CS/CS/SB 1758 full text · Session Watch

Florida Senate - 2026 CS for CS for SB 1758 By the Committees on Appropriations; and Health Policy; and Senators Gaetz, Brodeur, and Massullo 576-03342-26 20261758c2

1 A bill to be entitled

2 An act relating to public assistance; amending s.

3 409.904, F.S.; authorizing the Agency for Health Care

4 Administration to conduct retrospective reviews and

5 audits of certain claims under the state Medicaid

6 program for a specified purpose; creating s. 409.9041,

7 F.S.; providing legislative findings; requiring the

8 agency to seek federal approval to implement mandatory

9 work and community engagement requirements for able

10 bodied adults as a condition of obtaining and

11 maintaining Medicaid coverage; prohibiting the agency

12 from implementing such requirements until certain

13 conditions are met; requiring the agency, in

14 consultation with the Department of Children and

15 Families, to develop a business plan to implement

16 specified provisions; specifying requirements for the

17 plan; requiring the agency to submit the plan to the

18 Governor and the Legislature by a specified date;

19 specifying populations that are subject to such work

20 and community engagement requirements; providing

21 exceptions; defining the term “family caregiver”;

22 specifying the types of activities which may satisfy

23 the work and community engagement requirements;

24 providing that a certain population is required to

25 engage in work or community engagement activities only

26 during standard school hours; requiring persons

27 eligible for Medicaid to demonstrate compliance with

28 the work and community engagement requirements at

29 specified times as a condition of maintaining Medicaid

30 coverage; requiring the agency to develop a process

31 for ensuring compliance with the work and community

32 engagement requirements; requiring that such process

33 align, to the extent possible, with certain existing

34 processes; requiring the department to verify

35 compliance with the work and community engagement

36 requirements at specified intervals; requiring the

37 agency, in coordination with the department, to

38 conduct outreach regarding implementation of the work

39 and community engagement requirements; specifying

40 requirements for such outreach; specifying procedures

41 in the event of noncompliance; requiring the agency,

42 in coordination with the department, to notify a

43 Medicaid recipient of a finding of noncompliance and

44 the impact to eligibility for continued receipt of

45 services; specifying requirements for such notice;

46 amending s. 409.905, F.S.; deleting a requirement that

47 the agency discontinue its hospital retrospective

48 review program under certain circumstances; revising

49 construction; requiring the agency to maintain cost

50 effective purchasing practices in its coverage of

51 hospital inpatient services rendered to Medicaid

52 recipients; amending s. 409.906, F.S.; requiring the

53 agency to seek federal approval to implement a program

54 for expanded coverage of home- and community-based

55 behavioral health services for a specified population;

56 specifying the goal of the program; requiring the

57 agency to work in coordination with the department to

58 develop the program; requiring the agency and the

59 department to develop certain estimates and submit

60 them to the Legislature in a specified manner before

61 the program may be implemented; amending s. 409.91195,

62 F.S.; revising the purpose of the Medicaid

63 Pharmaceutical and Therapeutics Committee to include

64 creation of a Medicaid preferred physician

65 administered drug list, a Medicaid preferred product

66 list, and a high-cost drug list; requiring the agency

67 to adopt such lists upon recommendation of the

68 committee; specifying the frequency with which the

69 committee must review such lists for any recommended

70 additions or deletions; specifying parameters for such

71 recommended additions and deletions; providing that

72 reimbursement for drugs not included on such lists is

73 subject to prior authorization, with an exception;

74 requiring the agency to publish and disseminate such

75 lists to all Medicaid providers in the state by

76 posting on the agency’s website or in other media;

77 providing requirements for public testimony related to

78 proposed inclusions on or exclusions from certain

79 lists; requiring the committee to consider certain

80 factors when developing such recommended additions and

81 deletions; amending s. 409.912, F.S.; revising the

82 components of the Medicaid prescribed-drug spending

83 control program to include the preferred physician

84 administered drug list, the preferred product list,

85 and the high-cost drug list; providing requirements

86 for such lists; providing that the agency does not

87 need to follow rulemaking procedures of ch. 120, F.S.,

88 when posting updates to such lists; requiring the

89 agency to establish certain procedures relating to

90 prior authorization requests for drugs on the high

91 cost drug list; establishing an alternative

92 reimbursement methodology for long-acting injectables

93 administered for severe mental illness in a hospital

94 facility setting; requiring the agency to contract

95 with a vendor to perform a fiscal impact study of the

96 federal 340B Drug Pricing Program; providing

97 requirements for the study; requiring specified

98 entities to submit certain data to the agency for

99 purposes of the study; providing that noncompliance

100 with such requirement may result in sanctions from the

101 agency or the Board of Pharmacy, as applicable;

102 requiring the agency to submit the results of the

103 study to the Governor and the Legislature by a

104 specified date; providing construction; amending s.

105 409.913, F.S.; revising the definition of the term

106 “overpayment”; providing that determinations of an

107 overpayment under the Medicaid program may be based

108 upon retrospective reviews, investigations, analyses,

109 or audits conducted by the agency to determine

110 possible fraud, abuse, overpayment, or recipient

111 neglect; providing that certain notices may be

112 provided using other common carriers, as well as

113 through the United States Postal Service; creating s.

114 414.321, F.S.; requiring the department to limit

115 eligibility for food assistance to individuals meeting

116 specified criteria; requiring that food assistance

117 recipients provide certain documentation for purposes

118 of eligibility redeterminations; prohibiting the

119 department from relying solely on an individual’s

120 self-attestations to determine certain expenses;

121 authorizing the department to adopt policies and

122 procedures to accommodate certain applicants and

123 recipients; creating s. 414.332, F.S.; requiring the

124 department to develop and implement a food assistance

125 payment accuracy improvement plan for a specified

126 purpose; requiring the department to reduce the

127 payment error rate to below a specified percentage;

128 providing requirements for the plan; requiring the

129 department to submit the plan to the Governor and the

130 Legislature by a specified date; requiring the

131 department, by a specified date, to submit quarterly

132 progress reports of specified information to the

133 Governor and the Legislature; providing for future

134 repeal; amending s. 414.39, F.S.; requiring the

135 department to require photographic identification on

136 the front of electronic benefits transfer (EBT) cards,

137 to the extent allowable under federal law; amending s.

138 414.455, F.S.; revising criteria for individuals

139 required to participate in an employment and training

140 program to receive food assistance from the

141 Supplemental Nutrition Assistance Program; requiring

142 the department to apply and comply with certain work

143 requirements in accordance with federal law for food

144 assistance; amending s. 409.91196, F.S.; conforming a

145 cross-reference; providing an effective date.

