Bill Text: FL S1374 | 2020 | Regular Session | Introduced
Bill Title: Regional Perinatal Intensive Care Centers
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2020-03-14 - Died in Appropriations Subcommittee on Health and Human Services [S1374 Detail]
Download: Florida-2020-S1374-Introduced.html
Florida Senate - 2020 SB 1374 By Senator Harrell 25-01225B-20 20201374__ 1 A bill to be entitled 2 An act relating to regional perinatal intensive care 3 centers; amending s. 383.16, F.S.; defining and 4 revising terms; amending s. 383.17, F.S.; authorizing 5 the Department of Health to designate regional 6 perinatal intensive care centers; amending s. 383.18, 7 F.S.; providing that designation by the department is 8 required for participation in the regional perinatal 9 intensive care centers program; amending s. 383.19, 10 F.S.; specifying standards that must be included in 11 department rules relating to the designation, 12 development, and operation of a regional perinatal 13 intensive care center; authorizing the department to 14 designate two regional perinatal intensive care 15 centers in a district under certain circumstances; 16 specifying reimbursement parameters for certain 17 services provided in a regional perinatal intensive 18 care center setting; providing parameters for removal 19 of a regional perinatal intensive care center′s 20 designation; specifying criteria centers must meet for 21 the department′s selection and designation as regional 22 perinatal intensive care centers; requiring the 23 department, in consultation with the agency, to 24 develop and implement a process by a specified date to 25 determine levels of maternal care provided by regional 26 perinatal intensive care centers; revising the 27 contents of certain annual reports that regional 28 perinatal intensive care centers are required to 29 submit to the department; requiring the department to 30 conduct an onsite review of each center at least once 31 every 3 years; amending s. 409.908, F.S.; conforming 32 provisions to changes made by the act; amending s. 33 409.975, F.S.; conforming a cross-reference; providing 34 an effective date. 35 36 Be It Enacted by the Legislature of the State of Florida: 37 38 Section 1. Present subsections (1), (2), and (3) of section 39 383.16, Florida Statutes, are redesignated as subsections (2), 40 (4), and (5), respectively, new subsections (1) and (3) are 41 added to that section, and present subsection (2) of that 42 section is amended, to read: 43 383.16 Definitions; ss. 383.15-383.19.—As used in ss. 44 383.15-383.19, the term: 45 (1) “Agency” means the Agency for Health Care 46 Administration. 47 (3) “District” has the same meaning as in s. 408.032. 48 (4)(2)“Regional perinatal intensive care center” or 49 “center” means a unit designated by the department, located 50 within a hospital, and specifically designed to provide a full 51 range of perinatal health services to its patients. 52 Section 2. Section 383.17, Florida Statutes, is amended to 53 read: 54 383.17 Regional perinatal intensive care centers program; 55 authority.—The department may designate and contract with health 56 care providers in establishing and maintaining centers in 57 accordance with ss. 383.15-383.19. The cost of administering the 58 regional perinatal intensive care centers program shall be paid 59 by the department from funds appropriated for this purpose. 60 Section 3. Section 383.18, Florida Statutes, is amended to 61 read: 62 383.18 Designations; contracts; conditions.—Participation 63 in the regional perinatal intensive care centers program under 64 ss. 383.15-383.19 is contingent upon the department designating 65 and entering into a contract with a provider. The contract must 66shallprovide that patients will receive services from the 67 center and that parents or guardians of patients who participate 68 in the program and who are in compliance with Medicaid 69 eligibility requirements as determined by the department are not 70 additionally charged for treatment and care thatwhichhas been 71 contracted for by the department. Financial eligibility for the 72 program is based on the Medicaid income guidelines for pregnant 73 women and for children younger thanunder1 year of age. Funding 74 mustshallbe provided in accordance with ss. 383.19 and 75 409.908. 76 Section 4. Section 383.19, Florida Statutes, is amended to 77 read: 78 383.19 Standards; funding; ineligibility.— 79 (1) The department shall adopt rules that specify standards 80 for designation, development, and operation of a center which 81 must include, but need not beare notlimited to: 82 (a) The need to provide services through a regional 83 perinatal intensive care center and the requirements of the 84 population to be served. 85 (b) Equipment. 86 (c) Facilities. 87 (d) Staffing and qualifications of personnel. 88 (e) Transportation services. 89 (f) Data collection. 90 (g) Levels of care. 91 (h) Educational outreach. 92 (i) Access to consultative specialist services. 