Florida Senate - 2026 SB 1758
By Senator Gaetz
1-00651C-26 20261758__
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; establishing an
89 alternative reimbursement methodology for long-acting
90 injectables administered in a hospital facility
91 setting for severe mental illness; requiring the
92 agency to contract with a vendor to perform a fiscal
93 impact study of the federal 340B Drug Pricing Program;
94 providing requirements for the study; requiring
95 specified entities to submit certain data to the
96 agency for purposes of the study; providing that
97 noncompliance with such requirement may result in
98 sanctions from the agency or the Board of Pharmacy, as
99 applicable; requiring the agency to submit the results
100 of the study to the Governor and the Legislature by a
101 specified date; providing construction; amending s.
102 409.913, F.S.; revising the definition of the term
103 “overpayment”; providing that determinations of an
104 overpayment under the Medicaid program may be based
105 upon retrospective reviews, investigations, analyses,
106 or audits conducted by the agency to determine
107 possible fraud, abuse, overpayment, or recipient
108 neglect; providing that certain notices may be
109 provided using other common carriers, as well as
110 through the United States Postal Service; creating s.
111 414.321, F.S.; requiring the department to limit
112 eligibility for food assistance to individuals meeting
113 specified criteria; requiring that food assistance
114 recipients provide certain documentation for purposes
115 of eligibility redeterminations; prohibiting the
116 department from relying solely on an individual’s
117 self-attestations to determine certain expenses;
118 authorizing the department to adopt policies and
119 procedures to accommodate certain applicants and
120 recipients; creating s. 414.332, F.S.; requiring the
121 department to develop and implement a food assistance
122 payment accuracy improvement plan for a specified
123 purpose; requiring the department to reduce the
124 payment error rate to below a specified percentage;
125 providing requirements for the plan; requiring the
126 department to submit the plan to the Governor and the
127 Legislature by a specified date; requiring the
128 department, by a specified date, to submit quarterly
129 progress reports of specified information to the
130 Governor and the Legislature; providing for future
131 repeal; amending s. 414.39, F.S.; requiring the
132 department to require photographic identification on
133 the front of electronic benefits transfer (EBT) cards,
134 to the extent allowable under federal law; amending s.
135 414.455, F.S.; revising criteria for individuals
136 required to participate in an employment and training
137 program to receive food assistance from the
138 Supplemental Nutrition Assistance Program; requiring
139 the department to apply and comply with certain work
140 requirements in accordance with federal law for food
141 assistance; amending s. 409.91196, F.S.; conforming a
142 cross-reference; providing an effective date.
143
144 Be It Enacted by the Legislature of the State of Florida:
145
146 Section 1. Subsection (4) of section 409.904, Florida
147 Statutes, is amended to read:
148 409.904 Optional payments for eligible persons.—The agency
149 may make payments for medical assistance and related services on
150 behalf of the following persons who are determined to be
151 eligible subject to the income, assets, and categorical
152 eligibility tests set forth in federal and state law. Payment on
153 behalf of these Medicaid eligible persons is subject to the
154 availability of moneys and any limitations established by the
155 General Appropriations Act or chapter 216.
156 (4) A low-income person who meets all other requirements
157 for Medicaid eligibility except citizenship and who is in need
158 of emergency medical services. The eligibility of such a
159 recipient is limited to the period of the emergency, in
160 accordance with federal regulations. The agency may conduct
161 retrospective reviews or audits of services rendered to the
162 individual and claims submitted by the provider to validate the
163 existence and duration of the emergency medical condition and
164 whether the services rendered were necessary to treat the
165 emergency medical condition, regardless of whether the provider
166 obtained prior authorization for the services.
167 Section 2. Section 409.9041, Florida Statutes, is created
168 to read:
169 409.9041 Medicaid work and community engagement
170 requirements.—
171 (1) The Legislature finds that assisting able-bodied adult
172 Medicaid recipients in achieving self-sufficiency through
173 meaningful work and community engagement is essential to
174 ensuring that the state Medicaid program remains a sustainable
175 resource for residents who are most in need of such assistance.
176 (2)(a) The agency shall seek federal approval to implement
177 mandatory work and community engagement requirements for able
178 bodied adults, as specified in this section, as a condition of
179 obtaining and maintaining coverage under the state Medicaid
180 program. The agency may not implement the mandatory work and
181 community engagement requirements until it receives federal
182 approval through a Medicaid waiver and the agency’s business
183 plan submitted under paragraph (b) is specifically approved by
184 the Legislature.
185 (b) The agency shall, in consultation with the Department
186 of Children and Families and the Department of Commerce, develop
187 a business plan to implement this section. The plan must include
188 methods for determining Medicaid eligibility and the
189 applicability of exemptions under subsections (3) and (4) on an
190 ongoing basis and an analysis representing the potential effects
191 that implementing this section will have on Medicaid enrollment
192 and expenditures. The agency shall submit the plan to the
193 Governor, the President of the Senate, and the Speaker of the
194 House of Representatives no later than December 1, 2026.
195 (3)(a) Medicaid recipients between the ages of 19 and 64
196 years, inclusive, must meet the work or community engagement
197 requirements of this section, unless they are one of the
198 following:
199 1. Indian as defined under 42 C.F.R. s. 438.14(a).
200 2. A parent, guardian, caretaker relative, or family
201 caregiver of a dependent child younger than 14 years of age or
202 of a disabled individual. For purposes of this paragraph, the
203 term “family caregiver” means an adult family member or other
204 individual who has a significant relationship with, and who
205 provides a broad range of assistance to, an individual with a
206 chronic or other health condition, disability, or functional
207 limitation.
208 3. Former foster youth younger than 26 years of age.
209 4. A veteran with a total disability, as specified under 38
210 C.F.R. s. 3.340 or as specified by a Veteran Affairs Disability
211 Ratings Letter issued by the United States Department of
212 Veterans Affairs.
213 5. An individual classified as medically frail under the
214 Medicaid Institutionalized Care Program; categorized as aged,
215 blind, or disabled under the state Medicaid program; or who has
216 a developmental disability as defined in s. 393.063.
217 6. An individual living in a household that receives
218 Supplemental Nutrition Assistance Program benefits and who is
219 already in compliance with work requirements pursuant to s.
220 445.024.
