Florida 2023 Regular Session

Florida House Bill H1503 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 1503 2023
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1503-00
9	9	Page 1 of 47
10	10	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
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12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to the Children's Medical Services 2
16	16	program; amending s. 383.14, F.S.; deleting a 3
17	17	requirement that the Department of Health consult with 4
18	18	the Department of Education before prescribing certain 5
19	19	newborn testing and screening requirements; 6
20	20	authorizing the release of certain newborn screening 7
21	21	results to licensed genetic counselors; requiring that 8
22	22	newborns have a blood specimen collected for newborn 9
23	23	screenings before they reach a specified age; deleting 10
24	24	a requirement that newborns be subjected to a certain 11
25	25	test; conforming provisions to changes made by the 12
26	26	act; revising requirements related to a certain 13
27	27	assessment for hospitals and birth centers; deleting a 14
28	28	requirement that the department submit a certain 15
29	29	annual cost certification as part of its ann ual 16
30	30	legislative budget request; requiring certain health 17
31	31	care practitioners and health care providers to 18
32	32	prepare and send all newborn screening specimen cards 19
33	33	to the State Public Health Laboratory; amending s. 20
34	34	383.145, F.S.; defining the term "toddler"; re vising 21
35	35	newborn screening requirements for licensed birth 22
36	36	centers; requiring that a certain referral for newborn 23
37	37	screening be made before the newborn reaches a 24
38	38	specified age; requiring early childhood programs and 25
39	39
40	40	HB 1503 2023
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42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb1503-00
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47	47	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
48	48
49	49
50	50
51	51	entities that screen for hearing loss to re port the 26
52	52	screening results to the department within a specified 27
53	53	timeframe; amending s. 391.016, F.S.; revising the 28
54	54	purposes and functions of the Children's Medical 29
55	55	Services program; amending s. 391.021, F.S.; revising 30
56	56	definitions; amending s. 391.025, F.S. ; revising the 31
57	57	scope of the program; amending s. 391.026, F.S.; 32
58	58	revising the powers and duties of the Department of 33
59	59	Health to conform to changes made by the act; amending 34
60	60	s. 391.028, F.S.; revising activities within the 35
61	61	purview of the program; deleting a r equirement that 36
62	62	every office of the program be under the direction of 37
63	63	a licensed physician; amending s. 391.029, F.S.; 38
64	64	revising program eligibility requirements; amending s. 39
65	65	391.0315, F.S.; conforming provisions to changes made 40
66	66	by the act; repealing s. 391 .035, F.S., relating to 41
67	67	provider qualifications; amending s. 391.045, F.S.; 42
68	68	conforming provisions to changes made by the act; 43
69	69	amending s. 391.055, F.S.; conforming provisions to 44
70	70	changes made by the act; deleting specifications for 45
71	71	the components of the pro gram; deleting certain 46
72	72	requirements for newborns referred to the program 47
73	73	through the newborn screening program; amending s. 48
74	74	391.097, F.S.; conforming a provision to changes made 49
75	75	by the act; repealing part II of chapter 391, F.S., 50
76	76
77	77	HB 1503 2023
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79	79
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81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb1503-00
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84	84	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
85	85
86	86
87	87
88	88	relating to Children's Med ical Services councils and 51
89	89	panels; providing legislative findings and intent; 52
90	90	transferring operation of the Children's Medical 53
91	91	Services Managed Care Plan from the department to the 54
92	92	Agency for Health Care Administration, effective on a 55
93	93	specified date; provi ding construction as to judicial 56
94	94	and administrative actions pending as of a specified 57
95	95	date and time; requiring the department's Children's 58
96	96	Medical Services program to collaborate with and 59
97	97	assist the agency in specified activities; requiring 60
98	98	the department to conduct certain clinical eligibility 61
99	99	screenings; requiring the agency and the department to 62
100	100	submit a report to the Legislature by a specified 63
101	101	date; providing requirements for the report; amending 64
102	102	s. 409.974, F.S.; requiring the agency to 65
103	103	competitively procure one or more vendors to provide 66
104	104	services for certain children with special health care 67
105	105	needs; requiring the department's Children's Medical 68
106	106	Services program to assist the agency in developing 69
107	107	certain specifications for the vendor contract; 70
108	108	requiring the department to conduct clinical 71
109	109	eligibility screenings for services for such children 72
110	110	and collaborate with the agency in the care of such 73
111	111	children; conforming a provision to changes made by 74
112	112	the act; amending ss. 409.166, 409.811, 409.813, 75
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114	114	HB 1503 2023
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121	121	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
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123	123
124	124
125	125	409.8134, 409.814, 409.815, 409.8177, 409.818, 76
126	126	409.912, 409.9126, 409.9131, 409.920, and 409.962, 77
127	127	F.S.; conforming provisions to changes made by the 78
128	128	act; providing effective dates. 79
129	129	80
130	130	Be It Enacted by the Legislature of the State of Florida: 81
131	131	82
132	132	Section 1. Section 38 3.14, Florida Statutes, is amended to 83
133	133	read: 84
134	134	383.14 Screening for metabolic disorders, other hereditary 85
135	135	and congenital disorders, and environmental risk factors. — 86
136	136	(1) SCREENING REQUIREMENTS. —To help ensure access to the 87
137	137	maternal and child health care sy stem, the Department of Health 88
138	138	shall promote the screening of all newborns born in Florida for 89
139	139	metabolic, hereditary, and congenital disorders known to result 90
140	140	in significant impairment of health or intellect, as screening 91
141	141	programs accepted by current medic al practice become available 92
142	142	and practical in the judgment of the department. The department 93
143	143	shall also promote the identification and screening of all 94
144	144	newborns in this state and their families for environmental risk 95
145	145	factors such as low income, poor educat ion, maternal and family 96
146	146	stress, emotional instability, substance abuse, and other high -97
147	147	risk conditions associated with increased risk of infant 98
148	148	mortality and morbidity to provide early intervention, 99
149	149	remediation, and prevention services, including, but not limited 100
150	150
151	151	HB 1503 2023
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154	154
155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb1503-00
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158	158	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
159	159
160	160
161	161
162	162	to, parent support and training programs, home visitation, and 101
163	163	case management. Identification, perinatal screening, and 102
164	164	intervention efforts shall begin prior to and immediately 103
165	165	following the birth of the child by the attending health care 104
166	166	provider. Such efforts shall be conducted in hospitals, 105
167	167	perinatal centers, county health departments, school health 106
168	168	programs that provide prenatal care, and birthing centers, and 107
169	169	reported to the Office of Vital Statistics. 108
170	170	(a) Prenatal screening.—The department shall develop a 109
171	171	multilevel screening process that includes a risk assessment 110
172	172	instrument to identify women at risk for a preterm birth or 111
173	173	other high-risk condition. The primary health care provider 112
174	174	shall complete the risk assessment instrument and report the 113
175	175	results to the Office of Vital Statistics so that the woman may 114
176	176	immediately be notified and referred to appropriate health, 115
177	177	education, and social services. 116
178	178	(b) Postnatal screening. —A risk factor analysis using the 117
179	179	department's designated risk assessm ent instrument shall also be 118
180	180	conducted as part of the medical screening process upon the 119
181	181	birth of a child and submitted to the department's Office of 120
182	182	Vital Statistics for recording and other purposes provided for 121
183	183	in this chapter. The department's screening process for risk 122
184	184	assessment shall include a scoring mechanism and procedures that 123
185	185	establish thresholds for notification, further assessment, 124
186	186	referral, and eligibility for services by professionals or 125
187	187
188	188	HB 1503 2023
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190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb1503-00
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195	195	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
196	196
197	197
198	198
199	199	paraprofessionals consistent with the level of risk. Pr ocedures 126
200	200	for developing and using the screening instrument, notification, 127
201	201	referral, and care coordination services, reporting 128
202	202	requirements, management information, and maintenance of a 129
203	203	computer-driven registry in the Office of Vital Statistics which 130
204	204	ensures privacy safeguards must be consistent with the 131
205	205	provisions and plans established under chapter 411, Pub. L. No. 132
206	206	99-457, and this chapter. Procedures established for reporting 133
207	207	information and maintaining a confidential registry must include 134
208	208	a mechanism for a centralized information depository at the 135
209	209	state and county levels. The department shall coordinate with 136
210	210	existing risk assessment systems and information registries. The 137
211	211	department must ensure, to the maximum extent possible, that the 138
212	212	screening information registry is integrated with the 139
213	213	department's automated data systems, including the Florida On -140
214	214	line Recipient Integrated Data Access (FLORIDA) system. Tests 141
215	215	and screenings must be performed by the State Public Health 142
216	216	Laboratory, in coordination with Chil dren's Medical Services, at 143
217	217	such times and in such manner as is prescribed by the department 144
218	218	after consultation with the Genetics and Newborn Screening 145
219	219	Advisory Council and the Department of Education . 146
220	220	(c) Release of screening results. —Notwithstanding any law 147
221	221	to the contrary, the State Public Health Laboratory may release, 148
222	222	directly or through the Children's Medical Services program, the 149
223	223	results of a newborn's hearing and metabolic tests or screenings 150
