FL
Florida House Bill H0633

Florida 2025 Regular Session

Florida House Bill H0633 Compare Versions

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1010 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
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1414 A bill to be entitled 1
1515 An act relating to behavioral health managing 2
1616 entities; amending s. 394.9082, F.S.; requiring the 3
1717 Department of Children and Families to contract 4
1818 biennially for specified functions; requiring the 5
1919 department to contract for recommendations for certain 6
2020 transparency improvements; requiring the department to 7
2121 prepare and present to the Governor and Legislature a 8
2222 specified final report by a specified date; requiring 9
2323 managing entities to report required data to the 10
2424 department in a standardized electronic format; 11
2525 providing requirements for such format; requiring 12
2626 managing entities to electronically submit to the 13
2727 department certain documents in a specified format and 14
2828 with specified metadata; requiring managing entities 15
2929 to submit certain specific measures to the department; 16
3030 requiring the department to post and maintain such 17
3131 measures on its website by a specified date every 18
32-month; providing an exception; providing requirements 19
33-for such measures; requiring managing entities to 20
34-report each measure using a standard methodology 21
35-determined by the department; providing requirements 22
36-for such measures; providing that implementation of 23
37-specified requirements is contingent on certain 24
38-appropriations; providing an effective date. 25
32+month; requiring managing entities to report each 19
33+measure using a standard methodology determined by the 20
34+department; providing requirements for such measures; 21
35+providing an effective date. 22
36+ 23
37+Be It Enacted by the Legislature of the State of Florida: 24
38+ 25
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4747 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
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51- 26
52-Be It Enacted by the Legislature of the State of Florida: 27
53- 28
54- Section 1. Subsection (7) of section 394.9082, Florida 29
55-Statutes, is amended, paragraph (n) is added to subsection (3), 30
56-and paragraphs (v) and (w) a re added to subsection (5) of that 31
57-section, to read: 32
58- 394.9082 Behavioral health managing entities. — 33
59- (3) DEPARTMENT DUTIES. —The department shall: 34
60- (n)1. Contract for all of the following: 35
61- a. Biennial operational and financial audits of each 36
62-managing entity to include all of the following: 37
63- (I) A review of business practices, personnel, financial 38
64-records, related parties, compensation, and other areas as 39
51+ Section 1. Subsection (7) of section 394.9082, Florida 26
52+Statutes, is amended, paragraph (n) is added to subsection (3), 27
53+and paragraphs (v) and (w) are added to subsection (5) of that 28
54+section, to read: 29
55+ 394.9082 Behavioral health managing entities. — 30
56+ (3) DEPARTMENT DUTIES. —The department shall: 31
57+ (n)1. Contract for all of the following: 32
58+ a. Biennial operational and financial audits of each 33
59+managing entity to include all of the following: 34
60+ (I) A review of business practices, personnel, financial 35
61+records, related parties, compensation, and other areas as 36
62+determined by the department. 37
63+ (II) The services administered, the method of provider 38
64+payment, expenditures, outcomes, and other information as 39
6565 determined by the department. 40
66- (II) The services administered, the method of provider 41
67-payment, expenditures, outcomes, and other information as 42
68-determined by the department. 43
69- (III) Referral patterns, including managing entity 44
70-referral volume; provider referral assignments; services 45
71-referred; length of time to obtain services; and key referral 46
72-performance measures. 47
73- (IV) Provider network adequacy and provider network 48
74-participation in the department's available bed platform, the 49
75-Opioid Data Management System, the Agency for Health Care 50
66+ (III) Referral patterns, including managing entity 41
67+referral volume; provider referra l assignments; services 42
68+referred; length of time to obtain services; and key referral 43
69+performance measures. 44
70+ (IV) Provider network adequacy and provider network 45
71+participation in the department's available bed platform, the 46
72+Opioid Data Management System, t he Agency for Health Care 47
73+Administration Event Notification Service, and other department 48
74+required provider data submissions. 49
75+ (V) Audits of each managing entity's expenditures and 50
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8484 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
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88-Administration Event Notification Service, and other department 51
89-required provider data submissions. 52