221 7. An individual participating in a residential substance
222 use treatment program.
223 8. An inmate of a public institution.
224 9. A woman eligible for Medicaid coverage in a pregnancy
225 related or postpartum care category.
226 (b) A person may satisfy the work or community engagement
227 requirements of this section by participating in one or more of
228 the following activities for at least 80 hours per month:
229 1. Paid employment.
230 2. On-the-job-training.
231 3. Vocational educational training.
232 4. Job skills training directly related to employment.
233 5. Education directly related to employment.
234 6. Satisfactory attendance at a secondary school or in a
235 course of study leading to a high school equivalency diploma.
236 7. Enrollment at least half-time as defined in 34 C.F.R. s.
237 668.2(b) in a postsecondary education program to obtain a
238 credential on the Master Credentials List as maintained pursuant
239 to s. 445.004(6)(e).
240 8. Any other work activity designated as such by the
241 Department of Commerce and provided by a local workforce
242 development board pursuant to s. 445.024.
243 (c) Parents with children ages 14 through 18 are required
244 to engage in work or community engagement activities only during
245 standard school hours.
246 (4)(a) Notwithstanding any other statutory provision, in
247 order to maintain Medicaid coverage, an eligible Medicaid
248 recipient must, before enrollment and upon any redetermination
249 for coverage, demonstrate compliance with the work or community
250 engagement requirements of this section.
251 (b) The agency shall develop a process for ensuring
252 compliance with this section which aligns, to the extent
253 possible, with the processes currently in place relating to work
254 and community engagement requirements authorized under the
255 state’s Supplemental Nutrition Assistance Program, including,
256 but not limited to, participant registration with a local
257 CareerSource center, employment and training programs, and
258 collaboration with the state’s local workforce boards.
259 (c) The department shall verify, in accordance with its
260 procedures, that an individual subject to the work and community
261 engagement requirements of this section demonstrates compliance
262 during the individual’s regularly scheduled redetermination of
263 eligibility and at least every 6 months thereafter.
264 (5) The agency, in coordination with the department, shall
265 conduct outreach regarding the implementation of the work and
266 community engagement requirements of this section. The outreach
267 must include, at a minimum, notification to impacted
268 individuals, including timelines for implementation,
269 requirements for compliance, penalties for noncompliance, and
270 information on how to request an exemption.
271 (6) If a recipient subject to the work and community
272 engagement requirements of this section is determined to be in
273 noncompliance with such requirements, the agency, in
274 coordination with the department, must notify the recipient of
275 the finding of noncompliance and the impact to his or her
276 eligibility for continued receipt of Medicaid services. The
277 notice must include, at a minimum, notification of all of the
278 following:
279 (a) That the recipient is eligible for a grace period of 30
280 days to either come into compliance with the requirements or
281 request an exemption from the requirements and that Medicaid
282 coverage of services will continue during the grace period.
283 (b) That if, following the 30-day period, the individual
284 has not come into compliance with or requested an exemption from
285 the work and community engagement requirements, his or her
286 application for assistance will be denied and services
287 terminated at the end of the month following the month in which
288 such 30-calendar-day period ends.
289 (c) The right of the individual to request a fair hearing
290 if he or she is determined to be noncompliant with program
291 requirements and disenrolled from the state Medicaid program.
292 (d) The manner in which he or she can reapply for medical
293 assistance under the state Medicaid program.
294 Section 3. Paragraph (a) of subsection (5) of section
295 409.905, Florida Statutes, is amended, and paragraph (f) is
296 added to that subsection, to read:
297 409.905 Mandatory Medicaid services.—The agency may make
298 payments for the following services, which are required of the
299 state by Title XIX of the Social Security Act, furnished by
300 Medicaid providers to recipients who are determined to be
301 eligible on the dates on which the services were provided. Any
302 service under this section shall be provided only when medically
303 necessary and in accordance with state and federal law.
304 Mandatory services rendered by providers in mobile units to
305 Medicaid recipients may be restricted by the agency. Nothing in
306 this section shall be construed to prevent or limit the agency
307 from adjusting fees, reimbursement rates, lengths of stay,
308 number of visits, number of services, or any other adjustments
309 necessary to comply with the availability of moneys and any
310 limitations or directions provided for in the General
311 Appropriations Act or chapter 216.
312 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
313 all covered services provided for the medical care and treatment
314 of a recipient who is admitted as an inpatient by a licensed
315 physician or dentist to a hospital licensed under part I of
316 chapter 395. However, the agency shall limit the payment for
317 inpatient hospital services for a Medicaid recipient 21 years of
318 age or older to 45 days or the number of days necessary to
319 comply with the General Appropriations Act.
320 (a)1. The agency may implement reimbursement and
321 utilization management reforms in order to comply with any
322 limitations or directions in the General Appropriations Act,
323 which may include, but are not limited to: prior authorization
324 for inpatient psychiatric days; prior authorization for
325 nonemergency hospital inpatient admissions for individuals 21
326 years of age and older; authorization of emergency and urgent
327 care admissions within 24 hours after admission; enhanced
328 utilization and concurrent review programs for highly utilized
329 services; reduction or elimination of covered days of service;
330 adjusting reimbursement ceilings for variable costs; adjusting
331 reimbursement ceilings for fixed and property costs; and
332 implementing target rates of increase.
333 2. The agency may limit prior authorization for hospital
334 inpatient services to selected diagnosis-related groups, based
335 on an analysis of the cost and potential for unnecessary
336 hospitalizations represented by certain diagnoses. Admissions
337 for normal delivery and newborns are exempt from requirements
338 for prior authorization.
339 3. In implementing the provisions of this section related
340 to prior authorization, the agency shall ensure that the process
341 for authorization is accessible 24 hours per day, 7 days per
342 week and authorization is automatically granted when not denied
343 within 4 hours after the request. Authorization procedures must
344 include steps for review of denials.
345 4. Upon implementing the prior authorization program for
346 hospital inpatient services, the agency shall discontinue its
347 hospital retrospective review program. However, This paragraph
348 subparagraph may not be construed to prevent the agency from
349 conducting retrospective reviews under s. 409.913, including,
350 but not limited to, reviews of prior-authorized claims and
351 reviews in which an overpayment is suspected due to a mistake or
352 submission of an improper claim or for other reasons that do not
353 rise to the level of fraud or abuse.