147 Be It Enacted by the Legislature of the State of Florida:

149 Section 1. Subsection (4) of section 409.904, Florida

150 Statutes, is amended to read:

151 409.904 Optional payments for eligible persons.—The agency

152 may make payments for medical assistance and related services on

153 behalf of the following persons who are determined to be

154 eligible subject to the income, assets, and categorical

155 eligibility tests set forth in federal and state law. Payment on

156 behalf of these Medicaid eligible persons is subject to the

157 availability of moneys and any limitations established by the

158 General Appropriations Act or chapter 216.

159 (4) A low-income person who meets all other requirements

160 for Medicaid eligibility except citizenship and who is in need

161 of emergency medical services. The eligibility of such a

162 recipient is limited to the period of the emergency, in

163 accordance with federal regulations. The agency may conduct

164 retrospective reviews or audits of services rendered to the

165 individual and claims submitted by the provider to validate the

166 existence and duration of the emergency medical condition and

167 whether the services rendered were necessary to treat the

168 emergency medical condition, regardless of whether the provider

169 obtained prior authorization for the services.

170 Section 2. Section 409.9041, Florida Statutes, is created

171 to read:

172 409.9041 Medicaid work and community engagement

173 requirements.—

174 (1) The Legislature finds that assisting able-bodied adult

175 Medicaid recipients in achieving self-sufficiency through

176 meaningful work and community engagement is essential to

177 ensuring that the state Medicaid program remains a sustainable

178 resource for residents who are most in need of such assistance.

179 (2)(a) The agency shall seek federal approval to implement

180 mandatory work and community engagement requirements for able

181 bodied adults, as specified in this section, as a condition of

182 obtaining and maintaining coverage under the state Medicaid

183 program. The agency may not implement the mandatory work and

184 community engagement requirements until it receives federal

185 approval through a Medicaid waiver and the agency’s business

186 plan submitted under paragraph (b) is specifically approved by

187 the Legislature.

188 (b) The agency shall, in consultation with the Department

189 of Children and Families and the Department of Commerce, develop

190 a business plan to implement this section. The plan must include

191 methods for determining Medicaid eligibility and the

192 applicability of exemptions under subsections (3) and (4) on an

193 ongoing basis and an analysis representing the potential effects

194 that implementing this section will have on Medicaid enrollment

195 and expenditures. The plan must also include a methodology to

196 provide those Medicaid recipients who stand to lose Medicaid

197 eligibility due to earning income under the requirements of

198 subsection (3) with a transition period to temporarily maintain

199 eligibility, under parameters similar to those that enable a

200 family eligible for temporary cash assistance to temporarily

201 maintain Medicaid eligibility under s. 445.029. The agency shall

202 submit the plan to the Governor, the President of the Senate,

203 and the Speaker of the House of Representatives no later than

204 December 1, 2026.

205 (3)(a) Medicaid recipients between the ages of 19 and 64

206 years, inclusive, must meet the work or community engagement

207 requirements of this section, unless they are one of the

208 following:

209 1. Indian as defined under 42 C.F.R. s. 438.14(a).

210 2. A parent, guardian, caretaker relative, or family

211 caregiver of a dependent child younger than 14 years of age or

212 of a disabled individual. For purposes of this paragraph, the

213 term “family caregiver” means an adult family member or other

214 individual who has a significant relationship with, and who

215 provides a broad range of assistance to, an individual with a

216 chronic or other health condition, disability, or functional

217 limitation.

218 3. Former foster youth younger than 26 years of age.

219 4. A veteran with a total disability, as specified under 38

220 C.F.R. s. 3.340 or as specified by a Veteran Affairs Disability

221 Ratings Letter issued by the United States Department of

222 Veterans Affairs.

223 5. An individual classified as medically frail under the

224 Medicaid Institutionalized Care Program; categorized as aged,

225 blind, or disabled under the state Medicaid program; or who has

226 a developmental disability as defined in s. 393.063.

227 6. An individual living in a household that receives

228 Supplemental Nutrition Assistance Program benefits and who is

229 already in compliance with work requirements pursuant to s.

230 445.024.

231 7. An individual participating in a residential substance

232 use treatment program.

233 8. An inmate of a public institution.

234 9. A woman eligible for Medicaid coverage in a pregnancy

235 related or postpartum care category.

236 10. A person receiving hospice services under part IV of

237 chapter 400 who has a medical prognosis that his or her life

238 expectancy is 6 months or less if his or her illness runs its

239 normal course.

240 (b) A person may satisfy the work or community engagement

241 requirements of this section by participating in one or more of

242 the following activities for at least 80 hours per month:

243 1. Paid employment.

244 2. On-the-job-training.

245 3. Vocational educational training.

246 4. Job skills training directly related to employment.

247 5. Education directly related to employment.

248 6. Satisfactory attendance at a secondary school or in a

249 course of study leading to a high school equivalency diploma.

250 7. Enrollment at least half-time as defined in 34 C.F.R. s.

251 668.2(b) in a postsecondary education program to obtain a

252 credential on the Master Credentials List as maintained pursuant

253 to s. 445.004(6)(e).

254 8. Any other work activity designated as such by the

255 Department of Commerce and provided by a local workforce

256 development board pursuant to s. 445.024.

257 (c) Parents with children ages 14 through 18 are required

258 to engage in work or community engagement activities only during

259 standard school hours.

260 (4)(a) Notwithstanding any other statutory provision, in

261 order to maintain Medicaid coverage, an eligible Medicaid

262 recipient must, before enrollment and upon any redetermination

263 for coverage, demonstrate compliance with the work or community

264 engagement requirements of this section.

265 (b) The agency shall develop a process for ensuring

266 compliance with this section which aligns, to the extent

267 possible, with the processes currently in place relating to work

268 and community engagement requirements authorized under the

269 state’s Supplemental Nutrition Assistance Program, including,

270 but not limited to, participant registration with a local

271 CareerSource center, employment and training programs, and

272 collaboration with the state’s local workforce boards.

273 (c) The department shall verify, in accordance with its

274 procedures, that an individual subject to the work and community

275 engagement requirements of this section demonstrates compliance

276 during the individual’s regularly scheduled redetermination of

277 eligibility and at least every 6 months thereafter.

278 (5) The agency, in coordination with the department, shall

279 conduct outreach regarding the implementation of the work and

280 community engagement requirements of this section. The outreach

281 must include, at a minimum, notification to impacted

282 individuals, including timelines for implementation,

283 requirements for compliance, penalties for noncompliance, and

284 information on how to request an exemption.

285 (6) If a recipient subject to the work and community

286 engagement requirements of this section is determined to be in

287 noncompliance with such requirements, the agency, in

288 coordination with the department, must notify the recipient of

289 the finding of noncompliance and the impact to his or her

290 eligibility for continued receipt of Medicaid services. The

291 notice must include, at a minimum, notification of all of the

292 following:

293 (a) That the recipient is eligible for a grace period of 30

294 days to either come into compliance with the requirements or

295 request an exemption from the requirements and that Medicaid

296 coverage of services will continue during the grace period.

297 (b) That if, following the 30-day period, the individual

298 has not come into compliance with or requested an exemption from

299 the work and community engagement requirements, his or her

300 application for assistance will be denied and services

301 terminated at the end of the month following the month in which

302 such 30-calendar-day period ends.

