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
    1         Senate Amendment to Amendment (342762) (with title
    2  amendment)
    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.
   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.;