93 (j) Participation in quality collaborations, both within 94 and outside of the center’s district. 95 (k) Support of rural hospitals, as defined in s. 395.602. 96 (l)(g)Definitions of terms. 97 (2) The department shall designate at least one center to 98 serve a geographic area representing each districtregionof the 99 state, and one additional center may be designated in any 100 district in which at least 20,000 resident10,000live births 101 occur per year, as reported by the department’s Bureau of Vital 102 Statistics, but in no case may there be more than 2211regional 103 perinatal intensive care centers established unless specifically 104 authorized in the General Appropriations Act or in this 105 subsection. 106 (3) Medicaid reimbursement mustshallbe made for services 107 provided to patients who are Medicaid recipients. Medicaid 108 reimbursement for in-center and outpatient obstetrical and 109 neonatal physician services must be paid as follows: 110 (a) Reimbursement for such services provided at centers to 111 members of a managed care plan as defined in s. 409.962 must be 112 paid in accordance with the provider payment provisions of part 113 IV of chapter 409; or 114 (b) Reimbursement for such services provided at centers on 115 a fee-for-service basis mustshallbe based upon the obstetrical 116 care group payment system or. Medicaid reimbursement for in117center neonatal physician services shall be based uponthe 118 neonatal care group payment system, as applicable. These 119 prospective payment systems, developed by the department, must 120 place patients into homogeneous groups based on clinical 121 factors, severity of illness, and intensity of care.Outpatient122obstetrical services and otherRelated services provided on a 123 fee-for-service basis, such as consultations, mustshallbe 124 reimbursed based on the usual Medicaid method of fee-for-service 125 payment for suchoutpatientmedical services. 126 (4)(3)Failure to comply with any standardthe standards127 established under this section, department rules, or the terms 128 of the contract between the department and a center constitutes 129 grounds for terminating the contract and removal of the center′s 130 designation. 131 (5)(4)The department shall select and designate centers 132 that do all of the following:give priority to establishing133centers in hospitalsthat134 (a) Demonstrate an interest in perinatal intensive care by 135 meeting program standards established in this section and by the 136 department. 137 (b) Demonstrate a commitment to improving access to health 138 services, including the timely use of personal health services 139 to achieve the best health outcomes. 140 (c) Maintain a facility birth volume of at least 3,000 live 141 births per year. 142 (d) Actively participate in one or more perinatal quality 143 collaborations as defined by department rule. 144 (6) No later than July 1, 2023, the department, in 145 consultation with the agency, shall develop and implement a 146 statewide process to engage perinatal stakeholders for the 147 purpose of determining appropriate and efficacious levels of 148 maternal care provided by centers. The statewide process must 149 seek to standardize the centers’ internal assessments of levels 150 of maternal care guided by methodologies and tools developed by 151 the federal Centers for Disease Control and Prevention. 152 (7)(5)A private, for-profit hospital that does not accept 153 county, state, or federal funds or indigent patients is not 154 eligible to participate under ss. 383.15-383.19. 155 (8)(6)Each hospital that is designated by and contracts 156 with the department to provide services under the terms of ss. 157 383.15-383.19 shall prepare and submit to the department an 158 annual report that includes, but is not limited to, the number 159 of clients served, quality improvement measures and projects 160 that the center has engaged in, and the costs of services in the 161 center. The department shall annually conduct a programmatic and 162 financial evaluation of each center and shall conduct an onsite 163 review of each center at least once every 3 years. 164 Section 5. Paragraph (c) of subsection (12) of section 165 409.908, Florida Statutes, is amended to read: 166 409.908 Reimbursement of Medicaid providers.—Subject to 167 specific appropriations, the agency shall reimburse Medicaid 168 providers, in accordance with state and federal law, according 169 to methodologies set forth in the rules of the agency and in 170 policy manuals and handbooks incorporated by reference therein. 