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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to the Children's Medical Services 2
program; amending s. 383.14, F.S.; deleting a 3
requirement that the Department of Health consult with 4
the Department of Education before prescribing certain 5
newborn testing and screening requirements; 6
authorizing the release of certain newborn screening 7
results to licensed genetic counselors; requiring that 8
newborns have a blood specimen collected for newborn 9
screenings before they reach a specified age; deleting 10
a requirement that newborns be subjected to a certain 11
test; conforming provisions to changes made by the 12
act; revising requirements related to a certain 13
assessment for hospitals and birth centers; deleting a 14
requirement that the department submit a certain 15
annual cost certification as part of its ann ual 16
legislative budget request; requiring certain health 17
care practitioners and health care providers to 18
prepare and send all newborn screening specimen cards 19
to the State Public Health Laboratory; amending s. 20
383.145, F.S.; defining the term "toddler"; re vising 21
newborn screening requirements for licensed birth 22
centers; requiring that a certain referral for newborn 23
screening be made before the newborn reaches a 24
specified age; requiring early childhood programs and 25
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entities that screen for hearing loss to re port the 26
screening results to the department within a specified 27
timeframe; amending s. 391.016, F.S.; revising the 28
purposes and functions of the Children's Medical 29
Services program; amending s. 391.021, F.S.; revising 30
definitions; amending s. 391.025, F.S. ; revising the 31
scope of the program; amending s. 391.026, F.S.; 32
revising the powers and duties of the Department of 33
Health to conform to changes made by the act; amending 34
s. 391.028, F.S.; revising activities within the 35
purview of the program; deleting a r equirement that 36
every office of the program be under the direction of 37
a licensed physician; amending s. 391.029, F.S.; 38
revising program eligibility requirements; amending s. 39
391.0315, F.S.; conforming provisions to changes made 40
by the act; repealing s. 391 .035, F.S., relating to 41
provider qualifications; amending s. 391.045, F.S.; 42
conforming provisions to changes made by the act; 43
amending s. 391.055, F.S.; conforming provisions to 44
changes made by the act; deleting specifications for 45
the components of the pro gram; deleting certain 46
requirements for newborns referred to the program 47
through the newborn screening program; amending s. 48
391.097, F.S.; conforming a provision to changes made 49
by the act; repealing part II of chapter 391, F.S., 50
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relating to Children's Med ical Services councils and 51
panels; providing legislative findings and intent; 52
transferring operation of the Children's Medical 53
Services Managed Care Plan from the department to the 54
Agency for Health Care Administration, effective on a 55
specified date; provi ding construction as to judicial 56
and administrative actions pending as of a specified 57
date and time; requiring the department's Children's 58
Medical Services program to collaborate with and 59
assist the agency in specified activities; requiring 60
the department to conduct certain clinical eligibility 61
screenings; requiring the agency and the department to 62
submit a report to the Legislature by a specified 63
date; providing requirements for the report; amending 64
s. 409.974, F.S.; requiring the agency to 65
competitively procure one or more vendors to provide 66
services for certain children with special health care 67
needs; requiring the department's Children's Medical 68
Services program to assist the agency in developing 69
certain specifications for the vendor contract; 70
requiring the department to conduct clinical 71
eligibility screenings for services for such children 72
and collaborate with the agency in the care of such 73
children; conforming a provision to changes made by 74
the act; amending ss. 409.166, 409.811, 409.813, 75
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409.8134, 409.814, 409.815, 409.8177, 409.818, 76
409.912, 409.9126, 409.9131, 409.920, and 409.962, 77
F.S.; conforming provisions to changes made by the 78
act; providing effective dates. 79
80
Be It Enacted by the Legislature of the State of Florida: 81
82
Section 1. Section 38 3.14, Florida Statutes, is amended to 83
read: 84
383.14 Screening for metabolic disorders, other hereditary 85
and congenital disorders, and environmental risk factors. — 86
(1) SCREENING REQUIREMENTS. —To help ensure access to the 87
maternal and child health care sy stem, the Department of Health 88
shall promote the screening of all newborns born in Florida for 89
metabolic, hereditary, and congenital disorders known to result 90
in significant impairment of health or intellect, as screening 91
programs accepted by current medic al practice become available 92
and practical in the judgment of the department. The department 93
shall also promote the identification and screening of all 94
newborns in this state and their families for environmental risk 95
factors such as low income, poor educat ion, maternal and family 96
stress, emotional instability, substance abuse, and other high -97
risk conditions associated with increased risk of infant 98
mortality and morbidity to provide early intervention, 99
remediation, and prevention services, including, but not limited 100
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to, parent support and training programs, home visitation, and 101
case management. Identification, perinatal screening, and 102
intervention efforts shall begin prior to and immediately 103
following the birth of the child by the attending health care 104
provider. Such efforts shall be conducted in hospitals, 105
perinatal centers, county health departments, school health 106
programs that provide prenatal care, and birthing centers, and 107
reported to the Office of Vital Statistics. 108
(a) Prenatal screening.—The department shall develop a 109
multilevel screening process that includes a risk assessment 110
instrument to identify women at risk for a preterm birth or 111
other high-risk condition. The primary health care provider 112
shall complete the risk assessment instrument and report the 113
results to the Office of Vital Statistics so that the woman may 114
immediately be notified and referred to appropriate health, 115
education, and social services. 116
(b) Postnatal screening. —A risk factor analysis using the 117
department's designated risk assessm ent instrument shall also be 118
conducted as part of the medical screening process upon the 119
birth of a child and submitted to the department's Office of 120
Vital Statistics for recording and other purposes provided for 121
in this chapter. The department's screening process for risk 122
assessment shall include a scoring mechanism and procedures that 123
establish thresholds for notification, further assessment, 124
referral, and eligibility for services by professionals or 125
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paraprofessionals consistent with the level of risk. Pr ocedures 126
for developing and using the screening instrument, notification, 127
referral, and care coordination services, reporting 128
requirements, management information, and maintenance of a 129
computer-driven registry in the Office of Vital Statistics which 130
ensures privacy safeguards must be consistent with the 131
provisions and plans established under chapter 411, Pub. L. No. 132
99-457, and this chapter. Procedures established for reporting 133
information and maintaining a confidential registry must include 134
a mechanism for a centralized information depository at the 135
state and county levels. The department shall coordinate with 136
existing risk assessment systems and information registries. The 137
department must ensure, to the maximum extent possible, that the 138
screening information registry is integrated with the 139
department's automated data systems, including the Florida On -140
line Recipient Integrated Data Access (FLORIDA) system. Tests 141
and screenings must be performed by the State Public Health 142
Laboratory, in coordination with Chil dren's Medical Services, at 143
such times and in such manner as is prescribed by the department 144
after consultation with the Genetics and Newborn Screening 145
