Florida Senate - 2025 SB 1060 10-01068-25 20251060__ Page 3 of 5 CODING: Words stricken are deletions; words underlined are additions. functions to ensure the program is providing transparency in the 59 provision of health care plans and providers, ensuring access to 60 quality health care services to Medicaid recipients, and 61 providing stability to the state’s budget through a health care 62 delivery system designed to contain costs. 63 (

b) The committee shall identify and recommend policies 64 that limit Medicaid spending growth while improving health care 65 outcomes for Medicaid recipients. In developing its 66 recommendations, the committee shall do all of the following: 67 1. Evaluate legislation for its long-term impact on the 68 state Medicaid program. 69 2.

Review data submitted to the agency by the Medicaid 70 managed care plans pursuant to statutory and contract 71 requirements, including, but not limited to, timeliness of 72 provider credentialing, timely payment of claims, rate of claim 73 denials, prior authorizations for services, and consumer 74 complaints. 75 3. Review the Medicaid managed care plans’ encounter data, 76 financials, and audits and the data used to calculate the plans’ 77 achieved savings rebates and medical loss ratios. 78 4.

Review data related to health outcomes of Medicaid 79 recipients, including, but not limited to, Health Effectiveness 80 Data and Information Set measures for each Medicaid managed care 81 plan, each Medicaid managed care plan’s performance improvement 82 projects, and outcome data related to all quality goals included 83 in the Medicaid managed care organization contracts to improve 84 quality for recipients. 85 5.

Identify any areas for improvement in statute and rule 86 relating to the state Medicaid program. 87 Florida Senate - 2025 SB 1060 10-01068-25 20251060__ Page 5 of 5 CODING: Words stricken are deletions; words underlined are additions. (

a) Before implementing any change to the Medicaid managed 117 care capitation rates, the Agency for Health Care Administration 118 shall notify the committee of the change and appear before the 119 committee to provide a report detailing the managed care 120 capitation rates and administrative costs built into the 121 capitation rates. The report must include the agency’s 122 historical and projected Medicaid program expenditure and 123 utilization trend rates by Medicaid program and service category 124 for the rate year, an explanation of how the trend rates were 125 calculated, and the policy decisions that were included in 126 setting the capitation rates. 127 (

b) If the Agency for Health Care Administration or any 128 division within the agency is required by law to report to the 129 Legislature or to any legislative committee or subcommittee on 130 matters relating to the state Medicaid program, the agency must 131 also submit a copy of the report to the committee. 132

Section 2. This act shall take effect upon becoming a law. 133