per day. A facility may not staff below
119one licensed nurse per 40 residents.
120     a.  A minimum certified nursing assistant staffing of 2.6
121hours of direct care per resident per day beginning January 1,
1222003, and increasing to 2.7 hours of direct care per resident
123per day beginning January 1, 2007. Beginning January 1, 2002, no
124facility shall staff below one certified nursing assistant per
12520 residents, and a minimum licensed nursing staffing of 1.0
126hour of direct care per resident per day but never below one
127licensed nurse per 40 residents.
128     b.  Beginning January 1, 2007, a minimum weekly average
129certified nursing assistant staffing of 2.9 hours of direct care
130per resident per day. For the purpose of this sub-subparagraph,
131a week is defined as Sunday through Saturday.
132     2.  Nursing assistants employed under s. 400.211(2) may be
133included in computing the staffing ratio for certified nursing
134assistants only if their job responsibilities include only
135nursing-assistant-related duties.
136     3.  Each nursing home must document compliance with
137staffing standards as required under this paragraph and post
138daily the names of staff on duty for the benefit of facility
139residents and the public.
140     4.  The agency shall recognize the use of licensed nurses
141for compliance with minimum staffing requirements for certified
142nursing assistants, provided that the facility otherwise meets
143the minimum staffing requirements for licensed nurses and that
144the licensed nurses are performing the duties of a certified
145nursing assistant. Unless otherwise approved by the agency,
146licensed nurses counted toward the minimum staffing requirements
147for certified nursing assistants must exclusively perform the
148duties of a certified nursing assistant for the entire shift and
149not also be counted toward the minimum staffing requirements for
150licensed nurses. If the agency approved a facility's request to
151use a licensed nurse to perform both licensed nursing and
152certified nursing assistant duties, the facility must allocate
153the amount of staff time specifically spent on certified nursing
154assistant duties for the purpose of documenting compliance with
155minimum staffing requirements for certified and licensed nursing
156staff. In no event may the hours of a licensed nurse with dual
157job responsibilities be counted twice.
158     Section 3. Subsection (5) of section 409.903, Florida
159Statutes, is amended to read:
160     409.903  Mandatory payments for eligible persons.-The
161agency shall make payments for medical assistance and related
162services on behalf of the following persons who the department,
163or the Social Security Administration by contract with the
164Department of Children and Family Services, determines to be
165eligible, subject to the income, assets, and categorical
166eligibility tests set forth in federal and state law. Payment on
167behalf of these Medicaid eligible persons is subject to the
168availability of moneys and any limitations established by the
169General Appropriations Act or chapter 216.
170     (5)  A pregnant woman for the duration of her pregnancy and
171for the postpartum period as defined in federal law and rule, or
172a child under age 1, if either is living in a family that has an
173income which is at or below 150 percent of the most current
174federal poverty level, or, effective January 1, 2011 1992, a
175child under age 1 who is living in a family that has an income
176which is at or below 185 percent of the most current federal
177poverty level. Such a person is not subject to an assets test.
178Further, a pregnant woman who applies for eligibility for the
179Medicaid program through a qualified Medicaid provider must be
180offered the opportunity, subject to federal rules, to be made
181presumptively eligible for the Medicaid program.
182     Section 4.  Subsections (1) and (2) of section 409.904,
183Florida Statutes, are amended to read:
184     409.904  Optional payments for eligible persons.-The agency
185may make payments for medical assistance and related services on
186behalf of the following persons who are determined to be
187eligible subject to the income, assets, and categorical
188eligibility tests set forth in federal and state law. Payment on
189behalf of these Medicaid eligible persons is subject to the
190availability of moneys and any limitations established by the
191General Appropriations Act or chapter 216.
192     (1)  Effective January 1, 2006, and subject to federal
193waiver approval, a person who is age 65 or older or is
194determined to be disabled, whose income is at or below 88
195percent of the federal poverty level, whose assets do not exceed
196established limitations, and who is not eligible for Medicare
197or, if eligible for Medicare, is also eligible for and receiving
198Medicaid-covered institutional care services, hospice services,
199or home and community-based services. The agency shall seek
200federal authorization through a waiver to provide this coverage.
201This subsection expires June 30, 2011 December 31, 2010.
202     (2)(a)  A family, a pregnant woman, a child under age 21, a
203person age 65 or over, or a blind or disabled person, who would
204be eligible under any group listed in s. 409.903(1), (2), or
205(3), except that the income or assets of such family or person
206exceed established limitations. For a family or person in one of
207these coverage groups, medical expenses are deductible from
208income in accordance with federal requirements in order to make
209a determination of eligibility. A family or person eligible
210under the coverage known as the "medically needy," is eligible
211to receive the same services as other Medicaid recipients, with
212the exception of services in skilled nursing facilities and
213intermediate care facilities for the developmentally disabled.
214This paragraph expires June 30, 2011 December 31, 2010.
215     (b)  Effective July 1, 2011 January 1, 2011, a pregnant
216woman or a child younger than 21 years of age who would be
217eligible under any group listed in s. 409.903, except that the
218income or assets of such group exceed established limitations.
219For a person in one of these coverage groups, medical expenses
220are deductible from income in accordance with federal
221requirements in order to make a determination of eligibility. A
222person eligible under the coverage known as the "medically
223needy" is eligible to receive the same services as other
224Medicaid recipients, with the exception of services in skilled
225nursing facilities and intermediate care facilities for the
226developmentally disabled.
