Florida Senate - 2026 CS for SB 1758
By the Committee on Health Policy; and Senators Gaetz and
Brodeur
588-02430-26 20261758c1
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 in a hospital facility setting for severe
94 mental illness; requiring the agency to contract with
95 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.
146
147 Be It Enacted by the Legislature of the State of Florida:
148
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 agency shall submit the plan to the
196 Governor, the President of the Senate, and the Speaker of the
197 House of Representatives no later than December 1, 2026.
198 (3)(a) Medicaid recipients between the ages of 19 and 64
199 years, inclusive, must meet the work or community engagement
200 requirements of this section, unless they are one of the
201 following:
202 1. Indian as defined under 42 C.F.R. s. 438.14(a).
203 2. A parent, guardian, caretaker relative, or family
204 caregiver of a dependent child younger than 14 years of age or
205 of a disabled individual. For purposes of this paragraph, the
206 term “family caregiver” means an adult family member or other
207 individual who has a significant relationship with, and who
208 provides a broad range of assistance to, an individual with a
209 chronic or other health condition, disability, or functional
210 limitation.
211 3. Former foster youth younger than 26 years of age.
212 4. A veteran with a total disability, as specified under 38
213 C.F.R. s. 3.340 or as specified by a Veteran Affairs Disability
214 Ratings Letter issued by the United States Department of
215 Veterans Affairs.
216 5. An individual classified as medically frail under the
217 Medicaid Institutionalized Care Program; categorized as aged,
218 blind, or disabled under the state Medicaid program; or who has
219 a developmental disability as defined in s. 393.063.
220 6. An individual living in a household that receives
221 Supplemental Nutrition Assistance Program benefits and who is
222 already in compliance with work requirements pursuant to s.
223 445.024.
224 7. An individual participating in a residential substance
225 use treatment program.
226 8. An inmate of a public institution.
227 9. A woman eligible for Medicaid coverage in a pregnancy
228 related or postpartum care category.
229 (b) A person may satisfy the work or community engagement
230 requirements of this section by participating in one or more of
231 the following activities for at least 80 hours per month:
232 1. Paid employment.
233 2. On-the-job-training.
234 3. Vocational educational training.
235 4. Job skills training directly related to employment.
236 5. Education directly related to employment.
237 6. Satisfactory attendance at a secondary school or in a
238 course of study leading to a high school equivalency diploma.
239 7. Enrollment at least half-time as defined in 34 C.F.R. s.
240 668.2(b) in a postsecondary education program to obtain a
241 credential on the Master Credentials List as maintained pursuant
242 to s. 445.004(6)(e).
243 8. Any other work activity designated as such by the
244 Department of Commerce and provided by a local workforce
245 development board pursuant to s. 445.024.
246 (c) Parents with children ages 14 through 18 are required
247 to engage in work or community engagement activities only during
248 standard school hours.
249 (4)(a) Notwithstanding any other statutory provision, in
250 order to maintain Medicaid coverage, an eligible Medicaid
251 recipient must, before enrollment and upon any redetermination
252 for coverage, demonstrate compliance with the work or community
253 engagement requirements of this section.
254 (b) The agency shall develop a process for ensuring
255 compliance with this section which aligns, to the extent
256 possible, with the processes currently in place relating to work
257 and community engagement requirements authorized under the
258 state’s Supplemental Nutrition Assistance Program, including,
259 but not limited to, participant registration with a local
260 CareerSource center, employment and training programs, and
261 collaboration with the state’s local workforce boards.
262 (c) The department shall verify, in accordance with its
263 procedures, that an individual subject to the work and community
264 engagement requirements of this section demonstrates compliance
265 during the individual’s regularly scheduled redetermination of
266 eligibility and at least every 6 months thereafter.
267 (5) The agency, in coordination with the department, shall
268 conduct outreach regarding the implementation of the work and
269 community engagement requirements of this section. The outreach
270 must include, at a minimum, notification to impacted
271 individuals, including timelines for implementation,
272 requirements for compliance, penalties for noncompliance, and
273 information on how to request an exemption.
274 (6) If a recipient subject to the work and community
275 engagement requirements of this section is determined to be in
276 noncompliance with such requirements, the agency, in
277 coordination with the department, must notify the recipient of
278 the finding of noncompliance and the impact to his or her
279 eligibility for continued receipt of Medicaid services. The
280 notice must include, at a minimum, notification of all of the
281 following:
282 (a) That the recipient is eligible for a grace period of 30
283 days to either come into compliance with the requirements or
284 request an exemption from the requirements and that Medicaid
285 coverage of services will continue during the grace period.
286 (b) That if, following the 30-day period, the individual
287 has not come into compliance with or requested an exemption from
288 the work and community engagement requirements, his or her
289 application for assistance will be denied and services
290 terminated at the end of the month following the month in which
291 such 30-calendar-day period ends.
292 (c) The right of the individual to request a fair hearing
293 if he or she is determined to be noncompliant with program
294 requirements and disenrolled from the state Medicaid program.
