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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
A bill to be entitled 1
An act relating to Medicaid managed care; amending s. 2
409.908, F.S.; requiring the Agency for Health Care 3
Administration to determine compliance with essential 4
provider contracting requirements; requiring the 5
agency to withhold supplemental payments under certain 6
circumstances; requiring the agency to identify 7
certain essential providers by the end of each fiscal 8
year; requiring certain providers and managed care 9
plans to mediate network contracts and jointly notify 10
the agency of mediation commencement by a specified 11
date; specifying requirements for mediation; 12
specifying the content of a written postmediation 13
report and requiring that such report be submitted to 14
the agency by a specified date; requiring the agency 15
to publish all postmediation reports on its website; 16
amending s. 409.912, F.S.; requiring the reimbursement 17
of certain provider service networks on a prepaid 18
basis; removing obsolete language related to provider 19
service network reimbursement; repealing s. 409.9124, 20
F.S., relating to managed care re imbursement; amending 21
s. 409.964, F.S.; removing obsolete language related 22
to requiring the agency to provide public notice 23
before seeking a Medicaid waiver; amending s. 409.966, 24
F.S.; revising a provision related to a requirement 25
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that the agency include c ertain information in a 26
utilization and spending databook; requiring the 27
agency to conduct a single, statewide procurement and 28
negotiate and select plans on a regional basis; 29
authorizing the agency to select plans on a statewide 30
basis under certain circums tances; specifying the 31
procurement regions; removing obsolete language 32
related to prepaid rates and an additional procurement 33
award; making conforming changes; amending s. 409.967, 34
F.S.; removing obsolete language related to certain 35
hospital contracts; req uiring the agency to test 36
provider network databases to confirm that enrollees 37
have timely access to all covered benefits; removing 38
obsolete language related to a request for 39
information; authorizing plans to reduce an achieved 40
savings rebate under certain circumstances; 41
classifying certain expenditures as medical expenses; 42
amending s. 409.968, F.S.; removing obsolete language 43
related to provider service network reimbursement; 44
amending s. 409.973, F.S.; requiring healthy behaviors 45
programs to address tobacc o use and opioid abuse; 46
removing obsolete language related to primary care 47
appointments; requiring managed care plans to 48
establish certain programs to improve dental health 49
outcomes; requiring the agency to establish 50
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performance and outcome measures; requi ring the agency 51
to annually review certain data and expenditures for 52
dental-related emergency department visits and 53
reconcile such expenditures against prepaid dental 54
plan capitation payments; requiring prepaid dental 55
plans and nondental managed care plans to enter into a 56
mutual coordination of benefits agreement for 57
specified purposes by a specified date; requiring 58
prepaid dental plans and nondental managed care plans 59
to meet quarterly for certain purposes beginning on a 60
specified date; specifying the part ies' obligations 61
for such meetings; requiring the agency to establish 62
provider network requirements for dental plans, 63
including prepaid dental plan provider network 64
requirements regarding sedation dentistry services; 65
requiring sanctions under certain circu mstances; 66
requiring the agency to assess plan compliance at 67
least quarterly and enforce network adequacy 68
requirements in a timely manner; amending s. 409.974, 69
F.S.; establishing numbers of regional contract awards 70
in the Medicaid managed medical assistance program; 71
amending s. 409.975, F.S.; providing that regional 72
perinatal intensive care centers are regional 73
resources and essential providers for managed care 74
plans; requiring managed care plans to contract with 75
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such centers; requiring the agency to assess plan 76
compliance with certain requirements at least 77
quarterly; requiring the agency to impose contract 78
enforcement financial sanctions on or assess contract 79
damages against certain plans by a specified date 80
annually; removing regional perinatal intensive ca re 81
centers from, and including certain cancer hospitals 82
in, the list of statewide essential providers; 83
providing a payment rate for certain cancer hospitals 84
without network contracts; amending s. 409.977, F.S.; 85
prohibiting the agency from automatically enr olling 86
recipients in managed care plans under certain 87
circumstances; removing obsolete language related to 88
automatic enrollment and certain federal approvals; 89
providing that children receiving guardianship 90
assistance payments are eligible for a specialty p lan; 91
requiring the agency to amend existing contracts under 92
the Statewide Medicaid Managed Care program to 93
implement specified provisions of the act; requiring 94
the agency to implement specified provisions of the 95
act for the 2025 plan year; amending s. 409. 981, F.S.; 96
specifying the number of regional contract awards in 97
the long-term care managed care plan; making a 98
conforming change; amending ss. 409.8132 and 409.906, 99
F.S.; conforming cross -references; providing an 100
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effective date. 101
102
Be It Enacted by the L egislature of the State of Florida: 103
104
Section 1. Subsection (26) of section 409.908, Florida 105
Statutes, is amended to read: 106
409.908 Reimbursement of Medicaid providers. —Subject to 107
specific appropriations, the agency shall reimburse Medicaid 108
providers, in accordance with state and federal law, according 109
to methodologies set forth in the rules of the agency and in 110
policy manuals and handbooks incorporated by reference therein. 111
These methodologies may include fee schedules, reimbursement 112
methods based on cost reporting, negotiated fees, competitive 113
bidding pursuant to s. 287.057, and other mechanisms the agency 114
considers efficient and effective for purchasing services or 115
goods on behalf of recipients. If a provider is reimbursed based 116
on cost reporting and submits a cost report late and that cost 117
report would have been used to set a lower reimbursement rate 118
for a rate semester, then the provider's rate for that semester 119
shall be retroactively calculated using the new cost report, and 120
full payment at the reca lculated rate shall be effected 121
retroactively. Medicare -granted extensions for filing cost 122
reports, if applicable, shall also apply to Medicaid cost 123
reports. Payment for Medicaid compensable services made on 124
behalf of Medicaid-eligible persons is subject t o the 125
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availability of moneys and any limitations or directions 126
provided for in the General Appropriations Act or chapter 216. 127
Further, nothing in this section shall be construed to prevent 128
or limit the agency from adjusting fees, reimbursement rates, 129
lengths of stay, number of visits, or number of services, or 130
making any other adjustments necessary to comply with the 131
availability of moneys and any limitations or directions 132
provided for in the General Appropriations Act, provided the 133
adjustment is consistent with legislative intent. 134
(26) The agency may receive funds from state entities, 135
including, but not limited to, the Department of Health, local 136
governments, and other local political subdivisions, for the 137
purpose of making special exception payments and Low Income Pool 138
Program payments, including federal matching funds. Funds 139
received for this purpose shall be separately accounted for and 140
may not be commingled with other state or local funds in any 141
manner. The agency may certify all local governmental fun ds used 142