Advisory Council and the Department of Education . 146
(c) Release of screening results. —Notwithstanding any law 147
to the contrary, the State Public Health Laboratory may release, 148
directly or through the Children's Medical Services program, the 149
results of a newborn's hearing and metabolic tests or screenings 150
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to the newborn's health care practitioner, the newborn' s parent 151
or legal guardian, the newborn's personal representative, or a 152
person designated by the newborn's parent or legal guardian. As 153
used in this paragraph, the term "health care practitioner" 154
means a physician or physician assistant licensed under chap ter 155
458; an osteopathic physician or physician assistant licensed 156
under chapter 459; an advanced practice registered nurse, 157
registered nurse, or licensed practical nurse licensed under 158
part I of chapter 464; a midwife licensed under chapter 467; a 159
speech-language pathologist or audiologist licensed under part I 160
of chapter 468; or a dietician or nutritionist licensed under 161
part X of chapter 468 ; or a genetic counselor licensed under 162
part III of chapter 483 . 163
(2) RULES.— 164
(a) After consultation with the Gen etics and Newborn 165
Screening Advisory Council, the department shall adopt and 166
enforce rules requiring that every newborn in this state must 167
shall: 168
1. Before becoming 1 week of age, have a blood specimen 169
collected for newborn screenings be subjected to a test for 170
phenylketonuria; 171
2. Be tested for any condition included on the federal 172
Recommended Uniform Screening Panel which the council advises 173
the department should be included under the state's screening 174
program. After the council recommends that a condi tion be 175
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included, the department shall submit a legislative budget 176
request to seek an appropriation to add testing of the condition 177
to the newborn screening program. The department shall expand 178
statewide screening of newborns to include screening for such 179
conditions within 18 months after the council renders such 180
advice, if a test approved by the United States Food and Drug 181
Administration or a test offered by an alternative vendor is 182
available. If such a test is not available within 18 months 183
after the council makes its recommendation, the department shall 184
implement such screening as soon as a test offered by the United 185
States Food and Drug Administration or by an alternative vendor 186
is available; and 187
3. At the appropriate age, be tested for such other 188
metabolic diseases and hereditary or congenital disorders as the 189
department may deem necessary from time to time. 190
(b) After consultation with the Department of Education, 191
the department shall adopt and enforce rules requiring every 192
newborn in this state to b e screened for environmental risk 193
factors that place children and their families at risk for 194
increased morbidity, mortality, and other negative outcomes. 195
(c) The department shall adopt such additional rules as 196
are found necessary for the administration o f this section and 197
s. 383.145, including rules providing definitions of terms, 198
rules relating to the methods used and time or times for testing 199
as accepted medical practice indicates, rules relating to 200
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charging and collecting fees for the administration of the 201
newborn screening program authorized by this section, rules for 202
processing requests and releasing test and screening results, 203
and rules requiring mandatory reporting of the results of tests 204
and screenings for these conditions to the department. 205
(3) DEPARTMENT OF HEALTH; POWERS AND DUTIES. —The 206
department shall administer and provide certain services to 207
implement the provisions of this section and shall: 208
(a) Assure the availability and quality of the necessary 209
laboratory tests and materials. 210
(b) Furnish all physicians, county health departments, 211
perinatal centers, birthing centers, and hospitals forms on 212
which environmental screening and the results of tests for 213
phenylketonuria and such other disorders for which testing may 214
be required from time to time shall be reported to the 215
department. 216
(c) Promote education of the public about the prevention 217
and management of metabolic, hereditary, and congenital 218
disorders and dangers associated with environmental risk 219
factors. 220
(d) Maintain a confidential reg istry of cases, including 221
information of importance for the purpose of follow-up followup 222
services to prevent intellectual disabilities, to correct or 223
ameliorate physical disabilities, and for epidemiologic studies, 224
if indicated. Such registry shall be exe mpt from the provisions 225
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of s. 119.07(1). 226
(e) Supply the necessary dietary treatment products where 227
practicable for diagnosed cases of phenylketonuria and other 228
metabolic diseases for as long as medically indicated when the 229
products are not otherwise avai lable. Provide nutrition 230
education and supplemental foods to those families eligible for 231
the Special Supplemental Nutrition Program for Women, Infants, 232
and Children as provided in s. 383.011. 233
(f) Promote the availability of genetic studies, services, 234
and counseling in order that the parents, siblings, and affected 235
newborns may benefit from detection and available knowledge of 236
the condition. 237
(g) Have the authority to charge and collect fees for the 238
administration of the newborn screening program . authorized in 239
this section, as follows: 240
1. A fee not to exceed $15 will be charged for each live 241
birth, as recorded by the Office of Vital Statistics, occurring 242
in a hospital licensed under part I of chapter 395 or a birth 243
center licensed under s. 383.305 per y ear. The department shall 244
calculate the annual assessment for each hospital and birth 245
center, and this assessment must be paid in equal amounts 246
quarterly. Quarterly, The department shall generate and send 247
mail to each hospital and birth center a statement of the amount 248
due. 249
2. As part of the department's legislative budget request 250
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prepared pursuant to chapter 216, the department shall submit a 251
certification by the department's inspector general, or the 252
director of auditing within the inspector general's o ffice, of 253
the annual costs of the uniform testing and reporting procedures 254
of the newborn screening program. In certifying the annual 255
costs, the department's inspector general or the director of 256
auditing within the inspector general's office shall calculat e 257
the direct costs of the uniform testing and reporting 258
procedures, including applicable administrative costs. 259
Administrative costs shall be limited to those department costs 260
which are reasonably and directly associated with the 261
administration of the unifo rm testing and reporting procedures 262
of the newborn screening program. 263
(h) Have the authority to bill third -party payors for 264
newborn screening tests. 265
(i) Create and make available electronically a pamphlet 266
with information on screening for, and the trea tment of, 267
preventable infant and childhood eye and vision disorders, 268
including, but not limited to, retinoblastoma and amblyopia. 269
270
All provisions of this subsection must be coordinated with the 271
provisions and plans established under this chapter, chapter 272
411, and Pub. L. No. 99 -457. 273
(4) OBJECTIONS OF PARENT OR GUARDIAN. —The provisions of 274
this section shall not apply when the parent or guardian of the 275
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child objects thereto. A written statement of such objection 276
shall be presented to the physician or other person whose duty 277
it is to administer and report tests and screenings under this 278
section. 279
(5) SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS. —Any 280
physician, advanced practice registered nurse, licensed midwife, 281
or other licensed health care practitioner or other health care 282
provider whose duty it is to administer screenings under this 283
section shall prepare and send all newborn screening specimen 284
cards to the State Public Health Laboratory in accordance with 285
rules adopted under this section. 286
(6) ADVISORY COUNCIL.—There is established a Genetics and 287
