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Health News Florida

Lawmakers Address Medical Necessity, Reporting Requirements

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The House and Senate are considering identical bills that would make a variety of changes to Florida’s Medicaid laws.

Physicians wouldn’t be required to determine medical necessity for behavior analysis services for Medicaid patients under proposals moving through the Legislature.

The House and Senate are considering identical bills that would make a variety of changes to Florida’s Medicaid laws, from allowing doctoral-level, board-certified behavior analysts to determine medical necessity for patients to deleting a number of state-mandated reporting requirements.

The bills, for example, would eliminate a law that requires the state Agency for Health Care Administration to report quarterly on its efforts to control Medicaid prescription-drug spending on beneficiaries who aren’t enrolled in managed care plans.

According to a legislative staff analysis of the bill, AHCA contends the results of the reports “are not generally reflective of the Medicaid population.”

The bills also would eliminate a requirement that AHCA submit to the governor and legislative leaders quarterly reports on the state’s Medicaid managed-care program, including data on the number of enrollees in each managed care plan, the monthly percentage change in plan enrollment and the plans’ market shares.

Because the bills would amend Medicaid laws, they could become potential “trains” as the session moves along. A train is the name insiders give bills that could be used to attach other related issues.

The Senate Health and Human Services Appropriations Subcommittee on Thursday will consider the Senate version of the bill (SB 1292), filed by Chairman Aaron Bean, R-Fernandina Beach.

An identical House measure (HB 1057) has cleared committees and is available for consideration by the full House.