Senate Bill 794 (2024) — Medicaid managed care plan performance metrics
SB 794
Florida Bills
Florida Senate - 2024 SB 794 By Senator Harrell 31-01043A-24 2024794__ Page 1 of 4 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to Medicaid managed care plan 2 performance metrics; creating s. 409.9673, F.S.; 3 requiring Medicaid managed care plans to submit 4 certain performance metrics monthly to the Agency for 5 Health Care Administration; providing requirements for 6 such performance metrics; requiring the agency to 7 contract to develop and display on its public website 8 a dashboard containing certain information; requiring 9 the agency to update the information monthly; 10 requiring the agency to create a quarterly report, 11 beginning on a specified date, make it available to 12 the public, and submit it to certain entities; 13 providing an effective date. 14 15 Be It Enacted by the Legislature of the State of Florida: 16 17
Section
Section 409.9673, Florida Statutes, is created 18 to read: 19 409.9673 Managed care plan performance metrics.— 20
(1) Each managed care plan shall submit monthly to the 21 agency the managed care plan performance metrics specified in 22 this subsection by region and by county in a format prescribed 23 by the agency. Each managed care plan shall provide metrics that 24 include, at a minimum, all of the following: 25 (
a) Credentialing: 26 1. The percentage and total number of providers for which a 27 submitted provider application has been fully uploaded and 28 processed within 60 days for provider billing. 29 Florida Senate - 2024 SB 794 31-01043A-24 2024794__ Page 2 of 4 CODING: Words stricken are deletions; words underlined are additions. 2. The percentage and total number of providers for which a 30 submitted provider application has not been fully uploaded and 31 processed for provider billing in excess of: 32 a. Sixty days. 33 b. Ninety days. 34 c. One hundred twenty days. 35 (
b) Prior authorization: 36 1.a. The percentage and total number of standard prior 37 authorization requests approved. 38 b. The percentage and total number of standard prior 39 authorization requests denied. 40 c. The percentage and total number of standard prior 41 authorization requests approved after appeal and the length of 42 time it took to complete the appeal process, from the beginning 43 of the appeal until the approval. 44 2. The percentage and total number of expedited prior 45 authorization requests approved and the length of time it took 46 to receive approval. 47 3.
The average and median time between submissions of 48 requests and decisions for: 49 a. Standard prior authorizations. 50 b. Expedited prior authorizations. 51 (
c) Prompt payment: 52 1. The percentage and total number of claims that are: 53 a. Rejected before review. 54 b.(
I) Paid. 55 (II) Partially paid. 56 (III) Denied. 57 (IV) Suspended. 58 Florida Senate - 2024 SB 794 31-01043A-24 2024794__ Page 3 of 4 CODING: Words stricken are deletions; words underlined are additions. 2. The average length of time it took to pay clean claims, 59 or claims that did not have any errors, deficiencies, or other 60 issues. 61 3. The percentage of clean claims paid within: 62 a. Seven days. 63 b. Ten days. 64 c. Twenty days. 65 d. In excess of 120 days. 66 4. The top 10 reasons for claims denial, with the 67 percentage and total number of claims for each reason cited. 68
(2) The agency shall contract to develop and display on its 69 public website a dashboard containing the data provided under 70 subsection (1) by each managed care plan to show managed care 71 plan performance and utilization management. In addition to the 72 data provided under subsection (1), the agency shall publish on 73 the public dashboard all of the following information regarding 74 managed care plan complaints: 75 (
a) The number of Medicaid recipients enrolled in the 76 statewide managed medical assistance program. 77 (
b) The number of complaints per 1,000 Medicaid recipients. 78 (
c) By each managed care plan: 79 1. By provider category, the number of complaints received 80 by physicians, hospitals, outpatient services, skilled nursing 81 facilities, assisted living facilities, therapy services, 82 transportation services, laboratories, and home and community-83 based services. 84 2. The number of Medicaid recipient complaints received for 85 each region. 86 3. The number of Medicaid recipient complaints resolved for 87 Florida Senate - 2024 SB 794 31-01043A-24 2024794__ Page 4 of 4 CODING: Words stricken are deletions; words underlined are additions. each region. 88 4.
By provider category: 89 a. The number of provider complaints resolved for each 90 region. 91 b. The number of complaints pending resolution for each 92 region. 93 c. The average length of time it took to resolve provider 94 complaints for each region. 95 d. The average length of time it took to resolve Medicaid 96 recipient complaints for each region. 97 5. The number of complaints pending resolution for each 98 region. 99 6. The average length of time it took to resolve provider 100 complaints for each region. 101 7.
The average length of time it took to resolve Medicaid 102 recipient complaints for each region. 103
(3) The agency shall update monthly on the dashboard the 104 information described in subsections (1) and (2). 105
(4) The agency shall create a quarterly report, beginning 106 July 31, 2025, containing the information described in 107 subsections (1) and (2) and shall make the report publicly 108 available on its website no later than 30 days after the close 109 of each quarter. The agency shall also submit the report to the 110 agency’s Medical Care Advisory Committee, the Governor, the 111 President of the Senate, and the Speaker of the House of 112 Representatives. 113