303 (c) The right of the individual to request a fair hearing

304 if he or she is determined to be noncompliant with program

305 requirements and disenrolled from the state Medicaid program.

306 (d) The manner in which he or she can reapply for medical

307 assistance under the state Medicaid program.

308 Section 3. Paragraph (a) of subsection (5) of section

309 409.905, Florida Statutes, is amended, and paragraph (f) is

310 added to that subsection, to read:

311 409.905 Mandatory Medicaid services.—The agency may make

312 payments for the following services, which are required of the

313 state by Title XIX of the Social Security Act, furnished by

314 Medicaid providers to recipients who are determined to be

315 eligible on the dates on which the services were provided. Any

316 service under this section shall be provided only when medically

317 necessary and in accordance with state and federal law.

318 Mandatory services rendered by providers in mobile units to

319 Medicaid recipients may be restricted by the agency. Nothing in

320 this section shall be construed to prevent or limit the agency

321 from adjusting fees, reimbursement rates, lengths of stay,

322 number of visits, number of services, or any other adjustments

323 necessary to comply with the availability of moneys and any

324 limitations or directions provided for in the General

325 Appropriations Act or chapter 216.

326 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for

327 all covered services provided for the medical care and treatment

328 of a recipient who is admitted as an inpatient by a licensed

329 physician or dentist to a hospital licensed under part I of

330 chapter 395. However, the agency shall limit the payment for

331 inpatient hospital services for a Medicaid recipient 21 years of

332 age or older to 45 days or the number of days necessary to

333 comply with the General Appropriations Act.

334 (a)1. The agency may implement reimbursement and

335 utilization management reforms in order to comply with any

336 limitations or directions in the General Appropriations Act,

337 which may include, but are not limited to: prior authorization

338 for inpatient psychiatric days; prior authorization for

339 nonemergency hospital inpatient admissions for individuals 21

340 years of age and older; authorization of emergency and urgent

341 care admissions within 24 hours after admission; enhanced

342 utilization and concurrent review programs for highly utilized

343 services; reduction or elimination of covered days of service;

344 adjusting reimbursement ceilings for variable costs; adjusting

345 reimbursement ceilings for fixed and property costs; and

346 implementing target rates of increase.

347 2. The agency may limit prior authorization for hospital

348 inpatient services to selected diagnosis-related groups, based

349 on an analysis of the cost and potential for unnecessary

350 hospitalizations represented by certain diagnoses. Admissions

351 for normal delivery and newborns are exempt from requirements

352 for prior authorization.

353 3. In implementing the provisions of this section related

354 to prior authorization, the agency shall ensure that the process

355 for authorization is accessible 24 hours per day, 7 days per

356 week and authorization is automatically granted when not denied

357 within 4 hours after the request. Authorization procedures must

358 include steps for review of denials.

359 4. ~~Upon implementing the prior authorization program for~~

360 ~~hospital inpatient services, the agency shall discontinue its~~

361 ~~hospital retrospective review program. However,~~ This paragraph

362 ~~subparagraph~~ may not be construed to prevent the agency from

363 conducting retrospective reviews under s. 409.913, including,

364 but not limited to, reviews of prior-authorized claims and

365 reviews in which an overpayment is suspected due to a mistake or

366 submission of an improper claim or for other reasons that do not

367 rise to the level of fraud or abuse.

368 (f) In its coverage of services under this subsection, the

369 agency shall maintain cost-effective purchasing practices as

370 required by s. 409.912.

371 Section 4. Present subsections (14) through (29) of section

372 409.906, Florida Statutes, are redesignated as subsections (15)

373 through (30), respectively, and a new subsection (14) is added

374 to that section, to read:

375 409.906 Optional Medicaid services.—Subject to specific

376 appropriations, the agency may make payments for services which

377 are optional to the state under Title XIX of the Social Security

378 Act and are furnished by Medicaid providers to recipients who

379 are determined to be eligible on the dates on which the services

380 were provided. Any optional service that is provided shall be

381 provided only when medically necessary and in accordance with

382 state and federal law. Optional services rendered by providers

383 in mobile units to Medicaid recipients may be restricted or

384 prohibited by the agency. Nothing in this section shall be

385 construed to prevent or limit the agency from adjusting fees,

386 reimbursement rates, lengths of stay, number of visits, or

387 number of services, or making any other adjustments necessary to

388 comply with the availability of moneys and any limitations or

389 directions provided for in the General Appropriations Act or

390 chapter 216. If necessary to safeguard the state’s systems of

391 providing services to elderly and disabled persons and subject

392 to the notice and review provisions of s. 216.177, the Governor

393 may direct the Agency for Health Care Administration to amend

394 the Medicaid state plan to delete the optional Medicaid service

395 known as “Intermediate Care Facilities for the Developmentally

396 Disabled.” Optional services may include:

397 (14) HOME- AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES.

398 The agency shall seek federal approval to implement a program

399 that covers an expanded array of home- and community-based

400 services for adults 18 years of age and older diagnosed with a

401 serious mental illness who are high utilizers of behavioral

402 health services in an institutional setting. The program must be

403 designed to reduce the need for institutional levels of care for

404 adults with a serious mental illness. The agency shall work in

405 coordination with the Department of Children and Families to

406 develop the program. The agency and the department shall produce

407 estimates of the program′s potential costs to the Medicaid

408 program and cost-savings for the department. Such estimates must

409 be submitted to the Legislature as legislative budget requests

410 and appropriated in the General Appropriations Act before the

411 program may be implemented.

412 Section 5. Section 409.91195, Florida Statutes, is amended

413 to read:

414 409.91195 Medicaid Pharmaceutical and Therapeutics

415 Committee.—There is created a Medicaid Pharmaceutical and

416 Therapeutics Committee within the agency for the purpose of

417 developing a Medicaid preferred drug list , a Medicaid preferred

418 physician-administered drug list, a Medicaid preferred product

419 list, and a high-cost drug list .

420 (1) The committee shall be composed of 11 members appointed

421 by the Governor. Four members shall be physicians, licensed

422 under chapter 458; one member licensed under chapter 459; five

423 members shall be pharmacists licensed under chapter 465; and one

424 member shall be a consumer representative. The members shall be

425 appointed to serve for terms of 2 years from the date of their

426 appointment. Members may be appointed to more than one term. The

427 agency shall serve as staff for the committee and assist them

428 with all ministerial duties. The Governor shall ensure that at

429 least some of the members of the committee represent Medicaid

430 participating physicians and pharmacies serving all segments and

431 diversity of the Medicaid population, and have experience in

432 either developing or practicing under a preferred drug list. At

433 least one of the members shall represent the interests of

434 pharmaceutical manufacturers.

435 (2) Committee members shall select a chairperson and a vice

436 chairperson each year from the committee membership.

