Florida Senate - 2024 SB 1280
By Senator Davis
5-00015A-24 20241280__
1 A bill to be entitled
2 An act relating to Medicaid behavioral health provider
3 performance; amending s. 409.967, F.S.; revising
4 provider network requirements for behavioral health
5 providers in the Medicaid program; specifying network
6 testing requirements; requiring the Agency for Health
7 Care Administration to establish certain performance
8 measures; requiring that managed care plan contract
9 amendments be effective by a specified date; requiring
10 the agency to submit an annual report to the
11 Legislature; providing an effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Paragraphs (c) and (f) of subsection (2) of
16 section 409.967, Florida Statutes, are amended to read:
17 409.967 Managed care plan accountability.—
18 (2) The agency shall establish such contract requirements
19 as are necessary for the operation of the statewide managed care
20 program. In addition to any other provisions the agency may deem
21 necessary, the contract must require:
22 (c) Access.—
23 1. The agency shall establish specific standards for the
24 number, type, and regional distribution of providers in managed
25 care plan networks to ensure access to care for both adults and
26 children. Each plan must maintain a regionwide network of
27 providers in sufficient numbers to meet the access standards for
28 specific medical services for all recipients enrolled in the
29 plan. The exclusive use of mail-order pharmacies may not be
30 sufficient to meet network access standards. Consistent with the
31 standards established by the agency, provider networks may
32 include providers located outside the region. Each plan shall
33 establish and maintain an accurate and complete electronic
34 database of contracted providers, including information about
35 licensure or registration, locations and hours of operation,
36 specialty credentials and other certifications, specific
37 performance indicators, and such other information as the agency
38 deems necessary. The database must be available online to both
39 the agency and the public and have the capability to compare the
40 availability of providers to network adequacy standards and to
41 accept and display feedback from each provider’s patients. Each
42 plan shall submit quarterly reports to the agency identifying
43 the number of enrollees assigned to each primary care provider.
44 The agency shall conduct, or contract for, systematic and
45 continuous testing of the plan provider networks network
46 databases maintained by each plan to confirm accuracy, confirm
47 that behavioral health providers are accepting enrollees, and
48 confirm that enrollees have timely access to behavioral health
49 services. The agency shall specifically and expressly establish
50 network requirements for each type of behavioral health provider
51 serving Medicaid enrollees, including community-based and
52 residential providers. Testing of the behavioral health network
53 must include provider-specific data on timeliness of access to
54 services.
55 2. Each managed care plan must publish any prescribed drug
56 formulary or preferred drug list on the plan’s website in a
57 manner that is accessible to and searchable by enrollees and
58 providers. The plan must update the list within 24 hours after
59 making a change. Each plan must ensure that the prior
60 authorization process for prescribed drugs is readily accessible
61 to health care providers, including posting appropriate contact
62 information on its website and providing timely responses to
63 providers. For Medicaid recipients diagnosed with hemophilia who
64 have been prescribed anti-hemophilic-factor replacement
65 products, the agency shall provide for those products and
66 hemophilia overlay services through the agency’s hemophilia
67 disease management program.
68 3. Managed care plans, and their fiscal agents or
69 intermediaries, must accept prior authorization requests for any
70 service electronically.
71 4. Managed care plans serving children in the care and
72 custody of the Department of Children and Families must maintain
73 complete medical, dental, and behavioral health encounter
74 information and participate in making such information available
75 to the department or the applicable contracted community-based
76 care lead agency for use in providing comprehensive and
77 coordinated case management. The agency and the department shall
78 establish an interagency agreement to provide guidance for the
79 format, confidentiality, recipient, scope, and method of
80 information to be made available and the deadlines for
81 submission of the data. The scope of information available to
82 the department is shall be the data that managed care plans are
83 required to submit to the agency. The agency shall determine the
84 plan’s compliance with standards for access to medical, dental,
85 and behavioral health services; the use of medications; and
86 followup on all medically necessary services recommended as a
87 result of early and periodic screening, diagnosis, and
88 treatment.
89 (f) Continuous improvement.—The agency shall establish
90 specific performance standards and expected milestones or
91 timelines for improving performance over the term of the
92 contract.
93 1. Each managed care plan shall establish an internal
94 health care quality improvement system, including enrollee
95 satisfaction and disenrollment surveys. The quality improvement
96 system must include incentives and disincentives for network
97 providers.
98 2. Each managed care plan shall must collect and report the
99 Healthcare Effectiveness Data and Information Set (HEDIS)
100 measures, the federal Core Set of Children’s Health Care Quality
101 measures, and the federal Core Set of Adult Health Care Quality
102 Measures, as specified by the agency. Beginning with data
103 reports for the 2025 calendar year, each plan shall must collect
104 and report the Adult Core Set behavioral health measures
105 beginning with data reports for the 2025 calendar year.
106 Beginning with data reports for the 2026 calendar year, each
107 plan must stratify reported measures by age, sex, race,
108 ethnicity, primary language, and whether the enrollee received a
109 Social Security Administration determination of disability for
110 purposes of Supplemental Security Income beginning with data
111 reports for the 2026 calendar year. A plan’s performance on
112 these measures must be published on the plan’s website in a
113 manner that allows recipients to reliably compare the
114 performance of plans. The agency shall use the measures as a
115 tool to monitor plan performance.
116 3. Each managed care plan must be accredited by the
117 National Committee for Quality Assurance, the Joint Commission,
118 or another nationally recognized accrediting body, or have
119 initiated the accreditation process, within 1 year after the
120 contract is executed. The agency shall suspend automatic
121 assignment under ss. 409.977 and 409.984, for any plan not
122 accredited within 18 months after executing the contract, the
123 agency shall suspend automatic assignment under ss. 409.977 and
124 409.984.
125 4. The agency shall establish specific outcome performance
126 measures to reduce the incidence of crisis stabilization
127 services for children and adolescents who are high users of such
128 services. At a minimum, performance measures must establish
129 plan-specific, year-over-year improvement targets to reduce
130 repeated use of such services.
131 Section 2. The Agency for Health Care Administration shall
132 amend existing contracts with managed care plans to execute the
133 requirements of this act. Such contract amendments must be
134 effective before January 1, 2025.
135 Section 3. Beginning on October 1, 2024, and annually
136 thereafter, the Agency for Health Care Administration shall
137 submit to the Legislature an annual report on Medicaid-enrolled
138 children and adolescents who are the highest users of crisis
139 stabilization services. The report must include demographic and
140 geographic information; plan-specific performance data based on
141 the performance standards established under s. 409.967(2)(f),
142 Florida Statutes; plan-specific provider network testing data
143 generated pursuant to s. 409.967(2)(c), Florida Statutes,
144 including, but not limited to, an assessment of timeliness of
145 access to services; and trends on reported data points beginning
146 with the 2021-2022 fiscal year. The report must also include an
147 analysis of relevant managed care plan contract terms and the
148 contract enforcement mechanisms available to the agency to
149 ensure compliance; data on enforcement or incentive actions
150 taken by the agency to ensure compliance with network standards
151 and progress in performance improvement, including, but not
152 limited to, the use of the achieved savings rebate program as
153 provided under s. 409.967, Florida Statutes; and a listing of
154 other actions taken by the agency to better serve such children
155 and adolescents.
156 Section 4. This act shall take effect July 1, 2024.