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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 behavioral health managing 2
entities; amending s. 394.9082, F.S.; requiring the 3
Department of Children and Families to contract for 4
specified functions; requiring the department to 5
recommend certain transparency improvements; requiring 6
the department to prepare and present to the Governor 7
and Legislature a specified final report by a date 8
certain; requiring managing entities to report 9
required information to the department in a 10
standardized electronic format; providing requirements 11
for the such format; requiring managing entities to 12
submit documents to the department electronically in a 13
specified format and with specified metadata; 14
requiring managing entities to report certain specific 15
measures to the department; providing an effective 16
date. 17
18
Be It Enacted by the Legislature of the State of Florida: 19
20
Section 1. Subsection (7) of section 394.9082, Florida 21
Statutes, is amended, and paragraph (n) is added to subsection 22
(3) and paragraphs (v) and (w) are added to subsection (5) of 23
that section, to read: 24
394.9082 Behavioral health managing entities. — 25
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(3) DEPARTMENT DUTIES. —The department shall: 26
(n)1. Contract for all of the following: 27
a. Operational and financial audits of each managing 28
entity to include all of the following: 29
(I) A review of business practices, personnel, financial 30
records, related parties, compensation, and other areas as 31
determined by the department. 32
(II) The services administered, the method of provider 33
payment, expenditures, outcomes, and other information as 34
determined by the department. 35
(III) Referral patterns, including managing entity 36
referral volume; provider referral assignments; services 37
referred; length of time to obtain services; and key referral 38
performance measures. 39
(IV) Provider network adequacy and provider network 40
participation in the department's available bed platform, the 41
Opioid Data Management System, the Agency for Health Care 42
Administration Event Notification Service, and other department 43
required provider data submissions. 44
b. Audits of each managing entity's expenditures and 45
claims, in which such audit must do both of the following: 46
(I) Compare services administered through each managing 47
entity, the outcomes of each managing entity's expenditures, 48
each managing entity's Medicaid expenditures for behavioral 49
health services, and any other information as determined by the 50
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department. 51
(II) Analyze the claims paid by each managing entity for 52
Medicaid recipients. 53
c. Recommendations to improve transparency of system 54
performance including the metrics and criteria used to measure 55
performance and outcomes in behavioral health systems and the 56
format and method used to collect and report data and 57
information. 58
2. Prepare a report of the information gathered in 59
subparagraph 1. and present the final report on or before 60
December 1, 2025, to the Governor, the President of the Senate, 61
and the Speaker of the House of Representatives. 62
(5) MANAGING ENTITY DUTIES.—A managing entity shall: 63
(v) Report all required information to the department in a 64
standardized electronic format to ensure interoperability and to 65
facilitate data analysis. The submission format must meet all of 66
the following criteria: 67
1. Provider payments must be reported using a standardized 68
format for electronic data interchange that is used for health 69
care claims processing. 70
2. Information must be organized into discrete, machine -71
readable data elements that allow for efficient process ing and 72
integration with other datasets. 73
3. All data fields must comply with established protocols 74
as specified by the department. 75
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4. The standardized format must be compatible with 76
automated systems to enable the downloading, parsing, and 77
combining of data with other sources for analysis. 78
5. Submissions must pass validation checks to confirm 79
adherence to the required data structure and format before the 80
submission is accepted. 81
(w) Submit all documents to the department in a format 82
that allows for accurate text recognition and data extraction, 83
such as in Portable Document Format or machine -readable text 84
files. Documents must be submitted electronically and 85
accompanied by metadata containing key information to ensure 86
proper organization, processing, a nd integration into the 87
department's systems. The required metadata must include, but is 88
not limited to, all of the following elements: 89
1. A descriptive and unique name for the document, 90
following any naming conventions prescribed by the department. 91
2. The date the document is uploaded. 92
3. A predefined classification indicating the nature or 93
category of the document. 94
4. Any relevant identifiers, such as application numbers, 95
case numbers, or tracking codes, as specified by the department. 96
5. The name, contact information, and any other required 97
identification number, such as a license or registration number, 98
of the person or organization submitting the document. 99
6. Any other metadata fields as prescribed by the 100
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department to facilitate accurate pr ocessing and analysis. 101
(7) PERFORMANCE MEASUREMENT AND ACCOUNTABILITY. — 102
(a) Managing entities shall collect and submit data to the 103
department regarding persons served, outcomes of persons served, 104
costs of services provided through the department's cont ract, 105
and other data as required by the department. The department 106
shall evaluate managing entity performance and the overall 107
progress made by the managing entity, together with other 108
systems, in meeting the community's behavioral health needs, 109
based on consumer-centered outcome measures that reflect 110
national standards, if possible, that can be accurately 111
measured. The department shall work with managing entities to 112
establish performance standards, including, but not limited to: 113
1.(a) The extent to which individuals in the community 114
receive services, including, but not limited to, parents or 115
caregivers involved in the child welfare system who need 116
behavioral health services. 117
2.(b) The improvement in the overall behavioral health of 118
a community. 119
3.(c) The improvement in functioning or progress in the 120
recovery of individuals served by the managing entity, as 121
determined using person -centered measures tailored to the 122
population. 123
4.(d) The success of strategies to: 124
a.1. Divert admissions from acute level s of care, jails, 125
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prisons, and forensic facilities as measured by, at a minimum, 126
the total number and percentage of clients who, during a 127
specified period, experience multiple admissions to acute levels 128
of care, jails, prisons, or forensic facilities; 129
b.2. Integrate behavioral health services with the child 130
welfare system; and 131
c.3. Address the housing needs of individuals being 132
released from public receiving facilities who are homeless. 133
5.(e) Consumer and family satisfaction. 134
6.(f) The level of engagement of key community 135
constituencies, such as law enforcement agencies, community -136
based care lead agencies, juvenile justice agencies, the courts, 137
school districts, local government entities, hospitals, and 138
other organizations, as appr opriate, for the geographical 139
service area of the managing entity. 140
(b) Managing entities must submit all of the following 141
specific measures to the department: 142
1. The number and percentage of high utilizers. 143
2. The number and percentage of individuals who receive 144
outpatient services within 7 days after a hospitalization for 145
behavioral health-related issues. 146
3. The average wait time for initial appointments for 147
behavioral health services. 148
4. The number and percentage of individuals who are able 149
to schedule an urgent behavioral health appointment within 24 150
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hours. 151
5. The number and percentage of emergency room visits per 152
capita for behavioral health -related issues, and whether such 153
number and percentage are a decrease from the last report. 154
6. The incidence of medication errors in behavioral health 155
treatment plans. 156
7. The number and percentage of adverse incidents, such as 157
self-harm, in inpatient and outpatient settings. 158
8. The number and percentage of individuals with co -159
occurring conditions who receive integrated care. 160
9. The number and percentage of individuals successfully 161
transitioned from acute care to community -based services. 162
10. The rate of behavioral health readmissions within 30 163
days after discharge. 164
11. The average length of stay for inpatient behavioral 165
health services. 166
Section 2. This act shall take effect July 1, 2025. 167