437 (3) The committee shall meet at least quarterly and may

438 meet at other times at the discretion of the chairperson and

439 members. The committee shall comply with rules adopted by the

440 agency, including notice of any meeting of the committee

441 pursuant to the requirements of the Administrative Procedure

442 Act.

443 (4) Upon recommendation of the committee, the agency shall

444 adopt a preferred drug list , a preferred physician-administered

445 drug list, a preferred product list, and a high-cost drug list

446 as described in s. 409.912(5). To the extent feasible, the

447 committee shall review all drug or product classes included on

448 the preferred drug list , the preferred physician-administered

449 drug list, the preferred product list, and the high-cost drug

450 list every 6 12 months , and may recommend additions to and

451 deletions from the lists ~~preferred drug list~~ , such that the

452 lists provide ~~preferred drug list provides~~ for medically

453 appropriate drug and product therapies for Medicaid patients

454 which achieve cost savings contained in the General

455 Appropriations Act.

456 (5) Except for antiretroviral drugs, reimbursement of drugs

457 not included on the preferred drug list , preferred physician

458 administered drug list, preferred product list, or high-cost

459 drug list is subject to prior authorization.

460 (6) The agency shall publish and disseminate the preferred

461 drug list , preferred physician-administered drug list, preferred

462 product list, and high-cost drug list to all Medicaid providers

463 in the state by Internet posting on the agency’s website or in

464 other media.

465 (7) The committee shall ensure that interested parties,

466 including pharmaceutical manufacturers agreeing to provide a

467 supplemental rebate as outlined in this chapter, have an

468 opportunity to present public testimony to the committee with

469 information or evidence supporting inclusion of a drug or

470 product on the preferred drug list , preferred physician

471 administered drug list, preferred product list, or high-cost

472 drug list . Such public testimony must ~~shall~~ occur before ~~prior~~

473 to any recommendations made by the committee for inclusion or

474 exclusion from the preferred drug list , preferred physician

475 administered drug list, preferred product list, or high-cost

476 drug list . Upon timely notice, the agency shall ensure that any

477 drug that has been approved or had any of its particular uses

478 approved by the United States Food and Drug Administration under

479 a priority review classification will be reviewed by the

480 committee at the next regularly scheduled meeting following 3

481 months of distribution of the drug to the general public.

482 (8) The committee shall develop its preferred drug list ,

483 preferred physician-administered drug list, preferred product

484 list, and high-cost drug list recommendations by considering the

485 clinical efficacy, safety, and cost-effectiveness of a product.

486 (9) The Medicaid Pharmaceutical and Therapeutics Committee

487 may also make recommendations to the agency regarding the prior

488 authorization of any prescribed drug covered by Medicaid.

489 (10) Medicaid recipients may appeal agency preferred drug

490 formulary decisions using the Medicaid fair hearing process

491 administered by the Agency for Health Care Administration.

492 Section 6. Paragraph (a) of subsection (5) of section

493 409.912, Florida Statutes, is amended, and subsection (14) is

494 added to that section, to read:

495 409.912 Cost-effective purchasing of health care.—The

496 agency shall purchase goods and services for Medicaid recipients

497 in the most cost-effective manner consistent with the delivery

498 of quality medical care. To ensure that medical services are

499 effectively utilized, the agency may, in any case, require a

500 confirmation or second physician’s opinion of the correct

501 diagnosis for purposes of authorizing future services under the

502 Medicaid program. This section does not restrict access to

503 emergency services or poststabilization care services as defined

504 in 42 C.F.R. s. 438.114. Such confirmation or second opinion

505 shall be rendered in a manner approved by the agency. The agency

506 shall maximize the use of prepaid per capita and prepaid

507 aggregate fixed-sum basis services when appropriate and other

508 alternative service delivery and reimbursement methodologies,

509 including competitive bidding pursuant to s. 287.057, designed

510 to facilitate the cost-effective purchase of a case-managed

511 continuum of care. The agency shall also require providers to

512 minimize the exposure of recipients to the need for acute

513 inpatient, custodial, and other institutional care and the

514 inappropriate or unnecessary use of high-cost services. The

515 agency shall contract with a vendor to monitor and evaluate the

516 clinical practice patterns of providers in order to identify

517 trends that are outside the normal practice patterns of a

518 provider’s professional peers or the national guidelines of a

519 provider’s professional association. The vendor must be able to

520 provide information and counseling to a provider whose practice

521 patterns are outside the norms, in consultation with the agency,

522 to improve patient care and reduce inappropriate utilization.

523 The agency may mandate prior authorization, drug therapy

524 management, or disease management participation for certain

525 populations of Medicaid beneficiaries, certain drug classes, or

526 particular drugs to prevent fraud, abuse, overuse, and possible

527 dangerous drug interactions. The Pharmaceutical and Therapeutics

528 Committee shall make recommendations to the agency on drugs for

529 which prior authorization is required. The agency shall inform

530 the Pharmaceutical and Therapeutics Committee of its decisions

531 regarding drugs subject to prior authorization. The agency is

532 authorized to limit the entities it contracts with or enrolls as

533 Medicaid providers by developing a provider network through

534 provider credentialing. The agency may competitively bid single

535 source-provider contracts if procurement of goods or services

536 results in demonstrated cost savings to the state without

537 limiting access to care. The agency may limit its network based

538 on the assessment of beneficiary access to care, provider

539 availability, provider quality standards, time and distance

540 standards for access to care, the cultural competence of the

541 provider network, demographic characteristics of Medicaid

542 beneficiaries, practice and provider-to-beneficiary standards,

543 appointment wait times, beneficiary use of services, provider

544 turnover, provider profiling, provider licensure history,

545 previous program integrity investigations and findings, peer

546 review, provider Medicaid policy and billing compliance records,

547 clinical and medical record audits, and other factors. Providers

548 are not entitled to enrollment in the Medicaid provider network.

549 The agency shall determine instances in which allowing Medicaid

550 beneficiaries to purchase durable medical equipment and other

551 goods is less expensive to the Medicaid program than long-term

552 rental of the equipment or goods. The agency may establish rules

553 to facilitate purchases in lieu of long-term rentals in order to

554 protect against fraud and abuse in the Medicaid program as

555 defined in s. 409.913. The agency may seek federal waivers

556 necessary to administer these policies.

557 (5)(a) The agency shall implement a Medicaid prescribed

558 drug spending-control program that includes the following

559 components:

560 1. A Medicaid preferred drug list and a Medicaid physician

561 administered drug list. The preferred drug list ~~, which~~ shall be

562 a listing of cost-effective therapeutic options recommended by

563 the Medicaid Pharmacy and Therapeutics Committee established

564 pursuant to s. 409.91195 and adopted by the agency for each

565 therapeutic class on the preferred drug list. At the discretion

566 of the committee, and when feasible, the preferred drug list

567 should include at least two products in a therapeutic class. The

568 physician-administered drug list shall be a listing of

569 physician-administered drugs covered by the state Medicaid

570 program, based on the United States Food and Drug

571 Administration’s approved indications and compendia in 42 U.S.C.

572 s. 1396r-8(g)(1)(B). Within the preferred physician-administered

573 drug list, there must be a section containing a list of

574 preferred physician-administered drugs that are cost-effective

575 therapeutic options recommended by the Medicaid Pharmaceutical

576 and Therapeutics Committee established pursuant to s. 409.91195.

