The bill amends Florida Statutes concerning Medicaid provider networks, focusing on payment negotiations and provider network standards. It mandates that Medicaid managed care plans negotiate payment rates with providers, ensuring that dentists are compensated at rates equal to or higher than those established by the agency. New requirements for provider network contracts are introduced, including criteria for the active status of dental providers based on their patient care hours and the classification of specialty care providers. The legislation also emphasizes the need for accurate provider databases and reporting on provider availability, while making conforming changes to existing statutes.

Additionally, House Bill 517 establishes criteria for identifying essential Medicaid providers, such as federally qualified health centers and trauma centers, ensuring their inclusion in managed care plans. Managed care plans are required to negotiate in good faith with these essential providers if they have not contracted with them by the time of recipient enrollment. The bill outlines payment structures for services from nonparticipating essential providers and includes provisions for statewide essential providers, mandating their inclusion in managed care networks. It also allows for the exclusion of essential providers after 12 months if they do not meet quality standards, with a notification requirement for affected recipients. The act is set to take effect on July 1, 2026.

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