as state match under Title XIX of the Social Security Act to the 143
extent and in the manner authorized under the General 144
Appropriations Act and pursuant to an agreement between the 145
agency and the local governmental entity. In order for the 146
agency to certify such local governmental funds, a local 147
governmental entity must submit a final, executed letter of 148
agreement to the agency, which must be received by October 1 of 149
each fiscal year and provide the total amount of local 150
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governmental funds authorized by the entity for that fiscal year 151
under the General Appropriations Act. The local governmental 152
entity shall use a certification form prescribed by the agency. 153
At a minimum, the certification form must identify the amount 154
being certified and describe the r elationship between the 155
certifying local governmental entity and the local health care 156
provider. Local governmental funds outlined in the letters of 157
agreement must be received by the agency no later than October 158
31 of each fiscal year in which such funds a re pledged, unless 159
an alternative plan is specifically approved by the agency. To 160
be eligible for low-income pool funding or other forms of 161
supplemental payments funded by intergovernmental transfers, and 162
in addition to any other applicable requirements, e ssential 163
providers identified in s. 409.975(1)(a) s. 409.975(1)(a)2. must 164
have a network offer to contract with each managed care plan in 165
their region and essential providers identified in s. 166
409.975(1)(b) s. 409.975(1)(b)1. and 3. must have a network 167
offer to contract with each managed care plan in the state. 168
Before releasing such supplemental payments, in the event the 169
parties have not executed network contracts, the agency shall 170
determine whether such contracts are in place and evaluate the 171
parties' efforts to complete negotiations. If such efforts 172
continue to fail, the agency must withhold such supplemental 173
payments beginning no later than January 1 of each fiscal year 174
for essential providers without such contracts in place. By the 175
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end of each fiscal yea r, the agency shall identify essential 176
providers who have not executed required network contracts with 177
the applicable managed care plans for the next fiscal year. By 178
July 30, such providers and plans must enter into mediation and 179
jointly notify the agency of mediation commencement. Selection 180
of a mediator must be by mutual agreement of the plan and 181
provider, or, if they cannot agree, by the agency from a list of 182
at least four mediators submitted by the parties. The costs of 183
the mediation shall be borne equa lly by the parties. The 184
mediation must be completed before September 30. On or before 185
October 1, the mediator must submit a written postmediation 186
report to the agency, including the outcome of the mediation 187
and, if mediation resulted in an impasse, conclus ions and 188
recommendations as to the cause of the impasse, the party most 189
responsible for the impasse, and whether the mediator believes 190
that either party negotiated in bad faith. If the mediator 191
recommends to the agency that a party or both parties negotiat ed 192
in bad faith, the postmediation report must state the basis for 193
such recommendation, cite all relevant information forming the 194
basis of the recommendation, and attach any relevant 195
documentation. The agency must promptly publish all 196
postmediation reports on its website in the third quarter of the 197
fiscal year if it determines that, based upon the totality of 198
the circumstances, the essential provider has negotiated with 199
the managed care plan in bad faith. If the agency determines 200
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that an essential provider has negotiated in bad faith, it must 201
notify the essential provider at least 90 days in advance of the 202
start of the third quarter of the fiscal year and afford the 203
essential provider hearing rights in accordance with chapter 204
120. 205
Section 2. Subsection ( 1) of section 409.912, Florida 206
Statutes, is amended to read: 207
409.912 Cost-effective purchasing of health care. —The 208
agency shall purchase goods and services for Medicaid recipients 209
in the most cost-effective manner consistent with the delivery 210
of quality medical care. To ensure that medical services are 211
effectively utilized, the agency may, in any case, require a 212
confirmation or second physician's opinion of the correct 213
diagnosis for purposes of authorizing future services under the 214
Medicaid program. This section does not restrict access to 215
emergency services or poststabilization care services as defined 216
in 42 C.F.R. s. 438.114. Such confirmation or second opinion 217
shall be rendered in a manner approved by the agency. The agency 218
shall maximize the use of pre paid per capita and prepaid 219
aggregate fixed-sum basis services when appropriate and other 220
alternative service delivery and reimbursement methodologies, 221
including competitive bidding pursuant to s. 287.057, designed 222
to facilitate the cost -effective purchase of a case-managed 223
continuum of care. The agency shall also require providers to 224
minimize the exposure of recipients to the need for acute 225
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inpatient, custodial, and other institutional care and the 226
inappropriate or unnecessary use of high -cost services. The 227
agency shall contract with a vendor to monitor and evaluate the 228
clinical practice patterns of providers in order to identify 229
trends that are outside the normal practice patterns of a 230
provider's professional peers or the national guidelines of a 231
provider's professional association. The vendor must be able to 232
provide information and counseling to a provider whose practice 233
patterns are outside the norms, in consultation with the agency, 234
to improve patient care and reduce inappropriate utilization. 235
The agency may mandate prior authorization, drug therapy 236
management, or disease management participation for certain 237
populations of Medicaid beneficiaries, certain drug classes, or 238
particular drugs to prevent fraud, abuse, overuse, and possible 239
dangerous drug intera ctions. The Pharmaceutical and Therapeutics 240
Committee shall make recommendations to the agency on drugs for 241
which prior authorization is required. The agency shall inform 242
the Pharmaceutical and Therapeutics Committee of its decisions 243
regarding drugs subjec t to prior authorization. The agency is 244
authorized to limit the entities it contracts with or enrolls as 245
Medicaid providers by developing a provider network through 246
provider credentialing. The agency may competitively bid single -247
source-provider contracts i f procurement of goods or services 248
results in demonstrated cost savings to the state without 249
limiting access to care. The agency may limit its network based 250
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on the assessment of beneficiary access to care, provider 251
availability, provider quality standards, time and distance 252
standards for access to care, the cultural competence of the 253
provider network, demographic characteristics of Medicaid 254
beneficiaries, practice and provider -to-beneficiary standards, 255
appointment wait times, beneficiary use of services, pr ovider 256
turnover, provider profiling, provider licensure history, 257
previous program integrity investigations and findings, peer 258
review, provider Medicaid policy and billing compliance records, 259
clinical and medical record audits, and other factors. Providers 260
are not entitled to enrollment in the Medicaid provider network. 261
The agency shall determine instances in which allowing Medicaid 262
beneficiaries to purchase durable medical equipment and other 263
goods is less expensive to the Medicaid program than long -term 264
rental of the equipment or goods. The agency may establish rules 265