90- (V) Audits of each managing entity's expenditures and 53
91-claims. Such an audit must do both of the following: 54
92- (A) Compare services administered through each managing 55
93-entity, the outcomes of each managing entity's expenditu res, 56
94-each managing entity's expenditures for behavioral health 57
95-services, and any other information as determined by the 58
96-department. 59
97- (B) Analyze services funded by each managing entity 60
98-rendered to individuals who are also Medicaid beneficiaries to, 61
99-at a minimum, assess the extent to which managing entities are 62
100-funding services that are also available as covered services 63
101-under the Medicaid program. 64
102- b. Recommendations to improve transparency of system 65
103-performance, including, but not limited to, metrics and criteria 66
104-used to measure each managing entity's performance and patient 67
105-and system outcomes, and the format and method to be used to 68
106-collect and report necessary data and information. 69
107- 2. Prepare a report of the information gathered in 70
108-subparagraph 1. and present the final report on or before 71
109-December 1, 2025, to the Governor, the President of the Senate, 72
110-and the Speaker of the House of Representatives. 73
111- (5) MANAGING ENTITY DUTIES. —A managing entity shall: 74
112- (v) Report all required data to the department in a 75
88+claims. Such an audit must do both of the following: 51
89+ (A) Compare service s administered through each managing 52
90+entity, the outcomes of each managing entity's expenditures, 53
91+each managing entity's Medicaid expenditures for behavioral 54
92+health services, and any other information as determined by the 55
93+department. 56
94+ (B) Analyze services funded by each managing entity 57
95+rendered to individuals who are also Medicaid beneficiaries to, 58
96+at a minimum, assess the extent to which managing entities are 59
97+funding services that are also available as covered services 60
98+under the Medicaid program. 61
99+ b. Recommendations to improve transparency of system 62
100+performance, including, but not limited to, metrics and criteria 63
101+used to measure each managing entity's performance and patient 64
102+and system outcomes, and the format and method to be used to 65
103+collect and report necessary data and information. 66
104+ 2. Prepare a report of the information gathered in 67
105+subparagraph 1. and present the final report on or before 68
106+December 1, 2025, to the Governor, the President of the Senate, 69
107+and the Speaker of the House of Representatives . 70
108+ (5) MANAGING ENTITY DUTIES. —A managing entity shall: 71
109+ (v) Report all required data to the department in a 72
110+standardized electronic format to ensure interoperability and to 73
111+facilitate data analysis. The submission format must meet all of 74
112+the following criteria: 75
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121121 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
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125-standardized electronic format to ensure interoperability and to 76
126-facilitate data analysis. The submission format must meet all of 77
127-the following criteria: 78
128- 1. Payments made to providers for services reported in a 79
129-format that reflects the client; the service provided; the date 80
130-the service is provided; the place where the service is 81
131-provided; the diagnosis, if available; and other information 82
132-typically reported in a standardized format for electronic data 83
133-interchange that is used for health care claims processing. 84
134- 2. Information must be organized into discrete, machine -85
135-readable data elements that allow for efficient processing and 86
136-integration with other datasets. 87
137- 3. All data fields must comply with established protocols 88
138-as specified by the department . 89
139- 4. The standardized format must be compatible with 90
140-automated systems to enable the downloading, parsing, and 91
141-combining of data with other sources for analysis. 92
142- 5. Submissions must pass validation checks to confirm 93
143-adherence to the required data struc ture and format before the 94
144-submission is accepted. 95
145- (w) Submit to the department all documents that are 96
146-required under contract for submission on a routine basis in an 97
147-electronic format that allows for accurate text recognition and 98
148-data extraction as spec ified by the department, which may 99
149-include, but is not limited to, Portable Document Format or 100
125+ 1. Provider payments must be reported using a standardized 76
126+format for electronic data interchange that is used for health 77
127+care claims processing. 78
128+ 2. Information must be organized into discrete, machine -79
129+readable data elements that allow for eff icient processing and 80
130+integration with other datasets. 81
131+ 3. All data fields must comply with established protocols 82
132+as specified by the department. 83
133+ 4. The standardized format must be compatible with 84
