MM Curator summary
[MM Curator Summary]: As part of legislative efforts to overhaul the state’s Medicaid managed care system, the state would add the Core Set of BH measures and new demographic data reporting requirements to plan scope under a new proposal.
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Medicaid managed care plans would be required to report more data to the state in the coming years under a bill that cleared the Senate Rules Committee Tuesday morning.
Sponsored by Sen. Shevrin Jones, SB 1258 would require Medicaid managed care plans to collect and annually report HEDIS measures, the federal Core Set of Children’s Health Care Quality measures, and the federal Core Set of Adult Health Care Quality performance measures. Those reports would go to the Agency for Health Care Administration (AHCA).
Beginning in 2025, the bill requires the plans to report the Adult Core Set Behavioral Health measures. And beginning with the 2026 calendar year, the Medicaid managed care plans must stratify the required reported measures by age, sex, race, ethnicity, primary language and whether there is a disability determination from the Social Security Administration.
The Rules Committee was the third Senate panel to consider the bill, which can now be heard by the full Senate. Its counterpart, HB 855, also has cleared all committees and is awaiting floor debate. Reps. Robin Bartleman and Nick Duran are sponsoring the House bill.
In addition to requiring plans to submit additional health care measures to the state, the bill also makes a technical correction to reflect that HEDIS is an acronym for “Healthcare Effectiveness Data and Information Set.” HEDIS once stood for “Health Plan Employer Data and Information Set,” and the statutes still reflect the old moniker.
Florida has a Medicaid managed care mandate that requires most enrollees, from cradle to the grave, to join a managed care plan.
To hold down costs, Florida competitively bids its Medicaid program, inking contracts with health plans that submit winning bids in 11 regions across the state. The current law requires contracted Medicaid managed care plans to be accredited by the National Committee for Quality Assurance, the Joint Commission, or another nationally recognized accrediting body, or have initiated the accreditation process, within one year of signing the contract.
AHCA, which houses the state’s Medicaid program, is charged with ensuring the plans meet contractual requirements, and the current law requires the health plans to report HEDIS measures to the state.
AHCA says it currently requires health plans to report 27 HEDIS measures related to medical care and nine measures related to Child and Adult Core Set measures in its contracts with those plans.
A staff analysis of the bill indicates the state will need one additional employee and $79,930 to implement the provisions in the bill.
This is one of two Medicaid managed care bills Florida lawmakers are considering this Session. The Senate Appropriations Subcommittee on Health and Human Services will consider the other Medicaid managed care bill, SB 1950 by Sen. Jason Brodeur, Wednesday morning. That measure updates the Medicaid managed care statutes.