HB 783 — Medicaid Managed Care Plan Performance Metrics

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB783CS/HB783 2024 A bill to be entitled An act relating to Medicaid managed care plan performance metrics;

requiring Medicaidthe managedAgency carefor plansHealth toCare submitAdministration eachto monthproduce certain performanceMedicaid metricsmanaged tocare theperformance Agencydata; for Health Care Administration;

providingrequiring requirementsthe foragency's suchreports performanceto metrics;include certain data submitted by Medicaid managed care plans;

requiring the agency to contract with a third party vendor to developpublish andsuch displaydata on a public dashboard withquarterly; certain information;

requiring the agency to updatesubmit thean informationannual eachreport month;to certain entities;

requiringproviding therequirements agencyfor tosuch createreport; a quarterly report, make it available to the public, and submit it to certain entities;

409.9673 Managed care plan performance metrics.—metrics.—The (1)agency Each managed care plan shall submitproduce to the agency each month the managed care plan performance metricsdata byrelated regionto andthe byadministration countyof inprovider acontracts. format prescribed by the agency.

EachThe manageagency's carereports planmust shallinclude provide,data atsubmitted aby minimum,the managed care plans to the following:agency pursuant to statutory and contract requirements related to provider credentialing, service prior authorization, claims payment, and consumer complaints.

(a)The Credentialing:agency shall contract with a third party to analyze the data and develop a dashboard on the Page 1of 4 CODING:

1.

The percentage and total number of providers for which Page 1of 5 CODING:

hb0783-00hb0783-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB783CS/HB783 2024 aagency's submittedwebsite providerto applicationdisplay hasthe beendata, fullyand loadedshall publish the data by managed care plan and processedby forregion provideron billingthe withindashboard 60quarterly, days.beginning October 1, 2024.

2.An annual report of the data analyses, beginning January 1, 2026, shall be submitted to the Medical Care Advisory Committee, the Governor, the President of the Senate, and the Speaker of the House of Representatives and published on the website.

The percentageanalyses andmust totalinclude numberthe offollowing: providers for which a submitted provider application has not been fully loaded and processed for provider billing in excess of:

a.(1) Credentialing.

(a) The percentage and total number of providers for which a submitted provider application has been fully loaded and processed for provider billing within 60 days.

(b) The percentage and total number of providers for which a submitted provider application has not been fully loaded and processed for provider billing in excess of:

1.

b.2.

c.3.

(b)(2) Prior authorization:authorization.

1.a.(a)1.

The percentage and total number of standard prior authorizations requests approved.approved by service type.

b.

The percentage and total number of standard prior authorizations requests denied.

c.

The percentage and total number of standard prior authorization requests approved after appeal and the length of time of the appeal process, from the beginning of the appeal until the approval.

The percentage and total number of expeditedstandard prior authorizationauthorizations requests approveddenied. and the length of time to receive approval.

The averagepercentage and mediantotal timenumber betweenof submissionsstandard ofprior authorization requests approved after appeal and decisionsthe for:length of Page 2of 4 CODING:

a.

Standard prior authorizations.

b.

Expedited prior authorizations.

(c) Prompt payment:

Page 2of 5 CODING:

hb0783-00hb0783-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB783CS/HB783 2024 1.time of the appeal process, from the beginning of the appeal until the approval.

The4. percentage and total number of claims that are:

a.The percentage and total number of expedited prior authorization requests approved and the length of time to receive approval by service type.

(b) The average and median time between submissions of requests and decisions for:

1.