Florida 2023 Regular Session

Florida House Bill H1457 Compare Versions

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

Old	New	Differences
1	1
2	2
3	3	HB 1457 2023
4	4
5	5
6	6
7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1457-00
9	9	Page 1 of 7
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
11	11
12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to Medicaid behavioral health provider 2
16	16	performance; amending s. 409.967, F.S.; revising 3
17	17	provider network requirements for behavioral health 4
18	18	providers in the Medicaid program; specifying network 5
19	19	testing requirements; requiring the Agency for Health 6
20	20	Care Administration to establish certain performance 7
21	21	measures; requiring managed care plan contract 8
22	22	amendments by a specified date; requiring the ag ency 9
23	23	to submit an annual report to the Legislature; 10
24	24	providing an effective date. 11
25	25	12
26	26	Be It Enacted by the Legislature of the State of Florida: 13
27	27	14
28	28	Section 1. Paragraphs (c) and (f) of subsection (2) of 15
29	29	section 409.967, Florida Statutes, are amended to re ad: 16
30	30	409.967 Managed care plan accountability. — 17
31	31	(2) The agency shall establish such contract requirements 18
32	32	as are necessary for the operation of the statewide managed care 19
33	33	program. In addition to any other provisions the agency may deem 20
34	34	necessary, the contract must require: 21
35	35	(c) Access.— 22
36	36	1. The agency shall establish specific standards for the 23
37	37	number, type, and regional distribution of providers in managed 24
38	38	care plan networks to ensure access to care for both adults and 25
39	39
40	40	HB 1457 2023
41	41
42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb1457-00
46	46	Page 2 of 7
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
48	48
49	49
50	50
51	51	children. Each plan must maintain a regionwide network of 26
52	52	providers in sufficient numbers to meet the access standards for 27
53	53	specific medical services for all recipients enrolled in the 28
54	54	plan. The exclusive use of mail -order pharmacies may not be 29
55	55	sufficient to meet network access standards. Consistent with the 30
56	56	standards established by the agency, provider networks may 31
57	57	include providers located outside the region. Each plan shall 32
58	58	establish and maintain an accurate and complete electronic 33
59	59	database of contracted providers, including information about 34
60	60	licensure or registration, locations and hours of operation, 35
61	61	specialty credentials and other certifications, specific 36
62	62	performance indicators, and such other information as the agency 37
63	63	deems necessary. The database must be available online to both 38
64	64	the agency and the public and have the capability to compare the 39
65	65	availability of providers to network adequacy standards and to 40
66	66	accept and display feedback from each provider's patients. Each 41
67	67	plan shall submit quarterly reports to the agency identifying 42
68	68	the number of enrollees assigned to each primary care provider. 43
69	69	The agency shall conduct, or contract for, systematic and 44
70	70	continuous testing of the plan provider networks network 45
71	71	databases maintained by each plan to confirm accuracy, confirm 46
72	72	that behavioral heal th providers are accepting enrollees, and 47
73	73	confirm that enrollees have timely access to behavioral health 48
74	74	services. The agency shall specifically and expressly establish 49
75	75	network requirements for each type of behavioral health provider 50
76	76
77	77	HB 1457 2023
78	78
79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb1457-00
83	83	Page 3 of 7
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
85	85
86	86
87	87
88	88	serving Medicaid enrol lees, including community -based and 51
89	89	residential providers. Testing of the behavioral health network 52
90	90	shall also include provider -specific data on access timeliness. 53
91	91	2. Each managed care plan must publish any prescribed drug 54
92	92	formulary or preferred drug lis t on the plan's website in a 55
93	93	manner that is accessible to and searchable by enrollees and 56
94	94	providers. The plan must update the list within 24 hours after 57
95	95	making a change. Each plan must ensure that the prior 58
96	96	authorization process for prescribed drugs is rea dily accessible 59
97	97	to health care providers, including posting appropriate contact 60
98	98	information on its website and providing timely responses to 61
99	99	providers. For Medicaid recipients diagnosed with hemophilia who 62
100	100	have been prescribed anti -hemophilic-factor replacement 63
101	101	products, the agency shall provide for those products and 64
102	102	hemophilia overlay services through the agency's hemophilia 65
103	103	disease management program. 66
104	104	3. Managed care plans, and their fiscal agents or 67
105	105	intermediaries, must accept prior authorization requ ests for any 68
106	106	service electronically. 69
107	107	4. Managed care plans serving children in the care and 70
108	108	custody of the Department of Children and Families must maintain 71
109	109	complete medical, dental, and behavioral health encounter 72
110	110	information and participate in making s uch information available 73
111	111	to the department or the applicable contracted community -based 74
112	112	care lead agency for use in providing comprehensive and 75
113	113
114	114	HB 1457 2023
115	115
116	116
117	117
118	118	CODING: Words stricken are deletions; words underlined are additions.
119	119	hb1457-00
120	120	Page 4 of 7
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
122	122
123	123
124	124