577 The physician-administered drug list must be updated at least

578 twice a year. The agency may post and update the preferred drug

579 list and the preferred physician-administered drug ~~updates to~~

580 ~~the~~ list on the agency’s ~~an Internet~~ website without following

581 the rulemaking procedures of chapter 120. Antiretroviral agents

582 are excluded from the preferred drug list. The agency shall also

583 limit the amount of a prescribed drug dispensed to no more than

584 a 34-day supply unless the drug products’ smallest marketed

585 package is greater than a 34-day supply, or the drug is

586 determined by the agency to be a maintenance drug in which case

587 a 100-day maximum supply may be authorized. The agency may seek

588 any federal waivers necessary to implement these cost-control

589 programs and to continue participation in the federal Medicaid

590 rebate program, or alternatively to negotiate state-only

591 manufacturer rebates. The agency may adopt rules to administer

592 this subparagraph. The agency shall continue to provide

593 unlimited contraceptive drugs and items. The agency must

594 establish procedures to ensure that:

595 a. There is a response to a request for prior authorization

596 by telephone or other telecommunication device within 24 hours

597 after receipt of a request for prior authorization; and

598 b. A 72-hour supply of the drug prescribed is provided in

599 an emergency or when the agency does not provide a response

600 within 24 hours as required by sub-subparagraph a.

601 2. A Medicaid preferred product list, which shall be a

602 listing of cost-effective therapeutic supplies recommended by

603 the Medicaid Pharmaceutical and Therapeutics Committee

604 established pursuant to s. 409.91195 and adopted by the agency

605 for each product class listed on the preferred product list and

606 reimbursed by the state Medicaid program through the pharmacy

607 point-of-sale. The agency may post the preferred product list

608 and updates to the list on the agency’s website without

609 following the rulemaking procedures of chapter 120.

610 3. A list of high-cost drugs recommended by the Medicaid

611 Pharmaceutical and Therapeutics Committee established pursuant

612 to s. 409.91195 and adopted by the agency, for the purpose of

613 coverage, reimbursement, or billing guidance. The agency may

614 post the high-cost drug list and updates to the list on the

615 agency’s website without following the rulemaking procedures of

616 chapter 120. The agency must establish procedures to ensure

617 that:

618 a. There is a response to a request for prior authorization

619 for a high-cost drug by telephone or other telecommunication

620 device within 24 hours after receipt of the request for prior

621 authorization; and

622 b. A 72-hour supply of the high-cost drug prescribed is

623 provided in an emergency or when the agency does not provide a

624 response to a prior authorization request within 24 hours as

625 required by sub-subparagraph a.

626 4. A provider of prescribed drugs is reimbursed in an

627 amount not to exceed the lesser of the actual acquisition cost

628 based on the Centers for Medicare and Medicaid Services National

629 Average Drug Acquisition Cost pricing files plus a professional

630 dispensing fee, the wholesale acquisition cost plus a

631 professional dispensing fee, the state maximum allowable cost

632 plus a professional dispensing fee, or the usual and customary

633 charge billed by the provider.

634 5. A hospital facility administering long-acting

635 injectables for severe mental illness shall be reimbursed

636 separately from the diagnosis-related group. Long-acting

637 injectables administered for severe mental illness in a hospital

638 facility setting shall be reimbursed at no less than the actual

639 acquisition cost of the drug.

640 6. The agency shall contract with a vendor to perform a

641 detailed fiscal impact study to evaluate the 340B Drug Pricing

642 Program administered by the Health Resources and Services

643 Administration. The study must evaluate 340B compliance, 340B

644 drug purchases, and reimbursement methodologies within the fee

645 for-service program and Statewide Medicaid Managed Care program.

646 Statewide Medicaid Managed Care plans, pharmacy benefit

647 managers, and Medicaid providers shall submit to the agency all

648 data necessary for the completion of the study, including, but

649 not limited to, information related to drug purchasing,

650 reimbursement, billing and coding, and dispensing. Noncompliance

651 with the 340B data submission requirements of this subparagraph

652 may result in sanctions from the agency or the Board of

653 Pharmacy, as applicable. The agency shall submit the results of

654 the study to the Governor, the President of the Senate, and the

655 Speaker of the House of Representatives by June 30, 2027.

656 7. 3. The agency shall develop and implement a process for

657 managing the drug therapies of Medicaid recipients who are using

658 significant numbers of prescribed drugs each month. The

659 management process may include, but is not limited to,

660 comprehensive, physician-directed medical-record reviews, claims

661 analyses, and case evaluations to determine the medical

662 necessity and appropriateness of a patient’s treatment plan and

663 drug therapies. The agency may contract with a private

664 organization to provide drug-program-management services. The

665 Medicaid drug benefit management program shall include

666 initiatives to manage drug therapies for HIV/AIDS patients,

667 patients using 20 or more unique prescriptions in a 180-day

668 period, and the top 1,000 patients in annual spending. The

669 agency shall enroll any Medicaid recipient in the drug benefit

670 management program if he or she meets the specifications of this

671 provision and is not enrolled in a Medicaid health maintenance

672 organization.

673 8. 4. The agency may limit the size of its pharmacy network

674 based on need, competitive bidding, price negotiations,

675 credentialing, or similar criteria. The agency shall give

676 special consideration to rural areas in determining the size and

677 location of pharmacies included in the Medicaid pharmacy

678 network. A pharmacy credentialing process may include criteria

679 such as a pharmacy’s full-service status, location, size,

680 patient educational programs, patient consultation, disease

681 management services, and other characteristics. The agency may

682 impose a moratorium on Medicaid pharmacy enrollment if it is

683 determined that it has a sufficient number of Medicaid

684 participating providers. The agency must allow dispensing

685 practitioners to participate as a part of the Medicaid pharmacy

686 network regardless of the practitioner’s proximity to any other

687 entity that is dispensing prescription drugs under the Medicaid

688 program. A dispensing practitioner must meet all credentialing

689 requirements applicable to his or her practice, as determined by

690 the agency.

691 9. 5. The agency shall develop and implement a program that

692 requires Medicaid practitioners who issue written prescriptions

693 for medicinal drugs to use a counterfeit-proof prescription pad

694 for Medicaid prescriptions. The agency shall require the use of

695 standardized counterfeit-proof prescription pads by prescribers

696 who issue written prescriptions for Medicaid recipients. The

697 agency may implement the program in targeted geographic areas or

698 statewide.

