SESSION WATCH
THE BILL ITSELF

SB 1648

Access to Applied Behavior Analysis Services

VERSION S 1648 Filed · BACK TO THE SUMMARY · OFFICIAL RECORD

underlined language is being added; struck language is being deleted. Line numbers are the Legislature's own — the same ones amendments cite.

Florida Senate - 2026 SB 1648 By Senator Garcia 36-01064-26 20261648__
1 A bill to be entitled
2 An act relating to access to applied behavior analysis
3 services; creating s. 409.9775, F.S.; defining terms;
4 requiring the Agency for Health Care Administration to
5 consider certain factors when evaluating network
6 adequacy for applied behavior analysis services under
7 the Medicaid program; requiring Medicaid managed care
8 plans to take reasonable steps to support workforce
9 retention and recruitment; requiring managed care
10 plans to use a standardized, consolidated
11 credentialing process; prohibiting managed care plans
12 from requiring duplicative submission of identical
13 documents to multiple portals or entities; requiring
14 managed care plans to notify providers of
15 credentialing deficiencies in a specified manner and
16 timeframe; requiring that initial credentialing and
17 activation be completed within a specified timeframe;
18 prohibiting managed care plans from requiring a
19 provider to undergo the full credentialing process to
20 recredential under certain circumstances; prohibiting
21 managed care plans from imposing a moratorium on
22 applied behavior analysis services providers unless
23 such providers can demonstrate specified criteria to
24 the agency; if the agency approves a moratorium,
25 requiring managed care plans to provide certain notice
26 to providers and recipients and provide an exception
27 process for underserved or rural areas; prohibiting
28 the use of a moratorium to delay or deny continuity of
29 care for existing recipients; requiring managed care
30 plans to provide a specified continuity-of-care period
31 for certain recipients; providing requirements for
32 such period; requiring that coverage and utilization
33 decisions for applied behavior analysis services be
34 based on individualized medical necessity; prohibiting
35 the use of age-based hour targets or incentive
36 benchmarks for certain purposes; specifying
37 requirements for authorization and utilization review
38 decisions for applied behavior analysis services;
39 requiring managed care plans to pay clean claims for
40 applied behavior analysis services in accordance with
41 prompt payment requirements; requiring managed care
42 plans to provide an explanation of benefits in a
43 specified manner for any denial or partial payment;
44 prohibiting managed care plans from issuing recoupment
45 or overpayment demands based solely on certain
46 factors; requiring managed care plans to maintain
47 stable electronic portals capable of certain
48 functions; requiring that providers have access to a
49 defined escalation pathway for issues of
50 credentialing, utilization management, and claims
51 resolution; requiring that notices sent by managed
52 care plans be written in plain language and clearly
53 describe certain information; requiring managed care
54 plans to implement certain safeguards and maintain
55 certain procedures and transmission methods; requiring
56 the agency to amend managed care plan contracts as
57 needed to enforce specified provisions; authorizing
58 the agency to adopt rules; providing an effective
59 date.
61 WHEREAS, the Legislature finds that applied behavior
62 analysis services are a medically necessary benefit for Medicaid
63 recipients with autism spectrum disorder and other qualifying
64 conditions, and
65 WHEREAS, access to such services depends on adequate
66 provider networks, timely credentialing, clinically appropriate
67 utilization management, and prompt payment, and
68 WHEREAS, administrative barriers, including roster freezes,
69 duplicative credentialing requirements, inconsistent
70 authorization practices, and payment delays, can result in gaps
71 in care, regression, and harm to recipients and families, and
72 WHEREAS, it is the intent of the Legislature to ensure
73 continuity of care, workforce stability, administrative
74 transparency, and individualized, clinically driven
75 decisionmaking for applied behavior analysis services delivered
76 under the Medicaid program, NOW, THEREFORE,
78 Be It Enacted by the Legislature of the State of Florida:
80 Section 1. Section 409.9775, Florida Statutes, is created
81 to read:
82 409.9775 Applied behavior analysis services.—
83 (1) DEFINITIONS.—As used in this section, the term:
84 (a) “Applied behavior analysis” means the design,
85 implementation, and evaluation of environmental modifications,
86 using behavioral stimuli and consequences, to produce socially
87 significant improvements in human behavior, including, but not
88 limited to, the use of direct observation, measurement, and
89 functional analysis of the relations between environment and
90 behavior.
91 (b) “Continuity of care” means the uninterrupted provision
92 of authorized medically necessary services during transitions in
93 coverage, provider status, or plan enrollment.
94 (c) “Moratorium” means any temporary or indefinite
95 suspension of the enrollment or activation of new or existing
96 applied behavior analysis service providers by a managed care
97 plan.
98 (d) “Provider” means an individual or entity enrolled or
99 seeking enrollment to provide applied behavior analysis
100 services, including board-certified behavior analysts, assistant
101 behavior analysts, registered behavior technicians, and
102 supervising entities.