354 (f) In its coverage of services under this subsection, the
355 agency shall maintain cost-effective purchasing practices as
356 required by s. 409.912.
357 Section 4. Present subsections (14) through (29) of section
358 409.906, Florida Statutes, are redesignated as subsections (15)
359 through (30), respectively, and a new subsection (14) is added
360 to that section, to read:
361 409.906 Optional Medicaid services.—Subject to specific
362 appropriations, the agency may make payments for services which
363 are optional to the state under Title XIX of the Social Security
364 Act and are furnished by Medicaid providers to recipients who
365 are determined to be eligible on the dates on which the services
366 were provided. Any optional service that is provided shall be
367 provided only when medically necessary and in accordance with
368 state and federal law. Optional services rendered by providers
369 in mobile units to Medicaid recipients may be restricted or
370 prohibited by the agency. Nothing in this section shall be
371 construed to prevent or limit the agency from adjusting fees,
372 reimbursement rates, lengths of stay, number of visits, or
373 number of services, or making any other adjustments necessary to
374 comply with the availability of moneys and any limitations or
375 directions provided for in the General Appropriations Act or
376 chapter 216. If necessary to safeguard the state’s systems of
377 providing services to elderly and disabled persons and subject
378 to the notice and review provisions of s. 216.177, the Governor
379 may direct the Agency for Health Care Administration to amend
380 the Medicaid state plan to delete the optional Medicaid service
381 known as “Intermediate Care Facilities for the Developmentally
382 Disabled.” Optional services may include:
383 (14) HOME- AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES.
384 The agency shall seek federal approval to implement a program
385 that covers an expanded array of home- and community-based
386 services for adults 18 years of age and older diagnosed with a
387 serious mental illness who are high utilizers of behavioral
388 health services in an institutional setting. The program must be
389 designed to reduce the need for institutional levels of care for
390 adults with a serious mental illness. The agency shall work in
391 coordination with the Department of Children and Families to
392 develop the program. The agency and the department shall produce
393 estimates of the program′s potential costs to the Medicaid
394 program and cost-savings for the department. Such estimates must
395 be submitted to the Legislature as legislative budget requests
396 and appropriated in the General Appropriations Act before the
397 program may be implemented.
398 Section 5. Section 409.91195, Florida Statutes, is amended
399 to read:
400 409.91195 Medicaid Pharmaceutical and Therapeutics
401 Committee.—There is created a Medicaid Pharmaceutical and
402 Therapeutics Committee within the agency for the purpose of
403 developing a Medicaid preferred drug list, a Medicaid preferred
404 physician-administered drug list, a Medicaid preferred product
405 list, and a high-cost drug list.
406 (1) The committee shall be composed of 11 members appointed
407 by the Governor. Four members shall be physicians, licensed
408 under chapter 458; one member licensed under chapter 459; five
409 members shall be pharmacists licensed under chapter 465; and one
410 member shall be a consumer representative. The members shall be
411 appointed to serve for terms of 2 years from the date of their
412 appointment. Members may be appointed to more than one term. The
413 agency shall serve as staff for the committee and assist them
414 with all ministerial duties. The Governor shall ensure that at
415 least some of the members of the committee represent Medicaid
416 participating physicians and pharmacies serving all segments and
417 diversity of the Medicaid population, and have experience in
418 either developing or practicing under a preferred drug list. At
419 least one of the members shall represent the interests of
420 pharmaceutical manufacturers.
421 (2) Committee members shall select a chairperson and a vice
422 chairperson each year from the committee membership.
423 (3) The committee shall meet at least quarterly and may
424 meet at other times at the discretion of the chairperson and
425 members. The committee shall comply with rules adopted by the
426 agency, including notice of any meeting of the committee
427 pursuant to the requirements of the Administrative Procedure
428 Act.
429 (4) Upon recommendation of the committee, the agency shall
430 adopt a preferred drug list, a preferred physician-administered
431 drug list, a preferred product list, and a high-cost drug list
432 as described in s. 409.912(5). To the extent feasible, the
433 committee shall review all drug or product classes included on
434 the preferred drug list, the preferred physician-administered
435 drug list, and the preferred product list every 12 months, and
436 the high-cost drug list every 6 months. The committee may
437 recommend additions to and deletions from the lists preferred
438 drug list, such that the lists provide preferred drug list
439 provides for medically appropriate drug and product therapies
440 for Medicaid patients which achieve cost savings contained in
441 the General Appropriations Act.
442 (5) Except for antiretroviral drugs, reimbursement of drugs
443 not included on the preferred drug list, preferred physician
444 administered drug list, preferred product list, or high-cost
445 drug list is subject to prior authorization.
446 (6) The agency shall publish and disseminate the preferred
447 drug list, preferred physician-administered drug list, preferred
448 product list, and high-cost drug list to all Medicaid providers
449 in the state by Internet posting on the agency’s website or in
450 other media.
451 (7) The committee shall ensure that interested parties,
452 including pharmaceutical manufacturers agreeing to provide a
453 supplemental rebate as outlined in this chapter, have an
454 opportunity to present public testimony to the committee with
455 information or evidence supporting inclusion of a drug or
456 product on the preferred drug list, preferred physician
457 administered drug list, or preferred product list. Such public
458 testimony must shall occur before prior to any recommendations
459 made by the committee for inclusion or exclusion from the
460 preferred drug list, preferred physician-administered drug list,
461 or preferred product list. Upon timely notice, the agency shall
462 ensure that any drug that has been approved or had any of its
463 particular uses approved by the United States Food and Drug
464 Administration under a priority review classification will be
465 reviewed by the committee at the next regularly scheduled
466 meeting following 3 months of distribution of the drug to the
467 general public.
468 (8) The committee shall develop its preferred drug list,
469 preferred physician-administered drug list, preferred product
470 list, and high-cost drug list recommendations by considering the
471 clinical efficacy, safety, and cost-effectiveness of a product.
472 (9) The Medicaid Pharmaceutical and Therapeutics Committee
473 may also make recommendations to the agency regarding the prior
474 authorization of any prescribed drug covered by Medicaid.
475 (10) Medicaid recipients may appeal agency preferred drug
476 formulary decisions using the Medicaid fair hearing process
477 administered by the Agency for Health Care Administration.
