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