227     Section 5.  Subsection (7) of section 409.906, Florida
228Statutes, is amended to read:
229     409.906  Optional Medicaid services.-Subject to specific
230appropriations, the agency may make payments for services which
231are optional to the state under Title XIX of the Social Security
232Act and are furnished by Medicaid providers to recipients who
233are determined to be eligible on the dates on which the services
234were provided. Any optional service that is provided shall be
235provided only when medically necessary and in accordance with
236state and federal law. Optional services rendered by providers
237in mobile units to Medicaid recipients may be restricted or
238prohibited by the agency. Nothing in this section shall be
239construed to prevent or limit the agency from adjusting fees,
240reimbursement rates, lengths of stay, number of visits, or
241number of services, or making any other adjustments necessary to
242comply with the availability of moneys and any limitations or
243directions provided for in the General Appropriations Act or
244chapter 216. If necessary to safeguard the state's systems of
245providing services to elderly and disabled persons and subject
246to the notice and review provisions of s. 216.177, the Governor
247may direct the Agency for Health Care Administration to amend
248the Medicaid state plan to delete the optional Medicaid service
249known as "Intermediate Care Facilities for the Developmentally
250Disabled." Optional services may include:
251     (7)  CHIROPRACTIC SERVICES.-The agency may pay for manual
252manipulation of the spine and initial services, screening, and X
253rays provided to a recipient under the age of 21 by a licensed
254chiropractic physician.
255     Section 6.  Subsection (14) of section 409.908, Florida
256Statutes, is amended to read:
257     409.908  Reimbursement of Medicaid providers.-Subject to
258specific appropriations, the agency shall reimburse Medicaid
259providers, in accordance with state and federal law, according
260to methodologies set forth in the rules of the agency and in
261policy manuals and handbooks incorporated by reference therein.
262These methodologies may include fee schedules, reimbursement
263methods based on cost reporting, negotiated fees, competitive
264bidding pursuant to s. 287.057, and other mechanisms the agency
265considers efficient and effective for purchasing services or
266goods on behalf of recipients. If a provider is reimbursed based
267on cost reporting and submits a cost report late and that cost
268report would have been used to set a lower reimbursement rate
269for a rate semester, then the provider's rate for that semester
270shall be retroactively calculated using the new cost report, and
271full payment at the recalculated rate shall be effected
272retroactively. Medicare-granted extensions for filing cost
273reports, if applicable, shall also apply to Medicaid cost
274reports. Payment for Medicaid compensable services made on
275behalf of Medicaid eligible persons is subject to the
276availability of moneys and any limitations or directions
277provided for in the General Appropriations Act or chapter 216.
278Further, nothing in this section shall be construed to prevent
279or limit the agency from adjusting fees, reimbursement rates,
280lengths of stay, number of visits, or number of services, or
281making any other adjustments necessary to comply with the
282availability of moneys and any limitations or directions
283provided for in the General Appropriations Act, provided the
284adjustment is consistent with legislative intent.
285     (14)  A provider of prescribed drugs shall be reimbursed
286the least of the amount billed by the provider, the provider's
287usual and customary charge, or the Medicaid maximum allowable
288fee established by the agency, plus a dispensing fee. The
289Medicaid maximum allowable fee for ingredient cost shall will be
290based on the lowest lower of: the average wholesale price (AWP)
291minus 16.4 percent, the wholesaler acquisition cost (WAC) plus
2924.75 percent, the federal upper limit (FUL), the state maximum
293allowable cost (SMAC), or the usual and customary (UAC) charge
294billed by the provider. Effective March 1, 2011, the Medicaid
295maximum allowable fee for ingredient cost shall be based on the
296lowest of: the wholesaler acquisition cost (WAC), the federal
297upper limit (FUL), the state maximum allowable cost (SMAC), or
298the usual and customary (UAC) charge billed by the provider.
299Medicaid providers are required to dispense generic drugs if
300available at lower cost and the agency has not determined that
301the branded product is more cost-effective, unless the
302prescriber has requested and received approval to require the
303branded product. The agency is directed to implement a variable
304dispensing fee for payments for prescribed medicines while
305ensuring continued access for Medicaid recipients. The variable
306dispensing fee may be based upon, but not limited to, either or
307both the volume of prescriptions dispensed by a specific
308pharmacy provider, the volume of prescriptions dispensed to an
309individual recipient, and dispensing of preferred-drug-list
310products. The agency may increase the pharmacy dispensing fee
311authorized by statute and in the annual General Appropriations
312Act by $0.50 for the dispensing of a Medicaid preferred-drug-
313list product and reduce the pharmacy dispensing fee by $0.50 for
314the dispensing of a Medicaid product that is not included on the
315preferred drug list. The agency may establish a supplemental
316pharmaceutical dispensing fee to be paid to providers returning
317unused unit-dose packaged medications to stock and crediting the
318Medicaid program for the ingredient cost of those medications if
319the ingredient costs to be credited exceed the value of the
320supplemental dispensing fee. The agency is authorized to limit
321reimbursement for prescribed medicine in order to comply with
322any limitations or directions provided for in the General
323Appropriations Act, which may include implementing a prospective
324or concurrent utilization review program.
325     Section 7.  Subsection (4) of section 409.9082, Florida
326Statutes, is amended to read:
327     409.9082  Quality assessment on nursing home facility
328providers; exemptions; purpose; federal approval required;
329remedies.-
330     (4)  The purpose of the nursing home facility quality
331assessment is to ensure continued quality of care. Collected
332assessment funds shall be used to obtain federal financial
333participation through the Medicaid program to make Medicaid
334payments for nursing home facility services up to the amount of
335nursing home facility Medicaid rates as calculated in accordance
336with the approved state Medicaid plan in effect on December 31,
3372007. The quality assessment and federal matching funds shall be
338used exclusively for the following purposes and in the following
339order of priority:
340     (a)  To reimburse the Medicaid share of the quality
341assessment as a pass-through, Medicaid-allowable cost;
342     (b)  To increase to each nursing home facility's Medicaid
343rate, as needed, an amount that restores the rate reductions
344effective on or after implemented January 1, 2008, as provided
345in the General Appropriations Act; January 1, 2009; and March 1,
3462009; and
347     (c)  To increase to each nursing home facility's Medicaid
348rate, as needed, an amount that restores any rate reductions for
349the 2009-2010 fiscal year; and
350     (c)(d)  To increase each nursing home facility's Medicaid
351rate that accounts for the portion of the total assessment not
352included in paragraphs (a) and (b) (a)-(c) which begins a phase-
353in to a pricing model for the operating cost component.
