Florida Senate - 2023                                    SB 1652
       By Senator Davis
       5-01564-23                                            20231652__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid behavioral health provider
    3         performance; amending s. 409.967, F.S.; revising
    4         provider network requirements for behavioral health
    5         providers in the Medicaid program; specifying network
    6         testing requirements; requiring the Agency for Health
    7         Care Administration to establish certain performance
    8         measures; requiring managed care plan contract
    9         amendments by a specified date; requiring the agency
   10         to submit an annual report to the Legislature;
   11         providing an effective date.
   13  Be It Enacted by the Legislature of the State of Florida:
   15         Section 1. Paragraphs (c) and (f) of subsection (2) of
   16  section 409.967, Florida Statutes, are amended to read:
   17         409.967 Managed care plan accountability.—
   18         (2) The agency shall establish such contract requirements
   19  as are necessary for the operation of the statewide managed care
   20  program. In addition to any other provisions the agency may deem
   21  necessary, the contract must require:
   22         (c) Access.—
   23         1. The agency shall establish specific standards for the
   24  number, type, and regional distribution of providers in managed
   25  care plan networks to ensure access to care for both adults and
   26  children. Each plan must maintain a regionwide network of
   27  providers in sufficient numbers to meet the access standards for
   28  specific medical services for all recipients enrolled in the
   29  plan. The exclusive use of mail-order pharmacies may not be
   30  sufficient to meet network access standards. Consistent with the
   31  standards established by the agency, provider networks may
   32  include providers located outside the region. Each plan shall
   33  establish and maintain an accurate and complete electronic
   34  database of contracted providers, including information about
   35  licensure or registration, locations and hours of operation,
   36  specialty credentials and other certifications, specific
   37  performance indicators, and such other information as the agency
   38  deems necessary. The database must be available online to both
   39  the agency and the public and have the capability to compare the
   40  availability of providers to network adequacy standards and to
   41  accept and display feedback from each provider’s patients. Each
   42  plan shall submit quarterly reports to the agency identifying
   43  the number of enrollees assigned to each primary care provider.
   44  The agency shall conduct, or contract for, systematic and
   45  continuous testing of the plan provider networks network
   46  databases maintained by each plan to confirm accuracy, confirm
   47  that behavioral health providers are accepting enrollees, and
   48  confirm that enrollees have timely access to behavioral health
   49  services. The agency shall specifically and expressly establish
   50  network requirements for each type of behavioral health provider
   51  serving Medicaid enrollees, including community-based and
   52  residential providers. Testing of the behavioral health network
   53  shall also include provider-specific data on access timeliness.
   54         2. Each managed care plan must publish any prescribed drug
   55  formulary or preferred drug list on the plan’s website in a
   56  manner that is accessible to and searchable by enrollees and
   57  providers. The plan must update the list within 24 hours after
   58  making a change. Each plan must ensure that the prior
   59  authorization process for prescribed drugs is readily accessible
   60  to health care providers, including posting appropriate contact
   61  information on its website and providing timely responses to
   62  providers. For Medicaid recipients diagnosed with hemophilia who
   63  have been prescribed anti-hemophilic-factor replacement
   64  products, the agency shall provide for those products and
   65  hemophilia overlay services through the agency’s hemophilia
   66  disease management program.
   67         3. Managed care plans, and their fiscal agents or
   68  intermediaries, must accept prior authorization requests for any
   69  service electronically.
   70         4. Managed care plans serving children in the care and
   71  custody of the Department of Children and Families must maintain
   72  complete medical, dental, and behavioral health encounter
   73  information and participate in making such information available
   74  to the department or the applicable contracted community-based
   75  care lead agency for use in providing comprehensive and
   76  coordinated case management. The agency and the department shall
   77  establish an interagency agreement to provide guidance for the
   78  format, confidentiality, recipient, scope, and method of
   79  information to be made available and the deadlines for
   80  submission of the data. The scope of information available to
   81  the department shall be the data that managed care plans are
   82  required to submit to the agency. The agency shall determine the
   83  plan’s compliance with standards for access to medical, dental,
   84  and behavioral health services; the use of medications; and
   85  followup on all medically necessary services recommended as a
   86  result of early and periodic screening, diagnosis, and
   87  treatment.
   88         (f) Continuous improvement.—The agency shall establish
   89  specific performance standards and expected milestones or
   90  timelines for improving performance over the term of the
   91  contract.
   92         1. Each managed care plan shall establish an internal
   93  health care quality improvement system, including enrollee
   94  satisfaction and disenrollment surveys. The quality improvement
   95  system must include incentives and disincentives for network
   96  providers.
   97         2. Each managed care plan must collect and report the
   98  Healthcare Effectiveness Data and Information Set (HEDIS)
   99  measures, the federal Core Set of Children’s Health Care Quality
  100  measures, and the federal Core Set of Adult Health Care Quality
  101  Measures, as specified by the agency. Each plan must collect and
  102  report the Adult Core Set behavioral health measures beginning
  103  with data reports for the 2025 calendar year. Each plan must
  104  stratify reported measures by age, sex, race, ethnicity, primary
  105  language, and whether the enrollee received a Social Security
  106  Administration determination of disability for purposes of
  107  Supplemental Security Income beginning with data reports for the
  108  2026 calendar year. A plan’s performance on these measures must
  109  be published on the plan’s website in a manner that allows
  110  recipients to reliably compare the performance of plans. The
  111  agency shall use the measures as a tool to monitor plan
  112  performance.
  113         3. Each managed care plan must be accredited by the
  114  National Committee for Quality Assurance, the Joint Commission,
  115  or another nationally recognized accrediting body, or have
  116  initiated the accreditation process, within 1 year after the
  117  contract is executed. For any plan not accredited within 18
  118  months after executing the contract, the agency shall suspend
  119  automatic assignment under ss. 409.977 and 409.984.
  120         4.The agency shall establish specific outcome performance
  121  measures to reduce the incidence of crisis stabilization
  122  services for children and adolescents who are high users of such
  123  services. Performance measures must, at a minimum, establish
  124  plan-specific, year-over-year improvement targets to reduce
  125  repeated use.
  126         Section 2. The Agency for Health Care Administration shall
  127  amend existing contracts with managed care plans to execute the
  128  requirements of this act. Such contract amendments must be
  129  effective before January 1, 2024.
  130         Section 3. Beginning on October 1, 2023, and annually
  131  thereafter, the Agency for Health Care Administration shall
  132  submit to the Legislature an annual report on Medicaid-enrolled
  133  children and adolescents who are the highest users of crisis
  134  stabilization services. The report shall include demographic and
  135  geographic information; plan-specific performance data based on
  136  the performance measures in s. 409.967(2)(f), Florida Statutes;
  137  plan-specific provider network testing data generated pursuant
  138  to s. 409.967(2)(c), Florida Statutes, including, but not
  139  limited to, an assessment of access timeliness; and trends on
  140  reported data points beginning from fiscal year 2020-2021. The
  141  report shall include an analysis of relevant managed care plan
  142  contract terms and the contract enforcement mechanisms available
  143  to the agency to ensure compliance. The report shall include
  144  data on enforcement or incentive actions taken by the agency to
  145  ensure compliance with network standards and progress in
  146  performance improvement, including, but not limited to, the use
  147  of the achieved savings rebate program as provided under s.
  148  409.967, Florida Statutes. The report shall include a listing of
  149  other actions taken by the agency to better serve such children
  150  and adolescents.
  151         Section 4. This act shall take effect July 1, 2023.