The bill amends 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 payment terms, specifically requiring that plans pay dentists at rates equal to or higher than those established by the agency. New requirements for provider network contracts are introduced, including stipulations for the number and type of providers and the maintenance of an accurate electronic database of contracted providers. Additionally, the bill specifies that dentists must provide a minimum of 20 hours of direct patient care per week to be considered active Medicaid providers and outlines criteria for specialty care providers.

The legislation also 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, managed care plans must propose alternative arrangements to secure essential services, with payment rates for nonparticipating essential providers set at either 90% or 110% of the applicable Medicaid rate, depending on agency approval. The bill identifies certain statewide essential providers that must be included in managed care networks and establishes criteria for excluding providers after 12 months of participation. It also sets guidelines for selecting eligible plans for a pilot program for individuals with developmental disabilities, emphasizing experience and community partnerships. The act is scheduled to take effect on July 1, 2026.

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