Florida Senate - 2025                        COMMITTEE AMENDMENT
       Bill No. SB 1354
       
       
       
       
       
       
                                Ì797766aÎ797766                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  03/26/2025           .                                
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       The Committee on Children, Families, and Elder Affairs
       (Trumbull) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (7) of section 394.9082, Florida
    6  Statutes, is amended, paragraph (n) is added to subsection (3),
    7  and paragraphs (v) and (w) are added to subsection (5) of that
    8  section, to read:
    9         394.9082 Behavioral health managing entities.—
   10         (3) DEPARTMENT DUTIES.—The department shall:
   11         (n)1.Contract for all of the following:
   12         a.Biennial operational and financial audits of each
   13  managing entity to include all of the following:
   14         (I)A review of business practices, personnel, financial
   15  records, related parties, compensation, and other areas as
   16  determined by the department.
   17         (II)The services administered, the method of provider
   18  payment, expenditures, outcomes, and other information as
   19  determined by the department.
   20         (III)Referral patterns, including managing entity referral
   21  volume; provider referral assignments; services referred; length
   22  of time to obtain services; and key referral performance
   23  measures.
   24         (IV)Provider network adequacy and provider network
   25  participation in the department’s available bed platform, the
   26  Opioid Data Management System, the Agency for Health Care
   27  Administration Event Notification Service, and other department
   28  required provider data submissions.
   29         (V)Audits of each managing entity’s expenditures and
   30  claims. Such an audit must do both of the following:
   31         (A)Compare services administered through each managing
   32  entity, the outcomes of each managing entity’s expenditures,
   33  each managing entity’s Medicaid expenditures for behavioral
   34  health services, and any other information as determined by the
   35  department.
   36         (B)Analyze services funded by each managing entity
   37  rendered to individuals who are also Medicaid beneficiaries to,
   38  at a minimum, assess the extent to which managing entities are
   39  funding services that are also available as covered services
   40  under the Medicaid program.
   41         b.Recommendations to improve transparency of system
   42  performance, including, but not limited to, metrics and criteria
   43  used to measure each managing entity’s performance and patient
   44  and system outcomes, and the format and method to be used to
   45  collect and report necessary data and information.
   46         2.Prepare a report of the information gathered in
   47  subparagraph 1. and present the final report on or before
   48  December 1, 2025, to the Governor, the President of the Senate,
   49  and the Speaker of the House of Representatives.
   50         (5) MANAGING ENTITY DUTIES.—A managing entity shall:
   51         (v)Report all required data to the department in a
   52  standardized electronic format to ensure interoperability and to
   53  facilitate data analysis. The submission format must meet all of
   54  the following criteria:
   55         1.Provider payments must be reported using a standardized
   56  format for electronic data interchange that is used for health
   57  care claims processing.
   58         2.Information must be organized into discrete, machine
   59  readable data elements that allow for efficient processing and
   60  integration with other datasets.
   61         3.All data fields must comply with established protocols
   62  as specified by the department.
   63         4.The standardized format must be compatible with
   64  automated systems to enable the downloading, parsing, and
   65  combining of data with other sources for analysis.
   66         5.Submissions must pass validation checks to confirm
   67  adherence to the required data structure and format before the
   68  submission is accepted.
   69         (w)Submit to the department all documents that are
   70  required under contract for submission on a routine basis in an
   71  electronic format that allows for accurate text recognition and
   72  data extraction as specified by the department, which may
   73  include, but is not limited to, Portable Document Format or
   74  machine-readable text files. The documents must be accompanied
   75  by metadata containing key information that ensures proper
   76  organization, processing, and integration into the department’s
   77  systems. The required metadata must include, but is not limited
   78  to, all of the following elements:
   79         1.A descriptive and unique name for the document,
   80  following any naming conventions prescribed by the department.
   81         2.The date the document is uploaded.
   82         3.A predefined classification indicating the nature or
   83  category of the document.
   84         4.Any relevant identifiers, such as application numbers,
   85  case numbers, or tracking codes, as specified by the department.
   86         5.The name, contact information, and any other required
   87  identification number, which may include, but is not limited to,
   88  a contract, license, or registration number, of the person or
   89  organization submitting the document.
   90         6.Any other metadata fields as prescribed by the
   91  department to facilitate accurate processing and analysis.
   92         (7) PERFORMANCE MEASUREMENT AND ACCOUNTABILITY.—
   93         (a) Managing entities shall collect and submit data to the
   94  department regarding persons served, outcomes of persons served,
   95  costs of services provided through the department’s contract,
   96  and other data as required by the department. The department
   97  shall evaluate managing entity performance and the overall
   98  progress made by the managing entity, together with other
   99  systems, in meeting the community’s behavioral health needs,
  100  based on consumer-centered outcome measures that reflect
  101  national standards, if possible, that can be accurately
  102  measured. The department shall work with managing entities to