Newborn Screening Advisory Council made up of 15 members 288
appointed by the State Surgeon General. The council shall be 289
composed of two consumer members, three practicing 290
pediatricians, at least one of whom must be a pediatric 291
hematologist, a representative from each of four medical schools 292
in this state, the State Surgeon General or his or her designee, 293
one representative from the Department of Health representing 294
Children's Medical Services, one representative f rom the Florida 295
Hospital Association, one individual with experience in newborn 296
screening programs, one individual representing audiologists, 297
and one representative from the Agency for Persons with 298
Disabilities. All appointments shall be for a term of 4 ye ars. 299
The chairperson of the council shall be elected from the 300
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membership of the council and shall serve for a period of 2 301
years. The council shall meet at least semiannually or upon the 302
call of the chairperson. The council may establish ad hoc or 303
temporary technical advisory groups to assist the council with 304
specific topics which come before the council. Council members 305
shall serve without pay. Pursuant to the provisions of s. 306
112.061, the council members are entitled to be reimbursed for 307
per diem and travel expenses. It is the purpose of the council 308
to advise the department about: 309
(a) Conditions for which testing should be included under 310
the screening program and the genetics program. Within 1 year 311
after a condition is added to the federal Recommended Uni form 312
Screening Panel, the council shall consider whether the 313
condition should be included under the state's screening 314
program. 315
(b) Procedures for collection and transmission of 316
specimens and recording of results. 317
(c) Methods whereby screening programs and genetics 318
services for children now provided or proposed to be offered in 319
the state may be more effectively evaluated, coordinated, and 320
consolidated. 321
Section 2. Section 383.145, Florida Statutes, is amended 322
to read: 323
383.145 Newborn, and infant, and toddler hearing 324
screening.— 325
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(1) LEGISLATIVE INTENT. —It is the intent of the 326
Legislature to provide a statewide comprehensive and coordinated 327
interdisciplinary program of early hearing loss screening, 328
identification, and follow -up care for newborns. The goal is to 329
screen all newborns for hearing loss in order to alleviate the 330
adverse effects of hearing loss on speech and language 331
development, academic performance, and cognitive development. It 332
is further the intent of the Legislature that this section on ly 333
be implemented to the extent that funds are specifically 334
included in the General Appropriations Act for carrying out the 335
purposes of this section. 336
(2) DEFINITIONS.—As used in this section, the term: 337
(a) "Audiologist" means a person licensed under pa rt I of 338
chapter 468 to practice audiology. 339
(b) "Department" means the Department of Health. 340
(c) "Hearing loss" means a hearing loss of 30 dB HL or 341
greater in the frequency region important for speech recognition 342
and comprehension in one or both ears, a pproximately 500 through 343
4,000 hertz. 344
(d) "Hospital" means a facility as defined in s. 345
395.002(13) and licensed under chapter 395 and part II of 346
chapter 408. 347
(e) "Infant" means an age range from 30 days through 12 348
months. 349
(f) "Licensed health care provider" means a physician or 350
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physician assistant licensed under chapter 458; an osteopathic 351
physician or physician assistant licensed under chapter 459; an 352
advanced practice registered nurse, a registered nurse, or a 353
licensed practical nurse licensed under part I of chapter 464; a 354
midwife licensed under chapter 467; or a speech -language 355
pathologist or an audiologist licensed under part I of chapter 356
468. 357
(g) "Management" means the habilitation of the child with 358
hearing loss. 359
(h) "Newborn" means an age range from birth through 29 360
days. 361
(i) "Physician" means a person licensed under chapter 458 362
to practice medicine or chapter 459 to practice osteopathic 363
medicine. 364
(j) "Screening" means a test or battery of tests 365
administered to determine the need for an in -depth hearing 366
diagnostic evaluation. 367
(k) "Toddler" means a child from 12 months to 36 months of 368
age. 369
(3) REQUIREMENTS FOR SCREENING OF NEWBORNS , INFANTS, AND 370
TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES. — 371
(a) Each hospital or other state -licensed birthing 372
facility that provides maternity and newborn care services shall 373
ensure that all newborns are, before discharge, screened for the 374
detection of hearing loss to prevent the consequences of 375
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unidentified disorders. If a newborn fails the screening for the 376
detection of hearing loss, the hospital or other state -licensed 377
birthing facility must administer a test approved by the United 378
States Food and Drug Administration or another diagnostically 379
equivalent test on the newborn to screen for congenital 380
cytomegalovirus before the newborn becomes 21 days of age or 381
before discharge, whichever occurs earlier. 382
(b) Each licensed birth center that provides maternity and 383
newborn care services shall ensure that all newborns are, before 384
discharge, screened for the detection of hearing loss. The 385
licensed birth center must ensure that all newborns who do not 386
pass the hearing screening are referred to an audiologist, a 387
hospital, or another newborn hearing screening provider for a 388
test to screen for congenital cytomegalovirus before the newborn 389
becomes 21 days of age screening for the detection of hearing 390
loss to prevent the consequences of unidentified disorders. The 391
referral for appointment must be made within 7 days after 392
discharge. Written documentation of the referral must be placed 393
in the newborn's medical chart. 394
(c) If the parent or legal guardian of the newborn objects 395
to the screening, the screening must not be completed. In such 396
case, the physician, midwife, or other pe rson attending the 397
newborn shall maintain a record that the screening has not been 398
performed and attach a written objection that must be signed by 399
the parent or guardian. 400
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(d) For home births, the health care provider in 401
attendance is responsible for coor dination and referral to an 402
audiologist, a hospital, or another newborn hearing screening 403
provider. The health care provider in attendance must make the 404
referral for appointment within 7 days after the birth. In cases 405
in which the home birth is not attende d by a health care 406
provider, the newborn's primary health care provider is 407
responsible for coordinating the referral. 408
(e) For home births and births in a licensed birth center, 409
if a newborn is referred to a newborn hearing screening provider 410
and the newborn fails the screening for the detection of hearing 411
loss, the newborn's primary health care provider must refer the 412
newborn for administration of a test approved by the United 413
States Food and Drug Administration or another diagnostically 414
equivalent test on the newborn to screen for congenital 415
cytomegalovirus before the newborn becomes 21 days of age . 416
(f) All newborn and infant hearing screenings must be 417
conducted by an audiologist, a physician, or an appropriately 418
supervised individual who has completed documented training 419
specifically for newborn hearing screening. Every hospital that 420
provides maternity or newborn care services shall obtain the 421
services of an audiologist, a physician, or another newborn 422
hearing screening provider, through employment or c ontract or 423
written memorandum of understanding, for the purposes of 424
appropriate staff training, screening program supervision, 425
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monitoring the scoring and interpretation of test results, 426
rendering of appropriate recommendations, and coordination of 427
appropriate follow-up services. Appropriate documentation of the 428
screening completion, results, interpretation, and 429
recommendations must be placed in the medical record within 24 430
