Florida 2022 Regular Session

Florida House Bill H1165 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 1165 2022
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1165-00
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10	10	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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14	14	A bill to be entitled 1
15	15	An act relating to Medicaid managed care; amending s. 2
16	16	409.908, F.S.; requiring that the rental and purchase 3
17	17	of durable medical equipment and complex 4
18	18	rehabilitation technology be reimbursed by the Agency 5
19	19	for Health Care Administration, managed care plans, 6
20	20	and subcontractors at a specified amount; amending s. 7
21	21	409.967, F.S.; requiring that Medicaid enrollees be 8
22	22	allowed their choice of certain qualified Me dicaid 9
23	23	providers; requiring the agency to adopt rules; 10
24	24	prohibiting a managed care plan from referring its 11
25	25	members to, or entering into a contract or an 12
26	26	arrangement to provide services with, a subcontractor 13
27	27	under certain circumstances; requiring that a 14
28	28	subcontractor of a managed care plan provide all 15
29	29	services in compliance with such contract or 16
30	30	arrangement and applicable federal waivers; 17
31	31	prohibiting a managed care plan from referring its 18
32	32	members to a subcontractor for covered services if the 19
33	33	subcontractor has an ownership interest or a profit -20
34	34	sharing arrangement with certain entities; providing 21
35	35	an effective date. 22
36	36	23
37	37	Be It Enacted by the Legislature of the State of Florida: 24
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40	40	HB 1165 2022
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45	45	hb1165-00
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47	47	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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51	51	Section 1. Subsection (9) of section 409.908, Florida 26
52	52	Statutes, is amended to re ad: 27
53	53	409.908 Reimbursement of Medicaid providers. —Subject to 28
54	54	specific appropriations, the agency shall reimburse Medicaid 29
55	55	providers, in accordance with state and federal law, according 30
56	56	to methodologies set forth in the rules of the agency and in 31
57	57	policy manuals and handbooks incorporated by reference therein. 32
58	58	These methodologies may include fee schedules, reimbursement 33
59	59	methods based on cost reporting, negotiated fees, competitive 34
60	60	bidding pursuant to s. 287.057, and other mechanisms the agency 35
61	61	considers efficient and effective for purchasing services or 36
62	62	goods on behalf of recipients. If a provider is reimbursed based 37
63	63	on cost reporting and submits a cost report late and that cost 38
64	64	report would have been used to set a lower reimbursement rate 39
65	65	for a rate semester, then the provider's rate for that semester 40
66	66	shall be retroactively calculated using the new cost report, and 41
67	67	full payment at the recalculated rate shall be effected 42
68	68	retroactively. Medicare -granted extensions for filing cost 43
69	69	reports, if applicable, shall a lso apply to Medicaid cost 44
70	70	reports. Payment for Medicaid compensable services made on 45
71	71	behalf of Medicaid-eligible persons is subject to the 46
72	72	availability of moneys and any limitations or directions 47
73	73	provided for in the General Appropriations Act or chapter 2 16. 48
74	74	Further, nothing in this section shall be construed to prevent 49
75	75	or limit the agency from adjusting fees, reimbursement rates, 50
76	76
77	77	HB 1165 2022
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81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb1165-00
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84	84	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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88	88	lengths of stay, number of visits, or number of services, or 51
89	89	making any other adjustments necessary to comply with the 52
90	90	availability of moneys and any limitations or directions 53
91	91	provided for in the General Appropriations Act, provided the 54
92	92	adjustment is consistent with legislative intent. 55
93	93	(9) A provider of home health care services or of medical 56
94	94	supplies and appliances must shall be reimbursed on the basis of 57
95	95	competitive bidding or for the lesser of the amount billed by 58
96	96	the provider or the agency's established maximum allowable 59
97	97	amount, except that, in the case of the rental or purchase of 60
98	98	durable medical equipment and complex rehabilitation technology, 61
99	99	the provider must be reimbursed by the agency, managed care 62
100	100	plans, and any subcontractors at an amount equal to 100 percent 63
101	101	of the total rental payments may not exceed the purchase price 64
102	102	of the equipment over its expected useful life o r the agency's 65
103	103	established maximum allowable amount , whichever amount is less . 66
104	104	Section 2. Paragraph (c) of subsection (2) of section 67
105	105	409.967, Florida Statutes, is amended, and paragraph (p) is 68
106	106	added to that subsection, to read: 69
107	107	409.967 Managed care p lan accountability.— 70
108	108	(2) The agency shall establish such contract requirements 71
109	109	as are necessary for the operation of the statewide managed care 72
110	110	program. In addition to any other provisions the agency may deem 73
111	111	necessary, the contract must require: 74
112	112	(c) Access.— 75
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121	121	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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125	125	1. The agency shall establish specific standards for the 76
126	126	number, type, and regional distribution of providers in managed 77
127	127	care plan networks to ensure access to care for both adults and 78
128	128	children. Each plan must maintain a regionwide network of 79
129	129	providers in sufficient numbers to meet the access standards for 80