224	224
225	225	HB 1503 2023
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227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb1503-00
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232	232	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
233	233
234	234
235	235
236	236	to the newborn's health care practitioner, the newborn' s parent 151
237	237	or legal guardian, the newborn's personal representative, or a 152
238	238	person designated by the newborn's parent or legal guardian. As 153
239	239	used in this paragraph, the term "health care practitioner" 154
240	240	means a physician or physician assistant licensed under chap ter 155
241	241	458; an osteopathic physician or physician assistant licensed 156
242	242	under chapter 459; an advanced practice registered nurse, 157
243	243	registered nurse, or licensed practical nurse licensed under 158
244	244	part I of chapter 464; a midwife licensed under chapter 467; a 159
245	245	speech-language pathologist or audiologist licensed under part I 160
246	246	of chapter 468; or a dietician or nutritionist licensed under 161
247	247	part X of chapter 468 ; or a genetic counselor licensed under 162
248	248	part III of chapter 483 . 163
249	249	(2) RULES.— 164
250	250	(a) After consultation with the Gen etics and Newborn 165
251	251	Screening Advisory Council, the department shall adopt and 166
252	252	enforce rules requiring that every newborn in this state must 167
253	253	shall: 168
254	254	1. Before becoming 1 week of age, have a blood specimen 169
255	255	collected for newborn screenings be subjected to a test for 170
256	256	phenylketonuria; 171
257	257	2. Be tested for any condition included on the federal 172
258	258	Recommended Uniform Screening Panel which the council advises 173
259	259	the department should be included under the state's screening 174
260	260	program. After the council recommends that a condi tion be 175
261	261
262	262	HB 1503 2023
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264	264
265	265
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267	267	hb1503-00
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269	269	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
270	270
271	271
272	272
273	273	included, the department shall submit a legislative budget 176
274	274	request to seek an appropriation to add testing of the condition 177
275	275	to the newborn screening program. The department shall expand 178
276	276	statewide screening of newborns to include screening for such 179
277	277	conditions within 18 months after the council renders such 180
278	278	advice, if a test approved by the United States Food and Drug 181
279	279	Administration or a test offered by an alternative vendor is 182
280	280	available. If such a test is not available within 18 months 183
281	281	after the council makes its recommendation, the department shall 184
282	282	implement such screening as soon as a test offered by the United 185
283	283	States Food and Drug Administration or by an alternative vendor 186
284	284	is available; and 187
285	285	3. At the appropriate age, be tested for such other 188
286	286	metabolic diseases and hereditary or congenital disorders as the 189
287	287	department may deem necessary from time to time. 190
288	288	(b) After consultation with the Department of Education, 191
289	289	the department shall adopt and enforce rules requiring every 192
290	290	newborn in this state to b e screened for environmental risk 193
291	291	factors that place children and their families at risk for 194
292	292	increased morbidity, mortality, and other negative outcomes. 195
293	293	(c) The department shall adopt such additional rules as 196
294	294	are found necessary for the administration o f this section and 197
295	295	s. 383.145, including rules providing definitions of terms, 198
296	296	rules relating to the methods used and time or times for testing 199
297	297	as accepted medical practice indicates, rules relating to 200
298	298
299	299	HB 1503 2023
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301	301
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306	306	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
307	307
308	308
309	309
310	310	charging and collecting fees for the administration of the 201
311	311	newborn screening program authorized by this section, rules for 202
312	312	processing requests and releasing test and screening results, 203
313	313	and rules requiring mandatory reporting of the results of tests 204
314	314	and screenings for these conditions to the department. 205
315	315	(3) DEPARTMENT OF HEALTH; POWERS AND DUTIES. —The 206
316	316	department shall administer and provide certain services to 207
317	317	implement the provisions of this section and shall: 208
318	318	(a) Assure the availability and quality of the necessary 209
319	319	laboratory tests and materials. 210
320	320	(b) Furnish all physicians, county health departments, 211
321	321	perinatal centers, birthing centers, and hospitals forms on 212
322	322	which environmental screening and the results of tests for 213
323	323	phenylketonuria and such other disorders for which testing may 214
324	324	be required from time to time shall be reported to the 215
325	325	department. 216
326	326	(c) Promote education of the public about the prevention 217
327	327	and management of metabolic, hereditary, and congenital 218
328	328	disorders and dangers associated with environmental risk 219
329	329	factors. 220
330	330	(d) Maintain a confidential reg istry of cases, including 221
331	331	information of importance for the purpose of follow-up followup 222
332	332	services to prevent intellectual disabilities, to correct or 223
333	333	ameliorate physical disabilities, and for epidemiologic studies, 224
334	334	if indicated. Such registry shall be exe mpt from the provisions 225
335	335
336	336	HB 1503 2023
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341	341	hb1503-00
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343	343	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
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345	345
346	346
347	347	of s. 119.07(1). 226
348	348	(e) Supply the necessary dietary treatment products where 227
349	349	practicable for diagnosed cases of phenylketonuria and other 228
350	350	metabolic diseases for as long as medically indicated when the 229
351	351	products are not otherwise avai lable. Provide nutrition 230
352	352	education and supplemental foods to those families eligible for 231
353	353	the Special Supplemental Nutrition Program for Women, Infants, 232
354	354	and Children as provided in s. 383.011. 233
355	355	(f) Promote the availability of genetic studies, services, 234
356	356	and counseling in order that the parents, siblings, and affected 235
357	357	newborns may benefit from detection and available knowledge of 236
358	358	the condition. 237
359	359	(g) Have the authority to charge and collect fees for the 238
360	360	administration of the newborn screening program . authorized in 239
361	361	this section, as follows: 240
362	362	1. A fee not to exceed $15 will be charged for each live 241
363	363	birth, as recorded by the Office of Vital Statistics, occurring 242
364	364	in a hospital licensed under part I of chapter 395 or a birth 243
365	365	center licensed under s. 383.305 per y ear. The department shall 244
366	366	calculate the annual assessment for each hospital and birth 245
367	367	center, and this assessment must be paid in equal amounts 246
368	368	quarterly. Quarterly, The department shall generate and send 247
369	369	mail to each hospital and birth center a statement of the amount 248
370	370	due. 249
371	371	2. As part of the department's legislative budget request 250
372	372
373	373	HB 1503 2023
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380	380	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
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382	382
383	383
384	384	prepared pursuant to chapter 216, the department shall submit a 251
385	385	certification by the department's inspector general, or the 252
386	386	director of auditing within the inspector general's o ffice, of 253
387	387	the annual costs of the uniform testing and reporting procedures 254
388	388	of the newborn screening program. In certifying the annual 255
389	389	costs, the department's inspector general or the director of 256
390	390	auditing within the inspector general's office shall calculat e 257
391	391	the direct costs of the uniform testing and reporting 258
392	392	procedures, including applicable administrative costs. 259
393	393	Administrative costs shall be limited to those department costs 260
394	394	which are reasonably and directly associated with the 261
395	395	administration of the unifo rm testing and reporting procedures 262
396	396	of the newborn screening program. 263
397	397	(h) Have the authority to bill third -party payors for 264
398	398	newborn screening tests. 265
399	399	(i) Create and make available electronically a pamphlet 266
400	400	with information on screening for, and the trea tment of, 267
401	401	preventable infant and childhood eye and vision disorders, 268
402	402	including, but not limited to, retinoblastoma and amblyopia. 269
403	403	270
404	404	All provisions of this subsection must be coordinated with the 271
405	405	provisions and plans established under this chapter, chapter 272
406	406	411, and Pub. L. No. 99 -457. 273
407	407	(4) OBJECTIONS OF PARENT OR GUARDIAN. —The provisions of 274
408	408	this section shall not apply when the parent or guardian of the 275
409	409
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417	417	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
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421	421	child objects thereto. A written statement of such objection 276
422	422	shall be presented to the physician or other person whose duty 277
423	423	it is to administer and report tests and screenings under this 278
424	424	section. 279
425	425	(5) SUBMISSION OF NEWBORN SCREENING SPECIMEN CARDS. —Any 280
426	426	physician, advanced practice registered nurse, licensed midwife, 281
427	427	or other licensed health care practitioner or other health care 282
428	428	provider whose duty it is to administer screenings under this 283
429	429	section shall prepare and send all newborn screening specimen 284
430	430	cards to the State Public Health Laboratory in accordance with 285
431	431	rules adopted under this section. 286
432	432	(6) ADVISORY COUNCIL.—There is established a Genetics and 287
433	433	Newborn Screening Advisory Council made up of 15 members 288
434	434	appointed by the State Surgeon General. The council shall be 289
435	435	composed of two consumer members, three practicing 290
436	436	pediatricians, at least one of whom must be a pediatric 291
437	437	hematologist, a representative from each of four medical schools 292
438	438	in this state, the State Surgeon General or his or her designee, 293
439	439	one representative from the Department of Health representing 294
440	440	Children's Medical Services, one representative f rom the Florida 295
441	441	Hospital Association, one individual with experience in newborn 296
442	442	screening programs, one individual representing audiologists, 297
443	443	and one representative from the Agency for Persons with 298
