Florida Senate - 2013 COMMITTEE AMENDMENT
Bill No. CS for SB 966
Barcode 157570
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/22/2013 .
.
.
.
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
The Committee on Appropriations (Bean) recommended the
following:
1 Senate Amendment to Amendment (342762) (with title
2 amendment)
3
4 Delete lines 1861 - 1900
5 and insert:
6 Section 56. Paragraphs (c) and (e) of subsection (2) of
7 section 409.967, Florida Statutes, are amended to read:
8 409.967 Managed care plan accountability.—
9 (2) The agency shall establish such contract requirements
10 as are necessary for the operation of the statewide managed care
11 program. In addition to any other provisions the agency may deem
12 necessary, the contract must require:
13 (c) Access.—
14 1. The agency shall establish specific standards for the
15 number, type, and regional distribution of providers in managed
16 care plan networks to ensure access to care for both adults and
17 children. Each plan must maintain a regionwide network of
18 providers in sufficient numbers to meet the access standards for
19 specific medical services for all recipients enrolled in the
20 plan. The exclusive use of mail-order pharmacies may not be
21 sufficient to meet network access standards. Consistent with the
22 standards established by the agency, provider networks may
23 include providers located outside the region. A plan may
24 contract with a new hospital facility before the date the
25 hospital becomes operational if the hospital has commenced
26 construction, will be licensed and operational by January 1,
27 2013, and a final order has issued in any civil or
28 administrative challenge. Each plan shall establish and maintain
29 an accurate and complete electronic database of contracted
30 providers, including information about licensure or
31 registration, locations and hours of operation, specialty
32 credentials and other certifications, specific performance
33 indicators, and such other information as the agency deems
34 necessary. The database must be available online to both the
35 agency and the public and have the capability to compare the
36 availability of providers to network adequacy standards and to
37 accept and display feedback from each provider’s patients. Each
38 plan shall submit quarterly reports to the agency identifying
39 the number of enrollees assigned to each primary care provider.
40 2. Each managed care plan must publish any prescribed drug
41 formulary or preferred drug list on the plan’s website in a
42 manner that is accessible to and searchable by enrollees and
43 providers. The plan must update the list within 24 hours after
44 making a change. Each plan must ensure that the prior
45 authorization process for prescribed drugs is readily accessible
46 to health care providers, including posting appropriate contact
47 information on its website and providing timely responses to
48 providers. For Medicaid recipients diagnosed with hemophilia who
49 have been prescribed anti-hemophilic-factor replacement
50 products, the agency shall provide for those products and
51 hemophilia overlay services through the agency’s hemophilia
52 disease management program.
53 3. Managed care plans, and their fiscal agents or
54 intermediaries, must accept prior authorization requests for any
55 service electronically.
56 4. Managed care plans must permit an enrollee who was
57 receiving a prescription drug and was on the plan’s formulary
58 and subsequently removed or changed, to continue receiving that
59 drug if the provider submits a written request demonstrating
60 that the drug is medically necessary, and the enrollee meets
61 clinical criteria to receive the drug.
62 (e) Continuous improvement.—The agency shall establish
63 specific performance standards and expected milestones or
64 timelines for improving performance over the term of the
65 contract.
66 1. Each managed care plan shall establish an internal
67 health care quality improvement system, including enrollee
68 satisfaction and disenrollment surveys. The quality improvement
69 system must include incentives and disincentives for network
70 providers.
71 2. Each plan must collect and report the Health Plan
72 Employer Data and Information Set (HEDIS) measures, as specified
73 by the agency. These measures must be published on the plan’s
74 website in a manner that allows recipients to reliably compare
75 the performance of plans. The agency shall use the HEDIS
76 measures as a tool to monitor plan performance.
77 3. Each managed care plan must be accredited by the
78 National Committee for Quality Assurance, the Joint Commission,
79 a national accrediting organization that is approved by the
80 Centers for Medicare and Medicaid Services and whose standards
81 incorporate comparable licensure regulations required by the
82 state, or another nationally recognized accrediting body, or
83 have initiated the accreditation process, within 1 year after
84 the contract is executed. The agency shall suspend automatic
85 assignment under ss. 409.977 and 409.984 for a any plan not
86 accredited within 18 months after executing the contract, the
87 agency shall suspend automatic assignment under s. 409.977 and
88 409.984.
89 4. By the end of the fourth year of the first contract
90 term, the agency shall issue a request for information to
91 determine whether cost savings could be achieved by contracting
92 for plan oversight and monitoring, including analysis of
93 encounter data, assessment of performance measures, and
94 compliance with other contractual requirements.
95
96
97 ================= T I T L E A M E N D M E N T ================
98 And the title is amended as follows:
99 Delete lines 3520 - 3523
100 and insert:
101 treating individuals with HIV/AIDS; amending s.
102 409.966; F.S.; revising references to certain
103 accrediting organizations to conform to changes made
104 by the act; amending s. 409.967, F.S.; requiring a
105 managed care plan to permit enrollees to continue
106 receiving certain drugs that are removed from the
107 plan’s formulary; revising references to certain
108 accrediting organizations to conform to changes made
109 by the act; amending s. 429.07, F.S.;