THE BILL ITSELF
SB 40
Medicaid Providers
Florida Senate - 2026 SB 40 By Senator Sharief 35-00003-26 202640__
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A bill to be entitled
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An act relating to Medicaid providers; amending s.
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409.967, F.S.; requiring the Agency for Health Care
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Administration to include specified requirements in
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its contracts with Medicaid managed care plans;
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defining the term “outside of regular business hours”;
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providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Paragraph (c) of subsection (2) of section
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409.967, Florida Statutes, is amended to read:
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409.967 Managed care plan accountability.—
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(2) The agency shall establish such contract requirements
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as are necessary for the operation of the statewide managed care
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program. In addition to any other provisions the agency may deem
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necessary, the contract must require:
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(c) Access.—
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1. The agency shall establish specific standards for the
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number, type, and regional distribution of providers in managed
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care plan networks to ensure access to care for both adults and
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children. Each plan must maintain a regionwide network of
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providers in sufficient numbers to meet the access standards for
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specific medical services for all recipients enrolled in the
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plan. The exclusive use of mail-order pharmacies may not be
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sufficient to meet network access standards. Consistent with the
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standards established by the agency, provider networks may
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include providers located outside the region.
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2. The agency shall establish specific standards to ensure
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enrollees have access to network providers during state holidays
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and outside of regular business hours. At least 50 percent of
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primary care providers participating in a plan provider network
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must offer appointment availability to Medicaid enrollees
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outside of regular business hours. For the purposes of this
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subparagraph, the term “outside of regular business hours” means
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Monday through Friday between 5 p.m. and 8 a.m. local time and
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all day Saturday and Sunday.
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3. Each plan shall establish and maintain an accurate and
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complete electronic database of contracted providers, including
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information about licensure or registration, locations and hours
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of operation, specialty credentials and other certifications,
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specific performance indicators, and such other information as
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the agency deems necessary. The database must be available
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online to both the agency and the public and have the capability
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to compare the availability of providers to network adequacy
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standards and to accept and display feedback from each
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provider’s patients.
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4. Each plan shall submit quarterly reports to the agency
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identifying the number of enrollees assigned to each primary
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care provider.
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5. The agency shall conduct, or contract for, systematic
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and continuous testing of the provider network databases
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maintained by each plan to confirm accuracy, confirm that
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behavioral health providers are accepting enrollees, and confirm
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that enrollees have access to behavioral health services.
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6. 2. Each managed care plan shall must publish any
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prescribed drug formulary or preferred drug list on the plan’s
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website in a manner that is accessible to and searchable by
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enrollees and providers. The plan must update the list within 24
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hours after making a change. Each plan must ensure that the
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prior authorization process for prescribed drugs is readily
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accessible to health care providers, including posting
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appropriate contact information on its website and providing
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timely responses to providers. For Medicaid recipients diagnosed
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with hemophilia who have been prescribed anti-hemophilic-factor
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replacement products, the agency shall provide for those
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products and hemophilia overlay services through the agency’s
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hemophilia disease management program.
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7. 3. Managed care plans, and their fiscal agents or
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intermediaries, must accept prior authorization requests for any
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service electronically.
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8. 4. Managed care plans serving children in the care and
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custody of the Department of Children and Families must maintain
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complete medical, dental, and behavioral health encounter
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information and participate in making such information available
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to the department or the applicable contracted community-based
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care lead agency for use in providing comprehensive and
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coordinated case management. The agency and the department shall
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establish an interagency agreement to provide guidance for the
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format, confidentiality, recipient, scope, and method of
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information to be made available and the deadlines for
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submission of the data. The scope of information available to
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the department is shall be the data that managed care plans are
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required to submit to the agency. The agency shall determine the
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plan’s compliance with standards for access to medical, dental,
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and behavioral health services; the use of medications; and
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follow up followup on all medically necessary services
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recommended as a result of early and periodic screening,
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diagnosis, and treatment.
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Section 2. This act shall take effect July 1, 2026.