hours after completion of the screening procedure. 431
(g) The screening of a newborn's hearing must be completed 432
before the newborn is discharged from the hospital. However, if 433
the screening is not completed before discharge due to 434
scheduling or temporary staffing limitations, the screening must 435
be completed within 21 days after the birth. Screenings 436
completed after discharge or performed because of initial 437
screening failure must be completed by an audiologist, a 438
physician, a hospital, or another newborn hearing screening 439
provider. 440
(h) Each hospital shall formally designate a lead 441
physician responsible for programmatic oversight for newborn 442
hearing screening. Each birth center shall designate a licensed 443
health care provider to provide such programmatic oversight and 444
to ensure that the appropriate referrals are being completed. 445
(i) When ordered by the treating physician, the hearing 446
screening of a newborn, infant, or toddler newborn's hearing 447
must include auditory brainstem responses, or evoked otoacoustic 448
emissions, or appropriate technology as approved by the United 449
States Food and Drug Administration. 450
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(j) Early childhood programs or entities screening infants 451
and toddlers for hearing loss must report screening results to 452
the department within 7 days after completing the screening in 453
an effort to identify late -onset hearing loss not identified 454
during the newborn hearing screening process. 455
(k) The results of any test conducted pursuant to this 456
section, including, but not limited to, newborn hearing loss 457
screening, congenital cytomegalovirus testing, and any related 458
diagnostic testing, must be reported to the department within 7 459
days after receipt of such results. 460
(l)(k) The initial procedure for screening the hearing of 461
the newborn or infant and any medically necessary follow -up 462
reevaluations leading to diagnosis shall be a covered benefit 463
for Medicaid patients covered by a fee -for-service program. For 464
Medicaid patients enrolled in HMOs, p roviders shall be 465
reimbursed directly by the Medicaid Program Office at the 466
Medicaid rate. This service may not be considered a covered 467
service for the purposes of establishing the payment rate for 468
Medicaid HMOs. All health insurance policies and health 469
maintenance organizations as provided under ss. 627.6416, 470
627.6579, and 641.31(30), except for supplemental policies that 471
only provide coverage for specific diseases, hospital indemnity, 472
or Medicare supplement, or to the supplemental policies, shall 473
compensate providers for the covered benefit at the contracted 474
rate. Nonhospital-based providers are eligible to bill Medicaid 475
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for the professional and technical component of each procedure 476
code. 477
(m)(l) A child who is diagnosed as having permanent 478
hearing loss must be referred to the primary care physician for 479
medical management, treatment, and follow -up services. 480
Furthermore, in accordance with Part C of the Individuals with 481
Disabilities Education Act, Pub. L. No. 108 -446, Infants and 482
Toddlers with Disabilities, any child from birth to 36 months of 483
age who is diagnosed as having hearing loss that requires 484
ongoing special hearing services must be referred to the 485
Children's Medical Services Early Intervention Program serving 486
the geographical area in which the child resides. 487
Section 3. Subsection (1) of section 391.016, Florida 488
Statutes, is amended to read: 489
391.016 Purposes and functions. —The Children's Medical 490
Services program is established for the following purposes and 491
authorized to perform the following fu nctions: 492
(1) Provide to children and youth with special health care 493
needs a family-centered, comprehensive, and coordinated 494
statewide managed system of care that links community -based 495
health care with multidisciplinary, regional, and tertiary 496
pediatric specialty care. The program shall coordinate and 497
maintain a consistent medical home for participating children. 498
Section 4. Subsections (1), (2), and (4) of section 499
391.021, Florida Statutes, are amended to read: 500
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391.021 Definitions. —When used in this act, the term: 501
(2)(1) "Children's Medical Services Managed Care Plan 502
network" or "plan network" means a statewide managed care 503
service system that includes health care providers, as defined 504
in this section. 505
(1)(2) "Children and youth with special health care needs" 506
means those children younger than 21 years of age who have 507
chronic and serious physical, developmental, behavioral, or 508
emotional conditions and who require health care and related 509
services of a type or amount beyond that which is generally 510
required by children. 511
(4) "Eligible individual" means a child or youth with a 512
special health care need or a female with a high -risk pregnancy, 513
who meets the financial and medical eligibility standards 514
established in s. 391.029. 515
Section 5. Subsection (1 ) of section 391.025, Florida 516
Statutes, is amended to read: 517
391.025 Applicability and scope. — 518
(1) The Children's Medical Services program consists of 519
the following components: 520
(a) The newborn screening program established in s. 383.14 521
and the newborn, infant, and toddler hearing screening program 522
established in s. 383.145 . 523
(b) The regional perinatal intensive care centers program 524
established in ss. 383.15 -383.19. 525
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(c) The developmental evaluation and intervention program, 526
including the Early Steps Program established in ss. 391.301 -527
391.308. 528
(d) The Children's Medical Services Managed Care Plan 529
network. 530
(e) The Children's Multidisciplinary Assessment Team. 531
(f) The Medical Foster Care Program. 532
(g) The Title V program for children and yo uth with 533
special health care needs. 534
(h) The Safety Net Program. 535
(i) The Networks for Access and Quality. 536
(j) Child Protection Teams and sexual abuse treatment 537
programs established under s. 39.303. 538
(k) The State Child Abuse Death Review Committee an d local 539
child abuse death review committees established in s. 383.402. 540
Section 6. Section 391.026, Florida Statutes, is amended 541
to read: 542
391.026 Powers and duties of the department. —The 543
department shall have the following powers, duties, and 544
responsibilities: 545
(1) To provide or contract for the provision of health 546
services to eligible individuals. 547
(2) To provide services to abused and neglected children 548
through Child Protection Teams pursuant to s. 39.303. 549
(3) To determine the medical and financi al eligibility of 550
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individuals seeking health services from the program. 551
(4) To coordinate a comprehensive delivery system for 552
eligible individuals to take maximum advantage of all available 553
funds. 554
(5) To coordinate with programs relating to children's 555
medical services in cooperation with other public and private 556
agencies. 557
(6) To initiate and coordinate applications to federal 558
agencies and private organizations for funds, services, or 559
commodities relating to children's medical programs. 560
(7) To sponsor or promote grants for projects, programs, 561
education, or research in the field of children and youth with 562
special health care needs, with an emphasis on early diagnosis 563
and treatment. 564
(8) To oversee and operate the Children's Medical Services 565
Managed Care Plan network. 566
(9) To establish reimbursement mechanisms for the 567
Children's Medical Services Managed Care Plan network. 568
(10) To establish Children's Medical Services Managed Care 569
Plan network standards and, if applicable, credentialing 570
requirements for health care providers and health care services. 571
(11) To serve as a provider and principal case manager for 572
children with special health care needs under Titles XIX and XXI 573
of the Social Security Act. 574
(12) To monitor the provision of health services in the 575
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program, including the utilization and quality of health 576
services. 577
(12)(13) To administer the Children and Youth with Special 578
Health Care Needs program in accordance with Title V of the 579
Social Security Act. 580
(13)(14) To establish and operate a grievance resolution 581
