Florida § 409.982 - Long-term care managed care plan accountability.

§ 409.982. Long-term care managed care plan accountability.

In addition to the requirements of s. 409.967, plans and providers participating in the long-term care managed care program must comply with the requirements of this section. (1) PROVIDER NETWORKS. — Managed care plans may limit the providers in their networks based on credentials, quality indicators, and price. For the period between October 1, 2013, and September 30, 2014, each selected plan must offer a network contract to all the following providers in the region: (a) Nursing homes. (b) Hospices. (c) Aging network service providers that have previously participated in home and community-based waivers serving elders or community-service programs administered by the Department of Elderly Affairs. After 12 months of active participation in a managed care plan’s network, the plan may exclude any of the providers named in this subsection from the network for failure to meet quality or performance criteria. If the plan excludes a provider from the plan, the plan must provide written notice to all recipients who have chosen that provider for care. The notice must be provided at least 30 days before the effective date of the exclusion. The agency shall establish contract provisions governing the transfer of recipients from excluded residential providers. (2) SELECT PROVIDER PARTICIPATION. — Except as provided in this subsection, providers may limit the managed care plans they join. Nursing homes and hospices that are enrolled Medicaid providers must participate in all eligible plans selected by the agency in the region in which the provider is located. (3) PERFORMANCE MEASUREMENT. — Each managed care plan shall monitor the quality and performance of each participating provider using measures adopted by and collected by the agency and any additional measures mutually agreed upon by the provider and the plan. (4) PROVIDER NETWORK STANDARDS. — The agency shall establish and each managed care plan must comply with specific standards for the number, type, and regional distribution of providers in the plan’s network, which must include: (a) Adult day care centers. (b) Adult family-care homes. (c) Assisted living facilities. (d) Health care services pools. (e) Home health agencies. (f) Homemaker and companion services. (g) Hospices. (h) Community care for the elderly lead agencies. (i) Nurse registries. (j) Nursing homes. (5) PROVIDER PAYMENT. — Managed care plans and providers shall negotiate mutually acceptable rates, methods, and terms of payment. (a) Plans shall pay nursing homes an amount equal to the nursing facility-specific payment rates set by the agency; however, mutually acceptable higher rates may be negotiated for medically complex care. (b) Plans shall pay hospice providers through a prospective system for each enrollee an amount equal to the per diem rate set by the agency. For recipients residing in a nursing facility and receiving hospice services, the plan shall pay the hospice provider the per diem rate set by the agency minus the nursing facility component and shall pay the nursing facility the applicable state rate. (c) Plans must ensure that electronic nursing home and hospice claims that contain sufficient information for processing are paid within 10 business days after receipt. (d) The agency may establish a fee schedule to reimburse providers for adult day care services.