No. CS/CS/SB 1758
Filed under Healthcare.
Public Assistance; Authorizing the Agency for Health Care Administration to conduct retrospective reviews and audits of certain claims under the state Medicaid program for a specified purpose; requiring the agency to seek federal approval to implement mandatory work and community engagement requirements for able-bodied adults as a condition of obtaining and maintaining Medicaid coverage; requiring the agency, in consultation with the Department of Children and Families, to develop a business plan to implement specified provisions; revising the purpose of the Medicaid Pharmaceutical and Therapeutics Committee to include creation of a Medicaid preferred physician-administered drug list, a Medicaid preferred product list, and a high-cost drug list; requiring the department to develop and implement a food assistance payment accuracy improvement plan for a specified purpose, etc.
Plain English Summary
AI-GENERATEDA new law requires Florida to seek federal permission for mandatory work rules for able-bodied Medicaid adults aged 19 to 64. They would need 80 hours a month of work, training, or school, with exemptions for parents of young children, veterans, and others.
Medicaid audits get broader teeth. Hospitals no longer must stop retrospective review once prior authorization starts, and overpayment findings can reach claims that already passed a utilization review or prior-authorization check.
Food assistance rules tighten too. The mandatory work-program age rises to 64, the child exemption drops to under 14, self-attestation alone can no longer prove shelter costs, and new EBT cards need photo ID.
The state also expands its Medicaid drug-list system to cover physician-administered drugs and high-cost drugs, and directs the agency to plan new home-based care for adults with serious mental illness.
AIAdults 19 to 64 on Medicaid must complete about 80 hours a month of work, job training, or schooling to keep coverage, once the agency wins federal approval and the Legislature separately approves its business plan.
AIThe agency was required to stop retrospective review of hospital inpatient claims once it began requiring prior authorization for them. That mandatory stop is repealed, so review can continue indefinitely alongside prior authorization.
AIMedicaid's definition of a recoverable overpayment is broadened to explicitly include payments for services that already went through a utilization review or prior-authorization process, so upfront approval no longer forecloses a later repayment demand.
AIFood-assistance recipients must join a mandatory work and training program up to age 64, not 59, and the exemption for parents now covers only those with children under 14 instead of under 18, pulling in parents of teenagers.
AIThe agency may retroactively review and audit claims for emergency care given to people who qualify for Medicaid only because of a medical emergency, checking the emergency was real and treatment necessary, even after approving the service in advance.
AINew law limits food assistance to citizens, permanent residents, and other specified lawfully-present immigrants, and bars the department from accepting an applicant's word alone as proof of shelter or utility costs.
AIThe agency must seek federal approval for a new optional Medicaid service offering expanded home- and community-based care for adults with serious mental illness who are heavy users of institutional treatment, but cannot launch it until the Legislature funds it.
AIThe Pharmaceutical and Therapeutics Committee must build three new Medicaid lists beyond the existing preferred drug list, and the agency must adopt them; a drug or product left off a list can require prior authorization before Medicaid pays for it.