125	125	coordinated case management. The agency and the department shall 76
126	126	establish an interagency agreement to provide guidance for the 77
127	127	format, confidentiality, recipient, scope, and method of 78
128	128	information to be made available and the deadlines for 79
129	129	submission of the data. The scope of information available to 80
130	130	the department shall be the data that managed care plans are 81
131	131	required to submit to the agency. The agency shall determine the 82
132	132	plan's compliance with standards for access to medical, dental, 83
133	133	and behavioral health services; the use of medications; and 84
134	134	followup on all medically necessary services recommended as a 85
135	135	result of early and periodic screening, diagnosis, and 86
136	136	treatment. 87
137	137	(f) Continuous improvement. —The agency shall establish 88
138	138	specific performance standards and expected milestones or 89
139	139	timelines for improving performance over the term of the 90
140	140	contract. 91
141	141	1. Each managed care plan shall establish an internal 92
142	142	health care quality improvement system, including enrollee 93
143	143	satisfaction and disenrollment surveys. The quality improvement 94
144	144	system must include incentives and disincentives for network 95
145	145	providers. 96
146	146	2. Each managed care plan must collect and report the 97
147	147	Healthcare Effectiveness Data and Information Set (HEDIS) 98
148	148	measures, the federal Core Set of Children's Health Care Quality 99
149	149	measures, and the federal Core Set of Adult Health Care Quality 100
150	150
151	151	HB 1457 2023
152	152
153	153
154	154
155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb1457-00
157	157	Page 5 of 7
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
159	159
160	160
161	161
162	162	Measures, as specified by the agenc y. Each plan must collect and 101
163	163	report the Adult Core Set behavioral health measures beginning 102
164	164	with data reports for the 2025 calendar year. Each plan must 103
165	165	stratify reported measures by age, sex, race, ethnicity, primary 104
166	166	language, and whether the enrollee re ceived a Social Security 105
167	167	Administration determination of disability for purposes of 106
168	168	Supplemental Security Income beginning with data reports for the 107
169	169	2026 calendar year. A plan's performance on these measures must 108
170	170	be published on the plan's website in a man ner that allows 109
171	171	recipients to reliably compare the performance of plans. The 110
172	172	agency shall use the measures as a tool to monitor plan 111
173	173	performance. 112
174	174	3. Each managed care plan must be accredited by the 113
175	175	National Committee for Quality Assurance, the Joint Comm ission, 114
176	176	or another nationally recognized accrediting body, or have 115
177	177	initiated the accreditation process, within 1 year after the 116
178	178	contract is executed. For any plan not accredited within 18 117
179	179	months after executing the contract, the agency shall suspend 118
180	180	automatic assignment under ss. 409.977 and 409.984. 119
181	181	4. The agency shall establish specific outcome performance 120
182	182	measures to reduce the incidence of crisis stabilization 121
183	183	services for children and adolescents who are high users of such 122
184	184	services. Performance measures must at least establish plan -123
185	185	specific, year-over-year improvement targets to reduce repeated 124
186	186	use. 125
187	187
188	188	HB 1457 2023
189	189
190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb1457-00
194	194	Page 6 of 7
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
196	196
197	197
198	198
199	199	Section 2. The Agency for Health Care Administration shall 126
200	200	amend existing contracts with managed care plans to execute the 127
201	201	requirements of this a ct. Such contract amendments must be 128
202	202	effective before January 1, 2024. 129
203	203	Section 3. Beginning on October 1, 2023, and annually 130
204	204	thereafter, the Agency for Health Care Administration shall 131
205	205	submit to the Legislature an annual report on Medicaid -enrolled 132
206	206	children and adolescents who are the highest users of crisis 133
207	207	stabilization services. The report shall include demographic and 134
208	208	geographic information; plan -specific performance data based on 135
209	209	the performance measures in s. 409.967(2)(f), Florida Statutes; 136
210	210	plan-specific provider network testing data generated pursuant 137
211	211	to s. 409.967(2)(c), Florida Statutes, including, but not 138
212	212	limited to, an assessment of access timeliness; and trends on 139
213	213	reported data points beginning from fiscal year 2020 -2021. The 140
214	214	report shall include an analysis of relevant managed care plan 141
215	215	contract terms and the contract enforcement mechanisms available 142
216	216	to the agency to ensure compliance. The report shall include 143
217	217	data on enforcement or incentive actions taken by the agency to 144
218	218	ensure compliance with network standards and progress in 145
219	219	performance improvement, including, but not limited to, the use 146
220	220	of the achieved savings rebate program as provided under s. 147
221	221	409.967, Florida Statutes. The report shall include a listing of 148
222	222	other actions taken by the a gency to better serve such children 149
223	223	and adolescents. 150
224	224
225	225	HB 1457 2023
226	226
227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb1457-00
231	231	Page 7 of 7
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
233	233
234	234
235	235
236	236	Section 4. This act shall take effect July 1, 2023. 151