Florida Senate - 2017                        COMMITTEE AMENDMENT
       Bill No. SB 670
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Comm: UNFAV           .                                
                  03/06/2017           .                                

       The Committee on Banking and Insurance (Garcia) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete lines 27 - 132
    4  and insert:
    5         (a)1. A managed care plan may not exclude any of the
    6  following providers that meet the credentialing requirements of,
    7  comply with agency standards for, and accept the terms of the
    8  plan:
    9         a. A pharmacy.
   10         b. A primary care physician.
   11         c. A specialty physician.
   12         d. A physical or occupational therapist or an infusion
   13  therapy provider.
   14         e. A chiropractor.
   15         2. The managed care plan must offer the same rate of
   16  reimbursement in the plan’s network to all providers that are of
   17  the same type as any of those listed in subparagraph 1.
   18         (b) Plans must include all providers in the region which
   19  that are classified by the agency as essential Medicaid
   20  providers, unless the agency approves, in writing, an
   21  alternative arrangement for securing the types of services
   22  offered by the essential providers. Providers are essential for
   23  serving Medicaid enrollees if they offer services that are not
   24  available from any other provider within a reasonable access
   25  standard, or if they provided a substantial share of the total
   26  units of a particular service used by Medicaid patients within
   27  the region during the last 3 years and the combined capacity of
   28  other service providers in the region is insufficient to meet
   29  the total needs of the Medicaid patients. The agency may not
   30  classify physicians and other practitioners as essential
   31  providers. The agency, at a minimum, shall determine which
   32  providers in the following categories are essential Medicaid
   33  providers:
   34         1. Federally qualified health centers.
   35         2. Statutory teaching hospitals as defined in s.
   36  408.07(45).
   37         3. Hospitals that are trauma centers as defined in s.
   38  395.4001(14).
   39         4. Hospitals located at least 25 miles from any other
   40  hospital with similar services.
   42  Managed care plans that have not contracted with all essential
   43  providers in the region as of the first date of recipient
   44  enrollment, or with whom an essential provider has terminated
   45  its contract, must negotiate in good faith with such essential
   46  providers for 1 year or until an agreement is reached, whichever
   47  is first. Payments for services rendered by a nonparticipating
   48  essential provider shall be made at the applicable Medicaid rate
   49  as of the first day of the contract between the agency and the
   50  plan. A rate schedule for all essential providers shall be
   51  attached to the contract between the agency and the plan. After
   52  1 year, managed care plans that are unable to contract with
   53  essential providers shall notify the agency and propose an
   54  alternative arrangement for securing the essential services for
   55  Medicaid enrollees. The arrangement must rely on contracts with
   56  other participating providers, regardless of whether those
   57  providers are located within the same region as the
   58  nonparticipating essential service provider. If the alternative
   59  arrangement is approved by the agency, payments to
   60  nonparticipating essential providers after the date of the
   61  agency’s approval shall equal 90 percent of the applicable
   62  Medicaid rate. Except for payment for emergency services, if the
   63  alternative arrangement is not approved by the agency, payment
   64  to nonparticipating essential providers shall equal 110 percent
   65  of the applicable Medicaid rate.
   66         (c)(b) Certain providers are statewide resources and
   67  essential providers for all managed care plans in all regions.
   68  All managed care plans must include these essential providers in
   69  their networks. Statewide essential providers include:
   70         1. Faculty plans of Florida medical schools.
   71         2. Regional perinatal intensive care centers as defined in
   72  s. 383.16(2).
   73         3. Hospitals licensed as specialty children’s hospitals as
   74  defined in s. 395.002(28).
   75         4. Accredited and integrated systems serving medically
   76  complex children which comprise separately licensed, but
   77  commonly owned, health care providers delivering at least the
   78  following services: medical group home, in-home and outpatient
   79  nursing care and therapies, pharmacy services, durable medical
   80  equipment, and Prescribed Pediatric Extended Care.
   82  Managed care plans that have not contracted with all statewide
   83  essential providers in all regions as of the first date of
   84  recipient enrollment must continue to negotiate in good faith.
   85  Payments to physicians on the faculty of nonparticipating
   86  Florida medical schools shall be made at the applicable Medicaid
   87  rate. Payments for services rendered by regional perinatal
   88  intensive care centers shall be made at the applicable Medicaid
   89  rate as of the first day of the contract between the agency and
   90  the plan. Except for payments for emergency services, payments
   91  to nonparticipating specialty children’s hospitals shall equal
   92  the highest rate established by contract between that provider
   93  and any other Medicaid managed care plan.
   94         (d)(c) After 12 months of active participation in a plan’s
   95  network, the plan may exclude any essential provider from the
   96  network for failure to meet quality or performance criteria. If
   97  the plan excludes an essential provider from the plan, the plan
   98  must provide written notice to all recipients who have chosen
   99  that provider for care. The notice shall be provided at least 30
  100  days before the effective date of the exclusion. For purposes of
  101  this paragraph, the term “essential provider” includes providers
  102  determined by the agency to be essential Medicaid providers
  103  under paragraph (b) (a) and the statewide essential providers
  104  specified in paragraph (c) (b).
  105         (e)(d) The applicable Medicaid rates for emergency services
  106  paid by a plan under this section to a provider with which the
  107  plan does not have an active contract shall be determined
  108  according to s. 409.967(2)(b).
  109         (f)(e) Each managed care plan must offer a network contract
  110  to each home medical equipment and supplies provider in the
  111  region which meets quality and fraud prevention and detection
  112  standards established by the plan and which agrees to accept the
  113  lowest price previously negotiated between the plan and another
  114  such provider.
  115         (g) The agency shall adopt rules necessary to implement and
  116  administer this subsection, including rules establishing
  117  credentialing requirements and quality standards for the
  118  providers specified in paragraph (a).
  120  ================= T I T L E  A M E N D M E N T ================
  121  And the title is amended as follows:
  122         Delete lines 4 - 10
  123  and insert:
  124         managed care plan from excluding specified providers
  125         that meet the credentialing requirements and standards
  126         established by the Agency for Health Care
  127         Administration and that accept the terms of the plan;
  128         requiring a managed care plan to offer the same rate
  129         of reimbursement to providers of the same type in the
  130         plan’s network; providing rulemaking authority;
  131         providing an