Florida Statutes 409.974 – Eligible plans
Current as of: 2023 | Check for updates
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1(1) ELIGIBLE PLAN SELECTION.–The agency shall select eligible plans for the managed medical assistance program through the procurement process described in s. 409.966 through a single statewide procurement. The agency may award contracts to plans selected through the procurement process either on a regional or statewide basis. The awards must include at least one provider service network in each of the nine regions outlined in this subsection. The agency shall procure:
(a) At least 3 plans and up to 4 plans for Region A.
Terms Used In Florida Statutes 409.974
- Agency: means the Agency for Health Care Administration. See Florida Statutes 409.962
- Contract: A legal written agreement that becomes binding when signed.
- Eligible plan: means a health insurer authorized under chapter 624, an exclusive provider organization authorized under chapter 627, a health maintenance organization authorized under chapter 641, or a provider service network authorized under…. See Florida Statutes 409.962
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Medicaid: means the medical assistance program authorized by Title XIX of the Social Security Act, 42 U. See Florida Statutes 409.962
- Provider service network: means an entity qualified pursuant to…. See Florida Statutes 409.962
(b) At least 3 plans and up to 6 plans for Region B.
(c) At least 3 plans and up to 5 plans for Region C.
(d) At least 4 plans and up to 7 plans for Region D.
(e) At least 3 plans and up to 6 plans for Region E.
(f) At least 3 plans and up to 4 plans for Region F.
(g) At least 3 plans and up to 5 plans for Region G.
(h) At least 3 plans and up to 5 plans for Region H.
(i) At least 5 plans and up to 10 plans for Region I.
1(2) QUALITY SELECTION CRITERIA.–In addition to the criteria established in s. 409.966, the agency shall consider evidence that an eligible plan has obtained signed contracts or written agreements or has made substantial progress in establishing relationships with providers before the plan submits a response. The agency shall evaluate and give special weight to evidence of signed contracts with essential providers as defined by the agency pursuant to s. 409.975(1). When all other factors are equal, the agency shall consider whether the organization has a contract to provide managed long-term care services in the same region and shall exercise a preference for such plans.
(3) SPECIALTY PLANS.–Participation by specialty plans shall be subject to the procurement requirements of this section. The aggregate enrollment of all specialty plans in a region may not exceed 10 percent of the total enrollees of that region.
(4) CHILDREN’S MEDICAL SERVICES NETWORK.–Participation by the Children’s Medical Services Network shall be pursuant to a single, statewide contract with the agency that is not subject to the procurement requirements or regional plan number limits of this section. The Children’s Medical Services Network must meet all other plan requirements for the managed medical assistance program.
(5) MEDICARE PLANS.–Participation by a Medicare Advantage Preferred Provider Organization, Medicare Advantage Provider-sponsored Organization, Medicare Advantage Health Maintenance Organization, Medicare Advantage Coordinated Care Plan, or Medicare Advantage Special Needs Plan shall be pursuant to a contract with the agency that is consistent with the Medicare Improvement for Patients and Providers Act of 2008, Pub. L. No. 110-275. Such plans are not subject to the procurement requirements if the plan’s Medicaid enrollees consist exclusively of dually eligible recipients who are enrolled in the plan in order to receive Medicare benefits as of the date that the invitation to negotiate is issued. Otherwise, such plans are subject to all procurement requirements.