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 they are sufficient in number and distribution to meet the needs of both adults and children. 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 a participating provider or if a more accessible provider is available. In such cases, the managed care plans are mandated to reimburse these nonparticipating providers at the applicable Medicaid rates.

Additionally, the bill emphasizes the importance of maintaining accurate and complete electronic databases of contracted providers, which must be accessible to both the agency and the public. It also requires managed care plans to submit quarterly reports on enrollee assignments to primary care providers and to ensure that prior authorization processes for prescribed drugs are easily accessible. The act is set to take effect on July 1, 2025.

Statutes affected:
H 389 Filed: 409.967