process for participants and health care providers. 582
(14)(15) To maintain program integrity in the Children's 583
Medical Services program. 584
(15)(16) To receive and manage health care premiums, 585
capitation payments, and funds from federal, state, local, and 586
private entities for the program. The department may contract 587
with a third-party administrator for processing claims, 588
monitoring medical expenses, and other related services 589
necessary to the efficient and cost -effective operation of the 590
Children's Medical Services Managed Care Plan network. The 591
department is authorized to maintain a minimum reserve for the 592
Children's Medical Services Managed Care Plan network in an 593
amount that is the greater of: 594
(a) Ten percent of total projected expenditures for Title 595
XIX-funded and Title XXI -funded children; or 596
(b) Two percent of total annualized payments from the 597
Agency for Health Care Administration for Title XIX and Title 598
XXI of the Social Security Act. 599
(16)(17) To provide or contract for peer review and other 600
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quality-improvement activities. 601
(17)(18) To adopt rules pursuant to ss. 120.536(1) and 602
120.54 to administer the Children's Medical Services Act. 603
(18)(19) To serve as the lead agency in administering the 604
Early Steps Program pursuant to part C of the federal 605
Individuals with Disabilities Education Act and part III of this 606
chapter. 607
(19) To administer the Medical Foster Care Program, 608
including all of the following: 609
(a) Recruitment, training, assessment, and monitoring for 610
the Medical Foster Care Program. 611
(b) Monitoring access and facilitating admissions of 612
eligible children and youth to the program and designated 613
medical foster care homes. 614
(c) Coordination with the Department of Children and 615
Families and the Agency for Health Care Administration or their 616
designees. 617
Section 7. Section 391.028, Florida Statutes, is amended 618
to read: 619
391.028 Administration. — 620
(1) The Director of Children's Medi cal Services must be a 621
physician licensed under chapter 458 or chapter 459 who has 622
specialized training and experience in the provision of health 623
care to children and youth and who has recognized skills in 624
leadership and the promotion of children's health programs. The 625
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director shall be the deputy secretary and the Deputy State 626
Health Officer for Children's Medical Services and is appointed 627
by and reports to the State Surgeon General. The director may 628
appoint such other staff as necessary for the operation of the 629
program subject to the approval of the State Surgeon General. 630
(2) The director shall provide for an operational system 631
using such department staff and contract providers as necessary. 632
The program shall implement all of the following program 633
activities under physician supervision on a statewide basis: 634
(a) Case management services for network participants; 635
(b) Management and oversight of statewide local program 636
activities.; 637
(b)(c) Medical and financial eligibility determination for 638
the program in accordance with s. 391.029 .; 639
(c)(d) Determination of a level of care and medical 640
complexity for long-term care services.; 641
(d)(e) Authorizing services in the program and developing 642
spending plans.; 643
(f) Development of treatment plans; and 644
(e)(g) Resolution of complaints and grievances from 645
participants and health care providers. 646
(3) Each Children's Medical Services area office shall be 647
directed by a physician licensed under chapter 458 or chapter 648
459 who has specialized training and experience in the provision 649
of health care to children. The director of a Children's Medical 650
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Services area office shall be appointed by the director from the 651
active panel of Children's Medical Services physician 652
consultants. 653
Section 8. Subsections (2) and (3) of se ction 391.029, 654
Florida Statutes, are amended to read: 655
391.029 Program eligibility. — 656
(2) The following individuals are eligible to receive 657
services through the program: 658
(a) Related to the regional perinatal intensive care 659
centers, a high-risk pregnant female who is enrolled in 660
Medicaid. 661
(b) Children and youth with serious special health care 662
needs from birth to 21 years of age who are enrolled in 663
Medicaid. 664
(c) Children and youth with serious special health care 665
needs from birth to 19 years of age w ho are enrolled in a 666
program under Title XXI of the Social Security Act. 667
(3) Subject to the availability of funds, the following 668
individuals may receive services through the program: 669
(a) Children and youth with serious special health care 670
needs from birth to 21 years of age who do not qualify for 671
Medicaid or Title XXI of the Social Security Act but who are 672
unable to access, due to lack of providers or lack of financial 673
resources, specialized services that a re medically necessary or 674
essential family support services. Families shall participate 675
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financially in the cost of care based on a sliding fee scale 676
established by the department. 677
(b) Children and youth with special health care needs from 678
birth to 21 years of age, as provided in Title V of the Social 679
Security Act. 680
(c) An infant who receives an award of compensation under 681
s. 766.31(1). The Florida Birth -Related Neurological Injury 682
Compensation Associati on shall reimburse the Children's Medical 683
Services Managed Care Plan Network the state's share of funding, 684
which must thereafter be used to obtain matching federal funds 685
under Title XXI of the Social Security Act. 686
Section 9. Section 391.0315, Florida S tatutes, is amended 687
to read: 688
391.0315 Benefits.—Benefits provided under the Children's 689
Medical Services Managed Care Plan program for children with 690
special health care needs shall be equivalent to benefits 691
provided to children as specified in ss. 409.905 and 409.906. 692
The department may offer additional benefits through Children's 693
Medical Services programs for early intervention services, 694
respite services, genetic testing, genetic and nutritional 695
counseling, and parent support services, if such services ar e 696
determined to be medically necessary. 697
Section 10. Section 391.035, Florida Statutes, is 698
repealed. 699
Section 11. Section 391.045, Florida Statutes, is amended 700
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to read: 701
391.045 Reimbursement. — 702
(1) The department shall reimburse health care provid ers 703
for services rendered through the Children's Medical Services 704
Managed Care Plan network using cost-effective methods, 705
including, but not limited to, capitation, discounted fee -for-706
service, unit costs, and cost reimbursement. Medicaid 707
reimbursement rates shall be utilized to the maximum extent 708
possible, where applicable. 709
(2) Reimbursement to the Children's Medical Services 710
program for services provided to children and youth with special 711
health care needs who participate in the Florida Kidcare program 712
and who are not Medicaid recipients shall be on a capitated 713
basis. 714
Section 12. Section 391.055, Florida Statutes, is amended 715
to read: 716
391.055 Service delivery systems. — 717
(1) The program shall apply managed care methods to ensure 718
the efficient operati on of the Children's Medical Services 719
Managed Care Plan network. Such methods include, but are not 720
limited to, capitation payments, utilization management and 721
review, prior authorization, and case management. 722
(2) The components of the network are: 723
(a) Qualified primary care physicians who shall serve as 724
the gatekeepers and who shall be responsible for the provision 725
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or authorization of health services to an eligible individual 726
who is enrolled in the Children's Medical Services network. 727
(b) Comprehensive Specialty care arrangements that meet 728
the requirements of s. 391.035 to provide acute care, specialty 729
care, long-term care, and chronic disease management for 730
eligible individuals. 731
(c) Case management services. 732
(3) The Children's Medical Services Managed Care Plan 733
network may contract with school districts participating in the 734