699 10. 6. The agency may enter into arrangements that require

700 manufacturers of generic drugs prescribed to Medicaid recipients

701 to provide rebates of at least 15.1 percent of the average

702 manufacturer price for the manufacturer’s generic products.

703 These arrangements shall require that if a generic-drug

704 manufacturer pays federal rebates for Medicaid-reimbursed drugs

705 at a level below 15.1 percent, the manufacturer must provide a

706 supplemental rebate to the state in an amount necessary to

707 achieve a 15.1-percent rebate level.

708 11. 7. The agency may establish a preferred drug list as

709 described in this subsection, and, pursuant to the establishment

710 of such preferred drug list, negotiate supplemental rebates from

711 manufacturers that are in addition to those required by Title

712 XIX of the Social Security Act and at no less than 14 percent of

713 the average manufacturer price as defined in 42 U.S.C. s. 1936

714 on the last day of a quarter unless the federal or supplemental

715 rebate, or both, equals or exceeds 29 percent. There is no upper

716 limit on the supplemental rebates the agency may negotiate. The

717 agency may determine that specific products, brand-name or

718 generic, are competitive at lower rebate percentages. Agreement

719 to pay the minimum supplemental rebate percentage guarantees a

720 manufacturer that the Medicaid Pharmaceutical and Therapeutics

721 Committee will consider a product for inclusion on the preferred

722 drug list. However, a pharmaceutical manufacturer is not

723 guaranteed placement on the preferred drug list by simply paying

724 the minimum supplemental rebate. Agency decisions will be made

725 on the clinical efficacy of a drug and recommendations of the

726 Medicaid Pharmaceutical and Therapeutics Committee, as well as

727 the price of competing products minus federal and state rebates.

728 The agency may contract with an outside agency or contractor to

729 conduct negotiations for supplemental rebates. For the purposes

730 of this section, the term “supplemental rebates” means cash

731 rebates. Value-added programs as a substitution for supplemental

732 rebates are prohibited. The agency may seek any federal waivers

733 to implement this initiative.

734 12.a. ~~8.a.~~ The agency may implement a Medicaid behavioral

735 drug management system. The agency may contract with a vendor

736 that has experience in operating behavioral drug management

737 systems to implement this program. The agency may seek federal

738 waivers to implement this program.

739 b. The agency, in conjunction with the Department of

740 Children and Families, may implement the Medicaid behavioral

741 drug management system that is designed to improve the quality

742 of care and behavioral health prescribing practices based on

743 best practice guidelines, improve patient adherence to

744 medication plans, reduce clinical risk, and lower prescribed

745 drug costs and the rate of inappropriate spending on Medicaid

746 behavioral drugs. The program may include the following

747 elements:

748 (I) Provide for the development and adoption of best

749 practice guidelines for behavioral health-related drugs such as

750 antipsychotics, antidepressants, and medications for treating

751 bipolar disorders and other behavioral conditions; translate

752 them into practice; review behavioral health prescribers and

753 compare their prescribing patterns to a number of indicators

754 that are based on national standards; and determine deviations

755 from best practice guidelines.

756 (II) Implement processes for providing feedback to and

757 educating prescribers using best practice educational materials

758 and peer-to-peer consultation.

759 (III) Assess Medicaid beneficiaries who are outliers in

760 their use of behavioral health drugs with regard to the numbers

761 and types of drugs taken, drug dosages, combination drug

762 therapies, and other indicators of improper use of behavioral

763 health drugs.

764 (IV) Alert prescribers to patients who fail to refill

765 prescriptions in a timely fashion, are prescribed multiple same

766 class behavioral health drugs, and may have other potential

767 medication problems.

768 (V) Track spending trends for behavioral health drugs and

769 deviation from best practice guidelines.

770 (VI) Use educational and technological approaches to

771 promote best practices, educate consumers, and train prescribers

772 in the use of practice guidelines.

773 (VII) Disseminate electronic and published materials.

774 (VIII) Hold statewide and regional conferences.

775 (IX) Implement a disease management program with a model

776 quality-based medication component for severely mentally ill

777 individuals and emotionally disturbed children who are high

778 users of care.

779 13. 9. The agency shall implement a Medicaid prescription

780 drug management system.

781 a. The agency may contract with a vendor that has

782 experience in operating prescription drug management systems in

783 order to implement this system. Any management system that is

784 implemented in accordance with this subparagraph must rely on

785 cooperation between physicians and pharmacists to determine

786 appropriate practice patterns and clinical guidelines to improve

787 the prescribing, dispensing, and use of drugs in the Medicaid

788 program. The agency may seek federal waivers to implement this

789 program.

790 b. The drug management system must be designed to improve

791 the quality of care and prescribing practices based on best

792 practice guidelines, improve patient adherence to medication

793 plans, reduce clinical risk, and lower prescribed drug costs and

794 the rate of inappropriate spending on Medicaid prescription

795 drugs. The program must:

796 (I) Provide for the adoption of best practice guidelines

797 for the prescribing and use of drugs in the Medicaid program,

798 including translating best practice guidelines into practice;

799 reviewing prescriber patterns and comparing them to indicators

800 that are based on national standards and practice patterns of

801 clinical peers in their community, statewide, and nationally;

802 and determine deviations from best practice guidelines.

803 (II) Implement processes for providing feedback to and

804 educating prescribers using best practice educational materials

805 and peer-to-peer consultation.

806 (III) Assess Medicaid recipients who are outliers in their

807 use of a single or multiple prescription drugs with regard to

808 the numbers and types of drugs taken, drug dosages, combination

809 drug therapies, and other indicators of improper use of

810 prescription drugs.

811 (IV) Alert prescribers to recipients who fail to refill

812 prescriptions in a timely fashion, are prescribed multiple drugs

813 that may be redundant or contraindicated, or may have other

814 potential medication problems.

815 14. ~~10.~~ The agency may contract for drug rebate

816 administration, including, but not limited to, calculating

817 rebate amounts, invoicing manufacturers, negotiating disputes

818 with manufacturers, and maintaining a database of rebate

819 collections.

820 15. ~~11.~~ The agency may specify the preferred daily dosing

821 form or strength for the purpose of promoting best practices

822 with regard to the prescribing of certain drugs as specified in

823 the General Appropriations Act and ensuring cost-effective

824 prescribing practices.

825 16. ~~12.~~ The agency may require prior authorization for

826 Medicaid-covered prescribed drugs. The agency may prior

827 authorize the use of a product:

828 a. For an indication not approved in labeling;

829 b. To comply with certain clinical guidelines; or

830 c. If the product has the potential for overuse, misuse, or

831 abuse.

833 The agency may require the prescribing professional to provide

834 information about the rationale and supporting medical evidence

835 for the use of a drug. The agency shall post prior

836 authorization, step-edit criteria and protocol, and updates to

837 the list of drugs that are subject to prior authorization on the

838 agency’s ~~Internet~~ website within 21 days after the prior

839 authorization and step-edit criteria and protocol and updates

840 are approved by the agency. For purposes of this subparagraph,

841 the term “step-edit” means an automatic electronic review of

842 certain medications subject to prior authorization.

