This bill amends various sections of Florida Statutes concerning Medicaid provider networks, focusing on the negotiation of payment rates and the establishment of provider network standards. It mandates that Medicaid managed care plans and providers negotiate mutually acceptable rates, with a specific requirement that plans pay dentists at rates equal to or higher than those established by the agency. The bill introduces new requirements for provider network contracts, including stipulations regarding the active status of dental providers based on their hours of direct patient care and the categorization of specialty care providers. Additionally, it emphasizes the importance of maintaining accurate provider databases and mandates that managed care plans publish their drug formularies online.

Furthermore, the bill requires managed care plans to negotiate in good faith with essential providers for one year or until an agreement is reached. If no agreement is achieved, plans must propose alternative arrangements to secure essential services for Medicaid enrollees, with specific payment structures for nonparticipating essential providers based on agency approval. The bill identifies certain statewide essential providers that must be included in managed care networks and outlines criteria for excluding providers after 12 months of participation. It also establishes guidelines for selecting plans for a pilot program for individuals with developmental disabilities, emphasizing experience and community partnerships. The act is set to take effect on July 1, 2026.

Statutes affected:
S 152 Filed: 409.967, 409.9071, 427.0135