Florida Senate - 2021                                    SB 1272
       By Senator Rodriguez
       39-01610-21                                           20211272__
    1                        A bill to be entitled                      
    2         An act relating to managed care plan performance;
    3         amending s. 409.967, F.S.; requiring managed care
    4         plans to collect and report Health Plan Employer Data
    5         and Information Set measures by specified categories;
    6         requiring certain managed care plans to collect and
    7         report annually the Core Set of Children’s Health Care
    8         Quality measures by specified categories and to
    9         publish such measures on their websites; requiring the
   10         Agency for Health Care Administration to use such
   11         measures to monitor plan performance; providing an
   12         effective date.
   14  Be It Enacted by the Legislature of the State of Florida:
   16         Section 1. Paragraph (f) of subsection (2) of section
   17  409.967, Florida Statutes, is amended to read:
   18         409.967 Managed care plan accountability.—
   19         (2) The agency shall establish such contract requirements
   20  as are necessary for the operation of the statewide managed care
   21  program. In addition to any other provisions the agency may deem
   22  necessary, the contract must require:
   23         (f) Continuous improvement.—The agency shall establish
   24  specific performance standards and expected milestones or
   25  timelines for improving performance over the term of the
   26  contract.
   27         1. Each managed care plan shall establish an internal
   28  health care quality improvement system, including enrollee
   29  satisfaction and disenrollment surveys. The quality improvement
   30  system must include incentives and disincentives for network
   31  providers.
   32         2. Each managed care plan must collect and report the
   33  Health Plan Employer Data and Information Set (HEDIS) measures,
   34  as specified by the agency, which must be stratified by age,
   35  race, ethnicity, primary language, sex, and disability status.
   36  These measures must be published on the plan’s website in a
   37  manner that allows recipients to reliably compare the
   38  performance of plans. The agency shall use the HEDIS measures as
   39  a tool to monitor plan performance.
   40         3.Each managed care plan that has Medicaid enrollees from
   41  birth to 20 years of age must collect and report annually the
   42  Core Set of Children’s Health Care Quality (Child Core Set)
   43  measures, as developed by the Centers for Medicare and Medicaid
   44  Services, which must be stratified by age, race, ethnicity,
   45  primary language, sex, and disability status. These measures
   46  must be published on the plan’s website in a manner that allows
   47  recipients to reliably compare the performance of plans. The
   48  agency shall use the Child Core Set measures as a tool to
   49  monitor plan performance.
   50         4.3. Each managed care plan must be accredited by the
   51  National Committee for Quality Assurance, the Joint Commission,
   52  or another nationally recognized accrediting body, or have
   53  initiated the accreditation process, within 1 year after the
   54  contract is executed. For any plan not accredited within 18
   55  months after executing the contract, the agency shall suspend
   56  automatic assignment under s. 409.977 and 409.984.
   57         5.4. By the end of the fourth year of the first contract
   58  term, the agency shall issue a request for information to
   59  determine whether cost savings could be achieved by contracting
   60  for plan oversight and monitoring, including analysis of
   61  encounter data, assessment of performance measures, and
   62  compliance with other contractual requirements.
   63         Section 2. This act shall take effect July 1, 2021.