843 17. ~~13.~~ The agency, in conjunction with the Pharmaceutical

844 and Therapeutics Committee, may require age-related prior

845 authorizations for certain prescribed drugs. The agency may

846 preauthorize the use of a drug for a recipient who may not meet

847 the age requirement or may exceed the length of therapy for use

848 of this product as recommended by the manufacturer and approved

849 by the Food and Drug Administration. Prior authorization may

850 require the prescribing professional to provide information

851 about the rationale and supporting medical evidence for the use

852 of a drug.

853 18. ~~14.~~ The agency shall implement a step-therapy prior

854 authorization approval process for medications excluded from the

855 preferred drug list. Medications listed on the preferred drug

856 list must be used within the previous 12 months before the

857 alternative medications that are not listed. The step-therapy

858 prior authorization may require the prescriber to use the

859 medications of a similar drug class or for a similar medical

860 indication unless contraindicated in the Food and Drug

861 Administration labeling. The trial period between the specified

862 steps may vary according to the medical indication. The step

863 therapy approval process shall be developed in accordance with

864 the committee as stated in s. 409.91195(7) and (8). A drug

865 product may be approved without meeting the step-therapy prior

866 authorization criteria if the prescribing physician provides the

867 agency with additional written medical or clinical documentation

868 that the product is medically necessary because:

869 a. There is not a drug on the preferred drug list to treat

870 the disease or medical condition which is an acceptable clinical

871 alternative;

872 b. The alternatives have been ineffective in the treatment

873 of the beneficiary’s disease;

874 c. The drug product or medication of a similar drug class

875 is prescribed for the treatment of schizophrenia or schizotypal

876 or delusional disorders; prior authorization has been granted

877 previously for the prescribed drug; and the medication was

878 dispensed to the patient during the previous 12 months; or

879 d. Based on historical evidence and known characteristics

880 of the patient and the drug, the drug is likely to be

881 ineffective, or the number of doses have been ineffective.

883 The agency shall work with the physician to determine the best

884 alternative for the patient. The agency may adopt rules waiving

885 the requirements for written clinical documentation for specific

886 drugs in limited clinical situations.

887 19. ~~15.~~ The agency shall implement a return and reuse

888 program for drugs dispensed by pharmacies to institutional

889 recipients, which includes payment of a $5 restocking fee for

890 the implementation and operation of the program. The return and

891 reuse program shall be implemented electronically and in a

892 manner that promotes efficiency. The program must permit a

893 pharmacy to exclude drugs from the program if it is not

894 practical or cost-effective for the drug to be included and must

895 provide for the return to inventory of drugs that cannot be

896 credited or returned in a cost-effective manner. The agency

897 shall determine if the program has reduced the amount of

898 Medicaid prescription drugs which are destroyed on an annual

899 basis and if there are additional ways to ensure more

900 prescription drugs are not destroyed which could safely be

901 reused.

902 (14) Neither this section nor this chapter prevents the

903 agency from conducting retrospective reviews, investigations,

904 analyses, audits, or any combination thereof to determine

905 possible fraud, abuse, overpayment, or recipient neglect in the

906 state Medicaid program pursuant to s. 409.913, including, but

907 not limited to, reviews in which the services were the subject

908 of a utilization review or prior authorization process.

909 Section 7. Paragraph (e) of subsection (1) and subsections

910 (2) and (6) of section 409.913, Florida Statutes, are amended to

911 read:

912 409.913 Oversight of the integrity of the Medicaid

913 program.—The agency shall operate a program to oversee the

914 activities of Florida Medicaid recipients, and providers and

915 their representatives, to ensure that fraudulent and abusive

916 behavior and neglect of recipients occur to the minimum extent

917 possible, and to recover overpayments and impose sanctions as

918 appropriate. Each January 15, the agency and the Medicaid Fraud

919 Control Unit of the Department of Legal Affairs shall submit a

920 report to the Legislature documenting the effectiveness of the

921 state’s efforts to control Medicaid fraud and abuse and to

922 recover Medicaid overpayments during the previous fiscal year.

923 The report must describe the number of cases opened and

924 investigated each year; the sources of the cases opened; the

925 disposition of the cases closed each year; the amount of

926 overpayments alleged in preliminary and final audit letters; the

927 number and amount of fines or penalties imposed; any reductions

928 in overpayment amounts negotiated in settlement agreements or by

929 other means; the amount of final agency determinations of

930 overpayments; the amount deducted from federal claiming as a

931 result of overpayments; the amount of overpayments recovered

932 each year; the amount of cost of investigation recovered each

933 year; the average length of time to collect from the time the

934 case was opened until the overpayment is paid in full; the

935 amount determined as uncollectible and the portion of the

936 uncollectible amount subsequently reclaimed from the Federal

937 Government; the number of providers, by type, that are

938 terminated from participation in the Medicaid program as a

939 result of fraud and abuse; and all costs associated with

940 discovering and prosecuting cases of Medicaid overpayments and

941 making recoveries in such cases. The report must also document

942 actions taken to prevent overpayments and the number of

943 providers prevented from enrolling in or reenrolling in the

944 Medicaid program as a result of documented Medicaid fraud and

945 abuse and must include policy recommendations necessary to

946 prevent or recover overpayments and changes necessary to prevent

947 and detect Medicaid fraud. All policy recommendations in the

948 report must include a detailed fiscal analysis, including, but

949 not limited to, implementation costs, estimated savings to the

950 Medicaid program, and the return on investment. The agency must

951 submit the policy recommendations and fiscal analyses in the

952 report to the appropriate estimating conference, pursuant to s.

953 216.137, by February 15 of each year. The agency and the

954 Medicaid Fraud Control Unit of the Department of Legal Affairs

955 each must include detailed unit-specific performance standards,

956 benchmarks, and metrics in the report, including projected cost

957 savings to the state Medicaid program during the following

958 fiscal year.

959 (1) For the purposes of this section, the term:

960 (e) “Overpayment” includes any amount that is not

961 authorized to be paid by the Medicaid program or that should not

962 have been paid, including payments made ~~whether paid~~ as a result

963 of inaccurate or improper cost reporting, improper claiming,

964 unacceptable practices, fraud, abuse, or mistake , and may

965 include amounts paid for goods or services that were the subject

966 of a utilization review or prior authorization process .

967 (2) The agency shall conduct, or cause to be conducted by

968 contract or otherwise, reviews, investigations, analyses,

969 audits, or any combination thereof, to determine possible fraud,

970 abuse, overpayment, or recipient neglect in the Medicaid program

971 and shall report the findings of any overpayments in audit

972 reports as appropriate. An overpayment determination may be

973 based upon retrospective reviews, investigations, analyses,

974 audits, or any combination thereof to determine possible fraud,

975 abuse, overpayment, or recipient neglect in the Medicaid

976 program, regardless of whether a prior authorization was issued.