to facilitate purchases in lieu of long -term rentals in order to 266
protect against fraud and abuse in the Medicaid program as 267
defined in s. 409.913. The agency may seek federal waivers 268
necessary to administer these policies. 269
(1) The agency may contract with a provider service 270
network, which must may be reimbursed on a fee-for-service or 271
prepaid basis. Prepaid provider service networks shall receive 272
per-member, per-month payments. A provider service network that 273
does not choose to be a prepaid plan shall receive fee -for-274
service rates with a shared savings settlement. The fee -for-275
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service option shall be available to a provider service network 276
only for the first 2 years of the plan's operation or un til the 277
contract year beginning September 1, 2014, whichever is later. 278
The agency shall annually conduct cost reconciliations to 279
determine the amount of cost savings achieved by fee -for-service 280
provider service networks for the dates of service in the peri od 281
being reconciled. Only payments for covered services for dates 282
of service within the reconciliation period and paid within 6 283
months after the last date of service in the reconciliation 284
period shall be included. The agency shall perform the necessary 285
adjustments for the inclusion of claims incurred but not 286
reported within the reconciliation for claims that could be 287
received and paid by the agency after the 6 -month claims 288
processing time lag. The agency shall provide the results of the 289
reconciliations to t he fee-for-service provider service networks 290
within 45 days after the end of the reconciliation period. The 291
fee-for-service provider service networks shall review and 292
provide written comments or a letter of concurrence to the 293
agency within 45 days after re ceipt of the reconciliation 294
results. This reconciliation shall be considered final. 295
(a) A provider service network which is reimbursed by the 296
agency on a prepaid basis shall be exempt from parts I and III 297
of chapter 641 but must comply with the solvency requirements in 298
s. 641.2261(2) and meet appropriate financial reserve, quality 299
assurance, and patient rights requirements as established by the 300
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agency. 301
(b) A provider service network is a network established or 302
organized and operated by a health care pro vider, or group of 303
affiliated health care providers, which provides a substantial 304
proportion of the health care items and services under a 305
contract directly through the provider or affiliated group of 306
providers and may make arrangements with physicians or other 307
health care professionals, health care institutions, or any 308
combination of such individuals or institutions to assume all or 309
part of the financial risk on a prospective basis for the 310
provision of basic health services by the physicians, by other 311
health professionals, or through the institutions. The health 312
care providers must have a controlling interest in the governing 313
body of the provider service network organization. 314
Section 3. Section 409.9124, Florida Statutes, is 315
repealed. 316
Section 4. Section 409.964, Florida Statutes, is amended 317
to read: 318
409.964 Managed care program; state plan; waivers. —The 319
Medicaid program is established as a statewide, integrated 320
managed care program for all covered services, including long -321
term care services. The ag ency shall apply for and implement 322
state plan amendments or waivers of applicable federal laws and 323
regulations necessary to implement the program. Before seeking a 324
waiver, the agency shall provide public notice and the 325
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opportunity for public comment and in clude public feedback in 326
the waiver application. The agency shall hold one public meeting 327
in each of the regions described in s. 409.966(2), and the time 328
period for public comment for each region shall end no sooner 329
than 30 days after the completion of the public meeting in that 330
region. 331
Section 5. Paragraph (f) of subsection (3) of section 332
409.966, Florida Statutes, is redesignated as paragraph (d), and 333
subsection (2), present paragraphs (a), (d), and (e) of 334
subsection (3), and subsection (4) of that section are amended 335
to read: 336
409.966 Eligible plans; selection. — 337
(2) ELIGIBLE PLAN SELECTION. —The agency shall select a 338
limited number of eligible plans to participate in the Medicaid 339
program using invitations to negotiate in accordance with s. 340
287.057(1)(c). At least 90 days before issuing an invitation to 341
negotiate, the agency shall compile and publish a databook 342
consisting of a comprehensive set of utilization and spending 343
data consistent with actuarial rate -setting practices and 344
standards for at least the most recent 24 months 3 most recent 345
contract years consistent with the rate -setting periods for all 346
Medicaid recipients by region or county. The source of the data 347
in the report must include both historic fee-for-service claims 348
and validated data from the Medicaid Encounter Data System. The 349
report must be available in electronic form and delineate 350
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utilization use by age, gender, eligibility group, geographic 351
area, and aggregate clinical risk score. The agency shall 352
conduct a single, statewide procure ment, shall negotiate and 353
select plans on a regional basis, and may select plans on a 354
statewide basis if deemed the best value for the state and 355
Medicaid recipients. Plan selection separate and simultaneous 356
procurements shall be conducted in each of the fo llowing 357
regions: 358
(a) Region A, which consists of Bay, Calhoun, Escambia, 359
Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, 360
Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, 361
and Washington Counties. 362
(b) Region B, which consists o f Alachua, Baker, Bradford, 363
Citrus, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, 364
Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Nassau, 365
Putnam, St. Johns, Sumter, Suwannee, Union, and Volusia 366
Counties. 367
(c) Region C, which consists of Hardee, Hig hlands, 368
Hillsborough, Manatee, Pasco, Pinellas, and Polk Counties. 369
(d) Region D, which consists of Brevard, Orange, Osceola, 370
and Seminole Counties. 371
(e) Region E, which consists of Charlotte, Collier, 372
DeSoto, Glades, Hendry, Lee, and Sarasota Counties. 373
(f) Region F, which consists of Indian River, Martin, 374
Okeechobee, Palm Beach, and St. Lucie Counties. 375
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(g) Region G, which consists of Broward County. 376
(h) Region H, which consists of Miami -Dade and Monroe 377
Counties. 378
(a) Region 1, which consists of Escambia, Okaloosa, Santa 379
Rosa, and Walton Counties. 380
(b) Region 2, which consists of Bay, Calhoun, Franklin, 381
Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, 382
Madison, Taylor, Wakulla, and Washington Counties. 383
(c) Region 3, which consists of Al achua, Bradford, Citrus, 384
Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, 385
Levy, Marion, Putnam, Sumter, Suwannee, and Union Counties. 386
(d) Region 4, which consists of Baker, Clay, Duval, 387
Flagler, Nassau, St. Johns, and Volusia Counties. 388
(e) Region 5, which consists of Pasco and Pinellas 389
Counties. 390
(f) Region 6, which consists of Hardee, Highlands, 391
Hillsborough, Manatee, and Polk Counties. 392
(g) Region 7, which consists of Brevard, Orange, Osceola, 393
and Seminole Counties. 394
(h) Region 8, which consists of Charlotte, Collier, 395
DeSoto, Glades, Hendry, Lee, and Sarasota Counties. 396
(i) Region 9, which consists of Indian River, Martin, 397
Okeechobee, Palm Beach, and St. Lucie Counties. 398
(j) Region 10, which consists of Broward County. 399
(k) Region 11, which consists of Miami -Dade and Monroe 400
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Counties. 401
(3) QUALITY SELECTION CRITERIA. — 402
