Fla. Stat. § 409.974 — Florida Code / Title XXX / Chapter 409 / Part IV / Section 409.974
409.974 Eligible plans.
Status: in_force

(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. (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.

(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. — (a) The Department of Health’s Children’s Medical Services program shall do all of the following: 1. Effective July 1, 2025, transfer to the agency the operation of managed care contracts procured by the department for Medicaid and Children’s Health Insurance Program services provided to children and youth with special health care needs who are enrolled in the Children’s Medical Services Managed Care Plan. 2. Conduct clinical eligibility screening for children and youth with special health care needs who are eligible for or are enrolled in Medicaid or the Children’s Health Insurance Program. 3. Provide ongoing consultation to the agency to ensure high-quality, family-centered, coordinated health services are provided within an effective system of care for children and youth with special health care needs. (b) The agency shall establish specific measures of access, quality, and costs of providing health care services to children and youth with special health care needs. The agency shall contract with an independent evaluator to conduct an evaluation of services provided. The evaluation must include, but need not be limited to, all of the following: 1. A performance comparison of plans contracted to provide services to children and youth with special health care needs as well as plans contracted to serve a broader population of Managed Medical Assistance enrollees. The performance comparison must be based on the measures established by the agency and differentiated based on the age and medical condition or diagnosis of patients receiving services under each plan. 2. For each plan, an assessment of cost savings, patient choice, access to services, coordination of care, person-centered planning, health and quality-of-life outcomes, patient and provider satisfaction, and provider networks and quality of care. The agency shall submit the results of the evaluation to the Governor, the President of the Senate, and the Speaker of the House of Representatives by January 15, 2028.

(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.

History: s. 15, ch. 2011-134; s. 53, ch. 2012-5; s. 9, ch. 2012-44; s. 8, ch. 2022-42; s. 2, ch. 2025-88.