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Bill Summary · SB 152

Summary of SB 152 - Medicaid Provider Networks

Bill Number: SB 152
Title: Medicaid Provider Networks
Introduced: October 09, 2025
Status: Referred to Health Policy; Appropriations Committee on Health and Human Services; Appropriations
Sponsor: Senator Harrell

Purpose and Intent

SB 152 aims to enhance the Medicaid provider network in Florida by establishing clearer guidelines for reimbursement rates and improving access to care for Medicaid recipients. The bill seeks to ensure that managed care plans negotiate fair payment terms with providers, particularly dentists, and to strengthen the accountability of managed care plans in maintaining adequate provider networks.

Key Provisions

  1. Negotiation of Rates:

    • Managed care plans and providers are required to negotiate mutually acceptable rates, methods, and terms of payment for Medicaid reimbursements.
    • Plans must pay dentists at rates equal to or higher than those set by the state agency.

  2. Provider Network Standards:

    • The bill mandates specific standards for the number, type, and regional distribution of providers within managed care networks to ensure adequate access to care for both adults and children.
    • Managed care plans must maintain a comprehensive electronic database of contracted providers, which includes information on licensure, location, hours of operation, and specialty credentials.

  3. Reporting and Accountability:

    • Plans are required to submit quarterly reports to the state agency detailing the number of enrollees assigned to each primary care provider.
    • The agency will conduct systematic testing of provider network databases to confirm accuracy and ensure that enrollees have access to necessary services, including behavioral health.

  4. Provider Listing Requirements:

    • Dentists must provide a minimum of 20 hours of direct patient care per week to be listed as active Medicaid providers.
    • Specialty care providers must be listed separately from general dentists, and each provider must specify the services offered and whether they are accepting new patients.

Impact

  • Providers: The bill will directly affect Medicaid providers, particularly dentists, by establishing minimum payment rates and requiring them to meet specific care hours to be listed in the network.
  • Medicaid Recipients: The legislation aims to improve access to care for Medicaid recipients by ensuring that managed care plans maintain adequate provider networks and that providers are fairly compensated.
  • Managed Care Plans: Plans will face new requirements for reporting and maintaining provider databases, which may necessitate adjustments in their operational practices.

Procedural Aspects

  • The bill was filed on October 9, 2025, and has been referred to the Health Policy and Appropriations Committees for further consideration.
  • The effective date of the bill will be determined upon passage.

This summary provides an overview of SB 152, highlighting its objectives, key provisions, and potential impacts on Florida's Medicaid system.

Compiled from official sources — confirm details with the bill’s official record.

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