(a) The invitation to negotiate must specify the criteria 403
and the relative weight of the criteria that will be used for 404
determining the acceptability of the reply a nd guiding the 405
selection of the organizations with which the agency negotiates. 406
In addition to criteria established by the agency, the agency 407
shall consider the following factors in the selection of 408
eligible plans: 409
1. Accreditation by the National Commit tee for Quality 410
Assurance, the Joint Commission, or another nationally 411
recognized accrediting body. 412
2. Experience serving similar populations, including the 413
organization's record in achieving specific quality standards 414
with similar populations. 415
3. Availability and accessibility of primary care and 416
specialty physicians in the provider network. 417
4. Establishment of community partnerships with providers 418
that create opportunities for reinvestment in community -based 419
services. 420
5. Organization commitment to quality improvement and 421
documentation of achievements in specific quality improvement 422
projects, including active involvement by organization 423
leadership. 424
6. Provision of additional benefits, particularly dental 425
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care and disease management, and other initiatives that improve 426
health outcomes. 427
7. Evidence that an eligible plan has obtained signed 428
contracts or written agreements or signed contracts or has made 429
substantial progress in establishing relationships with 430
providers before the plan submits submitting a response. 431
8. Comments submitted in writing by any enrolled Medicaid 432
provider relating to a specifically identified plan 433
participating in the procurement in the same region as the 434
submitting provider. 435
9. Documentation of policies and procedures for preventing 436
fraud and abuse. 437
10. The business relationship an eligible plan has with 438
any other eligible plan that responds to the invitation to 439
negotiate. 440
(d) For the first year of the first contract term, the 441
agency shall negotiate capitation rate s or fee for service 442
payments with each plan in order to guarantee aggregate savings 443
of at least 5 percent. 444
1. For prepaid plans, determination of the amount of 445
savings shall be calculated by comparison to the Medicaid rates 446
that the agency paid managed care plans for similar populations 447
in the same areas in the prior year. In regions containing no 448
prepaid plans in the prior year, determination of the amount of 449
savings shall be calculated by comparison to the Medicaid rates 450
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established and certified for t hose regions in the prior year. 451
2. For provider service networks operating on a fee -for-452
service basis, determination of the amount of savings shall be 453
calculated by comparison to the Medicaid rates that the agency 454
paid on a fee-for-service basis for the same services in the 455
prior year. 456
(e) To ensure managed care plan participation in Regions 1 457
and 2, the agency shall award an additional contract to each 458
plan with a contract award in Region 1 or Region 2. Such 459
contract shall be in any other region in whi ch the plan 460
submitted a responsive bid and negotiates a rate acceptable to 461
the agency. If a plan that is awarded an additional contract 462
pursuant to this paragraph is subject to penalties pursuant to 463
s. 409.967(2)(i) for activities in Region 1 or Region 2, the 464
additional contract is automatically terminated 180 days after 465
the imposition of the penalties. the plan must reimburse the 466
agency for the cost of enrollment changes and other transition 467
activities. 468
(4) ADMINISTRATIVE CHALLENGE. —Any eligible plan tha t 469
participates in an invitation to negotiate in more than one 470
region and is selected in at least one region may not begin 471
serving Medicaid recipients in any region for which it was 472
selected until all administrative challenges to procurements 473
required by this section to which the eligible plan is a party 474
have been finalized. If the number of plans selected is less 475
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than the maximum amount of plans permitted in the region, the 476
agency may contract with other selected plans in the region not 477
participating in the administrative challenge before resolution 478
of the administrative challenge. For purposes of this 479
subsection, an administrative challenge is finalized if an order 480
granting voluntary dismissal with prejudice has been entered by 481
any court established under A rticle V of the State Constitution 482
or by the Division of Administrative Hearings, a final order has 483
been entered into by the agency and the deadline for appeal has 484
expired, a final order has been entered by the First District 485
Court of Appeal and the time t o seek any available review by the 486
Florida Supreme Court has expired, or a final order has been 487
entered by the Florida Supreme Court and a warrant has been 488
issued. 489
Section 6. Paragraphs (c) and (f) of subsection (2) and 490
paragraph (b) of subsection (4) of section 409.967, Florida 491
Statutes, are amended, and paragraph (k) is added to subsection 492
(3) of that section, to read: 493
409.967 Managed care plan accountability. — 494
(2) The agency shall establish such contract requirements 495
as are necessary for the oper ation of the statewide managed care 496
program. In addition to any other provisions the agency may deem 497
necessary, the contract must require: 498
(c) Access.— 499
1. The agency shall establish specific standards for the 500
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number, type, and regional distribution of providers in managed 501
care plan networks to ensure access to care for both adults and 502
children. Each plan must maintain a regionwide network of 503
providers in sufficient numbers to meet the access standards for 504
specific medical services for all recipients enr olled in the 505
plan. The exclusive use of mail -order pharmacies may not be 506
sufficient to meet network access standards. Consistent with the 507
standards established by the agency, provider networks may 508
include providers located outside the region. A plan may 509
contract with a new hospital facility before the date the 510
hospital becomes operational if the hospital has commenced 511
construction, will be licensed and operational by January 1, 512
2013, and a final order has issued in any civil or 513
administrative challenge. Each plan shall establish and maintain 514
an accurate and complete electronic database of contracted 515
providers, including information about licensure or 516
registration, locations and hours of operation, specialty 517
credentials and other certifications, specific perf ormance 518
indicators, and such other information as the agency deems 519
necessary. The database must be available online to both the 520
agency and the public and have the capability to compare the 521
availability of providers to network adequacy standards and to 522
accept and display feedback from each provider's patients. Each 523
plan shall submit quarterly reports to the agency identifying 524
the number of enrollees assigned to each primary care provider. 525
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The agency shall conduct, or contract for, systematic and 526
continuous testing of the provider network databases maintained 527
by each plan to confirm accuracy, confirm that behavioral health 528
providers are accepting enrollees, and confirm that enrollees 529
have timely access to all covered benefits behavioral health 530
services. 531
2. Each managed care plan must publish any prescribed drug 532
formulary or preferred drug list on the plan's website in a 533
manner that is accessible to and searchable by enrollees and 534
providers. The plan must update the list within 24 hours after 535
making a change. Each plan must ensure that the prior 536
authorization process for prescribed drugs is readily accessible 537
to health care providers, including posting appropriate contact 538
