Christine Jordan Sexton
A proposed Medicaid managed care overhaul was revamped before it heads to the full Senate.
The Senate Committee on Appropriations on Monday passed the rewrite (SB 1950) after legislators agreed to tag on a number of amendments.
Six amendments that tweak the Medicaid managed care regions — and the number of health plans in each region that can be awarded multiyear contracts as part of Florida’s multibillion safety net health care program — were tagged onto the bill during an all-day committee meeting.
The amendments have the cumulative effect of halting the proposed merger of Medicaid Regions 5 and 6 into a larger area and changing the number of Medicaid managed medical assistance (MMA) and Medicaid long term care (LTC) plans the state can contract with in those areas.
Filed by bill sponsor Sen. Jason Brodeur, the amendments also would increase the number of MMA and LTC plans that could be contracted within Region 5, upping it from the current four-plan maximum in statute to a six-plan maximum.
Conversely, Brodeur’s amendment decreases the maximum number of plans that can be contracted with in Medicaid Region 6, decreasing it from the current seven-plan maximum in statute to four.
The committee, however, tweaked two of Brodeur’s four amendments before members agreed to adopt them. The amendments to the amendments were offered by Senate President Pro Tempore and Senate Appropriations Subcommittee on Health and Human Services Chairman Aaron Bean.
Bean’s amendments kept intact the current requirement for the state to award a Medicaid contract to at least one provider service network (PSN) in each region.
A provider service network is a group of providers that perform associated insurance functions, such as enrollee services, provider credentialing, claims processing and quality assurance.
The state inked contracts with two PSNs in 2018, which is when the Medicaid program was last procured. But neither continues to operate in the Medicaid managed care system. Most recently, Lighthouse Health Plan in Northwest Florida, which was affiliated with Pensacola-based Baptist Health Care, was sold to Simply Health Care Plans, Inc. in 2021.
Bean said Monday that PSNs help ensure Medicaid enrollees can have a choice of providers. The requirement applies only to PSNs that submit responsive bids.
Brodeur’s move to change the number of districts increases the number of differences that need to be hammered out between House and Senate Republicans before the end of the 2022 Legislative Session.
Brodeur hinted a week ago that the Senate may not keep to the eight regions that AHCA had initially proposed as part of the Medicaid managed care rewrite.
The House last week backed off its push to require MMA and LTC plans to provide dental services as part of their contracts, which would have eliminated the Medicaid managed dental program. Though the House does not eliminate the separate dental program in its proposal, it does put guardrails on the current one and requires the agency to adopt rules.
The Senate bill does not include the dental language.
Meanwhile, the House continues in its bill (HB 7047) a push to require all “essential” hospital providers to contract with every Medicaid managed care plan in their region and, in some instances, the state. The essential provider contracting language is a significant difference between the bills as lawmakers head into the last two weeks of the 2022 Legislative Session.
The administration of Gov. Ron DeSantis wants to see the law updated before it begins working on the third Medicaid procurement.
