SB 306 — Medicaid Providers

Florida Senate - 2025 CS for SB 306 By Senatorthe ShariefCommittee 35-00489-25on 2025306__Health APolicy; bill to be entitled An act relating to managed care plan network access;

and Senators Sharief, Gaetz, and Davis 588-03163-25 2025306c1 A bill to be entitled An act relating to Medicaid providers;

requiring that the Agency for Health Care Administration to include specified requirements in its contracts with Medicaid managed care plans;

amendingdefining s.the term “outside regular business hours”;

409.975, F.S.;

authorizing enrollees of Medicaid managed care plans to receive care from Medicaid providers not under contract with the plan under certain circumstances;

requiring the plans to reimburse such providers at the applicable rates paid for such services under the plan;

9 Be It Enacted by the Legislature of the State of Florida:

Each plan must maintain a regionwide network of providers in sufficient numbers to meet the access standards for specific medical services for all recipients enrolled in the Pageplan. 1 of 5 CODING:

Words stricken are deletions;

words underlined are additions.

Florida Senate - 2025 SB 306 35-00489-25 2025306__ plan.

Plans must allow enrollees to receive care from Medicaid providers not under contract with the plan if an enrollee is unable to receive care from a participating provider under the plan in a timely manner consistent with a reasonable access standard, as determined by agency rule, or there is another appropriate Medicaid provider in a location more geographically accessible to the enrollee’s residence than those under the plan.

The plan must reimburse the nonparticipating Medicaid providers for such services at the applicable Medicaid rate for such services under the plan.

Each2. plan must shall establish and maintain an accurate and complete electronic database of contracted providers, including information about licensure or registration, locations and hours of operation, specialty credentials and other certifications, specific performance indicators, and such other information as the agency deems necessary.

The agency shall establish specific standards to ensure Page 1 of 4 CODING:

Words stricken are deletions;

words underlined are additions.

Florida Senate - 2025 CS for SB 306 588-03163-25 2025306c1 enrollees have access to network providers during state holidays and outside regular business hours.

At least 50 percent of primary care providers participating in a plan provider network must offer appointment availability to Medicaid enrollees outside regular business hours.

For the purposes of this subparagraph, the term “outside regular business hours” means Monday through Friday between 5 p.m.

and 8 a.m.

local time and all day Saturday and Sunday.

3.

Each plan shall establish and maintain an accurate and complete electronic database of contracted providers, including information about licensure or registration, locations and hours of operation, specialty credentials and other certifications, specific performance indicators, and such other information as the agency deems necessary.

4.

The5. agency shall conduct, or contract for, systematic and continuous testing of the provider network databases maintained by each plan to confirm accuracy, confirm that behavioral health providers are accepting enrollees, and Page 2 of 5 CODING:

The agency shall conduct, or contract for, systematic and continuous testing of the provider network databases maintained by each plan to confirm accuracy, confirm that behavioral health providers are accepting enrollees, and confirm that enrollees have access to behavioral health services.

6.2.

Each managed care plan must publish any prescribed drug formulary or preferred drug list on the plan’s website in a manner that is accessible to and searchable by enrollees and Page 2 of 4 CODING:

Florida Senate - 2025 CS for SB 306 35-00489-25588-03163-25 2025306__2025306c1 confirmproviders. that enrollees have access to behavioral health services.

2.

Each managed care plan must publish any prescribed drug formulary or preferred drug list on the plan’s website in a manner that is accessible to and searchable by enrollees and providers.

3.7.3.

4.8.4.

The scope of information available to Pagethe 3department ofshall 5be CODING:the data that managed care plans are required to submit to the agency.

Words stricken are deletions;

words underlined are additions.

Florida Senate - 2025 SB 306 35-00489-25 2025306__ the department is shall be the data that managed care plans are required to submit to the agency.

and follow-up followup on all medically necessary services recommendedPage as3 a result of early4 andCODING: periodic screening, diagnosis, and treatment.