103 (2) NETWORK ADEQUACY AND WORKFORCE STABILITY.—
104 (a) The agency shall consider the impact of credentialing
105 delays, administrative bottlenecks, and moratoria on providers
106 when evaluating network adequacy for applied behavior analysis
107 services.
108 (b) Managed care plans shall take reasonable steps to
109 support workforce retention and recruitment, particularly in
110 rural and underserved areas.
111 (3) CREDENTIALING AND RECREDENTIALING.—
112 (a) Managed care plans shall use a standardized,
113 consolidated credentialing process for applied behavior analysis
114 providers and may not require duplicative submissions of
115 identical documents to multiple portals or entities.
116 (b) Managed care plans shall notify a provider of all
117 credentialing deficiencies in a single, comprehensive notice
118 within 15 calendar days after receipt of an application.
119 (c) Initial credentialing and activation must be completed
120 within 60 calendar days after receipt of a clean application.
121 (d) Managed care plans may not require a provider to
122 undergo the full credentialing process to recredential solely
123 due to a gap in enrollment if the provider’s licensure and
124 national certification remained continuously active during such
125 gap.
126 (4) PROVIDER ROSTERS AND MORATORIA.—
127 (a) A managed care plan may not impose a moratorium on
128 applied behavior analysis service providers unless the plan
129 demonstrates to the agency, in writing, that:
130 1. Network adequacy standards are fully met in all affected
131 geographic areas; and
132 2. The moratorium is narrowly tailored, time-limited, and
133 necessary to address a documented administrative or compliance
134 issue.
135 (b) If the agency approves a moratorium, the managed care
136 plan must provide written notice to the providers and
137 recipients, specifying a definite end date for the moratorium,
138 and provide an exception process for underserved or rural areas.
139 (c) A managed care plan may not use a moratorium to delay
140 or deny continuity of care for existing recipients.
141 (5) CONTINUITY OF CARE.—
142 (a) A managed care plan shall provide a continuity-of-care
143 period of no less than 120 days for applied behavior analysis
144 services for a recipient newly enrolled in the plan or
145 transitioning providers.
146 (b) During the continuity-of-care period, prior
147 authorizations must be honored and backdated as necessary and
148 may not be terminated or reduced due to credentialing,
149 rostering, or other administrative delays.
150 (c) Services rendered during and immediately after the
151 continuity-of-care period must be reimbursed in accordance with
152 prompt payment requirements.
153 (6) INDIVIDUALIZED MEDICAL NECESSITY; AGE-BASED
154 BENCHMARKS.—
155 (a) Any determinations involving coverage and utilization
156 review for applied behavior analysis services must be based on
157 individualized medical necessity of the recipient.
158 (b) Age-based hour targets or incentive benchmarks may not
159 be used as fixed caps, minimums, or substitutes for
160 individualized clinical determinations.
161 (7) UTILIZATION MANAGEMENT.—
162 (a) Authorization and utilization review decisions for
163 applied behavior analysis services must be conducted by
164 reviewers with demonstrated training and experience in applied
165 behavior analysis.
166 (b) A managed care plan may not require a reauthorization
167 cycle of less than 90 days absent a documented material change
168 in the recipient’s clinical condition.
169 (c) Requests for updated diagnostic evaluations or
170 assessments may not be imposed more frequently than clinically
171 indicated.
172 (d) Peer-to-peer reviews must be scheduled and conducted
173 within required timeframes, and a failure attributable to the
174 managed care plan may not reset or delay the timeframe for
175 authorization.
176 (8) CLAIMS PAYMENT.—
177 (a) Managed care plans shall pay clean claims for applied
178 behavior analysis services in accordance with prompt payment
179 requirements.
180 (b) For any denial or partial payment, managed care plans
181 shall provide an explanation of benefits, including clear, code
182 specific, and unit-level reasons for the denial or partial
183 payment.
184 (c) Managed care plans may not issue recoupment or
185 overpayment demands based solely on administrative or system
186 errors without documented provider fault.
187 (9) ADMINISTRATIVE COMMUNICATIONS.—
188 (a) Managed care plans shall maintain stable electronic
189 portals capable of providing confirmation of receipt of
190 documentation submitted by providers.
191 (b) Managed care plans shall give providers access to a
192 defined escalation pathway with decisionmaking authority for
193 issues involving credentialing, utilization management, and
194 claims resolution.
195 (c) Any notice a managed care plan sends to a provider or
196 recipient must be written in plain language and clearly describe
197 applicable timelines, next steps, and appeal rights.
198 (10) PRIVACY AND SECURITY.—Managed care plans shall
199 implement safeguards to prevent the misdirection of protected
200 health information and shall maintain clear breach-response
201 procedures and approved secure transmission methods.
202 (11) ENFORCEMENT.—The agency shall amend existing managed
203 care plan contracts as needed to provide for enforcement of this
204 section, including through existing contract remedies, such as
205 corrective action plans, liquidated damages, or sanctions.
206 (12) RULES.—The agency may adopt rules to implement this
207 section.
208 Section 2. This act shall take effect July 1, 2026.