295 (d) The manner in which he or she can reapply for medical
296 assistance under the state Medicaid program.
297 Section 3. Paragraph (a) of subsection (5) of section
298 409.905, Florida Statutes, is amended, and paragraph (f) is
299 added to that subsection, to read:
300 409.905 Mandatory Medicaid services.—The agency may make
301 payments for the following services, which are required of the
302 state by Title XIX of the Social Security Act, furnished by
303 Medicaid providers to recipients who are determined to be
304 eligible on the dates on which the services were provided. Any
305 service under this section shall be provided only when medically
306 necessary and in accordance with state and federal law.
307 Mandatory services rendered by providers in mobile units to
308 Medicaid recipients may be restricted by the agency. Nothing in
309 this section shall be construed to prevent or limit the agency
310 from adjusting fees, reimbursement rates, lengths of stay,
311 number of visits, number of services, or any other adjustments
312 necessary to comply with the availability of moneys and any
313 limitations or directions provided for in the General
314 Appropriations Act or chapter 216.
315 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
316 all covered services provided for the medical care and treatment
317 of a recipient who is admitted as an inpatient by a licensed
318 physician or dentist to a hospital licensed under part I of
319 chapter 395. However, the agency shall limit the payment for
320 inpatient hospital services for a Medicaid recipient 21 years of
321 age or older to 45 days or the number of days necessary to
322 comply with the General Appropriations Act.
323 (a)1. The agency may implement reimbursement and
324 utilization management reforms in order to comply with any
325 limitations or directions in the General Appropriations Act,
326 which may include, but are not limited to: prior authorization
327 for inpatient psychiatric days; prior authorization for
328 nonemergency hospital inpatient admissions for individuals 21
329 years of age and older; authorization of emergency and urgent
330 care admissions within 24 hours after admission; enhanced
331 utilization and concurrent review programs for highly utilized
332 services; reduction or elimination of covered days of service;
333 adjusting reimbursement ceilings for variable costs; adjusting
334 reimbursement ceilings for fixed and property costs; and
335 implementing target rates of increase.
336 2. The agency may limit prior authorization for hospital
337 inpatient services to selected diagnosis-related groups, based
338 on an analysis of the cost and potential for unnecessary
339 hospitalizations represented by certain diagnoses. Admissions
340 for normal delivery and newborns are exempt from requirements
341 for prior authorization.
342 3. In implementing the provisions of this section related
343 to prior authorization, the agency shall ensure that the process
344 for authorization is accessible 24 hours per day, 7 days per
345 week and authorization is automatically granted when not denied
346 within 4 hours after the request. Authorization procedures must
347 include steps for review of denials.
348 4. Upon implementing the prior authorization program for
349 hospital inpatient services, the agency shall discontinue its
350 hospital retrospective review program. However, This paragraph
351 subparagraph may not be construed to prevent the agency from
352 conducting retrospective reviews under s. 409.913, including,
353 but not limited to, reviews of prior-authorized claims and
354 reviews in which an overpayment is suspected due to a mistake or
355 submission of an improper claim or for other reasons that do not
356 rise to the level of fraud or abuse.
357 (f) In its coverage of services under this subsection, the
358 agency shall maintain cost-effective purchasing practices as
359 required by s. 409.912.
360 Section 4. Present subsections (14) through (29) of section
361 409.906, Florida Statutes, are redesignated as subsections (15)
362 through (30), respectively, and a new subsection (14) is added
363 to that section, to read:
364 409.906 Optional Medicaid services.—Subject to specific
365 appropriations, the agency may make payments for services which
366 are optional to the state under Title XIX of the Social Security
367 Act and are furnished by Medicaid providers to recipients who
368 are determined to be eligible on the dates on which the services
369 were provided. Any optional service that is provided shall be
370 provided only when medically necessary and in accordance with
371 state and federal law. Optional services rendered by providers
372 in mobile units to Medicaid recipients may be restricted or
373 prohibited by the agency. Nothing in this section shall be
374 construed to prevent or limit the agency from adjusting fees,
375 reimbursement rates, lengths of stay, number of visits, or
376 number of services, or making any other adjustments necessary to
377 comply with the availability of moneys and any limitations or
378 directions provided for in the General Appropriations Act or
379 chapter 216. If necessary to safeguard the state’s systems of
380 providing services to elderly and disabled persons and subject
381 to the notice and review provisions of s. 216.177, the Governor
382 may direct the Agency for Health Care Administration to amend
383 the Medicaid state plan to delete the optional Medicaid service
384 known as “Intermediate Care Facilities for the Developmentally
385 Disabled.” Optional services may include:
386 (14) HOME- AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES.
387 The agency shall seek federal approval to implement a program
388 that covers an expanded array of home- and community-based
389 services for adults 18 years of age and older diagnosed with a
390 serious mental illness who are high utilizers of behavioral
391 health services in an institutional setting. The program must be
392 designed to reduce the need for institutional levels of care for
393 adults with a serious mental illness. The agency shall work in
394 coordination with the Department of Children and Families to
395 develop the program. The agency and the department shall produce
396 estimates of the program′s potential costs to the Medicaid
397 program and cost-savings for the department. Such estimates must
398 be submitted to the Legislature as legislative budget requests
399 and appropriated in the General Appropriations Act before the
400 program may be implemented.