354     Section 8.  Subsection (3) of section 409.9083, Florida
355Statutes, is amended to read:
356     409.9083  Quality assessment on privately operated
357intermediate care facilities for the developmentally disabled;
358exemptions; purpose; federal approval required; remedies.-
359     (3)  The purpose of the facility quality assessment is to
360ensure continued quality of care. Collected assessment funds
361shall be used to obtain federal financial participation through
362the Medicaid program to make Medicaid payments for ICF/DD
363services up to the amount of the Medicaid rates for such
364facilities as calculated in accordance with the approved state
365Medicaid plan in effect on April 1, 2008. The quality assessment
366and federal matching funds shall be used exclusively for the
367following purposes and in the following order of priority to:
368     (a)  Reimburse the Medicaid share of the quality assessment
369as a pass-through, Medicaid-allowable cost.
370     (b)  Increase each privately operated ICF/DD Medicaid rate,
371as needed, by an amount that restores the rate reductions
372effective on or after implemented on October 1, 2008, as
373provided in the General Appropriations Act.
374     (c)  Increase each ICF/DD Medicaid rate, as needed, by an
375amount that restores any rate reductions for the 2008-2009
376fiscal year and the 2009-2010 fiscal year.
377     (c)(d)  Increase payments to such facilities to fund
378covered services to Medicaid beneficiaries.
379     Section 9.  Paragraph (a) of subsection (2) and subsection
380(5) of section 409.911, Florida Statutes, are amended to read:
381     409.911  Disproportionate share program.-Subject to
382specific allocations established within the General
383Appropriations Act and any limitations established pursuant to
384chapter 216, the agency shall distribute, pursuant to this
385section, moneys to hospitals providing a disproportionate share
386of Medicaid or charity care services by making quarterly
387Medicaid payments as required. Notwithstanding the provisions of
388s. 409.915, counties are exempt from contributing toward the
389cost of this special reimbursement for hospitals serving a
390disproportionate share of low-income patients.
391     (2)  The Agency for Health Care Administration shall use
392the following actual audited data to determine the Medicaid days
393and charity care to be used in calculating the disproportionate
394share payment:
395     (a)  The average of the 2003, 2004, and 2005, and 2006
396audited disproportionate share data to determine each hospital's
397Medicaid days and charity care for the 2010-2011 2009-2010 state
398fiscal year.
399     (5)  The following formula shall be used to pay
400disproportionate share dollars to provider service network (PSN)
401hospitals:
402
DSHP = TAAPSNH x (IHPSND/THPSND IHPSND x THPSND)
403Where:
404     DSHP = Disproportionate share hospital payments.
405     TAAPSNH = Total amount available for PSN hospitals.
406     IHPSND = Individual hospital PSN days.
407     THPSND = Total of all hospital PSN days.
408For purposes of this subsection, the PSN inpatient days shall be
409provided in the General Appropriations Act.
410     Section 10.  Section 409.9112, Florida Statutes, is amended
411to read:
412     409.9112  Disproportionate share program for regional
413perinatal intensive care centers.-In addition to the payments
414made under s. 409.911, the agency shall design and implement a
415system for making disproportionate share payments to those
416hospitals that participate in the regional perinatal intensive
417care center program established pursuant to chapter 383. The
418system of payments must conform to federal requirements and
419distribute funds in each fiscal year for which an appropriation
420is made by making quarterly Medicaid payments. Notwithstanding
421s. 409.915, counties are exempt from contributing toward the
422cost of this special reimbursement for hospitals serving a
423disproportionate share of low-income patients. For the 2010-2011
4242009-2010 state fiscal year, the agency may not distribute
425moneys under the regional perinatal intensive care centers
426disproportionate share program.
427     (1)  The following formula shall be used by the agency to
428calculate the total amount earned for hospitals that participate
429in the regional perinatal intensive care center program:
430
TAE = HDSP/THDSP
431Where:
432     TAE = total amount earned by a regional perinatal intensive
433care center.
434     HDSP = the prior state fiscal year regional perinatal
435intensive care center disproportionate share payment to the
436individual hospital.
437     THDSP = the prior state fiscal year total regional
438perinatal intensive care center disproportionate share payments
439to all hospitals.
440     (2)  The total additional payment for hospitals that
441participate in the regional perinatal intensive care center
442program shall be calculated by the agency as follows:
443
TAP = TAE x TA
444Where:
445     TAP = total additional payment for a regional perinatal
446intensive care center.
447     TAE = total amount earned by a regional perinatal intensive
448care center.
449     TA = total appropriation for the regional perinatal
450intensive care center disproportionate share program.
451     (3)  In order to receive payments under this section, a
452hospital must be participating in the regional perinatal
453intensive care center program pursuant to chapter 383 and must
454meet the following additional requirements:
455     (a)  Agree to conform to all departmental and agency
456requirements to ensure high quality in the provision of
457services, including criteria adopted by departmental and agency
458rule concerning staffing ratios, medical records, standards of
459care, equipment, space, and such other standards and criteria as
460the department and agency deem appropriate as specified by rule.
461     (b)  Agree to provide information to the department and
462agency, in a form and manner to be prescribed by rule of the
463department and agency, concerning the care provided to all
464patients in neonatal intensive care centers and high-risk
465maternity care.
466     (c)  Agree to accept all patients for neonatal intensive
467care and high-risk maternity care, regardless of ability to pay,
468on a functional space-available basis.
469     (d)  Agree to develop arrangements with other maternity and
470neonatal care providers in the hospital's region for the
471appropriate receipt and transfer of patients in need of
472specialized maternity and neonatal intensive care services.
473     (e)  Agree to establish and provide a developmental
474evaluation and services program for certain high-risk neonates,
475as prescribed and defined by rule of the department.
476     (f)  Agree to sponsor a program of continuing education in
477perinatal care for health care professionals within the region
478of the hospital, as specified by rule.
