Florida Senate - 2022                                    SB 1258
       By Senator Jones
       35-01313A-22                                          20221258__
    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 specified measures
    5         beginning with a certain data reporting period;
    6         requiring plans to stratify reported measures by
    7         specified categories beginning with a certain data
    8         reporting period; requiring a plan’s performance to be
    9         published on its website in a specified manner;
   10         requiring the Agency for Health Care Administration to
   11         use the measures to monitor plan performance;
   12         providing an 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  Healthcare Effectiveness Health Plan Employer Data and
   34  Information Set (HEDIS) measures, the federal Core Set of
   35  Children’s Health Care Quality Measures, and the federal Core
   36  Set of Adult Health Care Quality Measures, as specified by the
   37  agency. Each plan must collect and report the Adult Core Set
   38  behavioral health measures beginning with data reports for the
   39  2025 calendar year. Each plan must stratify reported measures by
   40  age, sex, race, ethnicity, primary language, and whether the
   41  enrollee received a Social Security Administration determination
   42  of disability for purposes of Supplemental Security Income
   43  beginning with data reports for the 2026 calendar year. A plan’s
   44  performance on these measures must be published on the plan’s
   45  website in a manner that allows recipients to reliably compare
   46  the performance of plans. The agency shall use the HEDIS
   47  measures as a tool to monitor plan performance.
   48         3. Each managed care plan must be accredited by the
   49  National Committee for Quality Assurance, the Joint Commission,
   50  or another nationally recognized accrediting body, or have
   51  initiated the accreditation process, within 1 year after the
   52  contract is executed. For any plan not accredited within 18
   53  months after executing the contract, the agency shall suspend
   54  automatic assignment under ss. 409.977 and 409.984 s. 409.977
   55  and 409.984.
   56         4. By the end of the fourth year of the first contract
   57  term, the agency shall issue a request for information to
   58  determine whether cost savings could be achieved by contracting
   59  for plan oversight and monitoring, including analysis of
   60  encounter data, assessment of performance measures, and
   61  compliance with other contractual requirements.
   62         Section 2. This act shall take effect July 1, 2022.