401 Section 5. Section 409.91195, Florida Statutes, is amended
402 to read:
403 409.91195 Medicaid Pharmaceutical and Therapeutics
404 Committee.—There is created a Medicaid Pharmaceutical and
405 Therapeutics Committee within the agency for the purpose of
406 developing a Medicaid preferred drug list, a Medicaid preferred
407 physician-administered drug list, a Medicaid preferred product
408 list, and a high-cost drug list.
409 (1) The committee shall be composed of 11 members appointed
410 by the Governor. Four members shall be physicians, licensed
411 under chapter 458; one member licensed under chapter 459; five
412 members shall be pharmacists licensed under chapter 465; and one
413 member shall be a consumer representative. The members shall be
414 appointed to serve for terms of 2 years from the date of their
415 appointment. Members may be appointed to more than one term. The
416 agency shall serve as staff for the committee and assist them
417 with all ministerial duties. The Governor shall ensure that at
418 least some of the members of the committee represent Medicaid
419 participating physicians and pharmacies serving all segments and
420 diversity of the Medicaid population, and have experience in
421 either developing or practicing under a preferred drug list. At
422 least one of the members shall represent the interests of
423 pharmaceutical manufacturers.
424 (2) Committee members shall select a chairperson and a vice
425 chairperson each year from the committee membership.
426 (3) The committee shall meet at least quarterly and may
427 meet at other times at the discretion of the chairperson and
428 members. The committee shall comply with rules adopted by the
429 agency, including notice of any meeting of the committee
430 pursuant to the requirements of the Administrative Procedure
431 Act.
432 (4) Upon recommendation of the committee, the agency shall
433 adopt a preferred drug list, a preferred physician-administered
434 drug list, a preferred product list, and a high-cost drug list
435 as described in s. 409.912(5). To the extent feasible, the
436 committee shall review all drug or product classes included on
437 the preferred drug list, the preferred physician-administered
438 drug list, the preferred product list, and the high-cost drug
439 list every 6 12 months, and may recommend additions to and
440 deletions from the lists preferred drug list, such that the
441 lists provide preferred drug list provides for medically
442 appropriate drug and product therapies for Medicaid patients
443 which achieve cost savings contained in the General
444 Appropriations Act.
445 (5) Except for antiretroviral drugs, reimbursement of drugs
446 not included on the preferred drug list, preferred physician
447 administered drug list, preferred product list, or high-cost
448 drug list is subject to prior authorization.
449 (6) The agency shall publish and disseminate the preferred
450 drug list, preferred physician-administered drug list, preferred
451 product list, and high-cost drug list to all Medicaid providers
452 in the state by Internet posting on the agency’s website or in
453 other media.
454 (7) The committee shall ensure that interested parties,
455 including pharmaceutical manufacturers agreeing to provide a
456 supplemental rebate as outlined in this chapter, have an
457 opportunity to present public testimony to the committee with
458 information or evidence supporting inclusion of a drug or
459 product on the preferred drug list, preferred physician
460 administered drug list, preferred product list, or high-cost
461 drug list. Such public testimony must shall occur before prior
462 to any recommendations made by the committee for inclusion or
463 exclusion from the preferred drug list, preferred physician
464 administered drug list, preferred product list, or high-cost
465 drug list. Upon timely notice, the agency shall ensure that any
466 drug that has been approved or had any of its particular uses
467 approved by the United States Food and Drug Administration under
468 a priority review classification will be reviewed by the
469 committee at the next regularly scheduled meeting following 3
470 months of distribution of the drug to the general public.
471 (8) The committee shall develop its preferred drug list,
472 preferred physician-administered drug list, preferred product
473 list, and high-cost drug list recommendations by considering the
474 clinical efficacy, safety, and cost-effectiveness of a product.
475 (9) The Medicaid Pharmaceutical and Therapeutics Committee
476 may also make recommendations to the agency regarding the prior
477 authorization of any prescribed drug covered by Medicaid.
478 (10) Medicaid recipients may appeal agency preferred drug
479 formulary decisions using the Medicaid fair hearing process
480 administered by the Agency for Health Care Administration.