certified school match program pursuant to ss. 409.908(21) and 735
1011.70 for the provision of school -based services, as provided 736
for in s. 409.9071, for Medicaid -eligible children who are 737
enrolled in the Children's Medical Services Managed Care Plan 738
network. 739
(4) If a newborn has an abnormal screening result for 740
metabolic or other hereditary and congenital disorders which is 741
identified through the newborn screening program pursuan t to s. 742
383.14, the newborn shall be referred to the Children's Medical 743
Services program for additional testing, medical management, 744
early intervention services, or medical referral. 745
Section 13. Section 391.097, Florida Statutes, is amended 746
to read: 747
391.097 Research and evaluation. — 748
(1) The department may initiate, fund, and conduct 749
research and evaluation projects to improve the delivery of 750
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children's medical services. The department may cooperate with 751
public and private agencies engaged in work of a similar nature. 752
(2) The Children's Medical Services Managed Care Plan 753
network shall be included in any evaluation conducted in 754
accordance with the provisions of Title XXI of the Social 755
Security Act as enacted by the Legislature. 756
Section 14. Part II of chapter 391, Florida Statutes, 757
consisting of ss. 391.221 and 391.223, Florida Statutes, is 758
repealed, and part III of that chapter is redesignated as part 759
II. 760
Section 15. Legislative findings and intent. — 761
(1) The Legislature finds that: 762
(a) In August 2014, the Department of Health's Children's 763
Medical Services Network, which was a fee -for-service program 764
serving children with special health care needs who were 765
enrolled in Medicaid under Title XIX of the Social Security Act 766
and children with spec ial health care needs who were enrolled in 767
the Children's Health Insurance Program under Title XXI of the 768
Social Security Act, was transitioned to the Children's Medical 769
Services Managed Care Plan. 770
(b) The Agency for Health Care Administration serves as 771
the lead agency for Statewide Medicaid Managed Care for the 772
state of Florida, and the Agency for Health Care Administration 773
contracts with the Department of Health to provide Medicaid 774
services through the Children's Medical Services Managed Care 775
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Plan. 776
(c) The Department of Health subcontracts with a private 777
provider to operate various components of the Children's Medical 778
Services Managed Care Plan, including services for children with 779
special health care needs enrolled in Medicaid and children with 780
special health care needs enrolled in the Children's Health 781
Insurance Program. 782
(d) The administrative requirements of this intermediary 783
relationship can be addressed by transitioning the operations of 784
the Children's Medical Services Managed Care Plan to the Ag ency 785
for Health Care Administration. This transition shall include 786
children with special health care needs enrolled in Medicaid and 787
children with special health care needs enrolled in the 788
Children's Health Insurance Program. 789
(e) The Department of Health' s Children's Medical Services 790
program has a longstanding history of successfully and 791
compassionately caring for children with special health care 792
needs and their families. This knowledge, skill, and ability can 793
be used to collaborate with the Agency for He alth Care 794
Administration in the care of children with special health care 795
needs. 796
(2) It is the intent of the Legislature that the Agency 797
for Health Care Administration shall, in consultation with the 798
Department of Health, competitively procure and operat e one or 799
more specialty plan contracts for children and youth with 800
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special health care needs beginning with the 2024 -2025 plan 801
year. 802
Section 16. Transfer of operation of the Children's 803
Medical Services Managed Care Plan. — 804
(1) Effective October 1, 202 4, all statutory powers, 805
duties, functions, records, personnel, pending issues, existing 806
contracts, administrative authority, administrative rules, and 807
unexpended balances of appropriations, allocations, and other 808
funds for the operation of the Department of Health's Children's 809
Medical Services Managed Care Plan, except those powers, duties, 810
and personnel retained by the Department of Health in chapter 811
391, Florida Statutes, are transferred to the Agency for Health 812
Care Administration. 813
(2) The transfer of operations of the Children's Medical 814
Services Managed Care Plan does not affect the validity of any 815
judicial or administrative action pending as of 11:59 p.m. on 816
the day before the effective date of the transfer to which the 817
Department of Health's Childre n's Medical Services Managed Care 818
Plan is at that time a party, and the Agency for Health Care 819
Administration shall be substituted as a party in interest in 820
any such action. 821
(3) The Department of Health's Children's Medical Services 822
program shall use its knowledge, skill, and ability to 823
collaborate with the Agency for Health Care Administration in 824
the care of children with special health care needs. The 825
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Department of Health's Children's Medical Services program shall 826
do all of the following: 827
(a) Assist the agency in developing specifications for use 828
in the procurement of vendors and the model contract, including 829
provisions relating to referral, enrollment, disenrollment, 830
access, quality-of-care, network adequacy, care coordination, 831
and service integratio n. 832
(b) Conduct clinical eligibility screening for children 833
with special health care needs who are eligible for or enrolled 834
in Medicaid or the Children's Health Insurance Program. 835
(c) Collaborate with the agency in the care of children 836
with special health care needs. 837
Section 17. By November 1, 2023, the Agency for Health 838
Care Administration and the Department of Health shall submit to 839
each substantive and fiscal committee of the Legislature having 840
jurisdiction a report specifying any legislative and 841
administrative changes needed to effectively transfer operations 842
of the Children's Medical Services Managed Care Plan from the 843
department to the agency. 844
Section 18. Subsection (4) of section 409.974, Florida 845
Statutes, is amended to read: 846
409.974 Eligible plans.— 847
(4) CHILDREN'S MEDICAL SERVICES NETWORK.—The Agency for 848
Health Care Administration shall competitively procure one or 849
more vendors to provide services for children with special 850
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health care needs who are enrolled in Medicaid and children with 851
special health care needs who are enrolled in the Children's 852
Health Insurance Program for the 2024 -2025 plan year. The 853
Department of Health's Children's Medical Services program shall 854
do all of the following: 855
(a) Assist the agency in developing spec ifications for use 856
in the procurement of vendors and the model contract, including 857
provisions relating to referral, enrollment, disenrollment, 858
access, quality-of-care, network adequacy, care coordination, 859
and service integration. 860
(b) Conduct clinical eli gibility screening for children 861
with special health care needs who are eligible for or are 862
enrolled in Medicaid or the Children's Health Insurance Program. 863
(c) Collaborate with the agency in the care of children 864
with special health care needs Participation by the Children's 865
Medical Services Network shall be pursuant to a single, 866
statewide contract with the agency that is not subject to the 867
procurement requirements or regional plan number limits of this 868
section. The Children's Medical Services Network must meet all 869
other plan requirements for the managed medical assistance 870
program. 871
Section 19. Effective October 1, 2024, paragraph (f) of 872
subsection (4) and paragraph (b) of subsection (5) of section 873
409.166, Florida Statutes, is amended to read: 874
409.166 Children within the child welfare system; adoption 875
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assistance program.— 876
(4) ADOPTION ASSISTANCE. — 877
(f) The department may provide adoption assistance to the 878
adoptive parents, subject to specific appropriation, for medical 879
