Florida Senate - 2023 SB 1652 By Senator Davis 5-01564-23 20231652__ 1 A bill to be entitled 2 An act relating to Medicaid behavioral health provider 3 performance; amending s. 409.967, F.S.; revising 4 provider network requirements for behavioral health 5 providers in the Medicaid program; specifying network 6 testing requirements; requiring the Agency for Health 7 Care Administration to establish certain performance 8 measures; requiring managed care plan contract 9 amendments by a specified date; requiring the agency 10 to submit an annual report to the Legislature; 11 providing an effective date. 12 13 Be It Enacted by the Legislature of the State of Florida: 14 15 Section 1.Paragraphs (c) and (f) of subsection (2) of 16 section 409.967, Florida Statutes, are amended to read: 17 409.967Managed care plan accountability. 18 (2)The agency shall establish such contract requirements 19 as are necessary for the operation of the statewide managed care 20 program. In addition to any other provisions the agency may deem 21 necessary, the contract must require: 22 (c)Access. 23 1.The agency shall establish specific standards for the 24 number, type, and regional distribution of providers in managed 25 care plan networks to ensure access to care for both adults and 26 children. Each plan must maintain a regionwide network of 27 providers in sufficient numbers to meet the access standards for 28 specific medical services for all recipients enrolled in the 29 plan. The exclusive use of mail-order pharmacies may not be 30 sufficient to meet network access standards. Consistent with the 31 standards established by the agency, provider networks may 32 include providers located outside the region. Each plan shall 33 establish and maintain an accurate and complete electronic 34 database of contracted providers, including information about 35 licensure or registration, locations and hours of operation, 36 specialty credentials and other certifications, specific 37 performance indicators, and such other information as the agency 38 deems necessary. The database must be available online to both 39 the agency and the public and have the capability to compare the 40 availability of providers to network adequacy standards and to 41 accept and display feedback from each providers patients. Each 42 plan shall submit quarterly reports to the agency identifying 43 the number of enrollees assigned to each primary care provider. 44 The agency shall conduct, or contract for, systematic and 45 continuous testing of the plan provider networks network 46 databases maintained by each plan to confirm accuracy, confirm 47 that behavioral health providers are accepting enrollees, and 48 confirm that enrollees have timely access to behavioral health 49 services. The agency shall specifically and expressly establish 50 network requirements for each type of behavioral health provider 51 serving Medicaid enrollees, including community-based and 52 residential providers. Testing of the behavioral health network 53 shall also include provider-specific data on access timeliness. 54 2.Each managed care plan must publish any prescribed drug 55 formulary or preferred drug list on the plans website in a 56 manner that is accessible to and searchable by enrollees and 57 providers. The plan must update the list within 24 hours after 58 making a change. Each plan must ensure that the prior 59 authorization process for prescribed drugs is readily accessible 60 to health care providers, including posting appropriate contact 61 information on its website and providing timely responses to 62 providers. For Medicaid recipients diagnosed with hemophilia who 63 have been prescribed anti-hemophilic-factor replacement 64 products, the agency shall provide for those products and 65 hemophilia overlay services through the agencys hemophilia 66 disease management program. 67 3.Managed care plans, and their fiscal agents or 68 intermediaries, must accept prior authorization requests for any 69 service electronically. 70 4.Managed care plans serving children in the care and 71 custody of the Department of Children and Families must maintain 72 complete medical, dental, and behavioral health encounter 73 information and participate in making such information available 74 to the department or the applicable contracted community-based 75 care lead agency for use in providing comprehensive and 76 coordinated case management. The agency and the department shall 77 establish an interagency agreement to provide guidance for the 78 format, confidentiality, recipient, scope, and method of 79 information to be made available and the deadlines for 80 submission of the data. The scope of information available to 81 the department shall be the data that managed care plans are 82 required to submit to the agency. The agency shall determine the 83 plans compliance with standards for access to medical, dental, 84 and behavioral health services; the use of medications; and 85 followup on all medically necessary services recommended as a 86 result of early and periodic screening, diagnosis, and 87 treatment. 88 (f)Continuous improvement.The agency shall establish 89 specific performance standards and expected milestones or 90 timelines for improving performance over the term of the 91 contract. 92 1.Each managed care plan shall establish an internal 93 health care quality improvement system, including enrollee 94 satisfaction and disenrollment surveys. The quality improvement 95 system must include incentives and disincentives for network 96 providers. 97 2.Each managed care plan must collect and report the 98 Healthcare Effectiveness Data and Information Set (HEDIS) 99 measures, the federal Core Set of Childrens Health Care Quality 100 measures, and the federal Core Set of Adult Health Care Quality 101 Measures, as specified by the agency. Each plan must collect and 102 report the Adult Core Set behavioral health measures beginning 103 with data reports for the 2025 calendar year. Each plan must 104 stratify reported measures by age, sex, race, ethnicity, primary 105 language, and whether the enrollee received a Social Security 106 Administration determination of disability for purposes of 107 Supplemental Security Income beginning with data reports for the 108 2026 calendar year. A plans performance on these measures must 109 be published on the plans website in a manner that allows 110 recipients to reliably compare the performance of plans. The 111 agency shall use the measures as a tool to monitor plan 112 performance. 113 3.Each managed care plan must be accredited by the 114 National Committee for Quality Assurance, the Joint Commission, 115 or another nationally recognized accrediting body, or have 116 initiated the accreditation process, within 1 year after the 117 contract is executed. For any plan not accredited within 18 118 months after executing the contract, the agency shall suspend 119 automatic assignment under ss. 409.977 and 409.984. 120 4.The agency shall establish specific outcome performance 121 measures to reduce the incidence of crisis stabilization 122 services for children and adolescents who are high users of such 123 services. Performance measures must, at a minimum, establish 124 plan-specific, year-over-year improvement targets to reduce 125 repeated use. 126 Section 2.The Agency for Health Care Administration shall 127 amend existing contracts with managed care plans to execute the 128 requirements of this act. Such contract amendments must be 129 effective before January 1, 2024. 130 Section 3.Beginning on October 1, 2023, and annually 131 thereafter, the Agency for Health Care Administration shall 132 submit to the Legislature an annual report on Medicaid-enrolled 133 children and adolescents who are the highest users of crisis 134 stabilization services. The report shall include demographic and 135 geographic information; plan-specific performance data based on 136 the performance measures in s. 409.967(2)(f), Florida Statutes; 137 plan-specific provider network testing data generated pursuant 138 to s. 409.967(2)(c), Florida Statutes, including, but not 139 limited to, an assessment of access timeliness; and trends on 140 reported data points beginning from fiscal year 2020-2021. The 141 report shall include an analysis of relevant managed care plan 142 contract terms and the contract enforcement mechanisms available 143 to the agency to ensure compliance. The report shall include 144 data on enforcement or incentive actions taken by the agency to 145 ensure compliance with network standards and progress in 146 performance improvement, including, but not limited to, the use 147 of the achieved savings rebate program as provided under s. 148 409.967, Florida Statutes. The report shall include a listing of 149 other actions taken by the agency to better serve such children 150 and adolescents. 151 Section 4.This act shall take effect July 1, 2023.