Florida Senate - 2022                                    SB 1540
       
       
        
       By Senator Jones
       
       
       
       
       
       35-00194B-22                                          20221540__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid managed care; amending s.
    3         409.908, F.S.; requiring that the rental and purchase
    4         of durable medical equipment and complex
    5         rehabilitation technology by providers of home health
    6         care services or medical supplies and appliances be
    7         reimbursed by the Agency for Health Care
    8         Administration, managed care plans, and subcontractors
    9         at a specified amount; amending s. 409.967, F.S.;
   10         requiring that Medicaid enrollees be allowed their
   11         choice of certain qualified Medicaid providers;
   12         requiring the agency to adopt rules; prohibiting a
   13         managed care plan from referring its members to, or
   14         entering into a contract or an arrangement to provide
   15         services with, a subcontractor under certain
   16         circumstances; requiring that a subcontractor of a
   17         managed care plan provide all services in compliance
   18         with such contract or arrangement and applicable
   19         federal waivers; prohibiting a managed care plan from
   20         referring its members to a subcontractor for covered
   21         services if the subcontractor has an ownership
   22         interest or a profit-sharing arrangement with certain
   23         entities; providing an effective date.
   24          
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Subsection (9) of section 409.908, Florida
   28  Statutes, is amended to read:
   29         409.908 Reimbursement of Medicaid providers.—Subject to
   30  specific appropriations, the agency shall reimburse Medicaid
   31  providers, in accordance with state and federal law, according
   32  to methodologies set forth in the rules of the agency and in
   33  policy manuals and handbooks incorporated by reference therein.
   34  These methodologies may include fee schedules, reimbursement
   35  methods based on cost reporting, negotiated fees, competitive
   36  bidding pursuant to s. 287.057, and other mechanisms the agency
   37  considers efficient and effective for purchasing services or
   38  goods on behalf of recipients. If a provider is reimbursed based
   39  on cost reporting and submits a cost report late and that cost
   40  report would have been used to set a lower reimbursement rate
   41  for a rate semester, then the provider’s rate for that semester
   42  shall be retroactively calculated using the new cost report, and
   43  full payment at the recalculated rate shall be effected
   44  retroactively. Medicare-granted extensions for filing cost
   45  reports, if applicable, shall also apply to Medicaid cost
   46  reports. Payment for Medicaid compensable services made on
   47  behalf of Medicaid-eligible persons is subject to the
   48  availability of moneys and any limitations or directions
   49  provided for in the General Appropriations Act or chapter 216.
   50  Further, nothing in this section shall be construed to prevent
   51  or limit the agency from adjusting fees, reimbursement rates,
   52  lengths of stay, number of visits, or number of services, or
   53  making any other adjustments necessary to comply with the
   54  availability of moneys and any limitations or directions
   55  provided for in the General Appropriations Act, provided the
   56  adjustment is consistent with legislative intent.
   57         (9) A provider of home health care services or of medical
   58  supplies and appliances must shall be reimbursed on the basis of
   59  competitive bidding or for the lesser of the amount billed by
   60  the provider or the agency’s established maximum allowable
   61  amount, except that, in the case of the rental or purchase of
   62  durable medical equipment and complex rehabilitation technology,
   63  the provider must be reimbursed by the agency, managed care
   64  plans, and any subcontractors at an amount equal to 100 percent
   65  of the total rental payments may not exceed the purchase price
   66  of the equipment over its expected useful life or the agency’s
   67  established maximum allowable amount, whichever amount is less.
   68         Section 2. Paragraph (c) of subsection (2) of section
   69  409.967, Florida Statutes, is amended, and paragraph (p) is
   70  added to that subsection, to read:
   71         409.967 Managed care plan accountability.—
   72         (2) The agency shall establish such contract requirements
   73  as are necessary for the operation of the statewide managed care
   74  program. In addition to any other provisions the agency may deem
   75  necessary, the contract must require:
   76         (c) Access.—
   77         1. The agency shall establish specific standards for the
   78  number, type, and regional distribution of providers in managed
   79  care plan networks to ensure access to care for both adults and
   80  children. Each plan must maintain a regionwide network of
