Florida Senate - 2017 COMMITTEE AMENDMENT
Bill No. SB 670
Senate . House
Comm: UNFAV .
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
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
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
33 1. Federally qualified health centers.
34 2. Statutory teaching hospitals as defined in s.
36 3. Hospitals that are trauma centers as defined in s.
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