The bill amends sections 409.967 and 409.975 of the Florida Statutes to enhance access to care for enrollees in Medicaid managed care plans. It requires the Agency for Health Care Administration to establish specific standards for provider networks, ensuring that plans maintain sufficient numbers of providers to meet access standards for medical services. Notably, the bill allows enrollees to seek care from Medicaid providers not under contract with their managed care plan if they cannot receive timely care from participating providers or if a more accessible provider is available. In such cases, the plans are mandated to reimburse these nonparticipating providers at the applicable Medicaid rates.

Additionally, the bill emphasizes the importance of maintaining accurate provider databases and mandates that managed care plans submit quarterly reports on enrollee assignments to primary care providers. It also includes provisions for the publication of drug formularies and the electronic acceptance of prior authorization requests. The effective date for these changes is set for July 1, 2025.

Statutes affected:
S 306 Filed: 409.967