   81  providers in sufficient numbers to meet the access standards for
   82  specific medical services for all recipients enrolled in the
   83  plan. The exclusive use of mail-order pharmacies may not be
   84  sufficient to meet network access standards. Consistent with the
   85  standards established by the agency, provider networks may
   86  include providers located outside the region. A plan may
   87  contract with a new hospital facility before the date the
   88  hospital becomes operational if the hospital has commenced
   89  construction, will be licensed and operational by January 1,
   90  2013, and a final order has issued in any civil or
   91  administrative challenge. Each plan shall establish and maintain
   92  an accurate and complete electronic database of contracted
   93  providers, including information about licensure or
   94  registration, locations and hours of operation, specialty
   95  credentials and other certifications, specific performance
   96  indicators, and such other information as the agency deems
   97  necessary. The database must be available online to both the
   98  agency and the public and have the capability to compare the
   99  availability of providers to network adequacy standards and to
  100  accept and display feedback from each provider’s patients. Each
  101  plan shall submit quarterly reports to the agency identifying
  102  the number of enrollees assigned to each primary care provider.
  103  The agency shall conduct, or contract for, systematic and
  104  continuous testing of the provider network databases maintained
  105  by each plan to confirm accuracy, confirm that behavioral health
  106  providers are accepting enrollees, and confirm that enrollees
  107  have access to behavioral health services.
  108         2. Each managed care plan must publish any prescribed drug
  109  formulary or preferred drug list on the plan’s website in a
  110  manner that is accessible to and searchable by enrollees and
  111  providers. The plan must update the list within 24 hours after
  112  making a change. Each plan must ensure that the prior
  113  authorization process for prescribed drugs is readily accessible
  114  to health care providers, including posting appropriate contact
  115  information on its website and providing timely responses to
  116  providers. For Medicaid recipients diagnosed with hemophilia who
  117  have been prescribed anti-hemophilic-factor replacement
  118  products, the agency shall provide for those products and
  119  hemophilia overlay services through the agency’s hemophilia
  120  disease management program.
  121         3. Managed care plans, and their fiscal agents or
  122  intermediaries, must accept prior authorization requests for any
  123  service electronically.
  124         4. Managed care plans serving children in the care and
  125  custody of the Department of Children and Families must maintain
  126  complete medical, dental, and behavioral health encounter
  127  information and participate in making such information available
  128  to the department or the applicable contracted community-based
  129  care lead agency for use in providing comprehensive and
  130  coordinated case management. The agency and the department shall
  131  establish an interagency agreement to provide guidance for the
  132  format, confidentiality, recipient, scope, and method of
  133  information to be made available and the deadlines for
  134  submission of the data. The scope of information available to
  135  the department shall be the data that managed care plans are
  136  required to submit to the agency. The agency shall determine the
  137  plan’s compliance with standards for access to medical, dental,
  138  and behavioral health services; the use of medications; and
  139  follow up followup on all medically necessary services
  140  recommended as a result of early and periodic screening,
  141  diagnosis, and treatment.
  142         5.Notwithstanding any other law, Medicaid enrollees,
  143  including those enrolled in Medicaid managed care plans, must be
  144  allowed their choice of any qualified Medicaid durable medical
  145  equipment or complex rehabilitation technology provider. The
  146  agency shall adopt rules to implement this subparagraph.
  147         (p)Subcontractors.—A managed care plan may not refer its
  148  members to or enter into a contract or an arrangement with a
  149  subcontractor to provide services if the managed care plan or
  150  the principal of the managed care plan has a common ownership
  151  interest. A subcontractor of a managed care plan shall provide
  152  all services in compliance with the contract or arrangement and
  153  the applicable federal waivers as reasonably necessary to
  154  achieve the purpose for which such services are to be provided.
  155  A managed care plan may not refer its members to a subcontractor
  156  for covered services if the subcontractor has an ownership
  157  interest or a profit-sharing arrangement with a provider,
  158  another subcontractor, a third-party administrator, or a third
  159  party entity.
  160         Section 3. This act shall take effect July 1, 2022.