information on its website and providing timely responses to 539
providers. For Medicaid recip ients diagnosed with hemophilia who 540
have been prescribed anti -hemophilic-factor replacement 541
products, the agency shall provide for those products and 542
hemophilia overlay services through the agency's hemophilia 543
disease management program. 544
3. Managed care plans, and their fiscal agents or 545
intermediaries, must accept prior authorization requests for any 546
service electronically. 547
4. Managed care plans serving children in the care and 548
custody of the Department of Children and Families must maintain 549
complete medical, dental, and behavioral health encounter 550
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information and participate in making such information available 551
to the department or the applicable contracted community -based 552
care lead agency for use in providing comprehensive and 553
coordinated case manageme nt. The agency and the department shall 554
establish an interagency agreement to provide guidance for the 555
format, confidentiality, recipient, scope, and method of 556
information to be made available and the deadlines for 557
submission of the data. The scope of info rmation available to 558
the department shall be the data that managed care plans are 559
required to submit to the agency. The agency shall determine the 560
plan's compliance with standards for access to medical, dental, 561
and behavioral health services; the use of me dications; and 562
followup on all medically necessary services recommended as a 563
result of early and periodic screening, diagnosis, and 564
treatment. 565
(f) Continuous improvement. —The agency shall establish 566
specific performance standards and expected milestones o r 567
timelines for improving performance over the term of the 568
contract. 569
1. Each managed care plan shall establish an internal 570
health care quality improvement system, including enrollee 571
satisfaction and disenrollment surveys. The quality improvement 572
system must include incentives and disincentives for network 573
providers. 574
2. Each plan must collect and report the Health Plan 575
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Employer Data and Information Set (HEDIS) measures, as specified 576
by the agency. These measures must be published on the plan's 577
website in a manner that allows recipients to reliably compare 578
the performance of plans. The agency shall use the HEDIS 579
measures as a tool to monitor plan performance. 580
3. Each managed care plan must be accredited by the 581
National Committee for Quality Assurance, th e Joint Commission, 582
or another nationally recognized accrediting body, or have 583
initiated the accreditation process, within 1 year after the 584
contract is executed. For any plan not accredited within 18 585
months after executing the contract, the agency shall su spend 586
automatic assignment under s. 409.977 and 409.984. 587
4. By the end of the fourth year of the first contract 588
term, the agency shall issue a request for information to 589
determine whether cost savings could be achieved by contracting 590
for plan oversight a nd monitoring, including analysis of 591
encounter data, assessment of performance measures, and 592
compliance with other contractual requirements. 593
(3) ACHIEVED SAVINGS REBATE. — 594
(k) Plans that contribute funds pursuant to paragraph 595
(4)(b) or paragraph (4)(c) may reduce the rebate owed by an 596
amount equal to the amount of the contribution. 597
(4) MEDICAL LOSS RATIO. —If required as a condition of a 598
waiver, the agency may calculate a medical loss ratio for 599
managed care plans. The calculation shall use uniform finan cial 600
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data collected from all plans and shall be computed for each 601
plan on a statewide basis. The method for calculating the 602
medical loss ratio shall meet the following criteria: 603
(b) Funds provided by plans to graduate medical education 604
institutions to underwrite the costs of residency positions in 605
graduate medical education programs, undergraduate and graduate 606
student positions in nursing education programs, or student 607
positions in any degree or technical program deemed a critical 608
shortage area by the age ncy shall be classified as medical 609
expenditures, provided that the funding is sufficient to sustain 610
the positions for the number of years necessary to complete the 611
program residency requirements and the residency or student 612
positions funded by the plans ar e actively involved in the 613
institution's provision active providers of care to Medicaid and 614
uninsured patients. 615
Section 7. Subsection (2) of section 409.968, Florida 616
Statutes, is amended to read: 617
409.968 Managed care plan payments. — 618
(2) Provider service networks may be prepaid plans and 619
receive per-member, per-month payments negotiated pursuant to 620
the procurement process described in s. 409.966. Provider 621
service networks that choose not to be prepaid plans shall 622
receive fee-for-service rates with a shared savings settlement. 623
The fee-for-service option shall be available to a provider 624
service network only for the first 2 years of its operation. The 625
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agency shall annually conduct cost reconciliations to determine 626
the amount of cost savin gs achieved by fee-for-service provider 627
service networks for the dates of service within the period 628
being reconciled. Only payments for covered services for dates 629
of service within the reconciliation period and paid within 6 630
months after the last date of s ervice in the reconciliation 631
period must be included. The agency shall perform the necessary 632
adjustments for the inclusion of claims incurred but not 633
reported within the reconciliation period for claims that could 634
be received and paid by the agency after t he 6-month claims 635
processing time lag. The agency shall provide the results of the 636
reconciliations to the fee -for-service provider service networks 637
within 45 days after the end of the reconciliation period. The 638
fee-for-service provider service networks sha ll review and 639
provide written comments or a letter of concurrence to the 640
agency within 45 days after receipt of the reconciliation 641
results. This reconciliation is considered final. 642
Section 8. Subsection (3) and paragraph (b) of subsection 643
(4) of section 409.973, Florida Statutes, are amended, and 644
paragraphs (c) through (g) are added to subsection (5) of that 645
section, to read: 646
409.973 Benefits.— 647
(3) HEALTHY BEHAVIORS. —Each plan operating in the managed 648
medical assistance program shall establish a pro gram to 649
encourage and reward healthy behaviors. At a minimum, each plan 650
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must establish a medically approved tobacco use smoking 651
cessation program, a medically directed weight loss program, and 652
a medically approved alcohol or substance abuse recovery 653
program, which shall include, at a minimum, a focus on opioid 654
abuse recovery. Each plan must identify enrollees who use 655
tobacco smoke, are morbidly obese, or are diagnosed with alcohol 656
or substance abuse in order to establish written agreements to 657
secure the enrollees' commitment to participation in these 658
programs. 659
(4) PRIMARY CARE INITIATIVE. —Each plan operating in the 660
managed medical assistance program shall establish a program to 661
encourage enrollees to establish a relationship with their 662
primary care provider. Each plan shall: 663
(b) If the enrollee was not a Medicaid recipient before 664
enrollment in the plan, assist the enrollee in scheduling an 665
appointment with the primary care provider. If possible the 666
appointment should be made within 30 days after enroll ment in 667
the plan. For enrollees who become eligible for Medicaid between 668
January 1, 2014, and December 31, 2015, the appointment should 669
be scheduled within 6 months after enrollment in the plan. 670
(5) PROVISION OF DENTAL SERVICES. — 671