  103  establish performance standards, including, but not limited to:
  104         1.(a) The extent to which individuals in the community
  105  receive services, including, but not limited to, parents or
  106  caregivers involved in the child welfare system who need
  107  behavioral health services.
  108         2.(b) The improvement in the overall behavioral health of a
  109  community.
  110         3.(c) The improvement in functioning or progress in the
  111  recovery of individuals served by the managing entity, as
  112  determined using person-centered measures tailored to the
  113  population.
  114         4.(d) The success of strategies to:
  115         a.1. Divert admissions from acute levels of care, jails,
  116  prisons, and forensic facilities as measured by, at a minimum,
  117  the total number and percentage of clients who, during a
  118  specified period, experience multiple admissions to acute levels
  119  of care, jails, prisons, or forensic facilities;
  120         b.2. Integrate behavioral health services with the child
  121  welfare system; and
  122         c.3. Address the housing needs of individuals being
  123  released from public receiving facilities who are homeless.
  124         5.(e) Consumer and family satisfaction.
  125         6.(f) The level of engagement of key community
  126  constituencies, such as law enforcement agencies, community
  127  based care lead agencies, juvenile justice agencies, the courts,
  128  school districts, local government entities, hospitals, and
  129  other organizations, as appropriate, for the geographical
  130  service area of the managing entity.
  131         (b)Managing entities must submit specific measures to the
  132  department regarding individual outcomes and system functioning,
  133  which the department must post to, and maintain on, its website
  134  by the 15th of every month. The posted measures must reflect
  135  performance for the previous calendar month. Each managing
  136  entity must report each measure using a standard methodology
  137  determined by the department and submit the data to the
  138  department by the deadline specified by the department. The
  139  measures shall include data from individuals served by each
  140  managing entity for services funded by the managing entity, to
  141  the extent feasible and appropriate. The measures shall be
  142  reported and posted stratified by, at a minimum, whether the
  143  individual is a child or an adult and whether the individual is
  144  a Medicaid recipient. Such measures shall include, at a minimum,
  145  all of the following:
  146         1.The number and percentage of individuals who are high
  147  utilizers of crisis behavioral health services.
  148         2.The number and percentage of individuals referred to
  149  outpatient behavioral health services after their discharge from
  150  a receiving or treatment facility, an emergency department under
  151  this chapter, or an inpatient or residential licensed service
  152  component under chapter 397 and who begin receiving such
  153  services within 7 days after discharge.
  154         3.The average wait time for initial appointments for
  155  behavioral health services, categorized by the type of service.
  156         4.The number and percentage of individuals with
  157  significant behavioral health symptoms who are seeking urgent
  158  but noncrisis acute care and who are scheduled to be seen by a
  159  provider within 1 business day after initial contact with the
  160  provider.
  161         5.The number and percentage of emergency department visits
  162  per capita for behavioral health-related issues.
  163         6.The incidence of medication errors.
  164         7.The number and percentage of adverse incidents,
  165  including, but not limited to, self-harm, occurring during
  166  inpatient and outpatient behavioral health services.
  167         8.The number and percentage of individuals with co
  168  occurring conditions who receive integrated care.
  169         9.The number and percentage of individuals discharged from
  170  a receiving or treatment facility under this chapter or an
  171  inpatient or residential licensed service component under
  172  chapter 397 who successfully transition to ongoing services at
  173  the appropriate level of care.
  174         10.The rate of readmissions to emergency departments due
  175  to behavioral health issues or to crisis stabilization units,
  176  addictions receiving facilities, or other inpatient levels of
  177  care under this chapter and chapter 397 within 30 days after
  178  discharge from inpatient or outpatient behavioral health
  179  services.
  180         11.The average length of stay for inpatient behavioral
  181  health services.
  182         Section 2. This act shall take effect July 1, 2025.
  183  
  184  ================= T I T L E  A M E N D M E N T ================
  185  And the title is amended as follows:
  186         Delete everything before the enacting clause
  187  and insert:
  188                        A bill to be entitled                      
  189         An act relating to behavioral health managing
  190         entities; amending s. 394.9082, F.S.; requiring the
  191         Department of Children and Families to contract
  192         biennially for specified functions; requiring the
  193         department to contract for recommendations for certain
  194         transparency improvements; requiring the department to
  195         prepare and present to the Governor and Legislature a
  196         specified final report by a specified date; requiring
  197         managing entities to report required data to the
  198         department in a standardized electronic format;
  199         providing requirements for such format; requiring
  200         managing entities to electronically submit to the
  201         department certain documents in a specified format and
  202         with specified metadata; requiring managing entities
  203         to submit certain specific measures to the department;
  204         requiring the department to post and maintain such
  205         measures on its website by a specified date every
  206         month; requiring managing entities to report each
  207         measure using a standard methodology determined by the
  208         department; providing requirements for such measures;
  209         providing an effective date.