481 Section 6. Paragraph (a) of subsection (5) of section
482 409.912, Florida Statutes, is amended, and subsection (14) is
483 added to that section, to read:
484 409.912 Cost-effective purchasing of health care.—The
485 agency shall purchase goods and services for Medicaid recipients
486 in the most cost-effective manner consistent with the delivery
487 of quality medical care. To ensure that medical services are
488 effectively utilized, the agency may, in any case, require a
489 confirmation or second physician’s opinion of the correct
490 diagnosis for purposes of authorizing future services under the
491 Medicaid program. This section does not restrict access to
492 emergency services or poststabilization care services as defined
493 in 42 C.F.R. s. 438.114. Such confirmation or second opinion
494 shall be rendered in a manner approved by the agency. The agency
495 shall maximize the use of prepaid per capita and prepaid
496 aggregate fixed-sum basis services when appropriate and other
497 alternative service delivery and reimbursement methodologies,
498 including competitive bidding pursuant to s. 287.057, designed
499 to facilitate the cost-effective purchase of a case-managed
500 continuum of care. The agency shall also require providers to
501 minimize the exposure of recipients to the need for acute
502 inpatient, custodial, and other institutional care and the
503 inappropriate or unnecessary use of high-cost services. The
504 agency shall contract with a vendor to monitor and evaluate the
505 clinical practice patterns of providers in order to identify
506 trends that are outside the normal practice patterns of a
507 provider’s professional peers or the national guidelines of a
508 provider’s professional association. The vendor must be able to
509 provide information and counseling to a provider whose practice
510 patterns are outside the norms, in consultation with the agency,
511 to improve patient care and reduce inappropriate utilization.
512 The agency may mandate prior authorization, drug therapy
513 management, or disease management participation for certain
514 populations of Medicaid beneficiaries, certain drug classes, or
515 particular drugs to prevent fraud, abuse, overuse, and possible
516 dangerous drug interactions. The Pharmaceutical and Therapeutics
517 Committee shall make recommendations to the agency on drugs for
518 which prior authorization is required. The agency shall inform
519 the Pharmaceutical and Therapeutics Committee of its decisions
520 regarding drugs subject to prior authorization. The agency is
521 authorized to limit the entities it contracts with or enrolls as
522 Medicaid providers by developing a provider network through
523 provider credentialing. The agency may competitively bid single
524 source-provider contracts if procurement of goods or services
525 results in demonstrated cost savings to the state without
526 limiting access to care. The agency may limit its network based
527 on the assessment of beneficiary access to care, provider
528 availability, provider quality standards, time and distance
529 standards for access to care, the cultural competence of the
530 provider network, demographic characteristics of Medicaid
531 beneficiaries, practice and provider-to-beneficiary standards,
532 appointment wait times, beneficiary use of services, provider
533 turnover, provider profiling, provider licensure history,
534 previous program integrity investigations and findings, peer
535 review, provider Medicaid policy and billing compliance records,
536 clinical and medical record audits, and other factors. Providers
537 are not entitled to enrollment in the Medicaid provider network.
538 The agency shall determine instances in which allowing Medicaid
539 beneficiaries to purchase durable medical equipment and other
540 goods is less expensive to the Medicaid program than long-term
541 rental of the equipment or goods. The agency may establish rules
542 to facilitate purchases in lieu of long-term rentals in order to
543 protect against fraud and abuse in the Medicaid program as
544 defined in s. 409.913. The agency may seek federal waivers
545 necessary to administer these policies.
546 (5)(a) The agency shall implement a Medicaid prescribed
547 drug spending-control program that includes the following
548 components:
549 1. A Medicaid preferred drug list and a Medicaid physician
550 administered drug list. The preferred drug list, which shall be
551 a listing of cost-effective therapeutic options recommended by
552 the Medicaid Pharmacy and Therapeutics Committee established
553 pursuant to s. 409.91195 and adopted by the agency for each
554 therapeutic class on the preferred drug list. At the discretion
555 of the committee, and when feasible, the preferred drug list
556 should include at least two products in a therapeutic class. The
557 physician-administered drug list shall be a listing of
558 physician-administered drugs covered by the state Medicaid
559 program, based on the United States Food and Drug
560 Administration’s approved indications and compendia in 42 U.S.C.
561 s. 1396r-8(g)(1)(B). Within the preferred physician-administered
562 drug list, there must be a section containing a list of
563 preferred physician-administered drugs that are cost-effective
564 therapeutic options recommended by the Medicaid Pharmaceutical
565 and Therapeutics Committee established pursuant to s. 409.91195.
566 The physician-administered drug list must be updated at least
567 twice a year. The agency may post and update the preferred drug
568 list and the preferred physician-administered drug updates to
569 the list on the agency’s an Internet website without following
570 the rulemaking procedures of chapter 120. Antiretroviral agents
571 are excluded from the preferred drug list. The agency shall also
572 limit the amount of a prescribed drug dispensed to no more than
573 a 34-day supply unless the drug products’ smallest marketed
574 package is greater than a 34-day supply, or the drug is
575 determined by the agency to be a maintenance drug in which case
576 a 100-day maximum supply may be authorized. The agency may seek
577 any federal waivers necessary to implement these cost-control
578 programs and to continue participation in the federal Medicaid
579 rebate program, or alternatively to negotiate state-only
580 manufacturer rebates. The agency may adopt rules to administer
581 this subparagraph. The agency shall continue to provide
582 unlimited contraceptive drugs and items. The agency must
583 establish procedures to ensure that:
584 a. There is a response to a request for prior authorization
585 by telephone or other telecommunication device within 24 hours
586 after receipt of a request for prior authorization; and
587 b. A 72-hour supply of the drug prescribed is provided in
588 an emergency or when the agency does not provide a response
589 within 24 hours as required by sub-subparagraph a.