478 Section 6. Paragraph (a) of subsection (5) of section
479 409.912, Florida Statutes, is amended, and subsection (14) is
480 added to that section, to read:
481 409.912 Cost-effective purchasing of health care.—The
482 agency shall purchase goods and services for Medicaid recipients
483 in the most cost-effective manner consistent with the delivery
484 of quality medical care. To ensure that medical services are
485 effectively utilized, the agency may, in any case, require a
486 confirmation or second physician’s opinion of the correct
487 diagnosis for purposes of authorizing future services under the
488 Medicaid program. This section does not restrict access to
489 emergency services or poststabilization care services as defined
490 in 42 C.F.R. s. 438.114. Such confirmation or second opinion
491 shall be rendered in a manner approved by the agency. The agency
492 shall maximize the use of prepaid per capita and prepaid
493 aggregate fixed-sum basis services when appropriate and other
494 alternative service delivery and reimbursement methodologies,
495 including competitive bidding pursuant to s. 287.057, designed
496 to facilitate the cost-effective purchase of a case-managed
497 continuum of care. The agency shall also require providers to
498 minimize the exposure of recipients to the need for acute
499 inpatient, custodial, and other institutional care and the
500 inappropriate or unnecessary use of high-cost services. The
501 agency shall contract with a vendor to monitor and evaluate the
502 clinical practice patterns of providers in order to identify
503 trends that are outside the normal practice patterns of a
504 provider’s professional peers or the national guidelines of a
505 provider’s professional association. The vendor must be able to
506 provide information and counseling to a provider whose practice
507 patterns are outside the norms, in consultation with the agency,
508 to improve patient care and reduce inappropriate utilization.
509 The agency may mandate prior authorization, drug therapy
510 management, or disease management participation for certain
511 populations of Medicaid beneficiaries, certain drug classes, or
512 particular drugs to prevent fraud, abuse, overuse, and possible
513 dangerous drug interactions. The Pharmaceutical and Therapeutics
514 Committee shall make recommendations to the agency on drugs for
515 which prior authorization is required. The agency shall inform
516 the Pharmaceutical and Therapeutics Committee of its decisions
517 regarding drugs subject to prior authorization. The agency is
518 authorized to limit the entities it contracts with or enrolls as
519 Medicaid providers by developing a provider network through
520 provider credentialing. The agency may competitively bid single
521 source-provider contracts if procurement of goods or services
522 results in demonstrated cost savings to the state without
523 limiting access to care. The agency may limit its network based
524 on the assessment of beneficiary access to care, provider
525 availability, provider quality standards, time and distance
526 standards for access to care, the cultural competence of the
527 provider network, demographic characteristics of Medicaid
528 beneficiaries, practice and provider-to-beneficiary standards,
529 appointment wait times, beneficiary use of services, provider
530 turnover, provider profiling, provider licensure history,
531 previous program integrity investigations and findings, peer
532 review, provider Medicaid policy and billing compliance records,
533 clinical and medical record audits, and other factors. Providers
534 are not entitled to enrollment in the Medicaid provider network.
535 The agency shall determine instances in which allowing Medicaid
536 beneficiaries to purchase durable medical equipment and other
537 goods is less expensive to the Medicaid program than long-term
538 rental of the equipment or goods. The agency may establish rules
539 to facilitate purchases in lieu of long-term rentals in order to
540 protect against fraud and abuse in the Medicaid program as
541 defined in s. 409.913. The agency may seek federal waivers
542 necessary to administer these policies.
543 (5)(a) The agency shall implement a Medicaid prescribed
544 drug spending-control program that includes the following
545 components:
546 1. A Medicaid preferred drug list and a Medicaid physician
547 administered drug list. The preferred drug list, which shall be
548 a listing of cost-effective therapeutic options recommended by
549 the Medicaid Pharmacy and Therapeutics Committee established
550 pursuant to s. 409.91195 and adopted by the agency for each
551 therapeutic class on the preferred drug list. At the discretion
552 of the committee, and when feasible, the preferred drug list
553 should include at least two products in a therapeutic class. The
554 physician-administered drug list shall be a listing of
555 physician-administered drugs covered by the state Medicaid
556 program, based on the United States Food and Drug
557 Administration’s approved indications and compendia in 42 U.S.C.
558 s. 1396r-8(g)(1)(B). Within the preferred physician-administered
559 drug list, there must be a section containing a list of
560 preferred physician-administered drugs that are cost-effective
561 therapeutic options recommended by the Medicaid Pharmaceutical
562 and Therapeutics Committee established pursuant to s. 409.91195.
563 The physician-administered drug list must be updated at least
564 twice a year. The agency may post and update the preferred drug
565 list and the preferred physician-administered drug updates to
566 the list on the agency’s an Internet website without following
567 the rulemaking procedures of chapter 120. Antiretroviral agents
568 are excluded from the preferred drug list. The agency shall also
569 limit the amount of a prescribed drug dispensed to no more than
570 a 34-day supply unless the drug products’ smallest marketed
571 package is greater than a 34-day supply, or the drug is
572 determined by the agency to be a maintenance drug in which case
573 a 100-day maximum supply may be authorized. The agency may seek
574 any federal waivers necessary to implement these cost-control
575 programs and to continue participation in the federal Medicaid
576 rebate program, or alternatively to negotiate state-only
577 manufacturer rebates. The agency may adopt rules to administer
578 this subparagraph. The agency shall continue to provide
579 unlimited contraceptive drugs and items. The agency must
580 establish procedures to ensure that:
581 a. There is a response to a request for prior authorization
582 by telephone or other telecommunication device within 24 hours
583 after receipt of a request for prior authorization; and
584 b. A 72-hour supply of the drug prescribed is provided in
585 an emergency or when the agency does not provide a response
586 within 24 hours as required by sub-subparagraph a.
587 2. A Medicaid preferred product list, which shall be a
588 listing of cost-effective therapeutic supplies recommended by
589 the Medicaid Pharmaceutical and Therapeutics Committee
590 established pursuant to s. 409.91195 and adopted by the agency
591 for each product class listed on the preferred product list and
592 reimbursed by the state Medicaid program through the pharmacy
593 point-of-sale. The agency may post the preferred product list
594 and updates to the list on the agency’s website without
595 following the rulemaking procedures of chapter 120.