977 At least 5 percent of all audits shall be conducted on a random

978 basis. As part of its ongoing fraud detection activities, the

979 agency shall identify and monitor, by contract or otherwise,

980 patterns of overutilization of Medicaid services based on state

981 averages. The agency shall track Medicaid provider prescription

982 and billing patterns and evaluate them against Medicaid medical

983 necessity criteria and coverage and limitation guidelines

984 adopted by rule. Medical necessity determination requires that

985 service be consistent with symptoms or confirmed diagnosis of

986 illness or injury under treatment and not in excess of the

987 patient’s needs. The agency shall conduct reviews of provider

988 exceptions to peer group norms and shall, using statistical

989 methodologies, provider profiling, and analysis of billing

990 patterns, detect and investigate abnormal or unusual increases

991 in billing or payment of claims for Medicaid services and

992 medically unnecessary provision of services.

993 (6) Any notice required to be given to a provider under

994 this section is presumed to be sufficient notice if sent to the

995 mailing address last shown on the provider enrollment file. It

996 is the responsibility of the provider to furnish and keep the

997 agency informed of the provider’s current mailing and service

998 addresses ~~address~~ . United States Postal Service or other common

999 carrier’s proof of mailing or certified or registered mailing of

1000 such notice to the provider at the address shown on the provider

1001 enrollment file constitutes sufficient proof of notice. Any

1002 notice required to be given to the agency by this section must

1003 be sent to the agency at an address designated by rule.

1004 Section 8. Section 414.321, Florida Statutes, is created to

1005 read:

1006 414.321 Food assistance eligibility.—For purposes of

1007 eligibility determinations, the department shall:

1008 (1) Limit eligibility to individuals who are residents of

1009 the United States and:

1010 (a) Citizens or nationals of the United States;

1011 (b) Aliens lawfully admitted for permanent residence as

1012 defined in the Immigration and Nationality Act, as amended;

1013 (c) Aliens who have been granted the status of Cuban and

1014 Haitian entrant, as defined in the Refugee Education Assistance

1015 Act of 1980, as amended; or

1016 (d) Individuals who lawfully reside in the United States in

1017 accordance with the Compacts of Free Association referred to in

1018 the Personal Responsibility and Work Opportunity Reconciliation

1019 Act of 1996.

1020 (2) Require each applicant, or recipient for

1021 redetermination purposes, to provide documentation evidencing

1022 his or her shelter or utility expenses.

1023 (a) The department is prohibited from relying solely on an

1024 individual’s self-attestation in determining shelter or utility

1025 expenses.

1026 (b) The department may adopt policies and procedures to

1027 accommodate an applicant or a recipient who, due to recent

1028 residency changes, is temporarily unable to furnish adequate

1029 documentation of shelter or utility expenses.

1030 Section 9. Section 414.332, Florida Statutes, is created to

1031 read:

1032 414.332 Food assistance payment accuracy plan.—

1033 (1) The department shall develop and implement a

1034 comprehensive food assistance payment accuracy improvement plan

1035 to reduce the state’s payment error rate. The department must

1036 reduce the payment error rate to below 6 percent. The plan must

1037 address the root causes of payment errors identified through an

1038 in-depth, data-driven analysis. The plan must include, but need

1039 not be limited to, all of the following:

1040 (a) Enhanced employee training and quality assurance.

1041 1. The department shall administer standardized training

1042 for all economic self-sufficiency program staff at least

1043 annually. Training must, at a minimum, review the most common

1044 reasons for payment errors and methods for preventing such

1045 errors, and include pre- and post-training testing to measure

1046 staff proficiency.

1047 2. The department shall establish a robust quality

1048 assurance review process that frequently reviews a statistically

1049 significant sample of cases before final benefit determination.

1050 This process must incorporate real-time, corrective feedback and

1051 on-the-job training for program staff and may not delay benefit

1052 determinations.

1053 (b) Improvement in data sourcing. In contracting with

1054 entities providing data for verification of applicant and

1055 recipient information, the department shall maximize use of high

1056 quality automated data sources, including, but not limited to,

1057 comparing income and asset data with state, federal, and private

1058 sector data sources.

1059 (2) By July 15, 2026, the department shall submit the food

1060 assistance payment accuracy improvement plan to the Governor,

1061 the President of the Senate, and the Speaker of the House of

1062 Representatives.

1063 (3)(a) Beginning October 1, 2026, the department shall

1064 submit quarterly progress reports to the Governor, the President

1065 of the Senate, and the Speaker of the House of Representatives

1066 detailing:

1067 1. The state’s most recent official and preliminary food

1068 assistance payment error rate.

1069 2. A detailed breakdown of the most frequent and highest

1070 dollar value errors, including categorization by agency or

1071 client error and whether the error resulted in over- or under

1072 payment.

1073 3. Specific actions taken by the department under the food

1074 assistance payment accuracy improvement plan during the

1075 preceding quarter and data demonstrating the results of those

1076 actions.

1077 4. A detailed plan to correct the most recently identified

1078 deficiencies.

1079 (b) This subsection is repealed on October 1, 2028.

1080 Section 10. Present subsections (6) through (11) of section

1081 414.39, Florida Statutes, are redesignated as subsections (7)

1082 through (12), respectively, and a new subsection (6) is added to

1083 that section, to read:

1084 414.39 Fraud.—

1085 (6) The department shall require the use of photographic

1086 identification on the front of each newly issued and reissued

1087 electronic benefits transfer (EBT) card for each cardholder to

1088 the maximum extent allowed by federal laws and regulations.

1089 Section 11. Subsection (2) of section 414.455, Florida

1090 Statutes, is amended to read:

1091 414.455 Supplemental Nutrition Assistance Program;

1092 legislative authorization; mandatory participation in employment

1093 and training programs.—

1094 (2) Unless prohibited by the Federal Government, the

1095 department must require a person who is receiving food

1096 assistance; who is 18 to 64 59 years of age, inclusive; who does

1097 not have children under the age of 14 18 in his or her home; who

1098 does not qualify for an exemption; and who is determined by the

1099 department to be eligible, to participate in an employment and

1100 training program. The department shall apply and comply with

1101 exemptions from work requirements in accordance with applicable

1102 federal law.

1103 Section 12. Subsection (1) of section 409.91196, Florida

1104 Statutes, is amended to read:

1105 409.91196 Supplemental rebate agreements; public records

1106 and public meetings exemption.—

1107 (1) The rebate amount, percent of rebate, manufacturer’s

1108 pricing, and supplemental rebate, and other trade secrets as

1109 defined in s. 688.002 that the agency has identified for use in

1110 negotiations, held by the Agency for Health Care Administration

1111 under s. 409.912(5)(a)11. ~~s. 409.912(5)(a)7.~~ are confidential

1112 and exempt from s. 119.07(1) and s. 24(a), Art. I of the State

1113 Constitution.

1114 Section 13. This act shall take effect July 1, 2026.