590 2. A Medicaid preferred product list, which shall be a
591 listing of cost-effective therapeutic supplies recommended by
592 the Medicaid Pharmaceutical and Therapeutics Committee
593 established pursuant to s. 409.91195 and adopted by the agency
594 for each product class listed on the preferred product list and
595 reimbursed by the state Medicaid program through the pharmacy
596 point-of-sale. The agency may post the preferred product list
597 and updates to the list on the agency’s website without
598 following the rulemaking procedures of chapter 120.
599 3. A list of high-cost drugs recommended by the Medicaid
600 Pharmaceutical and Therapeutics Committee established pursuant
601 to s. 409.91195 and adopted by the agency, for the purpose of
602 coverage, reimbursement, or billing guidance. The agency may
603 post the high-cost drug list and updates to the list on the
604 agency’s website without following the rulemaking procedures of
605 chapter 120. The agency must establish procedures to ensure
606 that:
607 a. There is a response to a request for prior authorization
608 for a high-cost drug by telephone or other telecommunication
609 device within 24 hours after receipt of the request for prior
610 authorization; and
611 b. A 72-hour supply of the high-cost drug prescribed is
612 provided in an emergency or when the agency does not provide a
613 response to a prior authorization request within 24 hours as
614 required by sub-subparagraph a.
615 4. A provider of prescribed drugs is reimbursed in an
616 amount not to exceed the lesser of the actual acquisition cost
617 based on the Centers for Medicare and Medicaid Services National
618 Average Drug Acquisition Cost pricing files plus a professional
619 dispensing fee, the wholesale acquisition cost plus a
620 professional dispensing fee, the state maximum allowable cost
621 plus a professional dispensing fee, or the usual and customary
622 charge billed by the provider.
623 5. A hospital facility administering long-acting
624 injectables for severe mental illness shall be reimbursed
625 separately from the diagnosis-related group. Long-acting
626 injectables administered for severe mental illness in a hospital
627 facility setting shall be reimbursed at no less than the actual
628 acquisition cost of the drug.
629 6. The agency shall contract with a vendor to perform a
630 detailed fiscal impact study to evaluate the 340B Drug Pricing
631 Program administered by the Health Resources and Services
632 Administration. The study must evaluate 340B compliance, 340B
633 drug purchases, and reimbursement methodologies within the fee
634 for-service program and Statewide Medicaid Managed Care program.
635 Statewide Medicaid Managed Care plans, pharmacy benefit
636 managers, and Medicaid providers shall submit to the agency all
637 data necessary for the completion of the study, including, but
638 not limited to, information related to drug purchasing,
639 reimbursement, billing and coding, and dispensing. Noncompliance
640 with the 340B data submission requirements of this subparagraph
641 may result in sanctions from the agency or the Board of
642 Pharmacy, as applicable. The agency shall submit the results of
643 the study to the Governor, the President of the Senate, and the
644 Speaker of the House of Representatives by June 30, 2027.
645 7.3. The agency shall develop and implement a process for
646 managing the drug therapies of Medicaid recipients who are using
647 significant numbers of prescribed drugs each month. The
648 management process may include, but is not limited to,
649 comprehensive, physician-directed medical-record reviews, claims
650 analyses, and case evaluations to determine the medical
651 necessity and appropriateness of a patient’s treatment plan and
652 drug therapies. The agency may contract with a private
653 organization to provide drug-program-management services. The
654 Medicaid drug benefit management program shall include
655 initiatives to manage drug therapies for HIV/AIDS patients,
656 patients using 20 or more unique prescriptions in a 180-day
657 period, and the top 1,000 patients in annual spending. The
658 agency shall enroll any Medicaid recipient in the drug benefit
659 management program if he or she meets the specifications of this
660 provision and is not enrolled in a Medicaid health maintenance
661 organization.
662 8.4. The agency may limit the size of its pharmacy network
663 based on need, competitive bidding, price negotiations,
664 credentialing, or similar criteria. The agency shall give
665 special consideration to rural areas in determining the size and
666 location of pharmacies included in the Medicaid pharmacy
667 network. A pharmacy credentialing process may include criteria
668 such as a pharmacy’s full-service status, location, size,
669 patient educational programs, patient consultation, disease
670 management services, and other characteristics. The agency may
671 impose a moratorium on Medicaid pharmacy enrollment if it is
672 determined that it has a sufficient number of Medicaid
673 participating providers. The agency must allow dispensing
674 practitioners to participate as a part of the Medicaid pharmacy
675 network regardless of the practitioner’s proximity to any other
676 entity that is dispensing prescription drugs under the Medicaid
677 program. A dispensing practitioner must meet all credentialing
678 requirements applicable to his or her practice, as determined by
679 the agency.