479     (g)  Agree to provide backup and referral services to the
480county health departments and other low-income perinatal
481providers within the hospital's region, including the
482development of written agreements between these organizations
483and the hospital.
484     (h)  Agree to arrange for transportation for high-risk
485obstetrical patients and neonates in need of transfer from the
486community to the hospital or from the hospital to another more
487appropriate facility.
488     (4)  Hospitals which fail to comply with any of the
489conditions in subsection (3) or the applicable rules of the
490department and agency may not receive any payments under this
491section until full compliance is achieved. A hospital which is
492not in compliance in two or more consecutive quarters may not
493receive its share of the funds. Any forfeited funds shall be
494distributed by the remaining participating regional perinatal
495intensive care center program hospitals.
496     Section 11.  Section 409.9113, Florida Statutes, is amended
497to read:
498     409.9113  Disproportionate share program for teaching
499hospitals.-In addition to the payments made under ss. 409.911
500and 409.9112, the agency shall make disproportionate share
501payments to statutorily defined teaching hospitals for their
502increased costs associated with medical education programs and
503for tertiary health care services provided to the indigent. This
504system of payments must conform to federal requirements and
505distribute funds in each fiscal year for which an appropriation
506is made by making quarterly Medicaid payments. Notwithstanding
507s. 409.915, counties are exempt from contributing toward the
508cost of this special reimbursement for hospitals serving a
509disproportionate share of low-income patients. For the 2010-2011
5102009-2010 state fiscal year, the agency shall distribute the
511moneys provided in the General Appropriations Act to statutorily
512defined teaching hospitals and family practice teaching
513hospitals under the teaching hospital disproportionate share
514program. The funds provided for statutorily defined teaching
515hospitals shall be distributed in the same proportion as the
516state fiscal year 2003-2004 teaching hospital disproportionate
517share funds were distributed or as otherwise provided in the
518General Appropriations Act. The funds provided for family
519practice teaching hospitals shall be distributed equally among
520family practice teaching hospitals.
521     (1)  On or before September 15 of each year, the agency
522shall calculate an allocation fraction to be used for
523distributing funds to state statutory teaching hospitals.
524Subsequent to the end of each quarter of the state fiscal year,
525the agency shall distribute to each statutory teaching hospital,
526as defined in s. 408.07, an amount determined by multiplying
527one-fourth of the funds appropriated for this purpose by the
528Legislature times such hospital's allocation fraction. The
529allocation fraction for each such hospital shall be determined
530by the sum of the following three primary factors, divided by
531three:
532     (a)  The number of nationally accredited graduate medical
533education programs offered by the hospital, including programs
534accredited by the Accreditation Council for Graduate Medical
535Education and the combined Internal Medicine and Pediatrics
536programs acceptable to both the American Board of Internal
537Medicine and the American Board of Pediatrics at the beginning
538of the state fiscal year preceding the date on which the
539allocation fraction is calculated. The numerical value of this
540factor is the fraction that the hospital represents of the total
541number of programs, where the total is computed for all state
542statutory teaching hospitals.
543     (b)  The number of full-time equivalent trainees in the
544hospital, which comprises two components:
545     1.  The number of trainees enrolled in nationally
546accredited graduate medical education programs, as defined in
547paragraph (a). Full-time equivalents are computed using the
548fraction of the year during which each trainee is primarily
549assigned to the given institution, over the state fiscal year
550preceding the date on which the allocation fraction is
551calculated. The numerical value of this factor is the fraction
552that the hospital represents of the total number of full-time
553equivalent trainees enrolled in accredited graduate programs,
554where the total is computed for all state statutory teaching
555hospitals.
556     2.  The number of medical students enrolled in accredited
557colleges of medicine and engaged in clinical activities,
558including required clinical clerkships and clinical electives.
559Full-time equivalents are computed using the fraction of the
560year during which each trainee is primarily assigned to the
561given institution, over the course of the state fiscal year
562preceding the date on which the allocation fraction is
563calculated. The numerical value of this factor is the fraction
564that the given hospital represents of the total number of full-
565time equivalent students enrolled in accredited colleges of
566medicine, where the total is computed for all state statutory
567teaching hospitals.
568
569The primary factor for full-time equivalent trainees is computed
570as the sum of these two components, divided by two.
571     (c)  A service index that comprises three components:
572     1.  The Agency for Health Care Administration Service
573Index, computed by applying the standard Service Inventory
574Scores established by the agency to services offered by the
575given hospital, as reported on Worksheet A-2 for the last fiscal
576year reported to the agency before the date on which the
577allocation fraction is calculated. The numerical value of this
578factor is the fraction that the given hospital represents of the
579total Agency for Health Care Administration Service Index
580values, where the total is computed for all state statutory
581teaching hospitals.
582     2.  A volume-weighted service index, computed by applying
583the standard Service Inventory Scores established by the Agency
584for Health Care Administration to the volume of each service,
585expressed in terms of the standard units of measure reported on
586Worksheet A-2 for the last fiscal year reported to the agency
587before the date on which the allocation factor is calculated.
588The numerical value of this factor is the fraction that the
589given hospital represents of the total volume-weighted service
590index values, where the total is computed for all state
591statutory teaching hospitals.
592     3.  Total Medicaid payments to each hospital for direct
593inpatient and outpatient services during the fiscal year
594preceding the date on which the allocation factor is calculated.
595This includes payments made to each hospital for such services
596by Medicaid prepaid health plans, whether the plan was
597administered by the hospital or not. The numerical value of this
598factor is the fraction that each hospital represents of the
599total of such Medicaid payments, where the total is computed for
600all state statutory teaching hospitals.
601
602The primary factor for the service index is computed as the sum
603of these three components, divided by three.
604     (2)  By October 1 of each year, the agency shall use the
605following formula to calculate the maximum additional
606disproportionate share payment for statutorily defined teaching
607hospitals:
608
TAP = THAF x A
609Where:
610     TAP = total additional payment.
611     THAF = teaching hospital allocation factor.
612     A = amount appropriated for a teaching hospital
613disproportionate share program.
