House Bill 517 amends Florida Statutes to improve the Medicaid managed care system by establishing clear guidelines for the negotiation of payment rates and the identification of essential providers. The bill mandates that Medicaid managed care plans negotiate mutually acceptable payment terms with providers, specifically requiring that dentists be compensated at rates equal to or higher than those set by the agency. It introduces new requirements for provider network contracts, stipulating that dentists must provide a minimum of 20 hours of direct patient care per week to be listed as active Medicaid providers, while also allowing for a secondary network for those who do not meet this threshold. Additionally, the bill emphasizes the need for managed care plans to maintain accurate provider databases to ensure public access to information about services and availability.

The bill further categorizes certain providers, such as federally qualified health centers and trauma centers, as essential, requiring managed care plans to negotiate in good faith with these providers for one year if they have not contracted by the time of recipient enrollment. Payments for services from nonparticipating essential providers will be set at the applicable Medicaid rate, with provisions for alternative arrangements. It also outlines a process for excluding essential providers from networks after 12 months if they do not meet quality or performance criteria, necessitating written notice to affected recipients. The act is scheduled to take effect on July 1, 2026, and aims to enhance accountability and efficiency within Florida's Medicaid provider networks.

Statutes affected:
H 517 Filed: 409.967, 409.9071, 427.0135