680 9.5. The agency shall develop and implement a program that
681 requires Medicaid practitioners who issue written prescriptions
682 for medicinal drugs to use a counterfeit-proof prescription pad
683 for Medicaid prescriptions. The agency shall require the use of
684 standardized counterfeit-proof prescription pads by prescribers
685 who issue written prescriptions for Medicaid recipients. The
686 agency may implement the program in targeted geographic areas or
687 statewide.
688 10.6. The agency may enter into arrangements that require
689 manufacturers of generic drugs prescribed to Medicaid recipients
690 to provide rebates of at least 15.1 percent of the average
691 manufacturer price for the manufacturer’s generic products.
692 These arrangements shall require that if a generic-drug
693 manufacturer pays federal rebates for Medicaid-reimbursed drugs
694 at a level below 15.1 percent, the manufacturer must provide a
695 supplemental rebate to the state in an amount necessary to
696 achieve a 15.1-percent rebate level.
697 11.7. The agency may establish a preferred drug list as
698 described in this subsection, and, pursuant to the establishment
699 of such preferred drug list, negotiate supplemental rebates from
700 manufacturers that are in addition to those required by Title
701 XIX of the Social Security Act and at no less than 14 percent of
702 the average manufacturer price as defined in 42 U.S.C. s. 1936
703 on the last day of a quarter unless the federal or supplemental
704 rebate, or both, equals or exceeds 29 percent. There is no upper
705 limit on the supplemental rebates the agency may negotiate. The
706 agency may determine that specific products, brand-name or
707 generic, are competitive at lower rebate percentages. Agreement
708 to pay the minimum supplemental rebate percentage guarantees a
709 manufacturer that the Medicaid Pharmaceutical and Therapeutics
710 Committee will consider a product for inclusion on the preferred
711 drug list. However, a pharmaceutical manufacturer is not
712 guaranteed placement on the preferred drug list by simply paying
713 the minimum supplemental rebate. Agency decisions will be made
714 on the clinical efficacy of a drug and recommendations of the
715 Medicaid Pharmaceutical and Therapeutics Committee, as well as
716 the price of competing products minus federal and state rebates.
717 The agency may contract with an outside agency or contractor to
718 conduct negotiations for supplemental rebates. For the purposes
719 of this section, the term “supplemental rebates” means cash
720 rebates. Value-added programs as a substitution for supplemental
721 rebates are prohibited. The agency may seek any federal waivers
722 to implement this initiative.
723 12.a.8.a. The agency may implement a Medicaid behavioral
724 drug management system. The agency may contract with a vendor
725 that has experience in operating behavioral drug management
726 systems to implement this program. The agency may seek federal
727 waivers to implement this program.
728 b. The agency, in conjunction with the Department of
729 Children and Families, may implement the Medicaid behavioral
730 drug management system that is designed to improve the quality
731 of care and behavioral health prescribing practices based on
732 best practice guidelines, improve patient adherence to
733 medication plans, reduce clinical risk, and lower prescribed
734 drug costs and the rate of inappropriate spending on Medicaid
735 behavioral drugs. The program may include the following
736 elements:
737 (I) Provide for the development and adoption of best
738 practice guidelines for behavioral health-related drugs such as
739 antipsychotics, antidepressants, and medications for treating
740 bipolar disorders and other behavioral conditions; translate
741 them into practice; review behavioral health prescribers and
742 compare their prescribing patterns to a number of indicators
743 that are based on national standards; and determine deviations
744 from best practice guidelines.
745 (II) Implement processes for providing feedback to and
746 educating prescribers using best practice educational materials
747 and peer-to-peer consultation.
748 (III) Assess Medicaid beneficiaries who are outliers in
749 their use of behavioral health drugs with regard to the numbers
750 and types of drugs taken, drug dosages, combination drug
751 therapies, and other indicators of improper use of behavioral
752 health drugs.
753 (IV) Alert prescribers to patients who fail to refill
754 prescriptions in a timely fashion, are prescribed multiple same
755 class behavioral health drugs, and may have other potential
756 medication problems.
757 (V) Track spending trends for behavioral health drugs and
758 deviation from best practice guidelines.
759 (VI) Use educational and technological approaches to
760 promote best practices, educate consumers, and train prescribers
761 in the use of practice guidelines.
762 (VII) Disseminate electronic and published materials.
763 (VIII) Hold statewide and regional conferences.
764 (IX) Implement a disease management program with a model
765 quality-based medication component for severely mentally ill
766 individuals and emotionally disturbed children who are high
767 users of care.
768 13.9. The agency shall implement a Medicaid prescription
769 drug management system.
770 a. The agency may contract with a vendor that has
771 experience in operating prescription drug management systems in
772 order to implement this system. Any management system that is
773 implemented in accordance with this subparagraph must rely on
774 cooperation between physicians and pharmacists to determine
775 appropriate practice patterns and clinical guidelines to improve
776 the prescribing, dispensing, and use of drugs in the Medicaid
777 program. The agency may seek federal waivers to implement this
778 program.
