Bill Text: FL S1280 | 2024 | Regular Session | Introduced
Bill Title: Medicaid Behavioral Health Provider Performance
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2024-03-08 - Died in Health Policy [S1280 Detail]
Download: Florida-2024-S1280-Introduced.html
Florida Senate - 2024 SB 1280 By Senator Davis 5-00015A-24 20241280__ 1 A bill to be entitled 2 An act relating to Medicaid behavioral health provider 3 performance; amending s. 409.967, F.S.; revising 4 provider network requirements for behavioral health 5 providers in the Medicaid program; specifying network 6 testing requirements; requiring the Agency for Health 7 Care Administration to establish certain performance 8 measures; requiring that managed care plan contract 9 amendments be effective by a specified date; requiring 10 the agency to submit an annual report to the 11 Legislature; providing an effective date. 12 13 Be It Enacted by the Legislature of the State of Florida: 14 15 Section 1. Paragraphs (c) and (f) of subsection (2) of 16 section 409.967, Florida Statutes, are 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 provisions 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 care plan networks to ensure access to care for both adults 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. The exclusive use of mail-order pharmacies may not be 30 sufficient to meet network access standards. Consistent with the 31 standards established by the agency, provider networks may 32 include providers located outside the region. Each plan shall 33 establish and maintain an accurate and complete electronic 34 database of contracted providers, including information about 35 licensure or registration, locations and hours of operation, 36 specialty credentials and other certifications, specific 37 performance indicators, and such other information as the agency 38 deems necessary. The database must be available online to both 39 the agency and the public and have the capability to compare the 40 availability of providers to network adequacy standards and to 41 accept and display feedback from each provider’s patients. Each 42 plan shall submit quarterly reports to the agency identifying 43 the number of enrollees assigned to each primary care provider. 44 The agency shallconduct, orcontract for,systematic and 45 continuous testing of the plan provider networksnetwork46databases maintained by each planto confirm accuracy,confirm47 that behavioral health providers are accepting enrollees, and 48confirmthat enrollees have timely access tobehavioral health49 services. The agency shall specifically and expressly establish 50 network requirements for each type of behavioral health provider 51 serving Medicaid enrollees, including community-based and 52 residential providers. Testing of the behavioral health network 53 must include provider-specific data on timeliness of access to 54 services. 55 2. Each managed care plan must publish any prescribed drug 56 formulary or preferred drug list on the plan’s website in a 57 manner that is accessible to and searchable by enrollees and 58 providers. The plan must update the list within 24 hours after 59 making a change. Each plan must ensure that the prior 60 authorization process for prescribed drugs is readily accessible 61 to health care providers, including posting appropriate contact 62 information on its website and providing timely responses to 63 providers. For Medicaid recipients diagnosed with hemophilia who 64 have been prescribed anti-hemophilic-factor replacement 65 products, the agency shall provide for those products and 66 hemophilia overlay services through the agency’s hemophilia 67 disease management program. 68 3. Managed care plans, and their fiscal agents or 69 intermediaries, must accept prior authorization requests for any 70 service electronically. 71 4. Managed care plans serving children in the care and 72 custody of the Department of Children and Families must maintain 73 complete medical, dental, and behavioral health encounter 74 information and participate in making such information available 75 to the department or the applicable contracted community-based 76 care lead agency for use in providing comprehensive and 77 coordinated case management. The agency and the department shall 78 establish an interagency agreement to provide guidance for the 79 format, confidentiality, recipient, scope, and method of 80 information to be made available and the deadlines for 81 submission of the data. The scope of information available to 82 the department isshall bethe data that managed care plans are 83 required to submit to the agency. The agency shall determine the 84 plan’s compliance with standards for access to medical, dental, 85 and behavioral health services; the use of medications; and 86 followup on all medically necessary services recommended as a 87 result of early and periodic screening, diagnosis, and 88 treatment. 89 (f) Continuous improvement.—The agency shall establish 90 specific performance standards and expected milestones or 91 timelines for improving performance over the term of the 92 contract. 93 1. Each managed care plan shall establish an internal 94 health care quality improvement system, including enrollee 95 satisfaction and disenrollment surveys. The quality improvement 96 system must include incentives and disincentives for network 97 providers. 98 2. Each managed care plan shallmustcollect and report the 99 Healthcare Effectiveness Data and Information Set (HEDIS) 100 measures, the federal Core Set of Children’s Health Care Quality 101 measures, and the federal Core Set of Adult Health Care Quality 102 Measures, as specified by the agency. Beginning with data 103 reports for the 2025 calendar year, each plan shallmustcollect 104 and report the Adult Core Set behavioral health measures 105beginning with data reports for the 2025 calendar year. 106 Beginning with data reports for the 2026 calendar year, each 107 plan must stratify reported measures by age, sex, race, 108 ethnicity, primary language, and whether the enrollee received a 109 Social Security Administration determination of disability for 110 purposes of Supplemental Security Incomebeginning with data111reports for the 2026 calendar year. A plan’s performance on 112 these measures must be published on the plan’s website in a 113 manner that allows recipients to reliably compare the 114 performance of plans. The agency shall use the measures as a 115 tool to monitor plan performance. 116 3. Each managed care plan must be accredited by the 117 National Committee for Quality Assurance, the Joint Commission, 118 or another nationally recognized accrediting body, or have 119 initiated the accreditation process, within 1 year after the 120 contract is executed. The agency shall suspend automatic 121 assignment under ss. 409.977 and 409.984, for any plan not 122 accredited within 18 months after executing the contract, the123agency shall suspend automatic assignment under ss. 409.977 and124409.984. 125 4. The agency shall establish specific outcome performance 126 measures to reduce the incidence of crisis stabilization 127 services for children and adolescents who are high users of such 128 services. At a minimum, performance measures must establish 129 plan-specific, year-over-year improvement targets to reduce 130 repeated use of such services. 131 Section 2. The Agency for Health Care Administration shall 132 amend existing contracts with managed care plans to execute the 133 requirements of this act. Such contract amendments must be 134 effective before January 1, 2025. 135 Section 3. Beginning on October 1, 2024, and annually 136 thereafter, the Agency for Health Care Administration shall 137 submit to the Legislature an annual report on Medicaid-enrolled 138 children and adolescents who are the highest users of crisis 139 stabilization services. The report must include demographic and 140 geographic information; plan-specific performance data based on 141 the performance standards established under s. 409.967(2)(f), 142 Florida Statutes; plan-specific provider network testing data 143 generated pursuant to s. 409.967(2)(c), Florida Statutes, 144 including, but not limited to, an assessment of timeliness of 145 access to services; and trends on reported data points beginning 146 with the 2021-2022 fiscal year. The report must also include an 147 analysis of relevant managed care plan contract terms and the 148 contract enforcement mechanisms available to the agency to 149 ensure compliance; data on enforcement or incentive actions 150 taken by the agency to ensure compliance with network standards 151 and progress in performance improvement, including, but not 152 limited to, the use of the achieved savings rebate program as 153 provided under s. 409.967, Florida Statutes; and a listing of 154 other actions taken by the agency to better serve such children 155 and adolescents. 156 Section 4. This act shall take effect July 1, 2024.