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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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An act relating to managed care plan performance; 2
amending s. 409.967, F.S.; requiring managed care 3
plans to collect and report specified measures 4
beginning with a certain data reporting period; 5
requiring plans to stratify reported measures by 6
specified categories beginning with a certain data 7
reporting period; requiring a plan's performance to be 8
published on its website in a specified manner; 9
requiring the Agency for Health Care Administration to 10
use the measures to monitor plan performance; 11
providing an effective date. 12
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Be It Enacted by the Legislature of the State of Florida: 14
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Section 1. Paragraph (f) of subsection (2) of section 16
409.967, Florida Statutes, is 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
(f) Continuous improvement. —The agency shall establish 23
specific performance standards and expected milestones or 24
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
timelines for improving performance over the term of the 25
contract. 26
1. Each managed care plan shall establish an internal 27
health care quality improvement system, including enrollee 28
satisfaction and disenrollment surveys. The quality improvement 29
system must include incentives and disincentives for network 30
providers. 31
2. Each managed care plan must collect and report the 32
Healthcare Effectiveness Health Plan Employer Data and 33
Information Set (HEDIS) measures , the federal Core Set of 34
Children's Health Care Quality measures, and the federal Core 35
Set of Adult Health Care Quality Measures , as specified by the 36
agency. Each plan must collect and report the Adult Core Set 37
behavioral health measures beginning with data reports for the 38
2025 calendar year. Each plan must stratify reported measures by 39
age, sex, race, ethnicity, primary language, and whet her the 40
enrollee received a Social Security Administration determination 41
of disability for purposes of Supplemental Security Income 42
beginning with data reports for the 2026 calendar year . A plan's 43
performance on these measures must be published on the plan 's 44
website in a manner that allows recipients to reliably compare 45
the performance of plans. The agency shall use the HEDIS 46
measures as a tool to monitor plan performance. 47
3. Each managed care plan must be accredited by the 48
National Committee for Quality Assurance, the Joint Commission, 49
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
or another nationally recognized accrediting body, or have 50
initiated the accreditation process, within 1 year after the 51
contract is executed. For any plan not accredited within 18 52
months after executing the contract, the ag ency shall suspend 53
automatic assignment under ss. 409.977 and 409.984 s. 409.977 54
and 409.984. 55
4. By the end of the fourth year of the first contract 56
term, the agency shall issue a request for information to 57
determine whether cost savings could be achieve d by contracting 58
for plan oversight and monitoring, including analysis of 59
encounter data, assessment of performance measures, and 60
compliance with other contractual requirements. 61
Section 2. This act shall take effect July 1, 2022. 62