No. HB 5301
Filed under Healthcare.
Health Care; Removes provisions relating to Florida health care innovation; revises payment methodology for reimbursement of Medicaid providers; provides legislative intent; creates Eligibility Assistance Program within DCF; provides program requirements; requires department to select independent contractor based on specified criteria to operate program; provides Medicaid waiver funding requirements for certain individuals; requires APD & AHCA to reconcile funding amounts in specified manner.
Plain English Summary
AI-GENERATEDCreates the Eligibility Assistance Program inside the Department of Children and Families. A nonprofit contractor with at least 20 years of experience will run call centers and online help for disabled Floridians navigating Medicaid eligibility.
Extends Medicaid managed care plan contracts from six years to eight years. A new quality incentive withholds 2 percent of each plan's payment annually, tied to infant mortality performance, with penalties for plans that get worse.
Hospitals must be paid separately, and at no less than actual acquisition cost, for long-acting injectable drugs given to patients with severe mental illness in a hospital setting.
Repeals the state's Florida health care innovation provisions entirely. Separately, funding will follow individuals with developmental disabilities when they switch between home-based waiver services and the state's managed care pilot program.
AIEstablishes the Eligibility Assistance Program inside the Department of Children and Families to help people with disabilities complete the steps required to qualify for Medicaid and other community-based services.
AIManaged care plans selected in the 2023 procurement round get an 8-year contract instead of 6. Contracts still cannot be renewed, so this locks in the same plan for two extra years before rebidding.
AIHospitals administering long-acting injectable drugs for severe mental illness get paid for that drug separately from the flat per-stay hospital rate, and the payment can never be less than what the hospital paid to acquire it.
AIThe program is run by one selected contractor statewide, which must be a tax-exempt nonprofit already in good standing with at least 20 years running disability services and the capacity to operate a call center.
AIFor the contract term ending in 2033, the agency withholds 2 percent of each plan's capitation rate every year and pays it back based on how much the plan cuts infant mortality versus other plans. A plan whose rate rises instead loses new-member automatic assignment for four months.
AIWhen someone moves between the developmental-disabilities home care waiver and the managed care pilot program, their state Medicaid funding transfers with them between the two state agencies, reconciled every quarter.
AISection 381.4015, Florida Statutes, is eliminated entirely. The bill does not restate what that section required, so the practical effect of removing it cannot be fully assessed from this text alone.
AIThe pool of money used for quality incentive payments to included facilities rises from 10 percent to 15.2344 percent of certain 2016 payments, and the quality score needed to qualify changes from a percentile ranking to 33 percent of available program points.