596 3. A list of high-cost drugs recommended by the Medicaid
597 Pharmaceutical and Therapeutics Committee established pursuant
598 to s. 409.91195 and adopted by the agency, for the purpose of
599 coverage, reimbursement, or billing guidance. The agency may
600 post the high-cost drug list and updates to the list on the
601 agency’s website without following the rulemaking procedures of
602 chapter 120.
603 4. A provider of prescribed drugs is reimbursed in an
604 amount not to exceed the lesser of the actual acquisition cost
605 based on the Centers for Medicare and Medicaid Services National
606 Average Drug Acquisition Cost pricing files plus a professional
607 dispensing fee, the wholesale acquisition cost plus a
608 professional dispensing fee, the state maximum allowable cost
609 plus a professional dispensing fee, or the usual and customary
610 charge billed by the provider.
611 5. A hospital facility administering long-acting
612 injectables for severe mental illness shall be reimbursed
613 separately from the diagnosis-related group. Long-acting
614 injectables administered for severe mental illness in a hospital
615 facility setting shall be reimbursed at no less than the actual
616 acquisition cost of the drug.
617 6. The agency shall contract with a vendor to perform a
618 detailed fiscal impact study to evaluate the 340B Drug Pricing
619 Program administered by the Health Resources and Services
620 Administration. The study must evaluate 340B compliance, 340B
621 drug purchases, and reimbursement methodologies within the fee
622 for-service program and Statewide Medicaid Managed Care program.
623 Statewide Medicaid Managed Care plans, pharmacy benefit
624 managers, and Medicaid providers shall submit to the agency all
625 data necessary for the completion of the study, including, but
626 not limited to, information related to drug purchasing,
627 reimbursement, billing and coding, and dispensing. Noncompliance
628 with the 340B data submission requirements of this subparagraph
629 may result in sanctions from the agency or the Board of
630 Pharmacy, as applicable. The agency shall submit the results of
631 the study to the Governor, the President of the Senate, and the
632 Speaker of the House of Representatives by June 30, 2027.
633 7.3. The agency shall develop and implement a process for
634 managing the drug therapies of Medicaid recipients who are using
635 significant numbers of prescribed drugs each month. The
636 management process may include, but is not limited to,
637 comprehensive, physician-directed medical-record reviews, claims
638 analyses, and case evaluations to determine the medical
639 necessity and appropriateness of a patient’s treatment plan and
640 drug therapies. The agency may contract with a private
641 organization to provide drug-program-management services. The
642 Medicaid drug benefit management program shall include
643 initiatives to manage drug therapies for HIV/AIDS patients,
644 patients using 20 or more unique prescriptions in a 180-day
645 period, and the top 1,000 patients in annual spending. The
646 agency shall enroll any Medicaid recipient in the drug benefit
647 management program if he or she meets the specifications of this
648 provision and is not enrolled in a Medicaid health maintenance
649 organization.
650 8.4. The agency may limit the size of its pharmacy network
651 based on need, competitive bidding, price negotiations,
652 credentialing, or similar criteria. The agency shall give
653 special consideration to rural areas in determining the size and
654 location of pharmacies included in the Medicaid pharmacy
655 network. A pharmacy credentialing process may include criteria
656 such as a pharmacy’s full-service status, location, size,
657 patient educational programs, patient consultation, disease
658 management services, and other characteristics. The agency may
659 impose a moratorium on Medicaid pharmacy enrollment if it is
660 determined that it has a sufficient number of Medicaid
661 participating providers. The agency must allow dispensing
662 practitioners to participate as a part of the Medicaid pharmacy
663 network regardless of the practitioner’s proximity to any other
664 entity that is dispensing prescription drugs under the Medicaid
665 program. A dispensing practitioner must meet all credentialing
666 requirements applicable to his or her practice, as determined by
667 the agency.
668 9.5. The agency shall develop and implement a program that
669 requires Medicaid practitioners who issue written prescriptions
670 for medicinal drugs to use a counterfeit-proof prescription pad
671 for Medicaid prescriptions. The agency shall require the use of
672 standardized counterfeit-proof prescription pads by prescribers
673 who issue written prescriptions for Medicaid recipients. The
674 agency may implement the program in targeted geographic areas or
675 statewide.
676 10.6. The agency may enter into arrangements that require
677 manufacturers of generic drugs prescribed to Medicaid recipients
678 to provide rebates of at least 15.1 percent of the average
679 manufacturer price for the manufacturer’s generic products.
680 These arrangements shall require that if a generic-drug
681 manufacturer pays federal rebates for Medicaid-reimbursed drugs
682 at a level below 15.1 percent, the manufacturer must provide a
683 supplemental rebate to the state in an amount necessary to
684 achieve a 15.1-percent rebate level.
685 11.7. The agency may establish a preferred drug list as
686 described in this subsection, and, pursuant to the establishment
687 of such preferred drug list, negotiate supplemental rebates from
688 manufacturers that are in addition to those required by Title
689 XIX of the Social Security Act and at no less than 14 percent of
690 the average manufacturer price as defined in 42 U.S.C. s. 1936
691 on the last day of a quarter unless the federal or supplemental
692 rebate, or both, equals or exceeds 29 percent. There is no upper
693 limit on the supplemental rebates the agency may negotiate. The
694 agency may determine that specific products, brand-name or
695 generic, are competitive at lower rebate percentages. Agreement
696 to pay the minimum supplemental rebate percentage guarantees a
697 manufacturer that the Medicaid Pharmaceutical and Therapeutics
698 Committee will consider a product for inclusion on the preferred
699 drug list. However, a pharmaceutical manufacturer is not
700 guaranteed placement on the preferred drug list by simply paying
701 the minimum supplemental rebate. Agency decisions will be made
702 on the clinical efficacy of a drug and recommendations of the
703 Medicaid Pharmaceutical and Therapeutics Committee, as well as
704 the price of competing products minus federal and state rebates.
705 The agency may contract with an outside agency or contractor to
706 conduct negotiations for supplemental rebates. For the purposes
707 of this section, the term “supplemental rebates” means cash
708 rebates. Value-added programs as a substitution for supplemental
709 rebates are prohibited. The agency may seek any federal waivers
710 to implement this initiative.
