Bills would require Medicaid plans to provide much more data
Time for a new look at Mediciad agreements.

Medicaid
Democrats in the House and Senate are pushing for more Medicaid managed care encounter data.

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.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


One comment

  • Cherry Wood

    February 18, 2022 at 6:12 pm

    Florida Healthcare facilities would have to accept and bill Medicaid first. I have the same United Dual Complete plan I had in Indiana. I had NO bills or problems. They even followed doctors orders, unlike Florida. In a year and 1/2 I have been billed at 10 different places, who won’t bill my plan (the Medicaid part of my United Medicaid and Medicare plan, so I got Medical bills galore, andy doctors orders have not been followed at all, so after losing the right leg, now my left legs is worse!! I’m a retired Hospital Auditor and I see fraud everywhere in Alachua County Nursing homes, doctor’s offices and off offices and Home Health Care. . The people who need audited are the ones making the rules, not the healthcare workers. I’ve been in 2 nursing homes now, and the nurses never had time to spend one hour a day with the patients, much less three. I’m disabled now too and so I see it very often. These places are hurting the patients by missbilling, and not following the doctors orders. I’ve never had worse health care in my life!! See the reality of the situation, because these people don’t even know how to write an order, much less real patient care. I thought it was a Federal law to follow doctors orders???

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