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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 VE S
A bill to be entitled 1
An act relating to Medicaid oversight; creating s. 2
11.405, F.S.; establishing the Joint Legislative 3
Committee on Medicaid Oversight within the Office of 4
the Auditor General for specified purposes; providing 5
for membership, subcommittees, and meetings of the 6
committee; specifying duties of the committee; 7
requiring the Auditor General and the Agency for 8
Health Care Administration to enter into a data 9
sharing agreement by a specified date; requiring the 10
Auditor General to assist the committee; providing 11
that the committee must be given access to certain 12
records, papers, and documents; authorizing the 13
committee to compel testimony and evidence according 14
to specified provisions; providing for additional 15
powers of the committee; providing that certain joint 16
rules of the Legislature apply to the proceedings of 17
the committee; requiring the agency to notify the 18
committee of certain changes and provide a report of 19
specified information to the committee; requiring the 20
agency to submit a copy of certain reports to the 21
committee; providing an effective date. 22
23
Be It Enacted by the Legislature of the State of Florida: 24
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 VE S
Section 1. Section 11.405, Florida Statutes, is c reated to 26
read: 27
11.405 Joint Legislative Committee on Medicaid Oversight. —28
The Joint Legislative Committee on Medicaid Oversight is created 29
within the Office of the Auditor General established under s. 30
11.42 to ensure that the state Medicaid program is op erating in 31
accordance with the Legislature's intent and to promote 32
transparency and efficiency in government spending. 33
(1) MEMBERSHIP; SUBCOMMITTEES; MEETINGS. — 34
(a) The committee shall be composed of three members of 35
the Senate appointed by the Preside nt of the Senate and three 36
members of the House of Representatives appointed by the Speaker 37
of the House of Representatives, with each member serving a 2 -38
year term. The chair and vice chair shall be appointed for 1 -39
year terms, with the appointments alterna ting between the 40
President of the Senate and the Speaker of the House of 41
Representatives. The chair and vice chair may not be members of 42
the same house of the Legislature. If both the chair and vice 43
chair are absent at any meeting, the members present must elect 44
a temporary chair by a majority vote. 45
(b) Members shall serve without compensation but may be 46
reimbursed for per diem and travel expenses pursuant to s. 47
112.061. 48
(c) The chair may establish subcommittees as needed to 49
fulfill the committee's duti es. 50
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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 VE S
(d) The committee shall convene at least twice a year, and 51
as often as necessary to conduct its business as required under 52
this section. Meetings may be held through teleconference or 53
other electronic means. 54
(2) COMMITTEE DUTIES. — 55
(a) The committee shall evaluate all aspects of the state 56
Medicaid program related to program financing, quality of care 57
and health outcomes, administrative functions, and operational 58
functions to ensure the program is providing transparency in the 59
provision of health ca re plans and providers, ensuring access to 60
quality health care services to Medicaid recipients, and 61
providing stability to the state's budget through a health care 62
delivery system designed to contain costs. 63
(b) The committee shall identify and recommend policies 64
that limit Medicaid spending growth while improving health care 65
outcomes for Medicaid recipients. In developing its 66
recommendations, the committee shall do all of the following: 67
1. Evaluate legislation for its long -term impact on the 68
state Medicaid program. 69
2. Review data submitted to the agency by the Medicaid 70
managed care plans pursuant to statutory and contract 71
requirements, including, but not limited to, timeliness of 72
provider credentialing, timely payment of claims, rate of claim 73
denials, prior authorizations for services, and consumer 74
complaints. 75
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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 VE S
3. Review the Medicaid managed care plans' encounter data, 76
financials, and audits and the data used to calculate the plans' 77
achieved savings rebates and medical loss ratios. 78
4. Review data related to health outcomes of Medicaid 79
recipients, including, but not limited to, Health Effectiveness 80
Data and Information Set measures for each Medicaid managed care 81
plan, each Medicaid managed care plan's performance improvement 82
projects, and outcome da ta related to all quality goals included 83
in the Medicaid managed care organization contracts to improve 84
quality for recipients. 85
5. Identify any areas for improvement in statute and rule 86
relating to the state Medicaid program. 87
6. Develop a plan of actio n for the future of the state 88
Medicaid program. 89
(c) The committee may submit periodic reports, including 90
recommendations, to the Legislature on issues related to the 91
state Medicaid program and any affiliated programs. 92
(3) COOPERATION.— 93
(a) The Auditor General and the Agency for Health Care 94
Administration shall enter into and maintain a data sharing 95
agreement by July 1, 2025, to ensure the committee has full 96
access to all data needed to fulfill its responsibilities. 97
(b) The Auditor General shall assi st the committee in its 98
work by providing credentialed professional staff or consulting 99
services, including, but not limited to, an actuary not 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 VE S
associated with the state Medicaid program or any Medicaid 101
managed care organization who currently has a contrac t with the 102
state. 103
(c) The committee, in the course of its official duties, 104
must be given access to any relevant record, paper, or document 105
in possession of a state agency, any political subdivision of 106
the state, or any entity engaged in business or under contract 107
with a state agency, and may compel the attendance and testimony 108
of any state official or employee before the committee or secure 109
any evidence as provided in s. 11.143. The committee shall also 110
have any other powers conferred on it by joint rules of the 111
Senate and the House of Representatives, and any joint rules of 112
the Senate and the House of Representatives applicable to joint 113
legislative committees apply to the proceedings of the committee 114
under this section. 115
(4) AGENCY REPORTS. — 116
(a) Before implementing any change to the Medicaid managed 117
care capitation rates, the Agency for Health Care Administration 118
shall notify the committee of the change and appear before the 119
committee to provide a report detailing the managed care 120
capitation rates and a dministrative costs built into the 121
capitation rates. The report must include the agency's 122
historical and projected Medicaid program expenditure and 123
utilization trend rates by Medicaid program and service category 124
for the rate year, an explanation of how th e trend rates were 125
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calculated, and the policy decisions that were included in 126
setting the capitation rates. 127
(b) If the Agency for Health Care Administration or any 128
division within the agency is required by law to report to the 129
Legislature or to any legis lative committee or subcommittee on 130
matters relating to the state Medicaid program, the agency must 131
also submit a copy of the report to the committee. 132
Section 2. This act shall take effect upon becoming a law. 133