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