711 12.a.8.a. The agency may implement a Medicaid behavioral
712 drug management system. The agency may contract with a vendor
713 that has experience in operating behavioral drug management
714 systems to implement this program. The agency may seek federal
715 waivers to implement this program.
716 b. The agency, in conjunction with the Department of
717 Children and Families, may implement the Medicaid behavioral
718 drug management system that is designed to improve the quality
719 of care and behavioral health prescribing practices based on
720 best practice guidelines, improve patient adherence to
721 medication plans, reduce clinical risk, and lower prescribed
722 drug costs and the rate of inappropriate spending on Medicaid
723 behavioral drugs. The program may include the following
724 elements:
725 (I) Provide for the development and adoption of best
726 practice guidelines for behavioral health-related drugs such as
727 antipsychotics, antidepressants, and medications for treating
728 bipolar disorders and other behavioral conditions; translate
729 them into practice; review behavioral health prescribers and
730 compare their prescribing patterns to a number of indicators
731 that are based on national standards; and determine deviations
732 from best practice guidelines.
733 (II) Implement processes for providing feedback to and
734 educating prescribers using best practice educational materials
735 and peer-to-peer consultation.
736 (III) Assess Medicaid beneficiaries who are outliers in
737 their use of behavioral health drugs with regard to the numbers
738 and types of drugs taken, drug dosages, combination drug
739 therapies, and other indicators of improper use of behavioral
740 health drugs.
741 (IV) Alert prescribers to patients who fail to refill
742 prescriptions in a timely fashion, are prescribed multiple same
743 class behavioral health drugs, and may have other potential
744 medication problems.
745 (V) Track spending trends for behavioral health drugs and
746 deviation from best practice guidelines.
747 (VI) Use educational and technological approaches to
748 promote best practices, educate consumers, and train prescribers
749 in the use of practice guidelines.
750 (VII) Disseminate electronic and published materials.
751 (VIII) Hold statewide and regional conferences.
752 (IX) Implement a disease management program with a model
753 quality-based medication component for severely mentally ill
754 individuals and emotionally disturbed children who are high
755 users of care.
756 13.9. The agency shall implement a Medicaid prescription
757 drug management system.
758 a. The agency may contract with a vendor that has
759 experience in operating prescription drug management systems in
760 order to implement this system. Any management system that is
761 implemented in accordance with this subparagraph must rely on
762 cooperation between physicians and pharmacists to determine
763 appropriate practice patterns and clinical guidelines to improve
764 the prescribing, dispensing, and use of drugs in the Medicaid
765 program. The agency may seek federal waivers to implement this
766 program.
767 b. The drug management system must be designed to improve
768 the quality of care and prescribing practices based on best
769 practice guidelines, improve patient adherence to medication
770 plans, reduce clinical risk, and lower prescribed drug costs and
771 the rate of inappropriate spending on Medicaid prescription
772 drugs. The program must:
773 (I) Provide for the adoption of best practice guidelines
774 for the prescribing and use of drugs in the Medicaid program,
775 including translating best practice guidelines into practice;
776 reviewing prescriber patterns and comparing them to indicators
777 that are based on national standards and practice patterns of
778 clinical peers in their community, statewide, and nationally;
779 and determine deviations from best practice guidelines.
780 (II) Implement processes for providing feedback to and
781 educating prescribers using best practice educational materials
782 and peer-to-peer consultation.
783 (III) Assess Medicaid recipients who are outliers in their
784 use of a single or multiple prescription drugs with regard to
785 the numbers and types of drugs taken, drug dosages, combination
786 drug therapies, and other indicators of improper use of
787 prescription drugs.
788 (IV) Alert prescribers to recipients who fail to refill
789 prescriptions in a timely fashion, are prescribed multiple drugs
790 that may be redundant or contraindicated, or may have other
791 potential medication problems.
792 14.10. The agency may contract for drug rebate
793 administration, including, but not limited to, calculating
794 rebate amounts, invoicing manufacturers, negotiating disputes
795 with manufacturers, and maintaining a database of rebate
796 collections.
797 15.11. The agency may specify the preferred daily dosing
798 form or strength for the purpose of promoting best practices
799 with regard to the prescribing of certain drugs as specified in
800 the General Appropriations Act and ensuring cost-effective
801 prescribing practices.
802 16.12. The agency may require prior authorization for
803 Medicaid-covered prescribed drugs. The agency may prior
804 authorize the use of a product:
805 a. For an indication not approved in labeling;
806 b. To comply with certain clinical guidelines; or
807 c. If the product has the potential for overuse, misuse, or
808 abuse.
809
810 The agency may require the prescribing professional to provide
811 information about the rationale and supporting medical evidence
812 for the use of a drug. The agency shall post prior
813 authorization, step-edit criteria and protocol, and updates to
814 the list of drugs that are subject to prior authorization on the
815 agency’s Internet website within 21 days after the prior
816 authorization and step-edit criteria and protocol and updates
817 are approved by the agency. For purposes of this subparagraph,
818 the term “step-edit” means an automatic electronic review of
819 certain medications subject to prior authorization.
820 17.13. The agency, in conjunction with the Pharmaceutical
821 and Therapeutics Committee, may require age-related prior
822 authorizations for certain prescribed drugs. The agency may
823 preauthorize the use of a drug for a recipient who may not meet
824 the age requirement or may exceed the length of therapy for use
825 of this product as recommended by the manufacturer and approved
826 by the Food and Drug Administration. Prior authorization may
827 require the prescribing professional to provide information
828 about the rationale and supporting medical evidence for the use
829 of a drug.