779 b. The drug management system must be designed to improve
780 the quality of care and prescribing practices based on best
781 practice guidelines, improve patient adherence to medication
782 plans, reduce clinical risk, and lower prescribed drug costs and
783 the rate of inappropriate spending on Medicaid prescription
784 drugs. The program must:
785 (I) Provide for the adoption of best practice guidelines
786 for the prescribing and use of drugs in the Medicaid program,
787 including translating best practice guidelines into practice;
788 reviewing prescriber patterns and comparing them to indicators
789 that are based on national standards and practice patterns of
790 clinical peers in their community, statewide, and nationally;
791 and determine deviations from best practice guidelines.
792 (II) Implement processes for providing feedback to and
793 educating prescribers using best practice educational materials
794 and peer-to-peer consultation.
795 (III) Assess Medicaid recipients who are outliers in their
796 use of a single or multiple prescription drugs with regard to
797 the numbers and types of drugs taken, drug dosages, combination
798 drug therapies, and other indicators of improper use of
799 prescription drugs.
800 (IV) Alert prescribers to recipients who fail to refill
801 prescriptions in a timely fashion, are prescribed multiple drugs
802 that may be redundant or contraindicated, or may have other
803 potential medication problems.
804 14.10. The agency may contract for drug rebate
805 administration, including, but not limited to, calculating
806 rebate amounts, invoicing manufacturers, negotiating disputes
807 with manufacturers, and maintaining a database of rebate
808 collections.
809 15.11. The agency may specify the preferred daily dosing
810 form or strength for the purpose of promoting best practices
811 with regard to the prescribing of certain drugs as specified in
812 the General Appropriations Act and ensuring cost-effective
813 prescribing practices.
814 16.12. The agency may require prior authorization for
815 Medicaid-covered prescribed drugs. The agency may prior
816 authorize the use of a product:
817 a. For an indication not approved in labeling;
818 b. To comply with certain clinical guidelines; or
819 c. If the product has the potential for overuse, misuse, or
820 abuse.
821
822 The agency may require the prescribing professional to provide
823 information about the rationale and supporting medical evidence
824 for the use of a drug. The agency shall post prior
825 authorization, step-edit criteria and protocol, and updates to
826 the list of drugs that are subject to prior authorization on the
827 agency’s Internet website within 21 days after the prior
828 authorization and step-edit criteria and protocol and updates
829 are approved by the agency. For purposes of this subparagraph,
830 the term “step-edit” means an automatic electronic review of
831 certain medications subject to prior authorization.
832 17.13. The agency, in conjunction with the Pharmaceutical
833 and Therapeutics Committee, may require age-related prior
834 authorizations for certain prescribed drugs. The agency may
835 preauthorize the use of a drug for a recipient who may not meet
836 the age requirement or may exceed the length of therapy for use
837 of this product as recommended by the manufacturer and approved
838 by the Food and Drug Administration. Prior authorization may
839 require the prescribing professional to provide information
840 about the rationale and supporting medical evidence for the use
841 of a drug.
842 18.14. The agency shall implement a step-therapy prior
843 authorization approval process for medications excluded from the
844 preferred drug list. Medications listed on the preferred drug
845 list must be used within the previous 12 months before the
846 alternative medications that are not listed. The step-therapy
847 prior authorization may require the prescriber to use the
848 medications of a similar drug class or for a similar medical
849 indication unless contraindicated in the Food and Drug
850 Administration labeling. The trial period between the specified
851 steps may vary according to the medical indication. The step
852 therapy approval process shall be developed in accordance with
853 the committee as stated in s. 409.91195(7) and (8). A drug
854 product may be approved without meeting the step-therapy prior
855 authorization criteria if the prescribing physician provides the
856 agency with additional written medical or clinical documentation
857 that the product is medically necessary because:
858 a. There is not a drug on the preferred drug list to treat
859 the disease or medical condition which is an acceptable clinical
860 alternative;
861 b. The alternatives have been ineffective in the treatment
862 of the beneficiary’s disease;
863 c. The drug product or medication of a similar drug class
864 is prescribed for the treatment of schizophrenia or schizotypal
865 or delusional disorders; prior authorization has been granted
866 previously for the prescribed drug; and the medication was
867 dispensed to the patient during the previous 12 months; or
868 d. Based on historical evidence and known characteristics
869 of the patient and the drug, the drug is likely to be
870 ineffective, or the number of doses have been ineffective.
871
872 The agency shall work with the physician to determine the best
873 alternative for the patient. The agency may adopt rules waiving
874 the requirements for written clinical documentation for specific
875 drugs in limited clinical situations.
876 19.15. The agency shall implement a return and reuse
877 program for drugs dispensed by pharmacies to institutional
878 recipients, which includes payment of a $5 restocking fee for
879 the implementation and operation of the program. The return and
880 reuse program shall be implemented electronically and in a
881 manner that promotes efficiency. The program must permit a
882 pharmacy to exclude drugs from the program if it is not
883 practical or cost-effective for the drug to be included and must
884 provide for the return to inventory of drugs that cannot be
885 credited or returned in a cost-effective manner. The agency
886 shall determine if the program has reduced the amount of
887 Medicaid prescription drugs which are destroyed on an annual
888 basis and if there are additional ways to ensure more
889 prescription drugs are not destroyed which could safely be
890 reused.