130	130	specific medical services for all recipients enrolled in the 81
131	131	plan. The exclusive use of mail -order pharmacies may not be 82
132	132	sufficient to meet network access standards. Consistent with the 83
133	133	standards established by the agency, provider networks may 84
134	134	include providers located outside the region. A plan may 85
135	135	contract with a new hospital facility before the date the 86
136	136	hospital becomes operational if the hospital has commenced 87
137	137	construction, will be licensed and operational by January 1, 88
138	138	2013, and a final order has issued in any civil or 89
139	139	administrative challenge. Each plan shall establish and maintain 90
140	140	an accurate and complete electronic database of contracted 91
141	141	providers, including information about licensure or 92
142	142	registration, locations and hours of operation, specialty 93
143	143	credentials and other certifications, specific performance 94
144	144	indicators, and such other information as the agency deems 95
145	145	necessary. The database must be available online to both the 96
146	146	agency and the public and have the capability to compare the 97
147	147	availability of providers to network adequacy standards and to 98
148	148	accept and display feedback from each provider's patients. Each 99
149	149	plan shall submit quarterly reports to the agency identifying 100
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158	158	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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162	162	the number of enrollees assigned to each primary care provider. 101
163	163	The agency shall conduct, or contract for, systematic and 102
164	164	continuous testing of the provider network databases maintained 103
165	165	by each plan to confirm accuracy, confirm that behavioral health 104
166	166	providers are accepting enrol lees, and confirm that enrollees 105
167	167	have access to behavioral health services. 106
168	168	2. Each managed care plan must publish any prescribed drug 107
169	169	formulary or preferred drug list on the plan's website in a 108
170	170	manner that is accessible to and searchable by enrollees an d 109
171	171	providers. The plan must update the list within 24 hours after 110
172	172	making a change. Each plan must ensure that the prior 111
173	173	authorization process for prescribed drugs is readily accessible 112
174	174	to health care providers, including posting appropriate contact 113
175	175	information on its website and providing timely responses to 114
176	176	providers. For Medicaid recipients diagnosed with hemophilia who 115
177	177	have been prescribed anti -hemophilic-factor replacement 116
178	178	products, the agency shall provide for those products and 117
179	179	hemophilia overlay servi ces through the agency's hemophilia 118
180	180	disease management program. 119
181	181	3. Managed care plans, and their fiscal agents or 120
182	182	intermediaries, must accept prior authorization requests for any 121
183	183	service electronically. 122
184	184	4. Managed care plans serving children in the car e and 123
185	185	custody of the Department of Children and Families must maintain 124
186	186	complete medical, dental, and behavioral health encounter 125
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188	188	HB 1165 2022
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195	195	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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199	199	information and participate in making such information available 126
200	200	to the department or the applicable contracted community -based 127
201	201	care lead agency for use in providing comprehensive and 128
202	202	coordinated case management. The agency and the department shall 129
203	203	establish an interagency agreement to provide guidance for the 130
204	204	format, confidentiality, recipient, scope, and method of 131
205	205	information to be made available and the deadlines for 132
206	206	submission of the data. The scope of information available to 133
207	207	the department shall be the data that managed care plans are 134
208	208	required to submit to the agency. The agency shall determine the 135
209	209	plan's compliance with stan dards for access to medical, dental, 136
210	210	and behavioral health services; the use of medications; and 137
211	211	follow up followup on all medically necessary services 138
212	212	recommended as a result of early and periodic screening, 139
213	213	diagnosis, and treatment. 140
214	214	5. Notwithstanding any other law, Medicaid enrollees, 141
215	215	including those enrolled in Medicaid managed care plans, must be 142
216	216	allowed their choice of any qualified Medicaid durable medical 143
217	217	equipment or complex rehabilitation technology provider. The 144
218	218	agency shall adopt rules to impl ement this subparagraph. 145
219	219	(p) Subcontractors.—A managed care plan may not refer its 146
220	220	members to or enter into a contract or an arrangement with a 147
221	221	subcontractor to provide services if the managed care plan or 148
222	222	the principal of the managed care plan has a com mon ownership 149
223	223	interest. A subcontractor of a managed care plan shall provide 150
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232	232	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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236	236	all services in compliance with the contract or arrangement and 151
237	237	the applicable federal waivers as reasonably necessary to 152
238	238	achieve the purpose for which such services are to be pro vided. 153
239	239	A managed care plan may not refer its members to a subcontractor 154
240	240	for covered services if the subcontractor has an ownership 155
241	241	interest or a profit -sharing arrangement with a provider, 156
242	242	another subcontractor, a third -party administrator, or a third -157
243	243	party entity. 158
244	244	Section 3. This act shall take effect July 1, 2022. 159