830 18.14. The agency shall implement a step-therapy prior
831 authorization approval process for medications excluded from the
832 preferred drug list. Medications listed on the preferred drug
833 list must be used within the previous 12 months before the
834 alternative medications that are not listed. The step-therapy
835 prior authorization may require the prescriber to use the
836 medications of a similar drug class or for a similar medical
837 indication unless contraindicated in the Food and Drug
838 Administration labeling. The trial period between the specified
839 steps may vary according to the medical indication. The step
840 therapy approval process shall be developed in accordance with
841 the committee as stated in s. 409.91195(7) and (8). A drug
842 product may be approved without meeting the step-therapy prior
843 authorization criteria if the prescribing physician provides the
844 agency with additional written medical or clinical documentation
845 that the product is medically necessary because:
846 a. There is not a drug on the preferred drug list to treat
847 the disease or medical condition which is an acceptable clinical
848 alternative;
849 b. The alternatives have been ineffective in the treatment
850 of the beneficiary’s disease;
851 c. The drug product or medication of a similar drug class
852 is prescribed for the treatment of schizophrenia or schizotypal
853 or delusional disorders; prior authorization has been granted
854 previously for the prescribed drug; and the medication was
855 dispensed to the patient during the previous 12 months; or
856 d. Based on historical evidence and known characteristics
857 of the patient and the drug, the drug is likely to be
858 ineffective, or the number of doses have been ineffective.
859
860 The agency shall work with the physician to determine the best
861 alternative for the patient. The agency may adopt rules waiving
862 the requirements for written clinical documentation for specific
863 drugs in limited clinical situations.
864 19.15. The agency shall implement a return and reuse
865 program for drugs dispensed by pharmacies to institutional
866 recipients, which includes payment of a $5 restocking fee for
867 the implementation and operation of the program. The return and
868 reuse program shall be implemented electronically and in a
869 manner that promotes efficiency. The program must permit a
870 pharmacy to exclude drugs from the program if it is not
871 practical or cost-effective for the drug to be included and must
872 provide for the return to inventory of drugs that cannot be
873 credited or returned in a cost-effective manner. The agency
874 shall determine if the program has reduced the amount of
875 Medicaid prescription drugs which are destroyed on an annual
876 basis and if there are additional ways to ensure more
877 prescription drugs are not destroyed which could safely be
878 reused.
879 (14) Neither this section nor this chapter prevents the
880 agency from conducting retrospective reviews, investigations,
881 analyses, audits, or any combination thereof to determine
882 possible fraud, abuse, overpayment, or recipient neglect in the
883 state Medicaid program pursuant to s. 409.913, including, but
884 not limited to, reviews in which the services were the subject
885 of a utilization review or prior authorization process.
886 Section 7. Paragraph (e) of subsection (1) and subsections
887 (2) and (6) of section 409.913, Florida Statutes, are amended to
888 read:
889 409.913 Oversight of the integrity of the Medicaid
890 program.—The agency shall operate a program to oversee the
891 activities of Florida Medicaid recipients, and providers and
892 their representatives, to ensure that fraudulent and abusive
893 behavior and neglect of recipients occur to the minimum extent
894 possible, and to recover overpayments and impose sanctions as
895 appropriate. Each January 15, the agency and the Medicaid Fraud
896 Control Unit of the Department of Legal Affairs shall submit a
897 report to the Legislature documenting the effectiveness of the
898 state’s efforts to control Medicaid fraud and abuse and to
899 recover Medicaid overpayments during the previous fiscal year.
900 The report must describe the number of cases opened and
901 investigated each year; the sources of the cases opened; the
902 disposition of the cases closed each year; the amount of
903 overpayments alleged in preliminary and final audit letters; the
904 number and amount of fines or penalties imposed; any reductions
905 in overpayment amounts negotiated in settlement agreements or by
906 other means; the amount of final agency determinations of
907 overpayments; the amount deducted from federal claiming as a
908 result of overpayments; the amount of overpayments recovered
909 each year; the amount of cost of investigation recovered each
910 year; the average length of time to collect from the time the
911 case was opened until the overpayment is paid in full; the
912 amount determined as uncollectible and the portion of the
913 uncollectible amount subsequently reclaimed from the Federal
914 Government; the number of providers, by type, that are
915 terminated from participation in the Medicaid program as a
916 result of fraud and abuse; and all costs associated with
917 discovering and prosecuting cases of Medicaid overpayments and
918 making recoveries in such cases. The report must also document
919 actions taken to prevent overpayments and the number of
920 providers prevented from enrolling in or reenrolling in the
921 Medicaid program as a result of documented Medicaid fraud and
922 abuse and must include policy recommendations necessary to
923 prevent or recover overpayments and changes necessary to prevent
924 and detect Medicaid fraud. All policy recommendations in the
925 report must include a detailed fiscal analysis, including, but
926 not limited to, implementation costs, estimated savings to the
927 Medicaid program, and the return on investment. The agency must
928 submit the policy recommendations and fiscal analyses in the
929 report to the appropriate estimating conference, pursuant to s.
930 216.137, by February 15 of each year. The agency and the
931 Medicaid Fraud Control Unit of the Department of Legal Affairs
932 each must include detailed unit-specific performance standards,
933 benchmarks, and metrics in the report, including projected cost
934 savings to the state Medicaid program during the following
935 fiscal year.
936 (1) For the purposes of this section, the term:
937 (e) “Overpayment” includes any amount that is not
938 authorized to be paid by the Medicaid program or that should not
939 have been paid, including payments made whether paid as a result
940 of inaccurate or improper cost reporting, improper claiming,
941 unacceptable practices, fraud, abuse, or mistake, and may
942 include amounts paid for goods or services that were the subject
943 of a utilization review or prior authorization process.
944 (2) The agency shall conduct, or cause to be conducted by
945 contract or otherwise, reviews, investigations, analyses,
946 audits, or any combination thereof, to determine possible fraud,
947 abuse, overpayment, or recipient neglect in the Medicaid program
948 and shall report the findings of any overpayments in audit
949 reports as appropriate. An overpayment determination may be
950 based upon retrospective reviews, investigations, analyses,
951 audits, or any combination thereof to determine possible fraud,
952 abuse, overpayment, or recipient neglect in the Medicaid
953 program, regardless of whether a prior authorization was issued.
954 At least 5 percent of all audits shall be conducted on a random
955 basis. As part of its ongoing fraud detection activities, the
956 agency shall identify and monitor, by contract or otherwise,
957 patterns of overutilization of Medicaid services based on state
958 averages. The agency shall track Medicaid provider prescription
959 and billing patterns and evaluate them against Medicaid medical
960 necessity criteria and coverage and limitation guidelines
961 adopted by rule. Medical necessity determination requires that
962 service be consistent with symptoms or confirmed diagnosis of
963 illness or injury under treatment and not in excess of the
964 patient’s needs. The agency shall conduct reviews of provider
965 exceptions to peer group norms and shall, using statistical
966 methodologies, provider profiling, and analysis of billing
967 patterns, detect and investigate abnormal or unusual increases
968 in billing or payment of claims for Medicaid services and
969 medically unnecessary provision of services.
