Bill Text: FL S1132 | 2010 | Regular Session | Introduced

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Bill Title: Antiretroviral Drugs [WPSC]

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Health Regulation [S1132 Detail]

Download: Florida-2010-S1132-Introduced.html

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Florida Senate - 2010                                    SB 1132 
 
By Senator Sobel 
31-00797A-10                                          20101132__ 
1                        A bill to be entitled 
2         An act relating to antiretroviral drugs; amending ss. 
3         409.912 and 627.6265, F.S.; prohibiting limitations on 
4         the prescribing of antiretroviral drugs for treating 
5         human immunodeficiency virus infection; amending s. 
6         627.6515, F.S.; conforming provisions to changes made 
7         by the act; creating ss. 627.65736 and 641.31093, 
8         F.S.; prohibiting health insurance policies and health 
9         maintenance organizations from limiting the 
10         prescribing of antiretroviral drugs for treating human 
11         immunodeficiency virus infection; providing an 
12         effective date. 
13 
14  Be It Enacted by the Legislature of the State of Florida: 
15 
16         Section 1. Subsection (54) is added to section 409.912, 
17  Florida Statutes, to read: 
18         409.912 Cost-effective purchasing of health care.—The 
19  agency shall purchase goods and services for Medicaid recipients 
20  in the most cost-effective manner consistent with the delivery 
21  of quality medical care. To ensure that medical services are 
22  effectively utilized, the agency may, in any case, require a 
23  confirmation or second physician’s opinion of the correct 
24  diagnosis for purposes of authorizing future services under the 
25  Medicaid program. This section does not restrict access to 
26  emergency services or poststabilization care services as defined 
27  in 42 C.F.R. part 438.114. Such confirmation or second opinion 
28  shall be rendered in a manner approved by the agency. The agency 
29  shall maximize the use of prepaid per capita and prepaid 
30  aggregate fixed-sum basis services when appropriate and other 
31  alternative service delivery and reimbursement methodologies, 
32  including competitive bidding pursuant to s. 287.057, designed 
33  to facilitate the cost-effective purchase of a case-managed 
34  continuum of care. The agency shall also require providers to 
35  minimize the exposure of recipients to the need for acute 
36  inpatient, custodial, and other institutional care and the 
37  inappropriate or unnecessary use of high-cost services. The 
38  agency shall contract with a vendor to monitor and evaluate the 
39  clinical practice patterns of providers in order to identify 
40  trends that are outside the normal practice patterns of a 
41  provider’s professional peers or the national guidelines of a 
42  provider’s professional association. The vendor must be able to 
43  provide information and counseling to a provider whose practice 
44  patterns are outside the norms, in consultation with the agency, 
45  to improve patient care and reduce inappropriate utilization. 
46  The agency may mandate prior authorization, drug therapy 
47  management, or disease management participation for certain 
48  populations of Medicaid beneficiaries, certain drug classes, or 
49  particular drugs to prevent fraud, abuse, overuse, and possible 
50  dangerous drug interactions. The Pharmaceutical and Therapeutics 
51  Committee shall make recommendations to the agency on drugs for 
52  which prior authorization is required. The agency shall inform 
53  the Pharmaceutical and Therapeutics Committee of its decisions 
54  regarding drugs subject to prior authorization. The agency is 
55  authorized to limit the entities it contracts with or enrolls as 
56  Medicaid providers by developing a provider network through 
57  provider credentialing. The agency may competitively bid single 
58  source-provider contracts if procurement of goods or services 
59  results in demonstrated cost savings to the state without 
60  limiting access to care. The agency may limit its network based 
61  on the assessment of beneficiary access to care, provider 
62  availability, provider quality standards, time and distance 
63  standards for access to care, the cultural competence of the 
64  provider network, demographic characteristics of Medicaid 
65  beneficiaries, practice and provider-to-beneficiary standards, 
66  appointment wait times, beneficiary use of services, provider 
67  turnover, provider profiling, provider licensure history, 
68  previous program integrity investigations and findings, peer 
69  review, provider Medicaid policy and billing compliance records, 
70  clinical and medical record audits, and other factors. Providers 
71  shall not be entitled to enrollment in the Medicaid provider 
72  network. The agency shall determine instances in which allowing 
73  Medicaid beneficiaries to purchase durable medical equipment and 
74  other goods is less expensive to the Medicaid program than long 
75  term rental of the equipment or goods. The agency may establish 
76  rules to facilitate purchases in lieu of long-term rentals in 
77  order to protect against fraud and abuse in the Medicaid program 
78  as defined in s. 409.913. The agency may seek federal waivers 
79  necessary to administer these policies. 
80         (54) Notwithstanding any other provision of this section, 
81  antiretroviral drugs prescribed to treat human immunodeficiency 
82  virus infection must be included on a provider’s formulary and 
83  may not be restricted through a requirement for prior 
84  authorization, a step-therapy approval process, or other 
85  limitation that restricts access to antiretroviral drugs. 
86         Section 2. Section 627.6265, Florida Statutes, is amended 
87  to read: 
88         627.6265 HIV infection Cancellation or nonrenewal 
89  prohibited.— 
90         (1) Notwithstanding any other provision of law to the 
91  contrary, an no insurer may not shall cancel or nonrenew the 
92  health insurance policy of an any insured because of diagnosis 
93  or treatment of human immunodeficiency virus infection or 
94  acquired immune deficiency syndrome. 
95         (2) Antiretroviral drugs prescribed to treat the human 
96  immunodeficiency virus infection of an insured must be included 
97  on a health plan formulary and may not be restricted through a 
98  requirement for prior authorization, a step-therapy approval 
99  process, or other limitation that restricts access to 
100  antiretroviral drugs. 
101         Section 3. Paragraph (c) of subsection (2) of section 
102  627.6515, Florida Statutes, is amended to read: 
103         627.6515 Out-of-state groups.— 
104         (2) Except as otherwise provided in this part, this part 
105  does not apply to a group health insurance policy issued or 
106  delivered outside this state under which a resident of this 
107  state is provided coverage if: 
108         (c) The policy provides the benefits specified in ss. 
109  627.419, 627.65736, 627.6574, 627.6575, 627.6579, 627.6612, 
110  627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 
111  627.66911. 
112         Section 4. Section 627.65736, Florida Statutes, is created 
113  to read: 
114         627.65736 HIV infection.—Antiretroviral drugs prescribed to 
115  treat the human immunodeficiency virus infection of an insured 
116  must be included on a health plan formulary and may not be 
117  restricted through a requirement for prior authorization, a 
118  step-therapy approval process, or other limitation that 
119  restricts access to antiretroviral drugs. 
120         Section 5. Section 641.31093, Florida Statutes, is created 
121  to read: 
122         641.31093 HIV infection.—Antiretroviral drugs prescribed to 
123  treat the human immunodeficiency virus infection of a subscriber 
124  must be included on a health plan formulary and may not be 
125  restricted through a requirement for prior authorization, a 
126  step-therapy approval process, or other limitation that 
127  restricts access to antiretroviral drugs. 
128         Section 6. This act shall take effect July 1, 2010.