614     Section 12.  Section 409.9117, Florida Statutes, is amended
615to read:
616     409.9117  Primary care disproportionate share program.-For
617the 2010-2011 2009-2010 state fiscal year, the agency shall not
618distribute moneys under the primary care disproportionate share
619program.
620     (1)  If federal funds are available for disproportionate
621share programs in addition to those otherwise provided by law,
622there shall be created a primary care disproportionate share
623program.
624     (2)  The following formula shall be used by the agency to
625calculate the total amount earned for hospitals that participate
626in the primary care disproportionate share program:
627
TAE = HDSP/THDSP
628Where:
629     TAE = total amount earned by a hospital participating in
630the primary care disproportionate share program.
631     HDSP = the prior state fiscal year primary care
632disproportionate share payment to the individual hospital.
633     THDSP = the prior state fiscal year total primary care
634disproportionate share payments to all hospitals.
635     (3)  The total additional payment for hospitals that
636participate in the primary care disproportionate share program
637shall be calculated by the agency as follows:
638
TAP = TAE x TA
639Where:
640     TAP = total additional payment for a primary care hospital.
641     TAE = total amount earned by a primary care hospital.
642     TA = total appropriation for the primary care
643disproportionate share program.
644     (4)  In the establishment and funding of this program, the
645agency shall use the following criteria in addition to those
646specified in s. 409.911, and payments may not be made to a
647hospital unless the hospital agrees to:
648     (a)  Cooperate with a Medicaid prepaid health plan, if one
649exists in the community.
650     (b)  Ensure the availability of primary and specialty care
651physicians to Medicaid recipients who are not enrolled in a
652prepaid capitated arrangement and who are in need of access to
653such physicians.
654     (c)  Coordinate and provide primary care services free of
655charge, except copayments, to all persons with incomes up to 100
656percent of the federal poverty level who are not otherwise
657covered by Medicaid or another program administered by a
658governmental entity, and to provide such services based on a
659sliding fee scale to all persons with incomes up to 200 percent
660of the federal poverty level who are not otherwise covered by
661Medicaid or another program administered by a governmental
662entity, except that eligibility may be limited to persons who
663reside within a more limited area, as agreed to by the agency
664and the hospital.
665     (d)  Contract with any federally qualified health center,
666if one exists within the agreed geopolitical boundaries,
667concerning the provision of primary care services, in order to
668guarantee delivery of services in a nonduplicative fashion, and
669to provide for referral arrangements, privileges, and
670admissions, as appropriate. The hospital shall agree to provide
671at an onsite or offsite facility primary care services within 24
672hours to which all Medicaid recipients and persons eligible
673under this paragraph who do not require emergency room services
674are referred during normal daylight hours.
675     (e)  Cooperate with the agency, the county, and other
676entities to ensure the provision of certain public health
677services, case management, referral and acceptance of patients,
678and sharing of epidemiological data, as the agency and the
679hospital find mutually necessary and desirable to promote and
680protect the public health within the agreed geopolitical
681boundaries.
682     (f)  In cooperation with the county in which the hospital
683resides, develop a low-cost, outpatient, prepaid health care
684program to persons who are not eligible for the Medicaid
685program, and who reside within the area.
686     (g)  Provide inpatient services to residents within the
687area who are not eligible for Medicaid or Medicare, and who do
688not have private health insurance, regardless of ability to pay,
689on the basis of available space, except that hospitals may not
690be prevented from establishing bill collection programs based on
691ability to pay.
692     (h)  Work with the Florida Healthy Kids Corporation, the
693Florida Health Care Purchasing Cooperative, and business health
694coalitions, as appropriate, to develop a feasibility study and
695plan to provide a low-cost comprehensive health insurance plan
696to persons who reside within the area and who do not have access
697to such a plan.
698     (i)  Work with public health officials and other experts to
699provide community health education and prevention activities
700designed to promote healthy lifestyles and appropriate use of
701health services.
702     (j)  Work with the local health council to develop a plan
703for promoting access to affordable health care services for all
704persons who reside within the area, including, but not limited
705to, public health services, primary care services, inpatient
706services, and affordable health insurance generally.
707
708Any hospital that fails to comply with any of the provisions of
709this subsection, or any other contractual condition, may not
710receive payments under this section until full compliance is
711achieved.
712     Section 13.  Paragraph (a) of subsection (39) of section
713409.912, Florida Statutes, is amended to read:
714     409.912  Cost-effective purchasing of health care.-The
715agency shall purchase goods and services for Medicaid recipients
716in the most cost-effective manner consistent with the delivery
717of quality medical care. To ensure that medical services are
718effectively utilized, the agency may, in any case, require a
719confirmation or second physician's opinion of the correct
720diagnosis for purposes of authorizing future services under the
721Medicaid program. This section does not restrict access to
722emergency services or poststabilization care services as defined
723in 42 C.F.R. part 438.114. Such confirmation or second opinion
724shall be rendered in a manner approved by the agency. The agency
725shall maximize the use of prepaid per capita and prepaid
726aggregate fixed-sum basis services when appropriate and other
727alternative service delivery and reimbursement methodologies,
728including competitive bidding pursuant to s. 287.057, designed
729to facilitate the cost-effective purchase of a case-managed
730continuum of care. The agency shall also require providers to
731minimize the exposure of recipients to the need for acute
732inpatient, custodial, and other institutional care and the
733inappropriate or unnecessary use of high-cost services. The
734agency shall contract with a vendor to monitor and evaluate the
735clinical practice patterns of providers in order to identify
736trends that are outside the normal practice patterns of a
737provider's professional peers or the national guidelines of a
738provider's professional association. The vendor must be able to
739provide information and counseling to a provider whose practice
740patterns are outside the norms, in consultation with the agency,
741to improve patient care and reduce inappropriate utilization.