970 (6) Any notice required to be given to a provider under
971 this section is presumed to be sufficient notice if sent to the
972 mailing address last shown on the provider enrollment file. It
973 is the responsibility of the provider to furnish and keep the
974 agency informed of the provider’s current mailing and service
975 addresses address. United States Postal Service or other common
976 carrier’s proof of mailing or certified or registered mailing of
977 such notice to the provider at the address shown on the provider
978 enrollment file constitutes sufficient proof of notice. Any
979 notice required to be given to the agency by this section must
980 be sent to the agency at an address designated by rule.
981 Section 8. Section 414.321, Florida Statutes, is created to
982 read:
983 414.321 Food assistance eligibility.—For purposes of
984 eligibility determinations, the department shall:
985 (1) Limit eligibility to individuals who are residents of
986 the United States and:
987 (a) Citizens or nationals of the United States;
988 (b) Aliens lawfully admitted for permanent residence as
989 defined in the Immigration and Nationality Act, as amended;
990 (c) Aliens who have been granted the status of Cuban and
991 Haitian entrant, as defined in the Refugee Education Assistance
992 Act of 1980, as amended; or
993 (d) Individuals who lawfully reside in the United States in
994 accordance with the Compacts of Free Association referred to in
995 the Personal Responsibility and Work Opportunity Reconciliation
996 Act of 1996.
997 (2) Require each applicant, or recipient for
998 redetermination purposes, to provide documentation evidencing
999 his or her shelter or utility expenses.
1000 (a) The department is prohibited from relying solely on an
1001 individual’s self-attestation in determining shelter or utility
1002 expenses.
1003 (b) The department may adopt policies and procedures to
1004 accommodate an applicant or a recipient who, due to recent
1005 residency changes, is temporarily unable to furnish adequate
1006 documentation of shelter or utility expenses.
1007 Section 9. Section 414.332, Florida Statutes, is created to
1008 read:
1009 414.332 Food assistance payment accuracy plan.—
1010 (1) The department shall develop and implement a
1011 comprehensive food assistance payment accuracy improvement plan
1012 to reduce the state’s payment error rate. The department must
1013 reduce the payment error rate to below 6 percent. The plan must
1014 address the root causes of payment errors identified through an
1015 in-depth, data-driven analysis. The plan must include, but need
1016 not be limited to, all of the following:
1017 (a) Enhanced employee training and quality assurance.
1018 1. The department shall administer standardized training
1019 for all economic self-sufficiency program staff at least
1020 annually. Training must, at a minimum, review the most common
1021 reasons for payment errors and methods for preventing such
1022 errors, and include pre- and post-training testing to measure
1023 staff proficiency.
1024 2. The department shall establish a robust quality
1025 assurance review process that frequently reviews a statistically
1026 significant sample of cases before final benefit determination.
1027 This process must incorporate real-time, corrective feedback and
1028 on-the-job training for program staff and may not delay benefit
1029 determinations.
1030 (b) Improvement in data sourcing. In contracting with
1031 entities providing data for verification of applicant and
1032 recipient information, the department shall maximize use of high
1033 quality automated data sources, including, but not limited to,
1034 comparing income and asset data with state, federal, and private
1035 sector data sources.
1036 (2) By July 15, 2026, the department shall submit the food
1037 assistance payment accuracy improvement plan to the Governor,
1038 the President of the Senate, and the Speaker of the House of
1039 Representatives.
1040 (3)(a) Beginning October 1, 2026, the department shall
1041 submit quarterly progress reports to the Governor, the President
1042 of the Senate, and the Speaker of the House of Representatives
1043 detailing:
1044 1. The state’s most recent official and preliminary food
1045 assistance payment error rate.
1046 2. A detailed breakdown of the most frequent and highest
1047 dollar value errors, including categorization by agency or
1048 client error and whether the error resulted in over- or under
1049 payment.
1050 3. Specific actions taken by the department under the food
1051 assistance payment accuracy improvement plan during the
1052 preceding quarter and data demonstrating the results of those
1053 actions.
1054 4. A detailed plan to correct the most recently identified
1055 deficiencies.
1056 (b) This subsection is repealed on October 1, 2028.
1057 Section 10. Present subsections (6) through (11) of section
1058 414.39, Florida Statutes, are redesignated as subsections (7)
1059 through (12), respectively, and a new subsection (6) is added to
1060 that section, to read:
1061 414.39 Fraud.—
1062 (6) The department shall require the use of photographic
1063 identification on the front of each newly issued and reissued
1064 electronic benefits transfer (EBT) card for each cardholder to
1065 the maximum extent allowed by federal laws and regulations.
1066 Section 11. Subsection (2) of section 414.455, Florida
1067 Statutes, is amended to read:
1068 414.455 Supplemental Nutrition Assistance Program;
1069 legislative authorization; mandatory participation in employment
1070 and training programs.—
1071 (2) Unless prohibited by the Federal Government, the
1072 department must require a person who is receiving food
1073 assistance; who is 18 to 64 59 years of age, inclusive; who does
1074 not have children under the age of 14 18 in his or her home; who
1075 does not qualify for an exemption; and who is determined by the
1076 department to be eligible, to participate in an employment and
1077 training program. The department shall apply and comply with
1078 exemptions from work requirements in accordance with applicable
1079 federal law.
1080 Section 12. Subsection (1) of section 409.91196, Florida
1081 Statutes, is amended to read:
1082 409.91196 Supplemental rebate agreements; public records
1083 and public meetings exemption.—
1084 (1) The rebate amount, percent of rebate, manufacturer’s
1085 pricing, and supplemental rebate, and other trade secrets as
1086 defined in s. 688.002 that the agency has identified for use in
1087 negotiations, held by the Agency for Health Care Administration
1088 under s. 409.912(5)(a)11. s. 409.912(5)(a)7. are confidential
1089 and exempt from s. 119.07(1) and s. 24(a), Art. I of the State
1090 Constitution.
1091 Section 13. This act shall take effect July 1, 2026.