Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. SB 1338
       
       
       
       
       
       
                                Ì632656<Î632656                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  01/28/2020           .                                
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       The Committee on Banking and Insurance (Lee) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Before line 44
    4  insert:
    5         Section 1. Present paragraphs (a) through (e) of subsection
    6  (1) of section 409.975, Florida Statutes, are redesignated as
    7  paragraphs (b) through (f), respectively, a new paragraph (a) is
    8  added to that subsection, and paragraph (c) of that subsection
    9  is amended, to read:
   10         409.975 Managed care plan accountability.—In addition to
   11  the requirements of s. 409.967, plans and providers
   12  participating in the managed medical assistance program shall
   13  comply with the requirements of this section.
   14         (1) PROVIDER NETWORKS.—Managed care plans must develop and
   15  maintain provider networks that meet the medical needs of their
   16  enrollees in accordance with standards established pursuant to
   17  s. 409.967(2)(c). Except as provided in this section, managed
   18  care plans may limit the providers in their networks based on
   19  credentials, quality indicators, and price.
   20         (a) A managed care plan may not exclude from its network an
   21  independent pharmacy that meets credentialing requirements,
   22  complies with agency standards, and accepts the terms of the
   23  plan. The managed care plan must offer the same rate of
   24  reimbursement to all pharmacies in the plan’s network. As used
   25  in this paragraph, the term “independent pharmacy” means a
   26  community pharmacy, as defined in s. 465.003(11)(a)1., which has
   27  only one location in this state.
   28         (c) After 12 months of active participation in a plan’s
   29  network, the plan may exclude any essential provider from the
   30  network for failure to meet quality or performance criteria. If
   31  the plan excludes an essential provider from the plan, the plan
   32  must provide written notice to all recipients who have chosen
   33  that provider for care. The notice shall be provided at least 30
   34  days before the effective date of the exclusion. For purposes of
   35  this paragraph, the term “essential provider” includes providers
   36  determined by the agency to be essential Medicaid providers
   37  under paragraph (b) (a) and the statewide essential providers
   38  specified in paragraph (c) (b).
   39         Section 2. Section 624.493, Florida Statutes, is created to
   40  read:
   41         624.493 Pharmacy benefit managers; network providers.—A
   42  pharmacy benefit manager may not exclude from its network an
   43  independent pharmacy that meets credentialing requirements,
   44  complies with the pharmacy benefit manager’s standards, and
   45  accepts the terms of the pharmacy benefit manager contract. The
   46  pharmacy benefit manager must offer the same rate of
   47  reimbursement to all pharmacies in the pharmacy benefit
   48  manager’s network. As used in this section, the term
   49  “independent pharmacy” means a community pharmacy, as defined in
   50  s. 465.003(11)(a)1., which has only one location in this state.
   51  
   52  ================= T I T L E  A M E N D M E N T ================
   53  And the title is amended as follows:
   54         Between lines 2 and 3
   55  insert:
   56         amending s. 409.975, F.S.; prohibiting a Medicaid
   57         managed care plan from excluding certain independent
   58         pharmacies from its network; requiring a managed care
   59         plan to offer the same rate of reimbursement to all
   60         pharmacies in its network; defining the term
   61         “independent pharmacy”; creating s. 624.493, F.S.;
   62         prohibiting a pharmacy benefit manager from excluding
   63         certain independent pharmacies from its network;
   64         requiring a pharmacy benefit manager to offer the same
   65         rate of reimbursement to all pharmacies in its
   66         network; defining the term “independent pharmacy”;