The bill amends section 409.967 of the Florida Statutes to enhance the requirements for Medicaid managed care plans, specifically focusing on access to care for enrollees. It mandates that the Agency for Health Care Administration establish standards to ensure that enrollees have access to network providers during state holidays and outside regular business hours, defined as Monday through Friday between 5 p.m. and 8 a.m. local time, as well as all day Saturday and Sunday. Additionally, at least 50 percent of primary care providers in a plan's network must offer appointment availability during these times. The bill also requires managed care plans to maintain an accurate electronic database of contracted providers and submit quarterly reports to the agency regarding the number of enrollees assigned to each primary care provider.

Furthermore, the bill introduces several new provisions, including systematic testing of provider network databases to confirm accuracy and access to behavioral health services, as well as the requirement for managed care plans to publish their drug formularies online and ensure electronic acceptance of prior authorization requests. The language also emphasizes the importance of follow-up on medically necessary services recommended from early and periodic screening, diagnosis, and treatment. The act is set to take effect on July 1, 2025.

Statutes affected:
S 306 Filed: 409.967
S 306 c1: 409.967