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 include specific contract requirements that ensure a sufficient number and distribution of providers in managed care networks. Notably, the bill allows enrollees to seek care from Medicaid providers not under contract with their plan if they cannot access timely care from participating providers 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 provider databases and mandates that managed care plans submit quarterly reports on enrollee assignments to primary care providers. It also introduces a requirement for plans to publish their drug formularies online and ensure that prior authorization processes are accessible to healthcare providers. The effective date for these changes is set for July 1, 2025.

Statutes affected:
H 389 Filed: 409.967