Andrew Powell
Rep. Traci Koster wants to make sure behavioral health services are delivered more efficiently.
Tampa Republican Rep. Koster filed a bill (HB 633) with the goal of enhancing transparency and accountability of behavioral health managing entities by requiring regular audits.
The bill would require the Department of Children and Families (DCF) to contract for operational and financial audits of managing entities. Those audits would include a review of business practices, personnel, financial records, compensation, services administered, the method of provider payment, expenditures, outcomes, referral patterns and referral volume, provider referral assignments, and key performance measures.
Furthermore, audits would need to include information on provider network adequacy and provider network participation in the Department’s available bed platform, the Opioid Management System, the Agency for Health Care Administration Event Notification Service, and any other Department required to provide data submissions.
Each audit of a managing entity’s expenditures and claims must compare services that have been administered with the outcomes of each entity’s expenditures, including Medicaid expenditures for behavioral health services.
Claims paid by each managing entity for Medicaid recipients would be required to be analyzed and include recommendations to improve the transparency of the system’s performance based on metrics and criteria used to measure performance and outcomes in behavioral health systems.
A managing entity would be required to report all required information to DCF in a standardized electronic format to facilitate data analysis.
DCF would work with managing entities to establish performance standards and the extent that individuals in the community receive services — including parents and caregivers involved in the child welfare system who need behavioral health services, the improvement in the overall behavioral health of a community, and the progress in the recovery of individuals served by the managing entity.
Managing entities would further work with DCF to outline the success of strategies designed to divert admission from acute levels of care, jails, prisons and forensic facilities, integrate behavioral health services with the child welfare system, and address housing needs for homeless individuals being released from facilities.
The bill would require managing entities to report the number and percentage of high utilizers, the number of individuals who receive outpatient services for behavioral health services, wait times and the number of individuals able to schedule an appointment within 24 hours, and emergency room visits.
The incidence of medication errors in treatment plans would also need to be reported, along with the number of adverse incidents such as self-harm in inpatient and outpatient settings, the rate of readmission and individuals who receive integrated care.
Data would be required to be prepared in a report to the Governor, the Senate President, and the House Speaker by Dec. 1. If passed, the bill would come into effect July 1.