444	444	Disabilities. All appointments shall be for a term of 4 ye ars. 299
445	445	The chairperson of the council shall be elected from the 300
446	446
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454	454	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
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456	456
457	457
458	458	membership of the council and shall serve for a period of 2 301
459	459	years. The council shall meet at least semiannually or upon the 302
460	460	call of the chairperson. The council may establish ad hoc or 303
461	461	temporary technical advisory groups to assist the council with 304
462	462	specific topics which come before the council. Council members 305
463	463	shall serve without pay. Pursuant to the provisions of s. 306
464	464	112.061, the council members are entitled to be reimbursed for 307
465	465	per diem and travel expenses. It is the purpose of the council 308
466	466	to advise the department about: 309
467	467	(a) Conditions for which testing should be included under 310
468	468	the screening program and the genetics program. Within 1 year 311
469	469	after a condition is added to the federal Recommended Uni form 312
470	470	Screening Panel, the council shall consider whether the 313
471	471	condition should be included under the state's screening 314
472	472	program. 315
473	473	(b) Procedures for collection and transmission of 316
474	474	specimens and recording of results. 317
475	475	(c) Methods whereby screening programs and genetics 318
476	476	services for children now provided or proposed to be offered in 319
477	477	the state may be more effectively evaluated, coordinated, and 320
478	478	consolidated. 321
479	479	Section 2. Section 383.145, Florida Statutes, is amended 322
480	480	to read: 323
481	481	383.145 Newborn, and infant, and toddler hearing 324
482	482	screening.— 325
483	483
484	484	HB 1503 2023
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491	491	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
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494	494
495	495	(1) LEGISLATIVE INTENT. —It is the intent of the 326
496	496	Legislature to provide a statewide comprehensive and coordinated 327
497	497	interdisciplinary program of early hearing loss screening, 328
498	498	identification, and follow -up care for newborns. The goal is to 329
499	499	screen all newborns for hearing loss in order to alleviate the 330
500	500	adverse effects of hearing loss on speech and language 331
501	501	development, academic performance, and cognitive development. It 332
502	502	is further the intent of the Legislature that this section on ly 333
503	503	be implemented to the extent that funds are specifically 334
504	504	included in the General Appropriations Act for carrying out the 335
505	505	purposes of this section. 336
506	506	(2) DEFINITIONS.—As used in this section, the term: 337
507	507	(a) "Audiologist" means a person licensed under pa rt I of 338
508	508	chapter 468 to practice audiology. 339
509	509	(b) "Department" means the Department of Health. 340
510	510	(c) "Hearing loss" means a hearing loss of 30 dB HL or 341
511	511	greater in the frequency region important for speech recognition 342
512	512	and comprehension in one or both ears, a pproximately 500 through 343
513	513	4,000 hertz. 344
514	514	(d) "Hospital" means a facility as defined in s. 345
515	515	395.002(13) and licensed under chapter 395 and part II of 346
516	516	chapter 408. 347
517	517	(e) "Infant" means an age range from 30 days through 12 348
518	518	months. 349
519	519	(f) "Licensed health care provider" means a physician or 350
520	520
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528	528	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
529	529
530	530
531	531
532	532	physician assistant licensed under chapter 458; an osteopathic 351
533	533	physician or physician assistant licensed under chapter 459; an 352
534	534	advanced practice registered nurse, a registered nurse, or a 353
535	535	licensed practical nurse licensed under part I of chapter 464; a 354
536	536	midwife licensed under chapter 467; or a speech -language 355
537	537	pathologist or an audiologist licensed under part I of chapter 356
538	538	468. 357
539	539	(g) "Management" means the habilitation of the child with 358
540	540	hearing loss. 359
541	541	(h) "Newborn" means an age range from birth through 29 360
542	542	days. 361
543	543	(i) "Physician" means a person licensed under chapter 458 362
544	544	to practice medicine or chapter 459 to practice osteopathic 363
545	545	medicine. 364
546	546	(j) "Screening" means a test or battery of tests 365
547	547	administered to determine the need for an in -depth hearing 366
548	548	diagnostic evaluation. 367
549	549	(k) "Toddler" means a child from 12 months to 36 months of 368
550	550	age. 369
551	551	(3) REQUIREMENTS FOR SCREENING OF NEWBORNS , INFANTS, AND 370
552	552	TODDLERS; INSURANCE COVERAGE; REFERRAL FOR ONGOING SERVICES. — 371
553	553	(a) Each hospital or other state -licensed birthing 372
554	554	facility that provides maternity and newborn care services shall 373
555	555	ensure that all newborns are, before discharge, screened for the 374
556	556	detection of hearing loss to prevent the consequences of 375
557	557
558	558	HB 1503 2023
559	559
560	560
561	561
562	562	CODING: Words stricken are deletions; words underlined are additions.
563	563	hb1503-00
564	564	Page 16 of 47
565	565	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
566	566
567	567
568	568
569	569	unidentified disorders. If a newborn fails the screening for the 376
570	570	detection of hearing loss, the hospital or other state -licensed 377
571	571	birthing facility must administer a test approved by the United 378
572	572	States Food and Drug Administration or another diagnostically 379
573	573	equivalent test on the newborn to screen for congenital 380
574	574	cytomegalovirus before the newborn becomes 21 days of age or 381
575	575	before discharge, whichever occurs earlier. 382
576	576	(b) Each licensed birth center that provides maternity and 383
577	577	newborn care services shall ensure that all newborns are, before 384
578	578	discharge, screened for the detection of hearing loss. The 385
579	579	licensed birth center must ensure that all newborns who do not 386
580	580	pass the hearing screening are referred to an audiologist, a 387
581	581	hospital, or another newborn hearing screening provider for a 388
582	582	test to screen for congenital cytomegalovirus before the newborn 389
583	583	becomes 21 days of age screening for the detection of hearing 390
584	584	loss to prevent the consequences of unidentified disorders. The 391
585	585	referral for appointment must be made within 7 days after 392
586	586	discharge. Written documentation of the referral must be placed 393
587	587	in the newborn's medical chart. 394
588	588	(c) If the parent or legal guardian of the newborn objects 395
589	589	to the screening, the screening must not be completed. In such 396
590	590	case, the physician, midwife, or other pe rson attending the 397
591	591	newborn shall maintain a record that the screening has not been 398
592	592	performed and attach a written objection that must be signed by 399
593	593	the parent or guardian. 400
594	594
595	595	HB 1503 2023
596	596
597	597
598	598
599	599	CODING: Words stricken are deletions; words underlined are additions.
600	600	hb1503-00
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602	602	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
603	603
604	604
605	605
606	606	(d) For home births, the health care provider in 401
607	607	attendance is responsible for coor dination and referral to an 402
608	608	audiologist, a hospital, or another newborn hearing screening 403
609	609	provider. The health care provider in attendance must make the 404
610	610	referral for appointment within 7 days after the birth. In cases 405
611	611	in which the home birth is not attende d by a health care 406
612	612	provider, the newborn's primary health care provider is 407
613	613	responsible for coordinating the referral. 408
614	614	(e) For home births and births in a licensed birth center, 409
615	615	if a newborn is referred to a newborn hearing screening provider 410
616	616	and the newborn fails the screening for the detection of hearing 411
617	617	loss, the newborn's primary health care provider must refer the 412
618	618	newborn for administration of a test approved by the United 413
619	619	States Food and Drug Administration or another diagnostically 414
620	620	equivalent test on the newborn to screen for congenital 415
621	621	cytomegalovirus before the newborn becomes 21 days of age . 416
622	622	(f) All newborn and infant hearing screenings must be 417
623	623	conducted by an audiologist, a physician, or an appropriately 418
624	624	supervised individual who has completed documented training 419
625	625	specifically for newborn hearing screening. Every hospital that 420
626	626	provides maternity or newborn care services shall obtain the 421
627	627	services of an audiologist, a physician, or another newborn 422
628	628	hearing screening provider, through employment or c ontract or 423
629	629	written memorandum of understanding, for the purposes of 424
630	630	appropriate staff training, screening program supervision, 425
631	631
632	632	HB 1503 2023
633	633
634	634
635	635
636	636	CODING: Words stricken are deletions; words underlined are additions.
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639	639	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
640	640
641	641
642	642
643	643	monitoring the scoring and interpretation of test results, 426
644	644	rendering of appropriate recommendations, and coordination of 427
645	645	appropriate follow-up services. Appropriate documentation of the 428
646	646	screening completion, results, interpretation, and 429
647	647	recommendations must be placed in the medical record within 24 430
648	648	hours after completion of the screening procedure. 431
649	649	(g) The screening of a newborn's hearing must be completed 432
650	650	before the newborn is discharged from the hospital. However, if 433
651	651	the screening is not completed before discharge due to 434
652	652	scheduling or temporary staffing limitations, the screening must 435
653	653	be completed within 21 days after the birth. Screenings 436
654	654	completed after discharge or performed because of initial 437
655	655	screening failure must be completed by an audiologist, a 438
656	656	physician, a hospital, or another newborn hearing screening 439
657	657	provider. 440
658	658	(h) Each hospital shall formally designate a lead 441
659	659	physician responsible for programmatic oversight for newborn 442
660	660	hearing screening. Each birth center shall designate a licensed 443
661	661	health care provider to provide such programmatic oversight and 444
662	662	to ensure that the appropriate referrals are being completed. 445
663	663	(i) When ordered by the treating physician, the hearing 446
664	664	screening of a newborn, infant, or toddler newborn's hearing 447
665	665	must include auditory brainstem responses, or evoked otoacoustic 448
666	666	emissions, or appropriate technology as approved by the United 449
667	667	States Food and Drug Administration. 450
668	668
669	669	HB 1503 2023
670	670
671	671
672	672
673	673	CODING: Words stricken are deletions; words underlined are additions.
