Medicaid provider networks must include essential providers and meet access standards for services.

The bill amends Florida Statutes to enhance Medicaid provider networks by requiring managed care plans to include essential providers and meet access standards. Essential providers are those offering unique services or a substantial share of services in a region. Managed care plans must negotiate with essential providers and may exclude nonparticipating providers after one year if an alternative arrangement is not approved. Payments to nonparticipating essential providers are set at 90% of the applicable Medicaid rate, except for emergency services, which are paid at 110%.

Medicaid provider networks must include essential providers and meet access standards for services.

The bill amends Florida Statutes to enhance Medicaid provider networks by requiring managed care plans to include essential providers and meet access standards. Essential providers are those offering unique services or a substantial share of services in a region. Managed care plans must negotiate with essential providers and may exclude nonparticipating providers after one year if an alternative arrangement is not approved. Payments to nonparticipating essential providers are set at 90% of the applicable Medicaid rate, except for emergency services, which are paid at 110%.