assistance initiated after the adoption of the child for 880
medical, surgical, hospital, and related services needed as a 881
result of a physical or mental condition of the child which 882
existed before the adoption and is not covered by Medicaid , 883
Children's Medical Services, or Children's Mental Health 884
Services. Such assistance may be initiated at any time but must 885
shall terminate on or before the child's 18th birthday. 886
(5) ELIGIBILITY FOR SERVICES. — 887
(b) A child who is handicapped at the time of adoption is 888
shall be eligible for services th rough a specialty plan under 889
contract with the agency to serve children with special heath 890
care needs the Children's Medical Services network established 891
under part I of chapter 391 if the child was eligible for such 892
services before prior to the adoption. 893
Section 20. Subsection (7) of section 409.811, Florida 894
Statutes, is amended to read: 895
409.811 Definitions relating to Florida Kidcare Act. —As 896
used in ss. 409.810-409.821, the term: 897
(7) "Children's Medical Services Managed Care Plan 898
Network" or "plan network" means a statewide managed care 899
service system as defined in s. 391.021 s. 391.021(1). 900
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Section 21. Effective October 1, 2024, subsection (1) of 901
section 409.813, Florida Statutes, is amended to read: 902
409.813 Health benefits coverage; program components; 903
entitlement and nonentitlement. — 904
(1) The Florida Kidcare program includes health benefits 905
coverage provided to children through the following program 906
components, which shall be marketed as the Florida Kidcare 907
program: 908
(a) Medicaid; 909
(b) Medikids as created in s. 409.8132; 910
(c) The Florida Healthy Kids Corporation as created in s. 911
624.91; 912
(d) Employer-sponsored group health insurance plans 913
approved under ss. 409.810 -409.821; and 914
(e) A specialty plan under contract with the agency to 915
serve children with special health care needs The Children's 916
Medical Services network established in chapter 391 . 917
Section 22. Effective October 1, 2024, subsection (3) of 918
section 409.8134, Florida Statutes, is amended to read: 919
409.8134 Program expendi ture ceiling; enrollment. — 920
(3) Upon determination by the Social Services Estimating 921
Conference that there are insufficient funds to finance the 922
current enrollment in the Florida Kidcare program within current 923
appropriations, the program shall initiate di senrollment 924
procedures to remove enrollees, except those children enrolled 925
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in a specialty plan under contract with the agency to serve 926
children with special health care needs the Children's Medical 927
Services Network, on a last-in, first-out basis until the 928
expenditure and appropriation levels are balanced. 929
Section 23. Subsection (3) and paragraph (c) of subsection 930
(10) of section 409.814, Florida Statutes, is amended to read: 931
409.814 Eligibility. —A child who has not reached 19 years 932
of age whose family income is equal to or below 200 percent of 933
the federal poverty level is eligible for the Florida Kidcare 934
program as provided in this section. If an enrolled individual 935
is determined to be ineligible for coverage, he or she must be 936
immediately disenrolled from the respective Florida Kidcare 937
program component. 938
(3) A Title XXI-funded child who is eligible for the 939
Florida Kidcare program who is a child with special health care 940
needs, as determined through a medical or behavioral screening 941
instrument, is eligible for health benefits coverage from and 942
shall be assigned to and may opt out of the Children's Medical 943
Services Managed Care Plan Network. 944
(10) In determining the eligibility of a child, an assets 945
test is not required. Each applicant shall provide doc umentation 946
during the application process and the redetermination process, 947
including, but not limited to, the following: 948
(c) To enroll in the Children's Medical Services Managed 949
Care Plan Network, a completed application, including a clinical 950
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screening. 951
Section 24. Effective October 1, 2024, paragraph (t) of 952
subsection (2) of section 409.815, Florida Statutes, is amended 953
to read: 954
409.815 Health benefits coverage; limitations. — 955
(2) BENCHMARK BENEFITS. —In order for health benefits 956
coverage to qualify for premium assistance payments for an 957
eligible child under ss. 409.810 -409.821, the health benefits 958
coverage, except for coverage under Medicaid and Medikids, must 959
include the following minimum benefits, as medically necessary. 960
(t) Enhancements to minimum requirements.— 961
1. This section sets the minimum benefits that must be 962
included in any health benefits coverage, other than Medicaid or 963
Medikids coverage, offered under ss. 409.810 -409.821. Health 964
benefits coverage may include additional benefits not included 965
under this subsection, but may not include benefits excluded 966
under paragraph (r). 967
2. Health benefits coverage may extend any limitations 968
beyond the minimum benefits described in this section. 969
970
Except for a specialty plan under contract with the agency to 971
serve children with special health care needs the Children's 972
Medical Services Network , the agency may not increase the 973
premium assistance payment for either additional benefits 974
provided beyond the minimum benefits described in this section 975
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or the imposition of less restrictive service limitations. 976
Section 25. Effective October 1, 2024, paragraph (i) of 977
subsection (1) of section 409.8177, Florida Statutes, is amended 978
to read: 979
409.8177 Program evaluation. — 980
(1) The agency, in consultation wi th the Department of 981
Health, the Department of Children and Families, and the Florida 982
Healthy Kids Corporation, shall contract for an evaluation of 983
the Florida Kidcare program and shall by January 1 of each year 984
submit to the Governor, the President of the Senate, and the 985
Speaker of the House of Representatives a report of the program. 986
In addition to the items specified under s. 2108 of Title XXI of 987
the Social Security Act, the report shall include an assessment 988
of crowd-out and access to health care, as we ll as the 989
following: 990
(i) An assessment of the effectiveness of the Florida 991
Kidcare program, including Medicaid, the Florida Healthy Kids 992
program, Medikids, and the specialty plans under contract with 993
the agency to serve children with special health care needs 994
Children's Medical Services network , and other public and 995
private programs in the state in increasing the availability of 996
affordable quality health insurance and health care for 997
children. 998
Section 26. Effective October 1, 2024, subsection (4) of 999
section 409.818, Florida Statutes, is amended to read: 1000
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409.818 Administration. —In order to implement ss. 409.810 -1001
409.821, the following agencies shall have the following duties: 1002
(4) The Office of Insurance Regulation shall certify that 1003
health benefits coverage plans that seek to provide services 1004
under the Florida Kidcare program, except those offered through 1005
the Florida Healthy Kids Corporation or the agency Children's 1006
Medical Services Network , meet, exceed, or are actuarially 1007
equivalent to the benchmar k benefit plan and that health 1008
insurance plans will be offered at an approved rate. In 1009
determining actuarial equivalence of benefits coverage, the 1010
Office of Insurance Regulation and health insurance plans must 1011
comply with the requirements of s. 2103 of Tit le XXI of the 1012
Social Security Act. The department shall adopt rules necessary 1013
for certifying health benefits coverage plans. 1014
Section 27. Effective October 1, 2024, subsection (11) of 1015
section 409.912, Florida Statutes, is amended to read: 1016
409.912 Cost-effective purchasing of health care. —The 1017
agency shall purchase goods and services for Medicaid recipients 1018
in the most cost-effective manner consistent with the delivery 1019
of quality medical care. To ensure that medical services are 1020
effectively utilized, the agency may, in any case, require a 1021
confirmation or second physician's opinion of the correct 1022
diagnosis for purposes of authorizing future services under the 1023