674	674	hb1503-00
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676	676	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
677	677
678	678
679	679
680	680	(j) Early childhood programs or entities screening infants 451
681	681	and toddlers for hearing loss must report screening results to 452
682	682	the department within 7 days after completing the screening in 453
683	683	an effort to identify late -onset hearing loss not identified 454
684	684	during the newborn hearing screening process. 455
685	685	(k) The results of any test conducted pursuant to this 456
686	686	section, including, but not limited to, newborn hearing loss 457
687	687	screening, congenital cytomegalovirus testing, and any related 458
688	688	diagnostic testing, must be reported to the department within 7 459
689	689	days after receipt of such results. 460
690	690	(l)(k) The initial procedure for screening the hearing of 461
691	691	the newborn or infant and any medically necessary follow -up 462
692	692	reevaluations leading to diagnosis shall be a covered benefit 463
693	693	for Medicaid patients covered by a fee -for-service program. For 464
694	694	Medicaid patients enrolled in HMOs, p roviders shall be 465
695	695	reimbursed directly by the Medicaid Program Office at the 466
696	696	Medicaid rate. This service may not be considered a covered 467
697	697	service for the purposes of establishing the payment rate for 468
698	698	Medicaid HMOs. All health insurance policies and health 469
699	699	maintenance organizations as provided under ss. 627.6416, 470
700	700	627.6579, and 641.31(30), except for supplemental policies that 471
701	701	only provide coverage for specific diseases, hospital indemnity, 472
702	702	or Medicare supplement, or to the supplemental policies, shall 473
703	703	compensate providers for the covered benefit at the contracted 474
704	704	rate. Nonhospital-based providers are eligible to bill Medicaid 475
705	705
706	706	HB 1503 2023
707	707
708	708
709	709
710	710	CODING: Words stricken are deletions; words underlined are additions.
711	711	hb1503-00
712	712	Page 20 of 47
713	713	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
714	714
715	715
716	716
717	717	for the professional and technical component of each procedure 476
718	718	code. 477
719	719	(m)(l) A child who is diagnosed as having permanent 478
720	720	hearing loss must be referred to the primary care physician for 479
721	721	medical management, treatment, and follow -up services. 480
722	722	Furthermore, in accordance with Part C of the Individuals with 481
723	723	Disabilities Education Act, Pub. L. No. 108 -446, Infants and 482
724	724	Toddlers with Disabilities, any child from birth to 36 months of 483
725	725	age who is diagnosed as having hearing loss that requires 484
726	726	ongoing special hearing services must be referred to the 485
727	727	Children's Medical Services Early Intervention Program serving 486
728	728	the geographical area in which the child resides. 487
729	729	Section 3. Subsection (1) of section 391.016, Florida 488
730	730	Statutes, is amended to read: 489
731	731	391.016 Purposes and functions. —The Children's Medical 490
732	732	Services program is established for the following purposes and 491
733	733	authorized to perform the following fu nctions: 492
734	734	(1) Provide to children and youth with special health care 493
735	735	needs a family-centered, comprehensive, and coordinated 494
736	736	statewide managed system of care that links community -based 495
737	737	health care with multidisciplinary, regional, and tertiary 496
738	738	pediatric specialty care. The program shall coordinate and 497
739	739	maintain a consistent medical home for participating children. 498
740	740	Section 4. Subsections (1), (2), and (4) of section 499
741	741	391.021, Florida Statutes, are amended to read: 500
742	742
743	743	HB 1503 2023
744	744
745	745
746	746
747	747	CODING: Words stricken are deletions; words underlined are additions.
748	748	hb1503-00
749	749	Page 21 of 47
750	750	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
751	751
752	752
753	753
754	754	391.021 Definitions. —When used in this act, the term: 501
755	755	(2)(1) "Children's Medical Services Managed Care Plan 502
756	756	network" or "plan network" means a statewide managed care 503
757	757	service system that includes health care providers, as defined 504
758	758	in this section. 505
759	759	(1)(2) "Children and youth with special health care needs" 506
760	760	means those children younger than 21 years of age who have 507
761	761	chronic and serious physical, developmental, behavioral, or 508
762	762	emotional conditions and who require health care and related 509
763	763	services of a type or amount beyond that which is generally 510
764	764	required by children. 511
765	765	(4) "Eligible individual" means a child or youth with a 512
766	766	special health care need or a female with a high -risk pregnancy, 513
767	767	who meets the financial and medical eligibility standards 514
768	768	established in s. 391.029. 515
769	769	Section 5. Subsection (1 ) of section 391.025, Florida 516
770	770	Statutes, is amended to read: 517
771	771	391.025 Applicability and scope. — 518
772	772	(1) The Children's Medical Services program consists of 519
773	773	the following components: 520
774	774	(a) The newborn screening program established in s. 383.14 521
775	775	and the newborn, infant, and toddler hearing screening program 522
776	776	established in s. 383.145 . 523
777	777	(b) The regional perinatal intensive care centers program 524
778	778	established in ss. 383.15 -383.19. 525
779	779
780	780	HB 1503 2023
781	781
782	782
783	783
784	784	CODING: Words stricken are deletions; words underlined are additions.
785	785	hb1503-00
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787	787	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
788	788
789	789
790	790
791	791	(c) The developmental evaluation and intervention program, 526
792	792	including the Early Steps Program established in ss. 391.301 -527
793	793	391.308. 528
794	794	(d) The Children's Medical Services Managed Care Plan 529
795	795	network. 530
796	796	(e) The Children's Multidisciplinary Assessment Team. 531
797	797	(f) The Medical Foster Care Program. 532
798	798	(g) The Title V program for children and yo uth with 533
799	799	special health care needs. 534
800	800	(h) The Safety Net Program. 535
801	801	(i) The Networks for Access and Quality. 536
802	802	(j) Child Protection Teams and sexual abuse treatment 537
803	803	programs established under s. 39.303. 538
804	804	(k) The State Child Abuse Death Review Committee an d local 539
805	805	child abuse death review committees established in s. 383.402. 540
806	806	Section 6. Section 391.026, Florida Statutes, is amended 541
807	807	to read: 542
808	808	391.026 Powers and duties of the department. —The 543
809	809	department shall have the following powers, duties, and 544
810	810	responsibilities: 545
811	811	(1) To provide or contract for the provision of health 546
812	812	services to eligible individuals. 547
813	813	(2) To provide services to abused and neglected children 548
814	814	through Child Protection Teams pursuant to s. 39.303. 549
815	815	(3) To determine the medical and financi al eligibility of 550
816	816
817	817	HB 1503 2023
818	818
819	819
820	820
821	821	CODING: Words stricken are deletions; words underlined are additions.
822	822	hb1503-00
823	823	Page 23 of 47
824	824	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
825	825
826	826
827	827
828	828	individuals seeking health services from the program. 551
829	829	(4) To coordinate a comprehensive delivery system for 552
830	830	eligible individuals to take maximum advantage of all available 553
831	831	funds. 554
832	832	(5) To coordinate with programs relating to children's 555
833	833	medical services in cooperation with other public and private 556
834	834	agencies. 557
835	835	(6) To initiate and coordinate applications to federal 558
836	836	agencies and private organizations for funds, services, or 559
837	837	commodities relating to children's medical programs. 560
838	838	(7) To sponsor or promote grants for projects, programs, 561
839	839	education, or research in the field of children and youth with 562
840	840	special health care needs, with an emphasis on early diagnosis 563
841	841	and treatment. 564
842	842	(8) To oversee and operate the Children's Medical Services 565
843	843	Managed Care Plan network. 566
844	844	(9) To establish reimbursement mechanisms for the 567
845	845	Children's Medical Services Managed Care Plan network. 568
846	846	(10) To establish Children's Medical Services Managed Care 569
847	847	Plan network standards and, if applicable, credentialing 570
848	848	requirements for health care providers and health care services. 571
849	849	(11) To serve as a provider and principal case manager for 572
850	850	children with special health care needs under Titles XIX and XXI 573
851	851	of the Social Security Act. 574
852	852	(12) To monitor the provision of health services in the 575
853	853
854	854	HB 1503 2023
855	855
856	856
857	857
858	858	CODING: Words stricken are deletions; words underlined are additions.
859	859	hb1503-00
860	860	Page 24 of 47
861	861	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
862	862
863	863
864	864
865	865	program, including the utilization and quality of health 576
866	866	services. 577
867	867	(12)(13) To administer the Children and Youth with Special 578
868	868	Health Care Needs program in accordance with Title V of the 579
869	869	Social Security Act. 580
870	870	(13)(14) To establish and operate a grievance resolution 581
871	871	process for participants and health care providers. 582
872	872	(14)(15) To maintain program integrity in the Children's 583
873	873	Medical Services program. 584
874	874	(15)(16) To receive and manage health care premiums, 585
875	875	capitation payments, and funds from federal, state, local, and 586
876	876	private entities for the program. The department may contract 587
877	877	with a third-party administrator for processing claims, 588
878	878	monitoring medical expenses, and other related services 589
879	879	necessary to the efficient and cost -effective operation of the 590
880	880	Children's Medical Services Managed Care Plan network. The 591
881	881	department is authorized to maintain a minimum reserve for the 592
882	882	Children's Medical Services Managed Care Plan network in an 593
883	883	amount that is the greater of: 594
884	884	(a) Ten percent of total projected expenditures for Title 595
885	885	XIX-funded and Title XXI -funded children; or 596
886	886	(b) Two percent of total annualized payments from the 597
887	887	Agency for Health Care Administration for Title XIX and Title 598
888	888	XXI of the Social Security Act. 599
889	889	(16)(17) To provide or contract for peer review and other 600
890	890
891	891	HB 1503 2023
892	892
893	893
894	894
895	895	CODING: Words stricken are deletions; words underlined are additions.
