THE BILL ITSELF
SB 568
Managed Care Plans
Florida Senate - 2026 SB 568 By Senator Harrell 31-00890-26 2026568__
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A bill to be entitled
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An act relating to managed care plans; amending s.
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409.967, F.S.; revising Medicaid managed care contract
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requirements to prohibit managed care plans from
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reviewing certain prior authorization claims for
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medical necessity; requiring that managed care plans
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provide coverage for durable medical equipment and
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complex rehabilitation technology from a qualified
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provider, from within the provider network, of the
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enrollee’s choosing; requiring the Agency for Health
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Care Administration to adopt certain rules; providing
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an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Paragraphs (p) and (q) are added to subsection
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(2) of section 409.967, Florida Statutes, 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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(p) Prior authorization reviews.—For any claims in which a
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Medicaid managed care plan has given prior authorization,
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prepayment or postpayment review may not include review for
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medical necessity for the previously approved equipment,
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supplies, or services.
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(q) Durable medical equipment.—Managed care plans, or their
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subcontractors, shall provide coverage for durable medical
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equipment or complex rehabilitation technology from any
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qualified durable medical equipment or complex rehabilitation
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technology provider within the provider network which the
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enrollee chooses. The agency shall adopt rules to implement this
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paragraph, including, but not limited to:
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1. Authorizing enrollees to choose the provider, within the
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provider network, from which they can receive eligible durable
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medical equipment or complex rehabilitation technology.
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2. Providing a procedure within the grievance resolution
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process adopted under paragraph (h) for enrollees to file a
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complaint if they believe they were not granted authority to
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choose their provider from within the provider network, as
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authorized under this paragraph.
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Section 2. This act shall take effect July 1, 2026.