742The agency may mandate prior authorization, drug therapy
743management, or disease management participation for certain
744populations of Medicaid beneficiaries, certain drug classes, or
745particular drugs to prevent fraud, abuse, overuse, and possible
746dangerous drug interactions. The Pharmaceutical and Therapeutics
747Committee shall make recommendations to the agency on drugs for
748which prior authorization is required. The agency shall inform
749the Pharmaceutical and Therapeutics Committee of its decisions
750regarding drugs subject to prior authorization. The agency is
751authorized to limit the entities it contracts with or enrolls as
752Medicaid providers by developing a provider network through
753provider credentialing. The agency may competitively bid single-
754source-provider contracts if procurement of goods or services
755results in demonstrated cost savings to the state without
756limiting access to care. The agency may limit its network based
757on the assessment of beneficiary access to care, provider
758availability, provider quality standards, time and distance
759standards for access to care, the cultural competence of the
760provider network, demographic characteristics of Medicaid
761beneficiaries, practice and provider-to-beneficiary standards,
762appointment wait times, beneficiary use of services, provider
763turnover, provider profiling, provider licensure history,
764previous program integrity investigations and findings, peer
765review, provider Medicaid policy and billing compliance records,
766clinical and medical record audits, and other factors. Providers
767shall not be entitled to enrollment in the Medicaid provider
768network. The agency shall determine instances in which allowing
769Medicaid beneficiaries to purchase durable medical equipment and
770other goods is less expensive to the Medicaid program than long-
771term rental of the equipment or goods. The agency may establish
772rules to facilitate purchases in lieu of long-term rentals in
773order to protect against fraud and abuse in the Medicaid program
774as defined in s. 409.913. The agency may seek federal waivers
775necessary to administer these policies.
776     (39)(a)  The agency shall implement a Medicaid prescribed-
777drug spending-control program that includes the following
778components:
779     1.  A Medicaid preferred drug list, which shall be a
780listing of cost-effective therapeutic options recommended by the
781Medicaid Pharmacy and Therapeutics Committee established
782pursuant to s. 409.91195 and adopted by the agency for each
783therapeutic class on the preferred drug list. At the discretion
784of the committee, and when feasible, the preferred drug list
785should include at least two products in a therapeutic class. The
786agency may post the preferred drug list and updates to the
787preferred drug list on an Internet website without following the
788rulemaking procedures of chapter 120. Antiretroviral agents are
789excluded from the preferred drug list. The agency shall also
790limit the amount of a prescribed drug dispensed to no more than
791a 34-day supply unless the drug products' smallest marketed
792package is greater than a 34-day supply, or the drug is
793determined by the agency to be a maintenance drug in which case
794a 100-day maximum supply may be authorized. The agency is
795authorized to seek any federal waivers necessary to implement
796these cost-control programs and to continue participation in the
797federal Medicaid rebate program, or alternatively to negotiate
798state-only manufacturer rebates. The agency may adopt rules to
799implement this subparagraph. The agency shall continue to
800provide unlimited contraceptive drugs and items. The agency must
801establish procedures to ensure that:
802     a.  There is a response to a request for prior consultation
803by telephone or other telecommunication device within 24 hours
804after receipt of a request for prior consultation; and
805     b.  A 72-hour supply of the drug prescribed is provided in
806an emergency or when the agency does not provide a response
807within 24 hours as required by sub-subparagraph a.
808     2.  Reimbursement to pharmacies for Medicaid prescribed
809drugs shall be set at the lowest lesser of: the average
810wholesale price (AWP) minus 16.4 percent, the wholesaler
811acquisition cost (WAC) plus 4.75 percent, the federal upper
812limit (FUL), the state maximum allowable cost (SMAC), or the
813usual and customary (UAC) charge billed by the provider.
814Effective March 1, 2011, the Medicaid maximum allowable fee for
815ingredient cost shall be based on the lowest of: the wholesaler
816acquisition costs (WAC), the federal upper limit (FUL), the
817state maximum allowable cost (SMAC), or the usual and customary
818(UAC) charge billed by the provider.
819     3.  The agency shall develop and implement a process for
820managing the drug therapies of Medicaid recipients who are using
821significant numbers of prescribed drugs each month. The
822management process may include, but is not limited to,
823comprehensive, physician-directed medical-record reviews, claims
824analyses, and case evaluations to determine the medical
825necessity and appropriateness of a patient's treatment plan and
826drug therapies. The agency may contract with a private
827organization to provide drug-program-management services. The
828Medicaid drug benefit management program shall include
829initiatives to manage drug therapies for HIV/AIDS patients,
830patients using 20 or more unique prescriptions in a 180-day
831period, and the top 1,000 patients in annual spending. The
832agency shall enroll any Medicaid recipient in the drug benefit
833management program if he or she meets the specifications of this
834provision and is not enrolled in a Medicaid health maintenance
835organization.
836     4.  The agency may limit the size of its pharmacy network
837based on need, competitive bidding, price negotiations,
838credentialing, or similar criteria. The agency shall give
839special consideration to rural areas in determining the size and
840location of pharmacies included in the Medicaid pharmacy
841network. A pharmacy credentialing process may include criteria
842such as a pharmacy's full-service status, location, size,
843patient educational programs, patient consultation, disease
844management services, and other characteristics. The agency may
845impose a moratorium on Medicaid pharmacy enrollment when it is
846determined that it has a sufficient number of Medicaid-
847participating providers. The agency must allow dispensing
848practitioners to participate as a part of the Medicaid pharmacy
849network regardless of the practitioner's proximity to any other
850entity that is dispensing prescription drugs under the Medicaid
851program. A dispensing practitioner must meet all credentialing
852requirements applicable to his or her practice, as determined by
853the agency.
854     5.  The agency shall develop and implement a program that
855requires Medicaid practitioners who prescribe drugs to use a
856counterfeit-proof prescription pad for Medicaid prescriptions.
857The agency shall require the use of standardized counterfeit-
858proof prescription pads by Medicaid-participating prescribers or
859prescribers who write prescriptions for Medicaid recipients. The
860agency may implement the program in targeted geographic areas or
861statewide.