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898	898	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
899	899
900	900
901	901
902	902	quality-improvement activities. 601
903	903	(17)(18) To adopt rules pursuant to ss. 120.536(1) and 602
904	904	120.54 to administer the Children's Medical Services Act. 603
905	905	(18)(19) To serve as the lead agency in administering the 604
906	906	Early Steps Program pursuant to part C of the federal 605
907	907	Individuals with Disabilities Education Act and part III of this 606
908	908	chapter. 607
909	909	(19) To administer the Medical Foster Care Program, 608
910	910	including all of the following: 609
911	911	(a) Recruitment, training, assessment, and monitoring for 610
912	912	the Medical Foster Care Program. 611
913	913	(b) Monitoring access and facilitating admissions of 612
914	914	eligible children and youth to the program and designated 613
915	915	medical foster care homes. 614
916	916	(c) Coordination with the Department of Children and 615
917	917	Families and the Agency for Health Care Administration or their 616
918	918	designees. 617
919	919	Section 7. Section 391.028, Florida Statutes, is amended 618
920	920	to read: 619
921	921	391.028 Administration. — 620
922	922	(1) The Director of Children's Medi cal Services must be a 621
923	923	physician licensed under chapter 458 or chapter 459 who has 622
924	924	specialized training and experience in the provision of health 623
925	925	care to children and youth and who has recognized skills in 624
926	926	leadership and the promotion of children's health programs. The 625
927	927
928	928	HB 1503 2023
929	929
930	930
931	931
932	932	CODING: Words stricken are deletions; words underlined are additions.
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935	935	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
936	936
937	937
938	938
939	939	director shall be the deputy secretary and the Deputy State 626
940	940	Health Officer for Children's Medical Services and is appointed 627
941	941	by and reports to the State Surgeon General. The director may 628
942	942	appoint such other staff as necessary for the operation of the 629
943	943	program subject to the approval of the State Surgeon General. 630
944	944	(2) The director shall provide for an operational system 631
945	945	using such department staff and contract providers as necessary. 632
946	946	The program shall implement all of the following program 633
947	947	activities under physician supervision on a statewide basis: 634
948	948	(a) Case management services for network participants; 635
949	949	(b) Management and oversight of statewide local program 636
950	950	activities.; 637
951	951	(b)(c) Medical and financial eligibility determination for 638
952	952	the program in accordance with s. 391.029 .; 639
953	953	(c)(d) Determination of a level of care and medical 640
954	954	complexity for long-term care services.; 641
955	955	(d)(e) Authorizing services in the program and developing 642
956	956	spending plans.; 643
957	957	(f) Development of treatment plans; and 644
958	958	(e)(g) Resolution of complaints and grievances from 645
959	959	participants and health care providers. 646
960	960	(3) Each Children's Medical Services area office shall be 647
961	961	directed by a physician licensed under chapter 458 or chapter 648
962	962	459 who has specialized training and experience in the provision 649
963	963	of health care to children. The director of a Children's Medical 650
964	964
965	965	HB 1503 2023
966	966
967	967
968	968
969	969	CODING: Words stricken are deletions; words underlined are additions.
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972	972	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
973	973
974	974
975	975
976	976	Services area office shall be appointed by the director from the 651
977	977	active panel of Children's Medical Services physician 652
978	978	consultants. 653
979	979	Section 8. Subsections (2) and (3) of se ction 391.029, 654
980	980	Florida Statutes, are amended to read: 655
981	981	391.029 Program eligibility. — 656
982	982	(2) The following individuals are eligible to receive 657
983	983	services through the program: 658
984	984	(a) Related to the regional perinatal intensive care 659
985	985	centers, a high-risk pregnant female who is enrolled in 660
986	986	Medicaid. 661
987	987	(b) Children and youth with serious special health care 662
988	988	needs from birth to 21 years of age who are enrolled in 663
989	989	Medicaid. 664
990	990	(c) Children and youth with serious special health care 665
991	991	needs from birth to 19 years of age w ho are enrolled in a 666
992	992	program under Title XXI of the Social Security Act. 667
993	993	(3) Subject to the availability of funds, the following 668
994	994	individuals may receive services through the program: 669
995	995	(a) Children and youth with serious special health care 670
996	996	needs from birth to 21 years of age who do not qualify for 671
997	997	Medicaid or Title XXI of the Social Security Act but who are 672
998	998	unable to access, due to lack of providers or lack of financial 673
999	999	resources, specialized services that a re medically necessary or 674
1000	1000	essential family support services. Families shall participate 675
1001	1001
1002	1002	HB 1503 2023
1003	1003
1004	1004
1005	1005
1006	1006	CODING: Words stricken are deletions; words underlined are additions.
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1009	1009	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
1010	1010
1011	1011
1012	1012
1013	1013	financially in the cost of care based on a sliding fee scale 676
1014	1014	established by the department. 677
1015	1015	(b) Children and youth with special health care needs from 678
1016	1016	birth to 21 years of age, as provided in Title V of the Social 679
1017	1017	Security Act. 680
1018	1018	(c) An infant who receives an award of compensation under 681
1019	1019	s. 766.31(1). The Florida Birth -Related Neurological Injury 682
1020	1020	Compensation Associati on shall reimburse the Children's Medical 683
1021	1021	Services Managed Care Plan Network the state's share of funding, 684
1022	1022	which must thereafter be used to obtain matching federal funds 685
1023	1023	under Title XXI of the Social Security Act. 686
1024	1024	Section 9. Section 391.0315, Florida S tatutes, is amended 687
1025	1025	to read: 688
1026	1026	391.0315 Benefits.—Benefits provided under the Children's 689
1027	1027	Medical Services Managed Care Plan program for children with 690
1028	1028	special health care needs shall be equivalent to benefits 691
1029	1029	provided to children as specified in ss. 409.905 and 409.906. 692
1030	1030	The department may offer additional benefits through Children's 693
1031	1031	Medical Services programs for early intervention services, 694
1032	1032	respite services, genetic testing, genetic and nutritional 695
1033	1033	counseling, and parent support services, if such services ar e 696
1034	1034	determined to be medically necessary. 697
1035	1035	Section 10. Section 391.035, Florida Statutes, is 698
1036	1036	repealed. 699
1037	1037	Section 11. Section 391.045, Florida Statutes, is amended 700
1038	1038
1039	1039	HB 1503 2023
1040	1040
1041	1041
1042	1042
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1046	1046	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
1047	1047
1048	1048
1049	1049
1050	1050	to read: 701
1051	1051	391.045 Reimbursement. — 702
1052	1052	(1) The department shall reimburse health care provid ers 703
1053	1053	for services rendered through the Children's Medical Services 704
1054	1054	Managed Care Plan network using cost-effective methods, 705
1055	1055	including, but not limited to, capitation, discounted fee -for-706
1056	1056	service, unit costs, and cost reimbursement. Medicaid 707
1057	1057	reimbursement rates shall be utilized to the maximum extent 708
1058	1058	possible, where applicable. 709
1059	1059	(2) Reimbursement to the Children's Medical Services 710
1060	1060	program for services provided to children and youth with special 711
1061	1061	health care needs who participate in the Florida Kidcare program 712
1062	1062	and who are not Medicaid recipients shall be on a capitated 713
1063	1063	basis. 714
1064	1064	Section 12. Section 391.055, Florida Statutes, is amended 715
1065	1065	to read: 716
1066	1066	391.055 Service delivery systems. — 717
1067	1067	(1) The program shall apply managed care methods to ensure 718
1068	1068	the efficient operati on of the Children's Medical Services 719
1069	1069	Managed Care Plan network. Such methods include, but are not 720
1070	1070	limited to, capitation payments, utilization management and 721
1071	1071	review, prior authorization, and case management. 722
1072	1072	(2) The components of the network are: 723
1073	1073	(a) Qualified primary care physicians who shall serve as 724
1074	1074	the gatekeepers and who shall be responsible for the provision 725
1075	1075
1076	1076	HB 1503 2023
1077	1077
1078	1078
1079	1079
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1083	1083	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
1084	1084
1085	1085
1086	1086
1087	1087	or authorization of health services to an eligible individual 726
1088	1088	who is enrolled in the Children's Medical Services network. 727
1089	1089	(b) Comprehensive Specialty care arrangements that meet 728
1090	1090	the requirements of s. 391.035 to provide acute care, specialty 729
1091	1091	care, long-term care, and chronic disease management for 730
1092	1092	eligible individuals. 731
1093	1093	(c) Case management services. 732
1094	1094	(3) The Children's Medical Services Managed Care Plan 733
1095	1095	network may contract with school districts participating in the 734
1096	1096	certified school match program pursuant to ss. 409.908(21) and 735
1097	1097	1011.70 for the provision of school -based services, as provided 736
1098	1098	for in s. 409.9071, for Medicaid -eligible children who are 737
1099	1099	enrolled in the Children's Medical Services Managed Care Plan 738
1100	1100	network. 739
1101	1101	(4) If a newborn has an abnormal screening result for 740
1102	1102	metabolic or other hereditary and congenital disorders which is 741
1103	1103	identified through the newborn screening program pursuan t to s. 742
1104	1104	383.14, the newborn shall be referred to the Children's Medical 743
1105	1105	Services program for additional testing, medical management, 744
1106	1106	early intervention services, or medical referral. 745
1107	1107	Section 13. Section 391.097, Florida Statutes, is amended 746
1108	1108	to read: 747
