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) 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
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
26 1. Federally qualified health centers.
27 2. Statutory teaching hospitals as defined in s.
29 3. Hospitals that are trauma centers as defined in s.
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