862     6.  The agency may enter into arrangements that require
863manufacturers of generic drugs prescribed to Medicaid recipients
864to provide rebates of at least 15.1 percent of the average
865manufacturer price for the manufacturer's generic products.
866These arrangements shall require that if a generic-drug
867manufacturer pays federal rebates for Medicaid-reimbursed drugs
868at a level below 15.1 percent, the manufacturer must provide a
869supplemental rebate to the state in an amount necessary to
870achieve a 15.1-percent rebate level.
871     7.  The agency may establish a preferred drug list as
872described in this subsection, and, pursuant to the establishment
873of such preferred drug list, it is authorized to negotiate
874supplemental rebates from manufacturers that are in addition to
875those required by Title XIX of the Social Security Act and at no
876less than 14 percent of the average manufacturer price as
877defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
878the federal or supplemental rebate, or both, equals or exceeds
87929 percent. There is no upper limit on the supplemental rebates
880the agency may negotiate. The agency may determine that specific
881products, brand-name or generic, are competitive at lower rebate
882percentages. Agreement to pay the minimum supplemental rebate
883percentage will guarantee a manufacturer that the Medicaid
884Pharmaceutical and Therapeutics Committee will consider a
885product for inclusion on the preferred drug list. However, a
886pharmaceutical manufacturer is not guaranteed placement on the
887preferred drug list by simply paying the minimum supplemental
888rebate. Agency decisions shall will be made on the clinical
889efficacy of a drug and recommendations of the Medicaid
890Pharmaceutical and Therapeutics Committee, as well as the price
891of competing products minus federal and state rebates. The
892agency is authorized to contract with an outside agency or
893contractor to conduct negotiations for supplemental rebates. For
894the purposes of this section, the term "supplemental rebates"
895means cash rebates. Effective July 1, 2004, value-added programs
896as a substitution for supplemental rebates are prohibited. The
897agency is authorized to seek any federal waivers to implement
898this initiative.
899     8.  The Agency for Health Care Administration shall expand
900home delivery of pharmacy products. To assist Medicaid patients
901in securing their prescriptions and reduce program costs, the
902agency shall expand its current mail-order-pharmacy diabetes-
903supply program to include all generic and brand-name drugs used
904by Medicaid patients with diabetes. Medicaid recipients in the
905current program may obtain nondiabetes drugs on a voluntary
906basis. This initiative is limited to the geographic area covered
907by the current contract. The agency may seek and implement any
908federal waivers necessary to implement this subparagraph.
909     9.  The agency shall limit to one dose per month any drug
910prescribed to treat erectile dysfunction.
911     10.a.  The agency may implement a Medicaid behavioral drug
912management system. The agency may contract with a vendor that
913has experience in operating behavioral drug management systems
914to implement this program. The agency is authorized to seek
915federal waivers to implement this program.
916     b.  The agency, in conjunction with the Department of
917Children and Family Services, may implement the Medicaid
918behavioral drug management system that is designed to improve
919the quality of care and behavioral health prescribing practices
920based on best practice guidelines, improve patient adherence to
921medication plans, reduce clinical risk, and lower prescribed
922drug costs and the rate of inappropriate spending on Medicaid
923behavioral drugs. The program may include the following
924elements:
925     (I)  Provide for the development and adoption of best
926practice guidelines for behavioral health-related drugs such as
927antipsychotics, antidepressants, and medications for treating
928bipolar disorders and other behavioral conditions; translate
929them into practice; review behavioral health prescribers and
930compare their prescribing patterns to a number of indicators
931that are based on national standards; and determine deviations
932from best practice guidelines.
933     (II)  Implement processes for providing feedback to and
934educating prescribers using best practice educational materials
935and peer-to-peer consultation.
936     (III)  Assess Medicaid beneficiaries who are outliers in
937their use of behavioral health drugs with regard to the numbers
938and types of drugs taken, drug dosages, combination drug
939therapies, and other indicators of improper use of behavioral
940health drugs.
941     (IV)  Alert prescribers to patients who fail to refill
942prescriptions in a timely fashion, are prescribed multiple same-
943class behavioral health drugs, and may have other potential
944medication problems.
945     (V)  Track spending trends for behavioral health drugs and
946deviation from best practice guidelines.
947     (VI)  Use educational and technological approaches to
948promote best practices, educate consumers, and train prescribers
949in the use of practice guidelines.
950     (VII)  Disseminate electronic and published materials.
951     (VIII)  Hold statewide and regional conferences.
952     (IX)  Implement a disease management program with a model
953quality-based medication component for severely mentally ill
954individuals and emotionally disturbed children who are high
955users of care.
956     11.a.  The agency shall implement a Medicaid prescription
957drug management system. The agency may contract with a vendor
958that has experience in operating prescription drug management
959systems in order to implement this system. Any management system
960that is implemented in accordance with this subparagraph must
961rely on cooperation between physicians and pharmacists to
962determine appropriate practice patterns and clinical guidelines
963to improve the prescribing, dispensing, and use of drugs in the
964Medicaid program. The agency may seek federal waivers to
965implement this program.
966     b.  The drug management system must be designed to improve
967the quality of care and prescribing practices based on best
968practice guidelines, improve patient adherence to medication
969plans, reduce clinical risk, and lower prescribed drug costs and
970the rate of inappropriate spending on Medicaid prescription
971drugs. The program must:
972     (I)  Provide for the development and adoption of best
973practice guidelines for the prescribing and use of drugs in the
974Medicaid program, including translating best practice guidelines
975into practice; reviewing prescriber patterns and comparing them
976to indicators that are based on national standards and practice
977patterns of clinical peers in their community, statewide, and
978nationally; and determine deviations from best practice
979guidelines.
980     (II)  Implement processes for providing feedback to and
981educating prescribers using best practice educational materials
982and peer-to-peer consultation.
