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