(c) Given the effect o f oral health on overall health, 672
each prepaid dental plan shall establish a program to improve 673
dental health outcomes and increase utilization of preventive 674
dental services. The agency shall establish performance and 675
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outcome measures, regularly assess plan performance, and publish 676
data on such measures. Program components shall, at a minimum, 677
include: 678
1. An education program to inform enrollees of the 679
connection between oral health and overall health and preventive 680
steps to improve dental health. 681
2. An enrollee incentive program designed to increase 682
utilization of preventive dental services. 683
(d) The agency shall annually review encounter data and 684
claims expenditures in the Statewide Medicaid Managed Care 685
program for emergency department visits relating to nontraumatic 686
and ambulatory sensitive dental conditions and reconcile service 687
expenditures for these visits against capitation payments made 688
to the prepaid dental plans. 689
(e) By October 1, 2022, each prepaid dental plan and each 690
nondental managed care plan shall enter into a mutual 691
coordination of benefits agreement that includes data sharing 692
requirements and coordination protocols to support the provision 693
of dental services and reduction of potentially preventable 694
events. 695
(f) Beginning July 2022, ea ch prepaid dental plan and each 696
nondental managed care plan must meet quarterly to collaborate 697
on specific goals to improve quality of care and enrollee 698
health. Plans shall mutually establish, in writing, shared 699
goals, specific and measurable objectives, a nd complementary 700
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strategies pertinent to state Medicaid priorities. The goals, 701
objectives, and strategies must address improving access and 702
appropriate utilization, maximizing efficiency by integrating 703
health and dental care, improving patient experiences, attending 704
to unmet social needs that affect preventive care utilization 705
and early disease detection, and identifying and reducing 706
disparities. 707
(g) The agency shall establish provider network 708
requirements for dental plans. In addition, the agency must 709
establish provider network requirements sufficient to ensure 710
access to medically necessary sedation services, including, but 711
not limited to, network participation by dentists credentialed 712
to provide services in inpatient and outpatient settings and by 713
inpatient and outpatient facilities and anesthesia service 714
providers. The agency shall assess plan compliance with network 715
adequacy requirements at least quarterly and shall enforce such 716
requirements in a timely manner. 717
Section 9. Subsections (1) and (2) of section 409.974, 718
Florida Statutes, are amended to read: 719
409.974 Eligible plans. — 720
(1) ELIGIBLE PLAN SELECTION. —The agency shall select 721
eligible plans for the managed medical assistance program 722
through the procurement process described in s. 409.966. The 723
agency shall select at least one provider service network for 724
each region, if any submit a responsive bid. The agency shall 725
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procure the number of plans, inclusive of statewide plans, if 726
any, for each region as follows: 727
(a) At least three plans and up to four plans for Region 728
A. 729
(b) At least five plans and up to six plans for Region B. 730
(c) At least six plans and up to ten plans for Region C. 731
(d) At least five plans and up to six plans for Region D. 732
(e) At least three plans and up to four plans for Region 733
E. 734
(f) At least three plans and up to five plans for Region 735
F. 736
(g) At least three plans and up to five plans for Region 737
G. 738
(h) At least five plans and up to ten plans for Region H 739
The agency shall notice invitations to negotiate no later than 740
January 1, 2013. 741
(a) The agency shall procure two plans for Region 1. At 742
least one plan shall be a provider service network if any 743
provider service networks submit a responsive bid. 744
(b) The agency shall procure two plans for Region 2. At 745
least one plan shall be a provider service network if any 746
provider service networks submit a responsive bid. 747
(c) The agency shall procure at least three plans and up 748
to five plans for Region 3. At least one plan must be a provider 749
service network if any provider serv ice networks submit a 750
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responsive bid. 751
(d) The agency shall procure at least three plans and up 752
to five plans for Region 4. At least one plan must be a provider 753
service network if any provider service networks submit a 754
responsive bid. 755
(e) The agency shall procure at least two plans and up to 756
four plans for Region 5. At least one plan must be a provider 757
service network if any provider service networks submit a 758
responsive bid. 759
(f) The agency shall procure at least four plans and up to 760
seven plans for Region 6. At least one plan must be a provider 761
service network if any provider service networks submit a 762
responsive bid. 763
(g) The agency shall procure at least three plans and up 764
to six plans for Region 7. At least one plan must be a provider 765
service network if any provider service networks submit a 766
responsive bid. 767
(h) The agency shall procure at least two plans and up to 768
four plans for Region 8. At least one plan must be a provider 769
service network if any provider service networks submit a 770
responsive bid. 771
(i) The agency shall procure at least two plans and up to 772
four plans for Region 9. At least one plan must be a provider 773
service network if any provider service networks submit a 774
responsive bid. 775
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(j) The agency shall procure at least two plans and up t o 776
four plans for Region 10. At least one plan must be a provider 777
service network if any provider service networks submit a 778
responsive bid. 779
(k) The agency shall procure at least five plans and up to 780
10 plans for Region 11. At least one plan must be a prov ider 781
service network if any provider service networks submit a 782
responsive bid. 783
784
If no provider service network submits a responsive bid, the 785
agency shall procure no more than one less than the maximum 786
number of eligible plans permitted in that region. With in 12 787
months after the initial invitation to negotiate, the agency 788
shall attempt to procure a provider service network. The agency 789
shall notice another invitation to negotiate only with provider 790
service networks in those regions where no provider service 791
network has been selected. 792
(2) QUALITY SELECTION CRITERIA. —In addition to the 793
criteria established in s. 409.966, the agency shall consider 794
evidence that an eligible plan has obtained signed contracts or 795
written agreements or signed contracts or has made substantial 796
progress in establishing relationships with providers before the 797
plan submits submitting a response. The agency shall evaluate 798
and give special weight to evidence of signed contracts with 799
essential providers as defined by the agency pursuant to s. 800
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409.975(1). The agency shall exercise a preference for plans 801
with a provider network in which over 10 percent of the 802
providers use electronic health records, as defined in s. 803
408.051. When all other factors are equal, the agency shall 804
consider whether the organization has a contract to provide 805
managed long-term care services in the same region and shall 806
exercise a preference for such plans. 807
Section 10. Paragraphs (a) and (b) of subsection (1) of 808
section 409.975, Florida Statutes, are amended to read : 809
409.975 Managed care plan accountability. —In addition to 810
the requirements of s. 409.967, plans and providers 811
participating in the managed medical assistance program shall 812
comply with the requirements of this section. 813