134+automated systems to enable the downloading, parsing, an d 85
135+combining of data with other sources for analysis. 86
136+ 5. Submissions must pass validation checks to confirm 87
137+adherence to the required data structure and format before the 88
138+submission is accepted. 89
139+ (w) Submit to the department all documents that are 90
140+required under contract for submission on a routine basis in an 91
141+electronic format that allows for accurate text recognition and 92
142+data extraction as specified by the department, which may 93
143+include, but is not limited to, Portable Document Format or 94
144+machine-readable text files. The documents must be accompanied 95
145+by metadata containing key information that ensures proper 96
146+organization, processing, and integration into the department's 97
147+systems. The required metadata must include, but is not limited 98
148+to, all of the followi ng elements: 99
149+ 1. A descriptive and unique name for the document, 100
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158158 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
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162-machine-readable text files. The documents must be accompanied 101
163-by metadata containing key information that ensures proper 102
164-organization, processing, and integrati on into the department's 103
165-systems. The required metadata must include, but is not limited 104
166-to, all of the following elements: 105
167- 1. A descriptive and unique name for the document, 106
168-following any naming conventions prescribed by the department. 107
169- 2. The date the document is uploaded. 108
170- 3. A predefined classification indicating the nature or 109
171-category of the document. 110
172- 4. Any relevant identifiers, such as application numbers, 111
173-case numbers, or tracking codes, as specified by the department. 112
174- 5. The name, contact information, and any other required 113
175-identification number, which may include, but is not limited to, 114
176-a contract, license, or registration number, of the person or 115
177-organization submitting the document. 116
178- 6. Any other metadata fields as prescribed by the 117
179-department to facilitate accurate processing and analysis. 118
180- (7) PERFORMANCE MEASUREMENT AND ACCOUNTABILITY. — 119
181- (a) Managing entities shall collect and submit data to the 120
182-department regarding persons served, outcomes of persons served, 121
183-costs of services provi ded through the department's contract, 122
184-and other data as required by the department. The department 123
185-shall evaluate managing entity performance and the overall 124
186-progress made by the managing entity, together with other 125
162+following any naming conventions prescribed by the department. 101
163+ 2. The date the document is uploaded. 102
164+ 3. A predefined classification indicating the nature or 103
165+category of the document. 104
166+ 4. Any relevant identifiers, such as application numbers, 105
167+case numbers, or tracking codes, as specified by the department. 106
168+ 5. The name, contact information, and any other required 107
169+identification number, which may include, but is not limited to, 108
170+a contract, license, or registration number, of the person or 109
171+organization submitting the document. 110
172+ 6. Any other metadata fields as prescribed by the 111
173+department to facilitate accurate processing and analysis. 112
174+ (7) PERFORMANCE MEASUREMENT AND ACCOUNTABILITY. — 113
175+ (a) Managing entities shall collect and submit data to the 114
176+department regarding persons served, outcomes of persons served, 115
177+costs of services provided through the department's contract, 116
178+and other data as required by the department. The department 117
179+shall evaluate managing entity performance and the overall 118
180+progress made by the managing entity, together with other 119
181+systems, in meeting the community's behavioral health needs, 120
182+based on consumer-centered outcome measures that reflect 121
183+national standards, if possible, that can be accurately 122
184+measured. The department shall work with managing entities to 123
185+establish performance standards, including, but not limited to: 124
186+ 1.(a) The extent to which individuals in the community 125
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195195 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
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199-systems, in meeting the community's beh avioral health needs, 126
200-based on consumer-centered outcome measures that reflect 127
201-national standards, if possible, that can be accurately 128
202-measured. The department shall work with managing entities to 129
203-establish performance standards, including, but not limited to: 130
204- 1.(a) The extent to which individuals in the community 131
205-receive services, including, but not limited to, parents or 132
206-caregivers involved in the child welfare system who need 133
207-behavioral health services. 134
