HB 389 2025
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hb389-00
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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 managed care plan network access; 2
amending s. 409.967, F.S.; requiring that the Agency 3
for Health Care Administration include specified 4
requirements in its contracts with Medicaid managed 5
care plans; amending s. 409.975, F.S.; authorizing 6
enrollees of Medicaid managed care plans to receive 7
care from Medicaid providers not under contract with 8
the plan under certain circumstances; requiring the 9
plans to reimburse such providers at the applicable 10
rates paid for such services under the plan ; providing 11
an effective date. 12
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Be It Enacted by the Legislature of the State of Florida: 14
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Section 1. Paragraph (c) of subsection (2) of section 16
409.967, Florida Statutes, is amended to read: 17
409.967 Managed 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 provision s 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
HB 389 2025
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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
care plan networks to ensure access to care for both adult s 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. Plans must allow enrollees to receive care from Medicaid 30
providers not under contract with the plan if an enrollee is 31
unable to receive care from a participating provider under the 32
plan in a timely manner consistent with a reasonable access 33
standard, as determined by agency rule, or there is another 34
appropriate Medicaid provider in a location more geographically 35
accessible to the enrollee's residence than those under the 36
plan. The plan must reimburse the nonparticipating Medicaid 37
providers for such services at the applicable Medicaid rate for 38
such services under the plan. The exclusive use of mail -order 39
pharmacies may not be sufficient to meet network access 40
standards. Consistent with the standards established by the 41
agency, provider networks may include providers located outside 42
the region. Each plan must shall establish and maintain an 43
accurate and complete electronic database of contracted 44
providers, including information about licensure or 45
registration, locations and hours of operation, specialty 46
credentials and other certifications, specific performance 47
indicators, and such other information as the agency deems 48
necessary. The database must be available online to both the 49
agency and the public and have the capability to compare the 50
HB 389 2025
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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
availability of providers to network adequacy standards and to 51
accept and display fe edback from each provider's patients. Each 52
plan must shall submit quarterly reports to the agency 53
identifying the number of enrollees assigned to each primary 54
care provider. The agency shall conduct, or contract for, 55
systematic and continuous testing of th e provider network 56
databases maintained by each plan to confirm accuracy, confirm 57
that behavioral health providers are accepting enrollees, and 58
confirm that enrollees have access to behavioral health 59
services. 60
2. Each managed care plan must publish any p rescribed drug 61
formulary or preferred drug list on the plan's website in a 62
manner that is accessible to and searchable by enrollees and 63
providers. The plan must update the list within 24 hours after 64
making a change. Each plan must ensure that the prior 65
authorization process for prescribed drugs is readily accessible 66
to health care providers, including posting appropriate contact 67
information on its website and providing timely responses to 68
providers. For Medicaid recipients diagnosed with hemophilia who 69
have been prescribed anti -hemophilic-factor replacement 70
products, the agency shall provide for those products and 71
hemophilia overlay services through the agency's hemophilia 72
disease management program. 73
3. Managed care plans, and their fiscal agents or 74
intermediaries, must accept prior authorization requests for any 75
HB 389 2025
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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
service electronically. 76
4. Managed care plans serving children in the care and 77
custody of the Department of Children and Families must maintain 78
complete medical, dental, and behavioral health enc ounter 79
information and participate in making such information available 80
to the department or the applicable contracted community -based 81
care lead agency for use in providing comprehensive and 82
coordinated case management. The agency and the department shall 83
establish an interagency agreement to provide guidance for the 84
format, confidentiality, recipient, scope, and method of 85
information to be made available and the deadlines for 86
submission of the data. The scope of information available to 87
the department is shall be the data that managed care plans are 88
required to submit to the agency. The agency shall determine the 89
plan's compliance with standards for access to medical, dental, 90
and behavioral health services; the use of medications; and 91
follow-up followup on all medically necessary services 92
recommended as a result of early and periodic screening, 93
diagnosis, and treatment. 94
Section 2. Paragraph (f) is added to subsection (1) of 95
section 409.975, Florida Statutes, to read: 96
409.975 Managed care plan accountab ility.—In addition to 97
the requirements of s. 409.967, plans and providers 98
participating in the managed medical assistance program shall 99
comply with the requirements of this section. 100
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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
(1) PROVIDER NETWORKS. —Managed care plans must develop and 101
maintain provider networks that meet the medical needs of their 102
enrollees in accordance with standards established pursuant to 103
s. 409.967(2)(c). Except as provided in this section, managed 104
care plans may limit the providers in their networks based on 105
credentials, quality indicators, and price. 106
(f) If an enrollee is unable to receive care from a 107
participating provider under the managed care plan in a timely 108
manner consistent with a reasonable access standard, as 109
determined by agency rule, or there is another appropriat e 110
Medicaid provider in a location more geographically accessible 111
to the enrollee's residence than those under the plan, an 112
enrollee may receive such care from a Medicaid provider not 113
under contract with the plan. Plans must reimburse a 114
nonparticipating Med icaid provider for services rendered under 115
this paragraph at the applicable Medicaid rate for such services 116
under the plan. 117
Section 3. This act shall take effect July 1, 2025. 118