Florida Senate - 2025                                    SB 1354
       
       
        
       By Senator Trumbull
       
       
       
       
       
       2-01280A-25                                           20251354__
    1                        A bill to be entitled                      
    2         An act relating to behavioral health managing
    3         entities; amending s. 394.9082, F.S.; requiring the
    4         Department of Children and Families to contract for
    5         specified functions; requiring the department to
    6         recommend certain transparency improvements; requiring
    7         the department to prepare and present to the Governor
    8         and Legislature a specified final report by a date
    9         certain; requiring managing entities to report
   10         required information to the department in a
   11         standardized electronic format; providing requirements
   12         for the such format; requiring managing entities to
   13         submit documents to the department electronically in a
   14         specified format and with specified metadata;
   15         requiring managing entities to report certain specific
   16         measures to the department; providing an effective
   17         date.
   18          
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. Subsection (7) of section 394.9082, Florida
   22  Statutes, is amended, and paragraph (n) is added to subsection
   23  (3) and paragraphs (v) and (w) are added to subsection (5) of
   24  that section, to read:
   25         394.9082 Behavioral health managing entities.—
   26         (3) DEPARTMENT DUTIES.—The department shall:
   27         (n)1.Contract for all of the following:
   28         a.Operational and financial audits of each managing entity
   29  to include all of the following:
   30         (I)A review of business practices, personnel, financial
   31  records, related parties, compensation, and other areas as
   32  determined by the department.
   33         (II)The services administered, the method of provider
   34  payment, expenditures, outcomes, and other information as
   35  determined by the department.
   36         (III)Referral patterns, including managing entity referral
   37  volume; provider referral assignments; services referred; length
   38  of time to obtain services; and key referral performance
   39  measures.
   40         (IV)Provider network adequacy and provider network
   41  participation in the department’s available bed platform, the
   42  Opioid Data Management System, the Agency for Health Care
   43  Administration Event Notification Service, and other department
   44  required provider data submissions.
   45         b.Audits of each managing entity’s expenditures and
   46  claims, in which such audit must do both of the following:
   47         (I)Compare services administered through each managing
   48  entity, the outcomes of each managing entity’s expenditures,
   49  each managing entity’s Medicaid expenditures for behavioral
   50  health services, and any other information as determined by the
   51  department.
   52         (II)Analyze the claims paid by each managing entity for
   53  Medicaid recipients.
   54         c.Recommendations to improve transparency of system
   55  performance including the metrics and criteria used to measure
   56  performance and outcomes in behavioral health systems and the
   57  format and method used to collect and report data and
   58  information.
   59         2.Prepare a report of the information gathered in
   60  subparagraph 1. and present the final report on or before
   61  December 1, 2025, to the Governor, the President of the Senate,
   62  and the Speaker of the House of Representatives.
   63         (5) MANAGING ENTITY DUTIES.—A managing entity shall:
   64         (v)Report all required information to the department in a
   65  standardized electronic format to ensure interoperability and to
   66  facilitate data analysis. The submission format must meet all of
   67  the following criteria:
   68         1.Provider payments must be reported using a standardized
   69  format for electronic data interchange that is used for health
   70  care claims processing.
   71         2.Information must be organized into discrete, machine
   72  readable data elements that allow for efficient processing and
   73  integration with other datasets.
   74         3.All data fields must comply with established protocols
   75  as specified by the department.
   76         4.The standardized format must be compatible with
   77  automated systems to enable the downloading, parsing, and
   78  combining of data with other sources for analysis.
   79         5.Submissions must pass validation checks to confirm
   80  adherence to the required data structure and format before the
   81  submission is accepted.
   82         (w)Submit all documents to the department in a format that
   83  allows for accurate text recognition and data extraction, such
   84  as in Portable Document Format or machine-readable text files.
   85  Documents must be submitted electronically and accompanied by
   86  metadata containing key information to ensure proper
   87  organization, processing, and integration into the department’s
   88  systems. The required metadata must include, but is not limited
   89  to, all of the following elements:
   90         1.A descriptive and unique name for the document,
   91  following any naming conventions prescribed by the department.
   92         2.The date the document is uploaded.
   93         3.A predefined classification indicating the nature or
   94  category of the document.
   95         4.Any relevant identifiers, such as application numbers,
   96  case numbers, or tracking codes, as specified by the department.
   97         5.The name, contact information, and any other required
   98  identification number, such as a license or registration number,
   99  of the person or organization submitting the document.
  100         6.Any other metadata fields as prescribed by the
  101  department to facilitate accurate processing and analysis.
  102         (7) PERFORMANCE MEASUREMENT AND ACCOUNTABILITY.—
  103         (a) Managing entities shall collect and submit data to the
  104  department regarding persons served, outcomes of persons served,
  105  costs of services provided through the department’s contract,
  106  and other data as required by the department. The department
  107  shall evaluate managing entity performance and the overall
  108  progress made by the managing entity, together with other
  109  systems, in meeting the community’s behavioral health needs,
  110  based on consumer-centered outcome measures that reflect
  111  national standards, if possible, that can be accurately
  112  measured. The department shall work with managing entities to
  113  establish performance standards, including, but not limited to:
  114         1.(a) The extent to which individuals in the community
  115  receive services, including, but not limited to, parents or
  116  caregivers involved in the child welfare system who need
  117  behavioral health services.
  118         2.(b) The improvement in the overall behavioral health of a
  119  community.
  120         3.(c) The improvement in functioning or progress in the
  121  recovery of individuals served by the managing entity, as
  122  determined using person-centered measures tailored to the
  123  population.
  124         4.(d) The success of strategies to:
  125         a.1. Divert admissions from acute levels of care, jails,
  126  prisons, and forensic facilities as measured by, at a minimum,
  127  the total number and percentage of clients who, during a
  128  specified period, experience multiple admissions to acute levels
  129  of care, jails, prisons, or forensic facilities;
  130         b.2. Integrate behavioral health services with the child
  131  welfare system; and
  132         c.3. Address the housing needs of individuals being
  133  released from public receiving facilities who are homeless.
  134         5.(e) Consumer and family satisfaction.
  135         6.(f) The level of engagement of key community
  136  constituencies, such as law enforcement agencies, community
  137  based care lead agencies, juvenile justice agencies, the courts,
  138  school districts, local government entities, hospitals, and
  139  other organizations, as appropriate, for the geographical
  140  service area of the managing entity.
  141         (b)Managing entities must submit all of the following
  142  specific measures to the department:
  143         1.The number and percentage of high utilizers.
  144         2.The number and percentage of individuals who receive
  145  outpatient services within 7 days after a hospitalization for
  146  behavioral health-related issues.
  147         3.The average wait time for initial appointments for
  148  behavioral health services.
  149         4.The number and percentage of individuals who are able to
  150  schedule an urgent behavioral health appointment within 24
  151  hours.
  152         5.The number and percentage of emergency room visits per
  153  capita for behavioral health-related issues, and whether such
  154  number and percentage are a decrease from the last report.
  155         6.The incidence of medication errors in behavioral health
  156  treatment plans.
  157         7.The number and percentage of adverse incidents, such as
  158  self-harm, in inpatient and outpatient settings.
  159         8.The number and percentage of individuals with co
  160  occurring conditions who receive integrated care.
  161         9.The number and percentage of individuals successfully
  162  transitioned from acute care to community-based services.
  163         10.The rate of behavioral health readmissions within 30
  164  days after discharge.
  165         11.The average length of stay for inpatient behavioral
  166  health services.
  167         Section 2. This act shall take effect July 1, 2025.