208- 2.(b) The improvement in the overall behavioral health of 135
209-a community. 136
210- 3.(c) The improvement in functioning or progress in the 137
211-recovery of individuals served by the managing entity, as 138
212-determined using person -centered measures tailored to the 139
213-population. 140
214- 4.(d) The success of strategies to: 141
215- a.1. Divert admissions from acute levels of care, jails, 142
216-prisons, and forensic facilities as measured by, at a minimum, 143
217-the total number and percentage of clients who, during a 144
218-specified period, experience multiple admissions to acute levels 145
219-of care, jails, pris ons, or forensic facilities; 146
220- b.2. Integrate behavioral health services with the child 147
221-welfare system; and 148
222- c.3. Address the housing needs of individuals being 149
223-released from public receiving facilities who are homeless. 150
199+receive services, including, but not limited to, parents or 126
200+caregivers involved in the child welfare system who need 127
201+behavioral health services. 128
202+ 2.(b) The improvement in the overall behavioral health of 129
203+a community. 130
204+ 3.(c) The improvement in functioning or progress in the 131
205+recovery of individuals serve d by the managing entity, as 132
206+determined using person -centered measures tailored to the 133
207+population. 134
208+ 4.(d) The success of strategies to: 135
209+ a.1. Divert admissions from acute levels of care, jails, 136
210+prisons, and forensic facilities as measured by, at a minimu m, 137
211+the total number and percentage of clients who, during a 138
212+specified period, experience multiple admissions to acute levels 139
213+of care, jails, prisons, or forensic facilities; 140
214+ b.2. Integrate behavioral health services with the child 141
215+welfare system; and 142
216+ c.3. Address the housing needs of individuals being 143
217+released from public receiving facilities who are homeless. 144
218+ 5.(e) Consumer and family satisfaction. 145
219+ 6.(f) The level of engagement of key community 146
220+constituencies, such as law enforcement agencies, community -147
221+based care lead agencies, juvenile justice agencies, the courts, 148
222+school districts, local government entities, hospitals, and 149
223+other organizations, as appr opriate, for the geographical 150
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232232 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
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236- 5.(e) Consumer and family satisfaction. 151
237- 6.(f) The level of engagement of key community 152
238-constituencies, such as law enforcement agencies, community -153
239-based care lead agencies, juvenile justice agencies, the courts, 154
240-school districts, local government entities, h ospitals, and 155
241-other organizations, as appropriate, for the geographical 156
242-service area of the managing entity. 157
243- (b) Managing entities must submit specific measures to the 158
244-department regarding individual outcomes and system functioning, 159
245-which the department must post to, and maintain on, its website 160
246-by the 22nd of every month or if the 22nd day occurs on a 161
247-weekend or a holiday under s. 110.117(1), the report must be 162
248-posted before the conclusion of the next business day. The 163
249-posted measures must reflect perfor mance for the previous 164
250-calendar month, including year -to-date totals and annual trends. 165
251-Each managing entity must report each measure using a standard 166
252-methodology determined by the department and submit the data to 167
253-the department by the deadline specified by the department. The 168
254-measures shall include data from individuals served by each 169
255-managing entity for services funded by the managing entity, to 170
256-the extent feasible and appropriate. The measures shall be 171
257-reported and posted stratified by, at a minimum, wh ether the 172
258-individual is a child or an adult and whether the individual is 173
259-a Medicaid recipient. Such measures shall include, at a minimum, 174
260-all of the following: 175
236+service area of the managing entity. 151
237+ (b) Managing entities must submit specific measures to the 152
238+department regarding individual outcomes and system functioning, 153
239+which the department must post to, and maintain on, its website 154
240+by the 15th of every month. The posted measures must reflect 155
241+performance for the previous calendar month. Each managing 156
242+entity must report each measure using a standard methodology 157
243+determined by the department and submit the data to the 158
244+department by the deadline specified by the department. The 159
245+measures shall include data from individuals served by each 160
246+managing entity for services funded by the managing entity, to 161
247+the extent feasible and appropriate. The measures shall be 162
248+reported and posted stratified b y, at a minimum, whether the 163
249+individual is a child or an adult and whether the individual is 164