171 These methodologies may include fee schedules, reimbursement 172 methods based on cost reporting, negotiated fees, competitive 173 bidding pursuant to s. 287.057, and other mechanisms the agency 174 considers efficient and effective for purchasing services or 175 goods on behalf of recipients. If a provider is reimbursed based 176 on cost reporting and submits a cost report late and that cost 177 report would have been used to set a lower reimbursement rate 178 for a rate semester, then the provider’s rate for that semester 179 shall be retroactively calculated using the new cost report, and 180 full payment at the recalculated rate shall be effected 181 retroactively. Medicare-granted extensions for filing cost 182 reports, if applicable, shall also apply to Medicaid cost 183 reports. Payment for Medicaid compensable services made on 184 behalf of Medicaid eligible persons is subject to the 185 availability of moneys and any limitations or directions 186 provided for in the General Appropriations Act or chapter 216. 187 Further, nothing in this section shall be construed to prevent 188 or limit the agency from adjusting fees, reimbursement rates, 189 lengths of stay, number of visits, or number of services, or 190 making any other adjustments necessary to comply with the 191 availability of moneys and any limitations or directions 192 provided for in the General Appropriations Act, provided the 193 adjustment is consistent with legislative intent. 194 (12) 195 (c) Notwithstanding paragraph (b), reimbursement fees to 196 physicians for providing total obstetrical services to Medicaid 197 recipients, which include prenatal, delivery, and postpartum 198 care, shall be at least $1,500 per delivery for a pregnant woman 199 with low medical risk and at least $2,000 per delivery for a 200 pregnant woman with high medical risk. However, reimbursement to 201 physicians working in regional perinatal intensive care centers 202 designated pursuant to chapter 383, for services to certain 203 pregnant Medicaid recipients with a high medical risk, mustmay204 be made according to s. 383.19(3)obstetrical care and neonatal205care groupings and rates established by the agency. Nurse 206 midwives licensed under part I of chapter 464 or midwives 207 licensed under chapter 467 shall be reimbursed at no less than 208 80 percent of the low medical risk fee. The agency shall by rule 209 determine, for the purpose of this paragraph, what constitutes a 210 high or low medical risk pregnant woman and shall not pay more 211 based solely on the fact that a caesarean section was performed, 212 rather than a vaginal delivery. The agency shall by rule 213 determine a prorated payment for obstetrical services in cases 214 where only part of the total prenatal, delivery, or postpartum 215 care was performed. The Department of Health shall adopt rules 216 for appropriate insurance coverage for midwives licensed under 217 chapter 467. Prior to the issuance and renewal of an active 218 license, or reactivation of an inactive license for midwives 219 licensed under chapter 467, such licensees shall submit proof of 220 coverage with each application. 221 Section 6. Paragraph (b) of subsection (1) of section 222 409.975, Florida Statutes, is amended to read: 223 409.975 Managed care plan accountability.—In addition to 224 the requirements of s. 409.967, plans and providers 225 participating in the managed medical assistance program shall 226 comply with the requirements of this section. 227 (1) PROVIDER NETWORKS.—Managed care plans must develop and 228 maintain provider networks that meet the medical needs of their 229 enrollees in accordance with standards established pursuant to 230 s. 409.967(2)(c). Except as provided in this section, managed 231 care plans may limit the providers in their networks based on 232 credentials, quality indicators, and price. 233 (b) Certain providers are statewide resources and essential 234 providers for all managed care plans in all regions. All managed 235 care plans must include these essential providers in their 236 networks. Statewide essential providers include: 237 1. Faculty plans of Florida medical schools. 238 2. Regional perinatal intensive care centers as defined in 239 s. 383.16(4)s. 383.16(2). 240 3. Hospitals licensed as specialty children’s hospitals as 241 defined in s. 395.002(27). 242 4. Accredited and integrated systems serving medically 243 complex children which comprise separately licensed, but 244 commonly owned, health care providers delivering at least the 245 following services: medical group home, in-home and outpatient 246 nursing care and therapies, pharmacy services, durable medical 247 equipment, and Prescribed Pediatric Extended Care. 248 249 Managed care plans that have not contracted with all statewide 250 essential providers in all regions as of the first date of 251 recipient enrollment must continue to negotiate in good faith. 252 Payments to physicians on the faculty of nonparticipating 253 Florida medical schools shall be made at the applicable Medicaid 254 rate. Payments for services rendered by regional perinatal 255 intensive care centers shall be made at the applicable Medicaid 256 rate as of the first day of the contract between the agency and 257 the plan. Except for payments for emergency services, payments 258 to nonparticipating specialty children’s hospitals shall equal 259 the highest rate established by contract between that provider 260 and any other Medicaid managed care plan. 261 Section 7. This act shall take effect July 1, 2020.