1109	1109	391.097 Research and evaluation. — 748
1110	1110	(1) The department may initiate, fund, and conduct 749
1111	1111	research and evaluation projects to improve the delivery of 750
1112	1112
1113	1113	HB 1503 2023
1114	1114
1115	1115
1116	1116
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1120	1120	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
1121	1121
1122	1122
1123	1123
1124	1124	children's medical services. The department may cooperate with 751
1125	1125	public and private agencies engaged in work of a similar nature. 752
1126	1126	(2) The Children's Medical Services Managed Care Plan 753
1127	1127	network shall be included in any evaluation conducted in 754
1128	1128	accordance with the provisions of Title XXI of the Social 755
1129	1129	Security Act as enacted by the Legislature. 756
1130	1130	Section 14. Part II of chapter 391, Florida Statutes, 757
1131	1131	consisting of ss. 391.221 and 391.223, Florida Statutes, is 758
1132	1132	repealed, and part III of that chapter is redesignated as part 759
1133	1133	II. 760
1134	1134	Section 15. Legislative findings and intent. — 761
1135	1135	(1) The Legislature finds that: 762
1136	1136	(a) In August 2014, the Department of Health's Children's 763
1137	1137	Medical Services Network, which was a fee -for-service program 764
1138	1138	serving children with special health care needs who were 765
1139	1139	enrolled in Medicaid under Title XIX of the Social Security Act 766
1140	1140	and children with spec ial health care needs who were enrolled in 767
1141	1141	the Children's Health Insurance Program under Title XXI of the 768
1142	1142	Social Security Act, was transitioned to the Children's Medical 769
1143	1143	Services Managed Care Plan. 770
1144	1144	(b) The Agency for Health Care Administration serves as 771
1145	1145	the lead agency for Statewide Medicaid Managed Care for the 772
1146	1146	state of Florida, and the Agency for Health Care Administration 773
1147	1147	contracts with the Department of Health to provide Medicaid 774
1148	1148	services through the Children's Medical Services Managed Care 775
1149	1149
1150	1150	HB 1503 2023
1151	1151
1152	1152
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1157	1157	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
1158	1158
1159	1159
1160	1160
1161	1161	Plan. 776
1162	1162	(c) The Department of Health subcontracts with a private 777
1163	1163	provider to operate various components of the Children's Medical 778
1164	1164	Services Managed Care Plan, including services for children with 779
1165	1165	special health care needs enrolled in Medicaid and children with 780
1166	1166	special health care needs enrolled in the Children's Health 781
1167	1167	Insurance Program. 782
1168	1168	(d) The administrative requirements of this intermediary 783
1169	1169	relationship can be addressed by transitioning the operations of 784
1170	1170	the Children's Medical Services Managed Care Plan to the Ag ency 785
1171	1171	for Health Care Administration. This transition shall include 786
1172	1172	children with special health care needs enrolled in Medicaid and 787
1173	1173	children with special health care needs enrolled in the 788
1174	1174	Children's Health Insurance Program. 789
1175	1175	(e) The Department of Health' s Children's Medical Services 790
1176	1176	program has a longstanding history of successfully and 791
1177	1177	compassionately caring for children with special health care 792
1178	1178	needs and their families. This knowledge, skill, and ability can 793
1179	1179	be used to collaborate with the Agency for He alth Care 794
1180	1180	Administration in the care of children with special health care 795
1181	1181	needs. 796
1182	1182	(2) It is the intent of the Legislature that the Agency 797
1183	1183	for Health Care Administration shall, in consultation with the 798
1184	1184	Department of Health, competitively procure and operat e one or 799
1185	1185	more specialty plan contracts for children and youth with 800
1186	1186
1187	1187	HB 1503 2023
1188	1188
1189	1189
1190	1190
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1194	1194	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
1195	1195
1196	1196
1197	1197
1198	1198	special health care needs beginning with the 2024 -2025 plan 801
1199	1199	year. 802
1200	1200	Section 16. Transfer of operation of the Children's 803
1201	1201	Medical Services Managed Care Plan. — 804
1202	1202	(1) Effective October 1, 202 4, all statutory powers, 805
1203	1203	duties, functions, records, personnel, pending issues, existing 806
1204	1204	contracts, administrative authority, administrative rules, and 807
1205	1205	unexpended balances of appropriations, allocations, and other 808
1206	1206	funds for the operation of the Department of Health's Children's 809
1207	1207	Medical Services Managed Care Plan, except those powers, duties, 810
1208	1208	and personnel retained by the Department of Health in chapter 811
1209	1209	391, Florida Statutes, are transferred to the Agency for Health 812
1210	1210	Care Administration. 813
1211	1211	(2) The transfer of operations of the Children's Medical 814
1212	1212	Services Managed Care Plan does not affect the validity of any 815
1213	1213	judicial or administrative action pending as of 11:59 p.m. on 816
1214	1214	the day before the effective date of the transfer to which the 817
1215	1215	Department of Health's Childre n's Medical Services Managed Care 818
1216	1216	Plan is at that time a party, and the Agency for Health Care 819
1217	1217	Administration shall be substituted as a party in interest in 820
1218	1218	any such action. 821
1219	1219	(3) The Department of Health's Children's Medical Services 822
1220	1220	program shall use its knowledge, skill, and ability to 823
1221	1221	collaborate with the Agency for Health Care Administration in 824
1222	1222	the care of children with special health care needs. The 825
1223	1223
1224	1224	HB 1503 2023
1225	1225
1226	1226
1227	1227
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1231	1231	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
1232	1232
1233	1233
1234	1234
1235	1235	Department of Health's Children's Medical Services program shall 826
1236	1236	do all of the following: 827
1237	1237	(a) Assist the agency in developing specifications for use 828
1238	1238	in the procurement of vendors and the model contract, including 829
1239	1239	provisions relating to referral, enrollment, disenrollment, 830
1240	1240	access, quality-of-care, network adequacy, care coordination, 831
1241	1241	and service integratio n. 832
1242	1242	(b) Conduct clinical eligibility screening for children 833
1243	1243	with special health care needs who are eligible for or enrolled 834
1244	1244	in Medicaid or the Children's Health Insurance Program. 835
1245	1245	(c) Collaborate with the agency in the care of children 836
1246	1246	with special health care needs. 837
1247	1247	Section 17. By November 1, 2023, the Agency for Health 838
1248	1248	Care Administration and the Department of Health shall submit to 839
1249	1249	each substantive and fiscal committee of the Legislature having 840
1250	1250	jurisdiction a report specifying any legislative and 841
1251	1251	administrative changes needed to effectively transfer operations 842
1252	1252	of the Children's Medical Services Managed Care Plan from the 843
1253	1253	department to the agency. 844
1254	1254	Section 18. Subsection (4) of section 409.974, Florida 845
1255	1255	Statutes, is amended to read: 846
1256	1256	409.974 Eligible plans.— 847
1257	1257	(4) CHILDREN'S MEDICAL SERVICES NETWORK.—The Agency for 848
1258	1258	Health Care Administration shall competitively procure one or 849
1259	1259	more vendors to provide services for children with special 850
1260	1260
1261	1261	HB 1503 2023
1262	1262
1263	1263
1264	1264
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1268	1268	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
1269	1269
1270	1270
1271	1271
1272	1272	health care needs who are enrolled in Medicaid and children with 851
1273	1273	special health care needs who are enrolled in the Children's 852
1274	1274	Health Insurance Program for the 2024 -2025 plan year. The 853
1275	1275	Department of Health's Children's Medical Services program shall 854
1276	1276	do all of the following: 855
1277	1277	(a) Assist the agency in developing spec ifications for use 856
1278	1278	in the procurement of vendors and the model contract, including 857
1279	1279	provisions relating to referral, enrollment, disenrollment, 858
1280	1280	access, quality-of-care, network adequacy, care coordination, 859
1281	1281	and service integration. 860
1282	1282	(b) Conduct clinical eli gibility screening for children 861
1283	1283	with special health care needs who are eligible for or are 862
1284	1284	enrolled in Medicaid or the Children's Health Insurance Program. 863
1285	1285	(c) Collaborate with the agency in the care of children 864
1286	1286	with special health care needs Participation by the Children's 865
1287	1287	Medical Services Network shall be pursuant to a single, 866
1288	1288	statewide contract with the agency that is not subject to the 867
1289	1289	procurement requirements or regional plan number limits of this 868
1290	1290	section. The Children's Medical Services Network must meet all 869
1291	1291	other plan requirements for the managed medical assistance 870
1292	1292	program. 871
1293	1293	Section 19. Effective October 1, 2024, paragraph (f) of 872
1294	1294	subsection (4) and paragraph (b) of subsection (5) of section 873
1295	1295	409.166, Florida Statutes, is amended to read: 874
1296	1296	409.166 Children within the child welfare system; adoption 875
1297	1297
1298	1298	HB 1503 2023
1299	1299
1300	1300
1301	1301
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1305	1305	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
1306	1306
1307	1307
1308	1308
1309	1309	assistance program.— 876
1310	1310	(4) ADOPTION ASSISTANCE. — 877
1311	1311	(f) The department may provide adoption assistance to the 878
1312	1312	adoptive parents, subject to specific appropriation, for medical 879
1313	1313	assistance initiated after the adoption of the child for 880
1314	1314	medical, surgical, hospital, and related services needed as a 881
1315	1315	result of a physical or mental condition of the child which 882
1316	1316	existed before the adoption and is not covered by Medicaid , 883
1317	1317	Children's Medical Services, or Children's Mental Health 884
1318	1318	Services. Such assistance may be initiated at any time but must 885
1319	1319	shall terminate on or before the child's 18th birthday. 886
