2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part IV - Medicaid Managed Care (Ss. 409.961-409.9855) › 409.981 - Eligible long-term care plans.

409.981 Eligible long-term care plans.—
(1) ELIGIBLE PLANS.—Provider service networks must be long-term care provider service networks. Other eligible plans may be long-term care plans or comprehensive long-term care plans.
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(2) ELIGIBLE PLAN SELECTION.—The agency shall select eligible plans for the long-term care managed care 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 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 4 plans for Region H.
(i) At least 5 plans and up to 10 plans for Region I.
(3) QUALITY SELECTION CRITERIA.—In addition to the criteria established in s. 409.966, the agency shall consider the following factors in the selection of eligible plans:
(a) Evidence of the employment of executive managers with expertise and experience in serving aged and disabled persons who require long-term care.
(b) Whether a plan has established a network of service providers dispersed throughout the region and in sufficient numbers to meet specific service standards established by the agency for specialty services for persons receiving home and community-based care.
(c) Whether a plan is proposing to establish a comprehensive long-term care plan and whether the eligible plan has a contract to provide managed medical assistance services in the same region.
(d) Whether a plan offers consumer-directed care services to enrollees pursuant to s. 409.221.
(e) Whether a plan is proposing to provide home and community-based services in addition to the minimum benefits required by s. 409.98.
(4) PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY.—Participation by the Program of All-inclusive Care for the Elderly (PACE) shall be pursuant to a contract with the agency and not subject to the procurement requirements or regional plan number limits of this section. PACE plans may continue to provide services to individuals at such levels and enrollment caps as authorized by the General Appropriations Act.
(5) MEDICARE ADVANTAGE SPECIAL NEEDS PLANS.—Participation by a 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 the invitation to negotiate is issued. Otherwise, Medicare Advantage Special Needs Plans are subject to all procurement requirements.
History.—s. 22, ch. 2011-134; s. 10, ch. 2012-44; s. 103, ch. 2014-17; s. 11, ch. 2022-42.
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Note.—Section 16, ch. 2022-42, provides that “[t]he Agency for Health Care Administration shall amend existing Statewide Medicaid Managed Care contracts to implement the changes made by this act to sections 409.973, 409.975, and 409.977, Florida Statutes. The agency shall implement the changes made by this act to sections 409.966, 409.974, and 409.981, Florida Statutes, for the 2025 plan year.”