Medicaid program. This section does not restrict access to 1024
emergency services or post stabilization care services as defined 1025
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in 42 C.F.R. s. 438.114. Such confirmation or second opinion 1026
shall be rendered in a manner approved by the agency. The agency 1027
shall maximize the use of prepaid per capita and prepaid 1028
aggregate fixed-sum basis services when appropriate and other 1029
alternative service delivery and reimbursement methodologies, 1030
including competitive bidding pursuant to s. 287.057, designed 1031
to facilitate the cost -effective purchase of a case -managed 1032
continuum of care. The agency shall also re quire providers to 1033
minimize the exposure of recipients to the need for acute 1034
inpatient, custodial, and other institutional care and the 1035
inappropriate or unnecessary use of high -cost services. The 1036
agency shall contract with a vendor to monitor and evaluate the 1037
clinical practice patterns of providers in order to identify 1038
trends that are outside the normal practice patterns of a 1039
provider's professional peers or the national guidelines of a 1040
provider's professional association. The vendor must be able to 1041
provide information and counseling to a provider whose practice 1042
patterns are outside the norms, in consultation with the agency, 1043
to improve patient care and reduce inappropriate utilization. 1044
The agency may mandate prior authorization, drug therapy 1045
management, or disease management participation for certain 1046
populations of Medicaid beneficiaries, certain drug classes, or 1047
particular drugs to prevent fraud, abuse, overuse, and possible 1048
dangerous drug interactions. The Pharmaceutical and Therapeutics 1049
Committee shall make recommendations to the agency on drugs for 1050
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which prior authorization is required. The agency shall inform 1051
the Pharmaceutical and Therapeutics Committee of its decisions 1052
regarding drugs subject to prior authorization. The agency is 1053
authorized to limit th e entities it contracts with or enrolls as 1054
Medicaid providers by developing a provider network through 1055
provider credentialing. The agency may competitively bid single -1056
source-provider contracts if procurement of goods or services 1057
results in demonstrated cos t savings to the state without 1058
limiting access to care. The agency may limit its network based 1059
on the assessment of beneficiary access to care, provider 1060
availability, provider quality standards, time and distance 1061
standards for access to care, the cultural competence of the 1062
provider network, demographic characteristics of Medicaid 1063
beneficiaries, practice and provider -to-beneficiary standards, 1064
appointment wait times, beneficiary use of services, provider 1065
turnover, provider profiling, provider licensure histor y, 1066
previous program integrity investigations and findings, peer 1067
review, provider Medicaid policy and billing compliance records, 1068
clinical and medical record audits, and other factors. Providers 1069
are not entitled to enrollment in the Medicaid provider networ k. 1070
The agency shall determine instances in which allowing Medicaid 1071
beneficiaries to purchase durable medical equipment and other 1072
goods is less expensive to the Medicaid program than long -term 1073
rental of the equipment or goods. The agency may establish rules 1074
to facilitate purchases in lieu of long -term rentals in order to 1075
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protect against fraud and abuse in the Medicaid program as 1076
defined in s. 409.913. The agency may seek federal waivers 1077
necessary to administer these policies. 1078
(11) The agency shall implemen t a program of all-inclusive 1079
care for children. The program of all -inclusive care for 1080
children shall be established to provide in -home hospice-like 1081
support services to children diagnosed with a life -threatening 1082
illness and enrolled in the Children's Medica l Services network 1083
to reduce hospitalizations as appropriate. The agency, in 1084
consultation with the Department of Health, may implement the 1085
program of all-inclusive care for children after obtaining 1086
approval from the Centers for Medicare and Medicaid Servic es. 1087
Section 28. Effective October 1, 2024, subsection (1) of 1088
section 409.9126, Florida Statutes, is amended to read: 1089
409.9126 Children with special health care needs. — 1090
(1) Except as provided in subsection (4), children 1091
eligible for Children's Medic al Services who receive Medicaid 1092
benefits, and other Medicaid -eligible children with special 1093
health care needs, are shall be exempt from the provisions of s. 1094
409.9122 and shall be served through the Children's Medical 1095
Services network established in chapte r 391. 1096
Section 29. Effective October 1, 2024, paragraph (a) of 1097
subsection (5) of section 409.9131, Florida Statutes, is amended 1098
to read: 1099
409.9131 Special provisions relating to integrity of the 1100
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Medicaid program.— 1101
(5) DETERMINATIONS OF OVERPAYMENT. —In making a 1102
determination of overpayment to a physician, the agency must: 1103
(a) Use accepted and valid auditing, accounting, 1104
analytical, statistical, or peer -review methods, or combinations 1105
thereof. Appropriate statistical methods may include, but are 1106
not limited to, sampling and extension to the population, 1107
parametric and nonparametric statistics, tests of hypotheses, 1108
other generally accepted statistical methods, review of medical 1109
records, and a consideration of the physician's client case mix. 1110
Before performing a review of the physician's Medicaid records, 1111
however, the agency shall make every effort to consider the 1112
physician's patient case mix, including, but not limited to, 1113
patient age and whether individual patients are clients of the 1114
Children's Medical Services Network established in chapter 391 . 1115
In meeting its burden of proof in any administrative or court 1116
proceeding, the agency may introduce the results of such 1117
statistical methods and its other audit findings as evidence of 1118
overpayment. 1119
Section 30. Effective October 1, 2024, paragraph (e) of 1120
subsection (1) of section 409.920, Florida Statutes, is amended 1121
to read: 1122
409.920 Medicaid provider fraud. — 1123
(1) For the purposes of this section, the term: 1124
(e) "Managed care plans" means a health insurer au thorized 1125
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under chapter 624, an exclusive provider organization authorized 1126
under chapter 627, a health maintenance organization authorized 1127
under chapter 641, the Children's Medical Services Network 1128
authorized under chapter 391 , a prepaid health plan authori zed 1129
under this chapter, a provider service network authorized under 1130
this chapter, a minority physician network authorized under this 1131
chapter, and an emergency department diversion program 1132
authorized under this chapter or the General Appropriations Act, 1133
providing health care services pursuant to a contract with the 1134
Medicaid program. 1135
Section 31. Effective October 1, 2024, subsection (7) of 1136
section 409.962, Florida Statutes, is amended to read: 1137
409.962 Definitions. —As used in this part, except as 1138
otherwise specifically provided, the term: 1139
(7) "Eligible plan" means a health insurer authorized 1140
under chapter 624, an exclusive provider organization authorized 1141
under chapter 627, a health maintenance organization authorized 1142
under chapter 641, or a provider se rvice network authorized 1143
under s. 409.912(1) or an accountable care organization 1144
authorized under federal law. For purposes of the managed 1145
medical assistance program, the term also includes the 1146
Children's Medical Services Network authorized under chapter 3 91 1147
and entities qualified under 42 C.F.R. part 422 as Medicare 1148
Advantage Preferred Provider Organizations, Medicare Advantage 1149
Provider-sponsored Organizations, Medicare Advantage Health 1150
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Maintenance Organizations, Medicare Advantage Coordinated Care 1151
Plans, and Medicare Advantage Special Needs Plans, and the 1152
Program of All-inclusive Care for the Elderly. 1153
Section 32. Except as otherwise expressly provided in this 1154
act, this act shall take effect July 1, 2023. 1155