1320	1320	(5) ELIGIBILITY FOR SERVICES. — 887
1321	1321	(b) A child who is handicapped at the time of adoption is 888
1322	1322	shall be eligible for services th rough a specialty plan under 889
1323	1323	contract with the agency to serve children with special heath 890
1324	1324	care needs the Children's Medical Services network established 891
1325	1325	under part I of chapter 391 if the child was eligible for such 892
1326	1326	services before prior to the adoption. 893
1327	1327	Section 20. Subsection (7) of section 409.811, Florida 894
1328	1328	Statutes, is amended to read: 895
1329	1329	409.811 Definitions relating to Florida Kidcare Act. —As 896
1330	1330	used in ss. 409.810-409.821, the term: 897
1331	1331	(7) "Children's Medical Services Managed Care Plan 898
1332	1332	Network" or "plan network" means a statewide managed care 899
1333	1333	service system as defined in s. 391.021 s. 391.021(1). 900
1334	1334
1335	1335	HB 1503 2023
1336	1336
1337	1337
1338	1338
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1342	1342	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
1343	1343
1344	1344
1345	1345
1346	1346	Section 21. Effective October 1, 2024, subsection (1) of 901
1347	1347	section 409.813, Florida Statutes, is amended to read: 902
1348	1348	409.813 Health benefits coverage; program components; 903
1349	1349	entitlement and nonentitlement. — 904
1350	1350	(1) The Florida Kidcare program includes health benefits 905
1351	1351	coverage provided to children through the following program 906
1352	1352	components, which shall be marketed as the Florida Kidcare 907
1353	1353	program: 908
1354	1354	(a) Medicaid; 909
1355	1355	(b) Medikids as created in s. 409.8132; 910
1356	1356	(c) The Florida Healthy Kids Corporation as created in s. 911
1357	1357	624.91; 912
1358	1358	(d) Employer-sponsored group health insurance plans 913
1359	1359	approved under ss. 409.810 -409.821; and 914
1360	1360	(e) A specialty plan under contract with the agency to 915
1361	1361	serve children with special health care needs The Children's 916
1362	1362	Medical Services network established in chapter 391 . 917
1363	1363	Section 22. Effective October 1, 2024, subsection (3) of 918
1364	1364	section 409.8134, Florida Statutes, is amended to read: 919
1365	1365	409.8134 Program expendi ture ceiling; enrollment. — 920
1366	1366	(3) Upon determination by the Social Services Estimating 921
1367	1367	Conference that there are insufficient funds to finance the 922
1368	1368	current enrollment in the Florida Kidcare program within current 923
1369	1369	appropriations, the program shall initiate di senrollment 924
1370	1370	procedures to remove enrollees, except those children enrolled 925
1371	1371
1372	1372	HB 1503 2023
1373	1373
1374	1374
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1379	1379	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
1380	1380
1381	1381
1382	1382
1383	1383	in a specialty plan under contract with the agency to serve 926
1384	1384	children with special health care needs the Children's Medical 927
1385	1385	Services Network, on a last-in, first-out basis until the 928
1386	1386	expenditure and appropriation levels are balanced. 929
1387	1387	Section 23. Subsection (3) and paragraph (c) of subsection 930
1388	1388	(10) of section 409.814, Florida Statutes, is amended to read: 931
1389	1389	409.814 Eligibility. —A child who has not reached 19 years 932
1390	1390	of age whose family income is equal to or below 200 percent of 933
1391	1391	the federal poverty level is eligible for the Florida Kidcare 934
1392	1392	program as provided in this section. If an enrolled individual 935
1393	1393	is determined to be ineligible for coverage, he or she must be 936
1394	1394	immediately disenrolled from the respective Florida Kidcare 937
1395	1395	program component. 938
1396	1396	(3) A Title XXI-funded child who is eligible for the 939
1397	1397	Florida Kidcare program who is a child with special health care 940
1398	1398	needs, as determined through a medical or behavioral screening 941
1399	1399	instrument, is eligible for health benefits coverage from and 942
1400	1400	shall be assigned to and may opt out of the Children's Medical 943
1401	1401	Services Managed Care Plan Network. 944
1402	1402	(10) In determining the eligibility of a child, an assets 945
1403	1403	test is not required. Each applicant shall provide doc umentation 946
1404	1404	during the application process and the redetermination process, 947
1405	1405	including, but not limited to, the following: 948
1406	1406	(c) To enroll in the Children's Medical Services Managed 949
1407	1407	Care Plan Network, a completed application, including a clinical 950
1408	1408
1409	1409	HB 1503 2023
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1411	1411
1412	1412
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1416	1416	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
1417	1417
1418	1418
1419	1419
1420	1420	screening. 951
1421	1421	Section 24. Effective October 1, 2024, paragraph (t) of 952
1422	1422	subsection (2) of section 409.815, Florida Statutes, is amended 953
1423	1423	to read: 954
1424	1424	409.815 Health benefits coverage; limitations. — 955
1425	1425	(2) BENCHMARK BENEFITS. —In order for health benefits 956
1426	1426	coverage to qualify for premium assistance payments for an 957
1427	1427	eligible child under ss. 409.810 -409.821, the health benefits 958
1428	1428	coverage, except for coverage under Medicaid and Medikids, must 959
1429	1429	include the following minimum benefits, as medically necessary. 960
1430	1430	(t) Enhancements to minimum requirements.— 961
1431	1431	1. This section sets the minimum benefits that must be 962
1432	1432	included in any health benefits coverage, other than Medicaid or 963
1433	1433	Medikids coverage, offered under ss. 409.810 -409.821. Health 964
1434	1434	benefits coverage may include additional benefits not included 965
1435	1435	under this subsection, but may not include benefits excluded 966
1436	1436	under paragraph (r). 967
1437	1437	2. Health benefits coverage may extend any limitations 968
1438	1438	beyond the minimum benefits described in this section. 969
1439	1439	970
1440	1440	Except for a specialty plan under contract with the agency to 971
1441	1441	serve children with special health care needs the Children's 972
1442	1442	Medical Services Network , the agency may not increase the 973
1443	1443	premium assistance payment for either additional benefits 974
1444	1444	provided beyond the minimum benefits described in this section 975
1445	1445
1446	1446	HB 1503 2023
1447	1447
1448	1448
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1453	1453	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
1454	1454
1455	1455
1456	1456
1457	1457	or the imposition of less restrictive service limitations. 976
1458	1458	Section 25. Effective October 1, 2024, paragraph (i) of 977
1459	1459	subsection (1) of section 409.8177, Florida Statutes, is amended 978
1460	1460	to read: 979
1461	1461	409.8177 Program evaluation. — 980
1462	1462	(1) The agency, in consultation wi th the Department of 981
1463	1463	Health, the Department of Children and Families, and the Florida 982
1464	1464	Healthy Kids Corporation, shall contract for an evaluation of 983
1465	1465	the Florida Kidcare program and shall by January 1 of each year 984
1466	1466	submit to the Governor, the President of the Senate, and the 985
1467	1467	Speaker of the House of Representatives a report of the program. 986
1468	1468	In addition to the items specified under s. 2108 of Title XXI of 987
1469	1469	the Social Security Act, the report shall include an assessment 988
1470	1470	of crowd-out and access to health care, as we ll as the 989
1471	1471	following: 990
1472	1472	(i) An assessment of the effectiveness of the Florida 991
1473	1473	Kidcare program, including Medicaid, the Florida Healthy Kids 992
1474	1474	program, Medikids, and the specialty plans under contract with 993
1475	1475	the agency to serve children with special health care needs 994
1476	1476	Children's Medical Services network , and other public and 995
1477	1477	private programs in the state in increasing the availability of 996
1478	1478	affordable quality health insurance and health care for 997
1479	1479	children. 998
1480	1480	Section 26. Effective October 1, 2024, subsection (4) of 999
1481	1481	section 409.818, Florida Statutes, is amended to read: 1000
1482	1482
1483	1483	HB 1503 2023
1484	1484
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1490	1490	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
1491	1491
1492	1492
1493	1493
1494	1494	409.818 Administration. —In order to implement ss. 409.810 -1001
1495	1495	409.821, the following agencies shall have the following duties: 1002
1496	1496	(4) The Office of Insurance Regulation shall certify that 1003
1497	1497	health benefits coverage plans that seek to provide services 1004
1498	1498	under the Florida Kidcare program, except those offered through 1005
1499	1499	the Florida Healthy Kids Corporation or the agency Children's 1006
1500	1500	Medical Services Network , meet, exceed, or are actuarially 1007
1501	1501	equivalent to the benchmar k benefit plan and that health 1008
1502	1502	insurance plans will be offered at an approved rate. In 1009
1503	1503	determining actuarial equivalence of benefits coverage, the 1010
1504	1504	Office of Insurance Regulation and health insurance plans must 1011
1505	1505	comply with the requirements of s. 2103 of Tit le XXI of the 1012
1506	1506	Social Security Act. The department shall adopt rules necessary 1013
1507	1507	for certifying health benefits coverage plans. 1014
1508	1508	Section 27. Effective October 1, 2024, subsection (11) of 1015
1509	1509	section 409.912, Florida Statutes, is amended to read: 1016
1510	1510	409.912 Cost-effective purchasing of health care. —The 1017
1511	1511	agency shall purchase goods and services for Medicaid recipients 1018
1512	1512	in the most cost-effective manner consistent with the delivery 1019
1513	1513	of quality medical care. To ensure that medical services are 1020
1514	1514	effectively utilized, the agency may, in any case, require a 1021
1515	1515	confirmation or second physician's opinion of the correct 1022
1516	1516	diagnosis for purposes of authorizing future services under the 1023
1517	1517	Medicaid program. This section does not restrict access to 1024
1518	1518	emergency services or post stabilization care services as defined 1025
1519	1519
1520	1520	HB 1503 2023
1521	1521
1522	1522
1523	1523
1524	1524	CODING: Words stricken are deletions; words underlined are additions.
