Florida Senate - 2025                        COMMITTEE AMENDMENT
       Bill No. SB 306
       
       
       
       
       
       
                                Ì931448;Î931448                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/01/2025           .                                
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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.