(1) PROVIDER NETWORKS. —Managed care plans must develop and 814
maintain provider networks that meet the medical needs of their 815
enrollees in accordance with standards established pursuant to 816
s. 409.967(2)(c). Except as provided in this section, managed 817
care plans may limit the providers in the ir networks based on 818
credentials, quality indicators, and price. 819
(a) Plans must include all providers in the region that 820
are classified by the agency as essential Medicaid providers, 821
unless the agency approves, in writing, an alternative 822
arrangement for securing the types of services offered by the 823
essential providers. Providers are essential for serving 824
Medicaid enrollees if they offer services that are not available 825
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from any other provider within a reasonable access standard, or 826
if they provided a subst antial share of the total units of a 827
particular service used by Medicaid patients within the region 828
during the last 3 years and the combined capacity of other 829
service providers in the region is insufficient to meet the 830
total needs of the Medicaid patients. The agency may not 831
classify physicians and other practitioners as essential 832
providers. 833
1. The agency, at a minimum, shall determine which 834
providers in the following categories are essential Medicaid 835
providers: 836
a.1. Federally qualified health centers. 837
b.2. Statutory teaching hospitals as defined in s. 838
408.07(46). 839
c.3. Hospitals that are trauma centers as defined in s. 840
395.4001(15). 841
d.4. Hospitals located at least 25 miles from any other 842
hospital with similar services. 843
2. Regional perinatal intensive care centers as defined in 844
s. 383.16(2) are regional resources and essential providers for 845
all managed care plans in the applicable region. All managed 846
care plans in a region must have a network contract with each 847
regional perinatal intensive car e center in the region. 848
3. Managed care plans that have not contracted with all 849
essential providers in the region as of the first date of 850
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recipient enrollment, or with whom an essential provider has 851
terminated its contract, must negotiate in good faith w ith such 852
essential providers for 1 year or until an agreement is reached, 853
whichever is first. Payments for services rendered by a 854
nonparticipating essential provider shall be made at the 855
applicable Medicaid rate as of the first day of the contract 856
between the agency and the plan. A rate schedule for all 857
essential providers shall be attached to the contract between 858
the agency and the plan. After 1 year, managed care plans that 859
are unable to contract with essential providers shall notify the 860
agency and propose an alternative arrangement for securing the 861
essential services for Medicaid enrollees. The arrangement must 862
rely on contracts with other participating providers, regardless 863
of whether those providers are located within the same region as 864
the nonparticipating essential service provider. If the 865
alternative arrangement is approved by the agency, payments to 866
nonparticipating essential providers after the date of the 867
agency's approval shall equal 90 percent of the applicable 868
Medicaid rate. Except for payment f or emergency services, if the 869
alternative arrangement is not approved by the agency, payment 870
to nonparticipating essential providers shall equal 110 percent 871
of the applicable Medicaid rate. 872
873
The agency shall assess plan compliance with this paragraph at 874
least quarterly. No later than January 1 of each year, the 875
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agency must impose contract enforcement financial sanctions on, 876
or assess contract damages against, a plan without a network 877
contract as required by this subsection with an essential 878
provider subject to the requirements of s. 409.908(26). 879
(b) Certain providers are statewide resources and 880
essential providers for all managed care plans in all regions. 881
All managed care plans must include these essential providers in 882
their networks. 883
1. Statewide essential providers include: 884
a.1. Faculty plans of Florida medical schools. 885
2. Regional perinatal intensive care centers as defined in 886
s. 383.16(2). 887
b.3. Hospitals licensed as specialty children's hospitals 888
as defined in s. 395.002(28). 889
c. Florida cancer hospitals that meet the criteria in 42 890
U.S.C. s. 1395ww(d)(1)(B)(v). 891
4. Accredited and integrated systems serving medically 892
complex children which comprise separately licensed, but 893
commonly owned, health care providers delivering at least the 894
following services: medical group home, in -home and outpatient 895
nursing care and therapies, pharmacy services, durable medical 896
equipment, and Prescribed Pediatric Extended Care. 897
2. Managed care plans that have not contracted with all 898
statewide essential provi ders in all regions as of the first 899
date of recipient enrollment must continue to negotiate in good 900
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faith. Payments to physicians on the faculty of nonparticipating 901
Florida medical schools shall be made at the applicable Medicaid 902
rate. Payments for service s rendered by regional perinatal 903
intensive care centers shall be made at the applicable Medicaid 904
rate as of the first day of the contract between the agency and 905
the plan. Except for payments for emergency services, payments 906
to nonparticipating specialty ch ildren's hospitals and payments 907
to nonparticipating Florida cancer hospitals that meet the 908
criteria in 42 U.S.C. s. 1395ww(d)(1)(B)(v) shall equal the 909
highest rate established by contract between that provider and 910
any other Medicaid managed care plan. 911
912
The agency shall assess plan compliance with this paragraph at 913
least quarterly. No later than January 1 of each year, the 914
agency must impose contract enforcement financial sanctions on, 915
or assess contract damages against, a plan without a network 916
contract as required by this subsection with an essential 917
provider subject to the requirements of s. 409.908(26). 918
Section 11. Subsections (1), (4), and (5) of section 919
409.977, Florida Statutes, are amended to read: 920
409.977 Enrollment. — 921
(1) The agency shall aut omatically enroll into a managed 922
care plan those Medicaid recipients who do not voluntarily 923
choose a plan pursuant to s. 409.969. The agency shall 924
automatically enroll recipients in plans that meet or exceed the 925
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performance or quality standards established pursuant to s. 926
409.967 and may not automatically enroll recipients in a plan 927
that is deficient in those performance or quality standards. 928
When a specialty plan is available to accommodate a specific 929
condition or diagnosis of a recipient, the agency shall assign 930
the recipient to that plan. The agency may not automatically 931
enroll recipients in a managed medical assistance plan that has 932
more than 50 percent of the enrollees in the region. In the 933
first year of the first contract term only, if a recipient was 934
previously enrolled in a plan that is still available in the 935
region, the agency shall automatically enroll the recipient in 936
that plan unless an applicable specialty plan is available. 937
Except as otherwise provided in this part, the agency may not 938
engage in practices that are designed to favor one managed care 939
plan over another. 940
(4) The agency shall develop a process to enable a 941
recipient with access to employer -sponsored health care coverage 942
to opt out of all managed care plans and to use Medicaid 943
financial assistance to pay for the recipient's share of the 944
cost in such employer -sponsored coverage. Contingent upon 945
federal approval, The agency shall also enable recipients with 946
access to other insurance or related products providing access 947
to health care servi ces created pursuant to state law, including 948