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1527	1527	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
1528	1528
1529	1529
1530	1530
1531	1531	in 42 C.F.R. s. 438.114. Such confirmation or second opinion 1026
1532	1532	shall be rendered in a manner approved by the agency. The agency 1027
1533	1533	shall maximize the use of prepaid per capita and prepaid 1028
1534	1534	aggregate fixed-sum basis services when appropriate and other 1029
1535	1535	alternative service delivery and reimbursement methodologies, 1030
1536	1536	including competitive bidding pursuant to s. 287.057, designed 1031
1537	1537	to facilitate the cost -effective purchase of a case -managed 1032
1538	1538	continuum of care. The agency shall also re quire providers to 1033
1539	1539	minimize the exposure of recipients to the need for acute 1034
1540	1540	inpatient, custodial, and other institutional care and the 1035
1541	1541	inappropriate or unnecessary use of high -cost services. The 1036
1542	1542	agency shall contract with a vendor to monitor and evaluate the 1037
1543	1543	clinical practice patterns of providers in order to identify 1038
1544	1544	trends that are outside the normal practice patterns of a 1039
1545	1545	provider's professional peers or the national guidelines of a 1040
1546	1546	provider's professional association. The vendor must be able to 1041
1547	1547	provide information and counseling to a provider whose practice 1042
1548	1548	patterns are outside the norms, in consultation with the agency, 1043
1549	1549	to improve patient care and reduce inappropriate utilization. 1044
1550	1550	The agency may mandate prior authorization, drug therapy 1045
1551	1551	management, or disease management participation for certain 1046
1552	1552	populations of Medicaid beneficiaries, certain drug classes, or 1047
1553	1553	particular drugs to prevent fraud, abuse, overuse, and possible 1048
1554	1554	dangerous drug interactions. The Pharmaceutical and Therapeutics 1049
1555	1555	Committee shall make recommendations to the agency on drugs for 1050
1556	1556
1557	1557	HB 1503 2023
1558	1558
1559	1559
1560	1560
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1564	1564	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
1565	1565
1566	1566
1567	1567
1568	1568	which prior authorization is required. The agency shall inform 1051
1569	1569	the Pharmaceutical and Therapeutics Committee of its decisions 1052
1570	1570	regarding drugs subject to prior authorization. The agency is 1053
1571	1571	authorized to limit th e entities it contracts with or enrolls as 1054
1572	1572	Medicaid providers by developing a provider network through 1055
1573	1573	provider credentialing. The agency may competitively bid single -1056
1574	1574	source-provider contracts if procurement of goods or services 1057
1575	1575	results in demonstrated cos t savings to the state without 1058
1576	1576	limiting access to care. The agency may limit its network based 1059
1577	1577	on the assessment of beneficiary access to care, provider 1060
1578	1578	availability, provider quality standards, time and distance 1061
1579	1579	standards for access to care, the cultural competence of the 1062
1580	1580	provider network, demographic characteristics of Medicaid 1063
1581	1581	beneficiaries, practice and provider -to-beneficiary standards, 1064
1582	1582	appointment wait times, beneficiary use of services, provider 1065
1583	1583	turnover, provider profiling, provider licensure histor y, 1066
1584	1584	previous program integrity investigations and findings, peer 1067
1585	1585	review, provider Medicaid policy and billing compliance records, 1068
1586	1586	clinical and medical record audits, and other factors. Providers 1069
1587	1587	are not entitled to enrollment in the Medicaid provider networ k. 1070
1588	1588	The agency shall determine instances in which allowing Medicaid 1071
1589	1589	beneficiaries to purchase durable medical equipment and other 1072
1590	1590	goods is less expensive to the Medicaid program than long -term 1073
1591	1591	rental of the equipment or goods. The agency may establish rules 1074
1592	1592	to facilitate purchases in lieu of long -term rentals in order to 1075
1593	1593
1594	1594	HB 1503 2023
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1596	1596
1597	1597
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1601	1601	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
1602	1602
1603	1603
1604	1604
1605	1605	protect against fraud and abuse in the Medicaid program as 1076
1606	1606	defined in s. 409.913. The agency may seek federal waivers 1077
1607	1607	necessary to administer these policies. 1078
1608	1608	(11) The agency shall implemen t a program of all-inclusive 1079
1609	1609	care for children. The program of all -inclusive care for 1080
1610	1610	children shall be established to provide in -home hospice-like 1081
1611	1611	support services to children diagnosed with a life -threatening 1082
1612	1612	illness and enrolled in the Children's Medica l Services network 1083
1613	1613	to reduce hospitalizations as appropriate. The agency, in 1084
1614	1614	consultation with the Department of Health, may implement the 1085
1615	1615	program of all-inclusive care for children after obtaining 1086
1616	1616	approval from the Centers for Medicare and Medicaid Servic es. 1087
1617	1617	Section 28. Effective October 1, 2024, subsection (1) of 1088
1618	1618	section 409.9126, Florida Statutes, is amended to read: 1089
1619	1619	409.9126 Children with special health care needs. — 1090
1620	1620	(1) Except as provided in subsection (4), children 1091
1621	1621	eligible for Children's Medic al Services who receive Medicaid 1092
1622	1622	benefits, and other Medicaid -eligible children with special 1093
1623	1623	health care needs, are shall be exempt from the provisions of s. 1094
1624	1624	409.9122 and shall be served through the Children's Medical 1095
1625	1625	Services network established in chapte r 391. 1096
1626	1626	Section 29. Effective October 1, 2024, paragraph (a) of 1097
1627	1627	subsection (5) of section 409.9131, Florida Statutes, is amended 1098
1628	1628	to read: 1099
1629	1629	409.9131 Special provisions relating to integrity of the 1100
1630	1630
1631	1631	HB 1503 2023
1632	1632
1633	1633
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1638	1638	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
1639	1639
1640	1640
1641	1641
1642	1642	Medicaid program.— 1101
1643	1643	(5) DETERMINATIONS OF OVERPAYMENT. —In making a 1102
1644	1644	determination of overpayment to a physician, the agency must: 1103
1645	1645	(a) Use accepted and valid auditing, accounting, 1104
1646	1646	analytical, statistical, or peer -review methods, or combinations 1105
1647	1647	thereof. Appropriate statistical methods may include, but are 1106
1648	1648	not limited to, sampling and extension to the population, 1107
1649	1649	parametric and nonparametric statistics, tests of hypotheses, 1108
1650	1650	other generally accepted statistical methods, review of medical 1109
1651	1651	records, and a consideration of the physician's client case mix. 1110
1652	1652	Before performing a review of the physician's Medicaid records, 1111
1653	1653	however, the agency shall make every effort to consider the 1112
1654	1654	physician's patient case mix, including, but not limited to, 1113
1655	1655	patient age and whether individual patients are clients of the 1114
1656	1656	Children's Medical Services Network established in chapter 391 . 1115
1657	1657	In meeting its burden of proof in any administrative or court 1116
1658	1658	proceeding, the agency may introduce the results of such 1117
1659	1659	statistical methods and its other audit findings as evidence of 1118
1660	1660	overpayment. 1119
1661	1661	Section 30. Effective October 1, 2024, paragraph (e) of 1120
1662	1662	subsection (1) of section 409.920, Florida Statutes, is amended 1121
1663	1663	to read: 1122
1664	1664	409.920 Medicaid provider fraud. — 1123
1665	1665	(1) For the purposes of this section, the term: 1124
1666	1666	(e) "Managed care plans" means a health insurer au thorized 1125
1667	1667
1668	1668	HB 1503 2023
1669	1669
1670	1670
1671	1671
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1675	1675	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
1676	1676
1677	1677
1678	1678
1679	1679	under chapter 624, an exclusive provider organization authorized 1126
1680	1680	under chapter 627, a health maintenance organization authorized 1127
1681	1681	under chapter 641, the Children's Medical Services Network 1128
1682	1682	authorized under chapter 391 , a prepaid health plan authori zed 1129
1683	1683	under this chapter, a provider service network authorized under 1130
1684	1684	this chapter, a minority physician network authorized under this 1131
1685	1685	chapter, and an emergency department diversion program 1132
1686	1686	authorized under this chapter or the General Appropriations Act, 1133
1687	1687	providing health care services pursuant to a contract with the 1134
1688	1688	Medicaid program. 1135
1689	1689	Section 31. Effective October 1, 2024, subsection (7) of 1136
1690	1690	section 409.962, Florida Statutes, is amended to read: 1137
1691	1691	409.962 Definitions. —As used in this part, except as 1138
1692	1692	otherwise specifically provided, the term: 1139
1693	1693	(7) "Eligible plan" means a health insurer authorized 1140
1694	1694	under chapter 624, an exclusive provider organization authorized 1141
1695	1695	under chapter 627, a health maintenance organization authorized 1142
1696	1696	under chapter 641, or a provider se rvice network authorized 1143
1697	1697	under s. 409.912(1) or an accountable care organization 1144
1698	1698	authorized under federal law. For purposes of the managed 1145
1699	1699	medical assistance program, the term also includes the 1146
1700	1700	Children's Medical Services Network authorized under chapter 3 91 1147
1701	1701	and entities qualified under 42 C.F.R. part 422 as Medicare 1148
1702	1702	Advantage Preferred Provider Organizations, Medicare Advantage 1149
1703	1703	Provider-sponsored Organizations, Medicare Advantage Health 1150
1704	1704
1705	1705	HB 1503 2023
1706	1706
1707	1707
1708	1708
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1712	1712	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
1713	1713
1714	1714
1715	1715
1716	1716	Maintenance Organizations, Medicare Advantage Coordinated Care 1151
1717	1717	Plans, and Medicare Advantage Special Needs Plans, and the 1152
1718	1718	Program of All-inclusive Care for the Elderly. 1153
1719	1719	Section 32. Except as otherwise expressly provided in this 1154
1720	1720	act, this act shall take effect July 1, 2023. 1155