Florida Senate - 2025 CS for SB 306 By the Committee on Health Policy; and Senators Sharief, Gaetz, and Davis 588-03163-25 2025306c1 1 A bill to be entitled 2 An act relating to Medicaid providers; amending s. 3 409.967, F.S.; requiring the Agency for Health Care 4 Administration to include specified requirements in 5 its contracts with Medicaid managed care plans; 6 defining the term outside regular business hours; 7 providing an effective date. 8 9 Be It Enacted by the Legislature of the State of Florida: 10 11 Section 1.Paragraph (c) of subsection (2) of section 12 409.967, Florida Statutes, is amended to read: 13 409.967Managed care plan accountability. 14 (2)The agency shall establish such contract requirements 15 as are necessary for the operation of the statewide managed care 16 program. In addition to any other provisions the agency may deem 17 necessary, the contract must require: 18 (c)Access. 19 1.The agency shall establish specific standards for the 20 number, type, and regional distribution of providers in managed 21 care plan networks to ensure access to care for both adults and 22 children. Each plan must maintain a regionwide network of 23 providers in sufficient numbers to meet the access standards for 24 specific medical services for all recipients enrolled in the 25 plan. The exclusive use of mail-order pharmacies may not be 26 sufficient to meet network access standards. Consistent with the 27 standards established by the agency, provider networks may 28 include providers located outside the region. 29 2.The agency shall establish specific standards to ensure 30 enrollees have access to network providers during state holidays 31 and outside regular business hours. At least 50 percent of 32 primary care providers participating in a plan provider network 33 must offer appointment availability to Medicaid enrollees 34 outside regular business hours. For the purposes of this 35 subparagraph, the term outside regular business hours means 36 Monday through Friday between 5 p.m. and 8 a.m. local time and 37 all day Saturday and Sunday. 38 3.Each plan shall establish and maintain an accurate and 39 complete electronic database of contracted providers, including 40 information about licensure or registration, locations and hours 41 of operation, specialty credentials and other certifications, 42 specific performance indicators, and such other information as 43 the agency deems necessary. The database must be available 44 online to both the agency and the public and have the capability 45 to compare the availability of providers to network adequacy 46 standards and to accept and display feedback from each 47 providers patients. 48 4.Each plan must shall submit quarterly reports to the 49 agency identifying the number of enrollees assigned to each 50 primary care provider. 51 5.The agency shall conduct, or contract for, systematic 52 and continuous testing of the provider network databases 53 maintained by each plan to confirm accuracy, confirm that 54 behavioral health providers are accepting enrollees, and confirm 55 that enrollees have access to behavioral health services. 56 6.2.Each managed care plan must publish any prescribed 57 drug formulary or preferred drug list on the plans website in a 58 manner that is accessible to and searchable by enrollees and 59 providers. The plan must update the list within 24 hours after 60 making a change. Each plan must ensure that the prior 61 authorization process for prescribed drugs is readily accessible 62 to health care providers, including posting appropriate contact 63 information on its website and providing timely responses to 64 providers. For Medicaid recipients diagnosed with hemophilia who 65 have been prescribed anti-hemophilic-factor replacement 66 products, the agency shall provide for those products and 67 hemophilia overlay services through the agencys hemophilia 68 disease management program. 69 7.3.Managed care plans, and their fiscal agents or 70 intermediaries, must accept prior authorization requests for any 71 service electronically. 72 8.4.Managed care plans serving children in the care and 73 custody of the Department of Children and Families must maintain 74 complete medical, dental, and behavioral health encounter 75 information and participate in making such information available 76 to the department or the applicable contracted community-based 77 care lead agency for use in providing comprehensive and 78 coordinated case management. The agency and the department shall 79 establish an interagency agreement to provide guidance for the 80 format, confidentiality, recipient, scope, and method of 81 information to be made available and the deadlines for 82 submission of the data. The scope of information available to 83 the department shall be the data that managed care plans are 84 required to submit to the agency. The agency shall determine the 85 plans compliance with standards for access to medical, dental, 86 and behavioral health services; the use of medications; and 87 follow-up followup on all medically necessary services 88 recommended as a result of early and periodic screening, 89 diagnosis, and treatment. 90 Section 2.This act shall take effect July 1, 2025.