Bill Text: FL S1602 | 2012 | Regular Session | Introduced

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Bill Title: Pharmacies

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2012-03-09 - Died in Budget Subcommittee on Health and Human Services Appropriations [S1602 Detail]

Download: Florida-2012-S1602-Introduced.html

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       Florida Senate - 2012                                    SB 1602
       
       
       
       By Senator Latvala
       
       
       
       
       16-01148A-12                                          20121602__
    1                        A bill to be entitled                      
    2         An act relating to pharmacies; amending s. 465.188,
    3         F.S.; revising requirements for the audit of Medicaid
    4         related pharmacy records; authorizing third-party
    5         payor and third-party administrator audits of
    6         pharmacies; providing that claims containing certain
    7         errors are not subject to financial recoupment under
    8         certain circumstances; specifying that certain audit
    9         criteria apply to third-party claims submitted after a
   10         specified date; prohibiting certain accounting
   11         practices used for calculating the recoupment of
   12         claims; prohibiting the audit criteria from requiring
   13         the recoupment of claims except under certain
   14         circumstances; providing procedures for the audit of
   15         third-party payor and third-party administrator
   16         audits; prohibiting a third-party payor or state
   17         agency from requiring the delivery by mail of pharmacy
   18         provider services and prescription drugs; authorizing
   19         a third-party payor or state agency to offer an
   20         incentive program for the delivery of prescription
   21         drugs by mail; providing an effective date.
   22  
   23  Be It Enacted by the Legislature of the State of Florida:
   24  
   25         Section 1. Section 465.188, Florida Statutes, is amended to
   26  read:
   27         465.188 Financial Medicaid audits of pharmacies.—
   28         (1) Notwithstanding any other provision of law, when an
   29  audit of the Medicaid-related, third-party payor, or third-party
   30  administrator records of a pharmacy permittee licensed under
   31  this chapter 465 is conducted, such audit must be conducted as
   32  provided in this section.
   33         (a) The agency or other entity conducting the audit must
   34  give the pharmacist at least 1 week’s prior notice of the
   35  initial audit for each audit cycle.
   36         (b) An audit must be conducted by a pharmacist licensed in
   37  this state.
   38         (c) Any clerical or recordkeeping error, such as a
   39  typographical error, scrivener’s error, or computer error
   40  regarding a document or record required under the third-party
   41  payor, third-party administrator, or Medicaid program does not
   42  constitute a willful violation and, without proof of intent to
   43  commit fraud, is not subject to criminal penalties without proof
   44  of intent to commit fraud. A claim is not subject to financial
   45  recoupment if, except for such typographical, scrivener’s,
   46  computer, clerical, or recordkeeping error, the claim is an
   47  otherwise valid claim.
   48         (d) A pharmacist may use the physician’s record or other
   49  order for drugs or medicinal supplies written or transmitted by
   50  any means of communication for purposes of validating the
   51  pharmacy record with respect to orders or refills of a legend or
   52  narcotic drug.
   53         (e) A finding of an overpayment or underpayment must be
   54  based on the actual overpayment or underpayment and may not be a
   55  projection based on the number of patients served having a
   56  similar diagnosis or on the number of similar orders or refills
   57  for similar drugs.
   58         (f) Each pharmacy shall be audited under the same standards
   59  and parameters.
   60         (g) A pharmacist must be allowed at least 10 days in which
   61  to produce documentation to address any discrepancy found during
   62  an audit.
   63         (h) The period covered by an audit may not exceed 1
   64  calendar year.
   65         (i) An audit may not be scheduled during the first 5 days
   66  of any month due to the high volume of prescriptions filled
   67  during that time.
   68         (j) The audit report must be delivered to the pharmacist
   69  within 90 days after conclusion of the audit. A final audit
   70  report shall be delivered to the pharmacist within 6 months
   71  after receipt of the preliminary audit report or final appeal,
   72  as provided for in subsection (2), whichever is later.
   73         (k) The audit criteria set forth in this section apply
   74  applies only to audits of Medicaid claims submitted for payment
   75  after subsequent to July 11, 2003, and to third-party claims
   76  submitted for payment after July 1, 2011. Notwithstanding any
   77  other provision of in this section, the agency or other entity
   78  conducting the audit may shall not use the accounting practice
   79  of extrapolation in calculating penalties or recoupment for
   80  Medicaid, third-party payor, or third-party administrator
   81  audits.
   82         (l) The audit criteria may not subject a claim to financial
   83  recoupment except in those circumstances when recoupment is
   84  required by law.
   85         (2) The Agency for Health Care Administration, in the case
   86  of a Medicaid-related audit, or the third-party payor or third
   87  party administrator contracting with the pharmacy, in the case
   88  of a third-party payor or third-party administrator audit, shall
   89  establish a process under which a pharmacist may obtain a
   90  preliminary review of an audit report and may appeal an
   91  unfavorable audit report without the necessity of obtaining
   92  legal counsel. The preliminary review and appeal may be
   93  conducted by an ad hoc peer review panel, appointed by the
   94  agency, in the case of a Medicaid-related audit, or appointed by
   95  the third-party payor or third-party administrator contracting
   96  with the pharmacy, in the case of a third-party payor or third
   97  party administrator audit, which consists of pharmacists who
   98  maintain an active practice. If, following the preliminary
   99  review, the agency or review panel finds that an unfavorable
  100  audit report is unsubstantiated, the agency, in the case of a
  101  Medicaid-related audit, or the third-party payor or third-party
  102  administrator contracting with the pharmacy, in the case of a
  103  third-party payor or third-party administrator audit, shall
  104  dismiss the audit report without the necessity of any further
  105  proceedings.
  106         (3) This section does not apply to investigative audits
  107  conducted by the Medicaid Fraud Control Unit of the Department
  108  of Legal Affairs.
  109         (4) This section does not apply to any investigative audit
  110  conducted by the Agency for Health Care Administration when the
  111  agency has reliable evidence that the claim that is the subject
  112  of the audit involves fraud, willful misrepresentation, or abuse
  113  under the Medicaid program.
  114         Section 2. Notwithstanding any other provision of law, a
  115  third-party payor or state agency may not require, by contract,
  116  administrative rule, or condition of participation in a pharmacy
  117  provider network, the delivery of pharmacy provider services and
  118  prescription drugs by mail. However, a third-party payor or
  119  state agency may offer an incentive program for the delivery of
  120  prescription drugs by mail.
  121         Section 3. This act shall take effect July 1, 2012.