250+a Medicaid recipient. Such measures shall include, at a minimum, 165
251+all of the following: 166
252+ 1. The number and percentage of individuals who are high 167
253+utilizers of crisis behavioral health services. 168
254+ 2. The number and percentage of individuals referred to 169
255+outpatient behavioral health services after their discharge from 170
256+a receiving or treatment facility, an emergency department under 171
257+this chapter, or an inpatient or residential licensed service 172
258+component under chapter 397 and who begin receiving such 173
259+services within 7 days after discharge. 174
260+ 3. The average wait time for initial appointments for 175
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269269 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
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273- 1. The number and percentage of individuals who are high 176
274-utilizers of crisis behavioral healt h services. 177
275- 2. The number and percentage of individuals referred to 178
276-outpatient behavioral health services after their discharge from 179
277-a receiving or treatment facility, an emergency department under 180
278-this chapter, or an inpatient or residential licensed service 181
279-component under chapter 397 and who begin receiving such 182
280-services within 7 days after discharge. 183
281- 3. The average wait time for initial appointments for 184
282-behavioral health services, categorized by the type of service. 185
283- 4. The number and percentage of individuals with 186
284-significant behavioral health symptoms who are seeking urgent 187
285-but noncrisis acute care and who are scheduled to be seen by a 188
286-provider within 1 business day after initial contact with the 189
287-provider. 190
288- 5. The number and percentage of emerg ency department 191
289-visits per capita for behavioral health -related issues. 192
290- 6. The incidence of medication errors. 193
291- 7. The number and percentage of adverse incidents, 194
292-including, but not limited to, self -harm, occurring during 195
293-inpatient and outpatient behavi oral health services. 196
294- 8. The number and percentage of individuals with co -197
295-occurring conditions who receive integrated care. 198
296- 9. The number and percentage of individuals discharged 199
297-from a receiving or treatment facility under this chapter or an 200
273+behavioral health services, categorized by the type of service. 176
274+ 4. The number and percentage of individuals with 177
275+significant behavioral health symptoms who are seeking urgent 178
276+but noncrisis acute care and who are scheduled to be seen by a 179
277+provider within 1 business day after initial contact with the 180
278+provider. 181
279+ 5. The number and percentage of emergency department 182
280+visits per capita for behavioral health -related issues. 183
281+ 6. The incidence of medication errors. 184
282+ 7. The number and percentage of adverse incidents, 185
283+including, but not limited to, self -harm, occurring during 186
284+inpatient and outpatient behavioral health services. 187
285+ 8. The number and percentage of individuals with co -188
286+occurring conditions who receive integrated care. 189
287+ 9. The number and percentage of individuals discharged 190
288+from a receiving or treatment facility under this ch apter or an 191
289+inpatient or residential licensed service component under 192
290+chapter 397 who successfully transition to ongoing services at 193
291+the appropriate level of care. 194
292+ 10. The rate of readmissions to emergency departments due 195
293+to behavioral health issues or t o crisis stabilization units, 196
294+addictions receiving facilities, or other inpatient levels of 197
295+care under this chapter and chapter 397 within 30 days after 198
296+discharge from inpatient or outpatient behavioral health 199
297+services. 200
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306306 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
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310-inpatient or residential licensed service component under 201
311-chapter 397 who successfully transition to ongoing services at 202
312-the appropriate level of care. 203
313- 10. The rate of readmissions to emergency departments due 204
314-to behavioral health issues or to crisis stabilizatio n units, 205
315-addictions receiving facilities, or other inpatient levels of 206
316-care under this chapter and chapter 397 within 30 days after 207
317-discharge from inpatient or outpatient behavioral health 208
318-services. 209
319- 11. The average length of stay for inpatient behavioral 210
320-health services. 211
321- Section 2. This act shall be implemented to the extent of 212
322-available appropriations contained in the annual General 213
323-Appropriations Act for such purpose. 214
324- Section 3. This act shall take effect July 1, 2025. 215
310+ 11. The average length of stay for inpatient behavioral 201
311+health services. 202
312+ Section 2. This act shall take effect July 1, 2025. 203