Florida Senate - 2025 COMMITTEE AMENDMENT
Bill No. SB 306
Ì931448;Î931448
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/02/2025 .
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The Committee on Health Policy (Sharief) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Paragraph (c) of subsection (2) of section
6 409.967, Florida Statutes, is amended to read:
7 409.967 Managed care plan accountability.—
8 (2) The agency shall establish such contract requirements
9 as are necessary for the operation of the statewide managed care
10 program. In addition to any other provisions the agency may deem
11 necessary, the contract must require:
12 (c) Access.—
13 1. The agency shall establish specific standards for the
14 number, type, and regional distribution of providers in managed
15 care plan networks to ensure access to care for both adults and
16 children. Each plan must maintain a regionwide network of
17 providers in sufficient numbers to meet the access standards for
18 specific medical services for all recipients enrolled in the
19 plan. The exclusive use of mail-order pharmacies may not be
20 sufficient to meet network access standards. Consistent with the
21 standards established by the agency, provider networks may
22 include providers located outside the region.
23 2. The agency shall establish specific standards to ensure
24 enrollees have access to network providers during state holidays
25 and outside regular business hours. At least 50 percent of
26 primary care providers participating in a plan provider network
27 must offer appointment availability to Medicaid enrollees
28 outside regular business hours. For the purposes of this
29 subparagraph, the term “outside regular business hours” means
30 Monday through Friday between 5 p.m. and 8 a.m. local time and
31 all day Saturday and Sunday.
32 3. Each plan shall establish and maintain an accurate and
33 complete electronic database of contracted providers, including
34 information about licensure or registration, locations and hours
35 of operation, specialty credentials and other certifications,
36 specific performance indicators, and such other information as
37 the agency deems necessary. The database must be available
38 online to both the agency and the public and have the capability
39 to compare the availability of providers to network adequacy
40 standards and to accept and display feedback from each
41 provider’s patients.
42 4. Each plan must shall submit quarterly reports to the
43 agency identifying the number of enrollees assigned to each
44 primary care provider.
45 5. The agency shall conduct, or contract for, systematic
46 and continuous testing of the provider network databases
47 maintained by each plan to confirm accuracy, confirm that
48 behavioral health providers are accepting enrollees, and confirm
49 that enrollees have access to behavioral health services.
50 6.2. Each managed care plan must publish any prescribed
51 drug formulary or preferred drug list on the plan’s website in a
52 manner that is accessible to and searchable by enrollees and
53 providers. The plan must update the list within 24 hours after
54 making a change. Each plan must ensure that the prior
55 authorization process for prescribed drugs is readily accessible
56 to health care providers, including posting appropriate contact
57 information on its website and providing timely responses to
58 providers. For Medicaid recipients diagnosed with hemophilia who
59 have been prescribed anti-hemophilic-factor replacement
60 products, the agency shall provide for those products and
61 hemophilia overlay services through the agency’s hemophilia
62 disease management program.
63 7.3. Managed care plans, and their fiscal agents or
64 intermediaries, must accept prior authorization requests for any
65 service electronically.
66 8.4. Managed care plans serving children in the care and
67 custody of the Department of Children and Families must maintain
68 complete medical, dental, and behavioral health encounter
69 information and participate in making such information available
70 to the department or the applicable contracted community-based
71 care lead agency for use in providing comprehensive and
72 coordinated case management. The agency and the department shall
73 establish an interagency agreement to provide guidance for the
74 format, confidentiality, recipient, scope, and method of
75 information to be made available and the deadlines for
76 submission of the data. The scope of information available to
77 the department shall be the data that managed care plans are
78 required to submit to the agency. The agency shall determine the
79 plan’s compliance with standards for access to medical, dental,
80 and behavioral health services; the use of medications; and
81 follow-up followup on all medically necessary services
82 recommended as a result of early and periodic screening,
83 diagnosis, and treatment.
84 Section 2. This act shall take effect July 1, 2025.
85
86 ================= T I T L E A M E N D M E N T ================
87 And the title is amended as follows:
88 Delete everything before the enacting clause
89 and insert:
90 A bill to be entitled
91 An act relating to Medicaid providers; amending s.
92 409.967, F.S.; requiring the Agency for Health Care
93 Administration to include specified requirements in
94 its contracts with Medicaid managed care plans;
95 defining the term “outside regular business hours”;
96 providing an effective date.