983     (III)  Assess Medicaid recipients who are outliers in their
984use of a single or multiple prescription drugs with regard to
985the numbers and types of drugs taken, drug dosages, combination
986drug therapies, and other indicators of improper use of
987prescription drugs.
988     (IV)  Alert prescribers to patients who fail to refill
989prescriptions in a timely fashion, are prescribed multiple drugs
990that may be redundant or contraindicated, or may have other
991potential medication problems.
992     (V)  Track spending trends for prescription drugs and
993deviation from best practice guidelines.
994     (VI)  Use educational and technological approaches to
995promote best practices, educate consumers, and train prescribers
996in the use of practice guidelines.
997     (VII)  Disseminate electronic and published materials.
998     (VIII)  Hold statewide and regional conferences.
999     (IX)  Implement disease management programs in cooperation
1000with physicians and pharmacists, along with a model quality-
1001based medication component for individuals having chronic
1002medical conditions.
1003     12.  The agency is authorized to contract for drug rebate
1004administration, including, but not limited to, calculating
1005rebate amounts, invoicing manufacturers, negotiating disputes
1006with manufacturers, and maintaining a database of rebate
1007collections.
1008     13.  The agency may specify the preferred daily dosing form
1009or strength for the purpose of promoting best practices with
1010regard to the prescribing of certain drugs as specified in the
1011General Appropriations Act and ensuring cost-effective
1012prescribing practices.
1013     14.  The agency may require prior authorization for
1014Medicaid-covered prescribed drugs. The agency may, but is not
1015required to, prior-authorize the use of a product:
1016     a.  For an indication not approved in labeling;
1017     b.  To comply with certain clinical guidelines; or
1018     c.  If the product has the potential for overuse, misuse,
1019or abuse.
1020
1021The agency may require the prescribing professional to provide
1022information about the rationale and supporting medical evidence
1023for the use of a drug. The agency may post prior authorization
1024criteria and protocol and updates to the list of drugs that are
1025subject to prior authorization on an Internet website without
1026amending its rule or engaging in additional rulemaking.
1027     15.  The agency, in conjunction with the Pharmaceutical and
1028Therapeutics Committee, may require age-related prior
1029authorizations for certain prescribed drugs. The agency may
1030preauthorize the use of a drug for a recipient who may not meet
1031the age requirement or may exceed the length of therapy for use
1032of this product as recommended by the manufacturer and approved
1033by the Food and Drug Administration. Prior authorization may
1034require the prescribing professional to provide information
1035about the rationale and supporting medical evidence for the use
1036of a drug.
1037     16.  The agency shall implement a step-therapy prior
1038authorization approval process for medications excluded from the
1039preferred drug list. Medications listed on the preferred drug
1040list must be used within the previous 12 months prior to the
1041alternative medications that are not listed. The step-therapy
1042prior authorization may require the prescriber to use the
1043medications of a similar drug class or for a similar medical
1044indication unless contraindicated in the Food and Drug
1045Administration labeling. The trial period between the specified
1046steps may vary according to the medical indication. The step-
1047therapy approval process shall be developed in accordance with
1048the committee as stated in s. 409.91195(7) and (8). A drug
1049product may be approved without meeting the step-therapy prior
1050authorization criteria if the prescribing physician provides the
1051agency with additional written medical or clinical documentation
1052that the product is medically necessary because:
1053     a.  There is not a drug on the preferred drug list to treat
1054the disease or medical condition which is an acceptable clinical
1055alternative;
1056     b.  The alternatives have been ineffective in the treatment
1057of the beneficiary's disease; or
1058     c.  Based on historic evidence and known characteristics of
1059the patient and the drug, the drug is likely to be ineffective,
1060or the number of doses have been ineffective.
1061
1062The agency shall work with the physician to determine the best
1063alternative for the patient. The agency may adopt rules waiving
1064the requirements for written clinical documentation for specific
1065drugs in limited clinical situations.
1066     17.  The agency shall implement a return and reuse program
1067for drugs dispensed by pharmacies to institutional recipients,
1068which includes payment of a $5 restocking fee for the
1069implementation and operation of the program. The return and
1070reuse program shall be implemented electronically and in a
1071manner that promotes efficiency. The program must permit a
1072pharmacy to exclude drugs from the program if it is not
1073practical or cost-effective for the drug to be included and must
1074provide for the return to inventory of drugs that cannot be
1075credited or returned in a cost-effective manner. The agency
1076shall determine if the program has reduced the amount of
1077Medicaid prescription drugs which are destroyed on an annual
1078basis and if there are additional ways to ensure more
1079prescription drugs are not destroyed which could safely be
1080reused. The agency's conclusion and recommendations shall be
1081reported to the Legislature by December 1, 2005.
1082     Section 14.  Subsection (3) is added to section 430.707,
1083Florida Statutes, to read:
1084     430.707  Contracts.-
1085     (3)  Any entity that provides or is authorized by state law
1086to provide benefits pursuant to the Program of All-inclusive
1087Care for the Elderly on or before July 1, 2010, may submit an
1088application for an expansion of service capacity sufficient to
1089meet the needs of potentially eligible program enrollees within
1090the service area designated by state law. The agency, in
1091consultation with the department, shall accept and forward to
1092the Centers for Medicare and Medicaid Services the application
1093for an expansion of service capacity for additional enrollees
1094from an entity that provides benefits pursuant to the Program of
1095All-inclusive Care for the Elderly and that is in good standing
1096with the agency, the department, and the Centers for Medicare
1097and Medicaid Services.
1098     Section 15.  This act shall take effect July 1, 2010.


CODING: Words stricken are deletions; words underlined are additions.
Site Map
Session:   Bills ·   Calendars ·   Bound Journals ·   Citator ·   Search ·   Appropriations ·   Redistricting ·   Bill Information Reports
Committee Publications
Historical Information
Statutes:   Introduction ·   View Statutes ·   Search Statutes
Flsenate.gov
Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chambers should be consulted for official purposes.    Copyright © 2000-2019 State of Florida.     Privacy Statement     Contact Us     Get Acrobat Reader