Florida Senate - 2024                                    SB 1280
       By Senator Davis
       5-00015A-24                                           20241280__
    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 that managed care plan contract
    9         amendments be effective by a specified date; requiring
   10         the agency to submit an annual report to the
   11         Legislature; 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  must include provider-specific data on timeliness of access to
   54  services.
   55         2. Each managed care plan must publish any prescribed drug
   56  formulary or preferred drug list on the plan’s website in a
   57  manner that is accessible to and searchable by enrollees and
   58  providers. The plan must update the list within 24 hours after
   59  making a change. Each plan must ensure that the prior
   60  authorization process for prescribed drugs is readily accessible
   61  to health care providers, including posting appropriate contact
   62  information on its website and providing timely responses to
   63  providers. For Medicaid recipients diagnosed with hemophilia who
   64  have been prescribed anti-hemophilic-factor replacement
   65  products, the agency shall provide for those products and
   66  hemophilia overlay services through the agency’s hemophilia
   67  disease management program.
   68         3. Managed care plans, and their fiscal agents or
   69  intermediaries, must accept prior authorization requests for any
   70  service electronically.
   71         4. Managed care plans serving children in the care and
   72  custody of the Department of Children and Families must maintain
   73  complete medical, dental, and behavioral health encounter
   74  information and participate in making such information available
   75  to the department or the applicable contracted community-based
   76  care lead agency for use in providing comprehensive and
   77  coordinated case management. The agency and the department shall
   78  establish an interagency agreement to provide guidance for the
   79  format, confidentiality, recipient, scope, and method of
   80  information to be made available and the deadlines for
   81  submission of the data. The scope of information available to
   82  the department is shall be the data that managed care plans are
   83  required to submit to the agency. The agency shall determine the
   84  plan’s compliance with standards for access to medical, dental,
   85  and behavioral health services; the use of medications; and
   86  followup on all medically necessary services recommended as a
   87  result of early and periodic screening, diagnosis, and
   88  treatment.
   89         (f) Continuous improvement.—The agency shall establish
   90  specific performance standards and expected milestones or
   91  timelines for improving performance over the term of the
   92  contract.
   93         1. Each managed care plan shall establish an internal
   94  health care quality improvement system, including enrollee
   95  satisfaction and disenrollment surveys. The quality improvement
   96  system must include incentives and disincentives for network
   97  providers.
   98         2. Each managed care plan shall must collect and report the
   99  Healthcare Effectiveness Data and Information Set (HEDIS)
  100  measures, the federal Core Set of Children’s Health Care Quality
  101  measures, and the federal Core Set of Adult Health Care Quality
  102  Measures, as specified by the agency. Beginning with data
  103  reports for the 2025 calendar year, each plan shall must collect
  104  and report the Adult Core Set behavioral health measures
  105  beginning with data reports for the 2025 calendar year.
  106  Beginning with data reports for the 2026 calendar year, each
  107  plan must stratify reported measures by age, sex, race,
  108  ethnicity, primary language, and whether the enrollee received a
  109  Social Security Administration determination of disability for
  110  purposes of Supplemental Security Income beginning with data
  111  reports for the 2026 calendar year. A plan’s performance on
  112  these measures must be published on the plan’s website in a
  113  manner that allows recipients to reliably compare the
  114  performance of plans. The agency shall use the measures as a
  115  tool to monitor plan performance.
  116         3. Each managed care plan must be accredited by the
  117  National Committee for Quality Assurance, the Joint Commission,
  118  or another nationally recognized accrediting body, or have
  119  initiated the accreditation process, within 1 year after the
  120  contract is executed. The agency shall suspend automatic
  121  assignment under ss. 409.977 and 409.984, for any plan not
  122  accredited within 18 months after executing the contract, the
  123  agency shall suspend automatic assignment under ss. 409.977 and
  124  409.984.
  125         4.The agency shall establish specific outcome performance
  126  measures to reduce the incidence of crisis stabilization
  127  services for children and adolescents who are high users of such
  128  services. At a minimum, performance measures must establish
  129  plan-specific, year-over-year improvement targets to reduce
  130  repeated use of such services.
  131         Section 2. The Agency for Health Care Administration shall
  132  amend existing contracts with managed care plans to execute the
  133  requirements of this act. Such contract amendments must be
  134  effective before January 1, 2025.
  135         Section 3. Beginning on October 1, 2024, and annually
  136  thereafter, the Agency for Health Care Administration shall
  137  submit to the Legislature an annual report on Medicaid-enrolled
  138  children and adolescents who are the highest users of crisis
  139  stabilization services. The report must include demographic and
  140  geographic information; plan-specific performance data based on
  141  the performance standards established under s. 409.967(2)(f),
  142  Florida Statutes; plan-specific provider network testing data
  143  generated pursuant to s. 409.967(2)(c), Florida Statutes,
  144  including, but not limited to, an assessment of timeliness of
  145  access to services; and trends on reported data points beginning
  146  with the 2021-2022 fiscal year. The report must also include an
  147  analysis of relevant managed care plan contract terms and the
  148  contract enforcement mechanisms available to the agency to
  149  ensure compliance; data on enforcement or incentive actions
  150  taken by the agency to ensure compliance with network standards
  151  and progress in performance improvement, including, but not
  152  limited to, the use of the achieved savings rebate program as
  153  provided under s. 409.967, Florida Statutes; and a listing of
  154  other actions taken by the agency to better serve such children
  155  and adolescents.
  156         Section 4. This act shall take effect July 1, 2024.