any product available under the Florida Health Choices Program, 949
or any health exchange, to opt out. The amount of financial 950
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assistance provided for each recipient may not exceed the amount 951
of the Medicaid premiu m that would have been paid to a managed 952
care plan for that recipient. The agency shall seek federal 953
approval to require Medicaid recipients with access to employer -954
sponsored health care coverage to enroll in that coverage and 955
use Medicaid financial assist ance to pay for the recipient's 956
share of the cost for such coverage. The amount of financial 957
assistance provided for each recipient may not exceed the amount 958
of the Medicaid premium that would have been paid to a managed 959
care plan for that recipient. 960
(5) Specialty plans serving children in the care and 961
custody of the department may serve such children as long as 962
they remain in care, including those remaining in extended 963
foster care pursuant to s. 39.6251, or are in subsidized 964
adoption and continue to be e ligible for Medicaid pursuant to s. 965
409.903, or are receiving guardianship assistance payments and 966
continue to be eligible for Medicaid pursuant to s. 409.903 . 967
Section 12. The Agency for Health Care Administration must 968
amend existing contracts under th e Statewide Medicaid Managed 969
Care program to implement the amendments made by this act to ss. 970
409.908, 409.967, 409.973, 409.975, and 409.977, Florida 971
Statutes. The agency must implement the amendments made by this 972
act to ss. 409.966, 409.974, and 409.981, Florida Statutes, for 973
the 2025 plan year. 974
Section 13. Subsection (2) of section 409.981, Florida 975
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Statutes, is amended to read: 976
409.981 Eligible long -term care plans.— 977
(2) ELIGIBLE PLAN SELECTION. —The agency shall select 978
eligible plans for the long-term care managed care program 979
through the procurement process described in s. 409.966. The 980
agency shall select at least one provider service network for 981
each region, if any provider service network submits a 982
responsive bid. The agency shall procure the number of plans, 983
inclusive of statewide plans, if any, for each region as 984
follows: 985
(a) At least three plans and up to four plans for Region 986
A. 987
(b) At least three plans and up to six plans for Region B. 988
(c) At least five plans and up to ten plans for R egion C. 989
(d) At least three plans and up to six plans for Region D. 990
(e) At least three plans and up to four plans for Region 991
E. 992
(f) At least three plans and up to five plans for Region 993
F. 994
(g) At least three plans and up to four plans for Region 995
G. 996
(h) At least five plans and up to ten plans for Region H. 997
(a) Two plans for Region 1. At least one plan must be a 998
provider service network if any provider service networks submit 999
a responsive bid. 1000
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(b) Two plans for Region 2. At least one plan must be a 1001
provider service network if any provider service networks submit 1002
a responsive bid. 1003
(c) At least three plans and up to five plans for Region 1004
3. At least one plan must be a provider service network if any 1005
provider service networks submit a responsive bi d. 1006
(d) At least three plans and up to five plans for Region 1007
4. At least one plan must be a provider service network if any 1008
provider service network submits a responsive bid. 1009
(e) At least two plans and up to four plans for Region 5. 1010
At least one plan must be a provider service network if any 1011
provider service networks submit a responsive bid. 1012
(f) At least four plans and up to seven plans for Region 1013
6. At least one plan must be a provider service network if any 1014
provider service networks submit a respon sive bid. 1015
(g) At least three plans and up to six plans for Region 7. 1016
At least one plan must be a provider service network if any 1017
provider service networks submit a responsive bid. 1018
(h) At least two plans and up to four plans for Region 8. 1019
At least one plan must be a provider service network if any 1020
provider service networks submit a responsive bid. 1021
(i) At least two plans and up to four plans for Region 9. 1022
At least one plan must be a provider service network if any 1023
provider service networks submit a resp onsive bid. 1024
(j) At least two plans and up to four plans for Region 10. 1025
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At least one plan must be a provider service network if any 1026
provider service networks submit a responsive bid. 1027
(k) At least five plans and up to 10 plans for Region 11. 1028
At least one plan must be a provider service network if any 1029
provider service networks submit a responsive bid. 1030
1031
If no provider service network submits a responsive bid in a 1032
region other than Region A 1 or Region 2, the agency shall 1033
procure no more than one fewer less than the maximum number of 1034
eligible plans permitted in that region. Within 12 months after 1035
the initial invitation to negotiate, the agency shall attempt to 1036
procure a provider service network. The agency shall notice 1037
another invitation to negotiate only wi th provider service 1038
networks in regions where no provider service network has been 1039
selected. 1040
Section 14. Subsection (4) of section 409.8132, Florida 1041
Statutes, is amended to read: 1042
409.8132 Medikids program component. — 1043
(4) APPLICABILITY OF LAWS RELAT ING TO MEDICAID.—The 1044
provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908, 1045
409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127, 1046
409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205 apply 1047
to the administration of the Medikids program co mponent of the 1048
Florida Kidcare program, except that s. 409.9122 applies to 1049
Medikids as modified by the provisions of subsection (7). 1050
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Section 15. Paragraph (d) of subsection (13) of section 1051
409.906, Florida Statutes, is amended to read: 1052
409.906 Optional Medicaid services. —Subject to specific 1053
appropriations, the agency may make payments for services which 1054
are optional to the state under Title XIX of the Social Security 1055
Act and are furnished by Medicaid providers to recipients who 1056
are determined to be el igible on the dates on which the services 1057
were provided. Any optional service that is provided shall be 1058
provided only when medically necessary and in accordance with 1059
state and federal law. Optional services rendered by providers 1060
in mobile units to Medicaid recipients may be restricted or 1061
prohibited by the agency. Nothing in this section shall be 1062
construed to prevent or limit the agency from adjusting fees, 1063
reimbursement rates, lengths of stay, number of visits, or 1064
number of services, or making any other adj ustments necessary to 1065
comply with the availability of moneys and any limitations or 1066
directions provided for in the General Appropriations Act or 1067
chapter 216. If necessary to safeguard the state's systems of 1068
providing services to elderly and disabled person s and subject 1069
to the notice and review provisions of s. 216.177, the Governor 1070
may direct the Agency for Health Care Administration to amend 1071
the Medicaid state plan to delete the optional Medicaid service 1072
known as "Intermediate Care Facilities for the Devel opmentally 1073
Disabled." Optional services may include: 1074
(13) HOME AND COMMUNITY -BASED SERVICES.— 1075
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(d) The agency shall seek federal approval to pay for 1076
flexible services for persons with severe mental illness or 1077
substance use disorders, including, but not limited to, 1078
temporary housing assistance. Payments may be made as enhanced 1079
capitation rates or incentive payments to managed care plans 1080
that meet the requirements of s. 409.968(3) s. 409.968(4). 1081
Section 16. This act shall take effect July 1, 2022. 1082