CS for SB 730 - Medicaid Managed Care Summary

• Specifies that the subscriber assistance program applies only to prepaid health clinics, Florida Healthy Kids plans, and health plans meeting federal requirements under 45 C.F.R. § 147.140, unless the health plan elects to have all policies subject to independent external review processes.

• Authorizes the Agency for Health Care Administration to extend or modify contracts with behavioral health care providers through July 1, 2012, to ensure continuity of care, and removes the October 1, 2014 expiration date for the agency's authority to impose fines against contracted entities.

• Establishes a method for calculating medical loss ratios for managed care plans when required by federal waivers, classifying expenditures consistent with federal regulations and allowing plans to count graduate medical education funding and designated state trust fund contributions as medical expenditures.

• Specifies that Medicaid contracts are not rules subject to the Administrative Procedure Act and modifies eligibility requirements for Medicare Advantage plans, specialty plans, and long-term care plans in the managed medical assistance program.

• Applies federal internal grievance procedures (29 C.F.R. § 2560.503-1) to individual and group health insurance policies through new sections 627.6513 and 641.312, with exemptions for subscriber assistance program policies and certain benefit types.