891 (14) Neither this section nor this chapter prevents the
892 agency from conducting retrospective reviews, investigations,
893 analyses, audits, or any combination thereof to determine
894 possible fraud, abuse, overpayment, or recipient neglect in the
895 state Medicaid program pursuant to s. 409.913, including, but
896 not limited to, reviews in which the services were the subject
897 of a utilization review or prior authorization process.
898 Section 7. Paragraph (e) of subsection (1) and subsections
899 (2) and (6) of section 409.913, Florida Statutes, are amended to
900 read:
901 409.913 Oversight of the integrity of the Medicaid
902 program.—The agency shall operate a program to oversee the
903 activities of Florida Medicaid recipients, and providers and
904 their representatives, to ensure that fraudulent and abusive
905 behavior and neglect of recipients occur to the minimum extent
906 possible, and to recover overpayments and impose sanctions as
907 appropriate. Each January 15, the agency and the Medicaid Fraud
908 Control Unit of the Department of Legal Affairs shall submit a
909 report to the Legislature documenting the effectiveness of the
910 state’s efforts to control Medicaid fraud and abuse and to
911 recover Medicaid overpayments during the previous fiscal year.
912 The report must describe the number of cases opened and
913 investigated each year; the sources of the cases opened; the
914 disposition of the cases closed each year; the amount of
915 overpayments alleged in preliminary and final audit letters; the
916 number and amount of fines or penalties imposed; any reductions
917 in overpayment amounts negotiated in settlement agreements or by
918 other means; the amount of final agency determinations of
919 overpayments; the amount deducted from federal claiming as a
920 result of overpayments; the amount of overpayments recovered
921 each year; the amount of cost of investigation recovered each
922 year; the average length of time to collect from the time the
923 case was opened until the overpayment is paid in full; the
924 amount determined as uncollectible and the portion of the
925 uncollectible amount subsequently reclaimed from the Federal
926 Government; the number of providers, by type, that are
927 terminated from participation in the Medicaid program as a
928 result of fraud and abuse; and all costs associated with
929 discovering and prosecuting cases of Medicaid overpayments and
930 making recoveries in such cases. The report must also document
931 actions taken to prevent overpayments and the number of
932 providers prevented from enrolling in or reenrolling in the
933 Medicaid program as a result of documented Medicaid fraud and
934 abuse and must include policy recommendations necessary to
935 prevent or recover overpayments and changes necessary to prevent
936 and detect Medicaid fraud. All policy recommendations in the
937 report must include a detailed fiscal analysis, including, but
938 not limited to, implementation costs, estimated savings to the
939 Medicaid program, and the return on investment. The agency must
940 submit the policy recommendations and fiscal analyses in the
941 report to the appropriate estimating conference, pursuant to s.
942 216.137, by February 15 of each year. The agency and the
943 Medicaid Fraud Control Unit of the Department of Legal Affairs
944 each must include detailed unit-specific performance standards,
945 benchmarks, and metrics in the report, including projected cost
946 savings to the state Medicaid program during the following
947 fiscal year.
948 (1) For the purposes of this section, the term:
949 (e) “Overpayment” includes any amount that is not
950 authorized to be paid by the Medicaid program or that should not
951 have been paid, including payments made whether paid as a result
952 of inaccurate or improper cost reporting, improper claiming,
953 unacceptable practices, fraud, abuse, or mistake, and may
954 include amounts paid for goods or services that were the subject
955 of a utilization review or prior authorization process.
956 (2) The agency shall conduct, or cause to be conducted by
957 contract or otherwise, reviews, investigations, analyses,
958 audits, or any combination thereof, to determine possible fraud,
959 abuse, overpayment, or recipient neglect in the Medicaid program
960 and shall report the findings of any overpayments in audit
961 reports as appropriate. An overpayment determination may be
962 based upon retrospective reviews, investigations, analyses,
963 audits, or any combination thereof to determine possible fraud,
964 abuse, overpayment, or recipient neglect in the Medicaid
965 program, regardless of whether a prior authorization was issued.
966 At least 5 percent of all audits shall be conducted on a random
967 basis. As part of its ongoing fraud detection activities, the
968 agency shall identify and monitor, by contract or otherwise,
969 patterns of overutilization of Medicaid services based on state
970 averages. The agency shall track Medicaid provider prescription
971 and billing patterns and evaluate them against Medicaid medical
972 necessity criteria and coverage and limitation guidelines
973 adopted by rule. Medical necessity determination requires that
974 service be consistent with symptoms or confirmed diagnosis of
975 illness or injury under treatment and not in excess of the
976 patient’s needs. The agency shall conduct reviews of provider
977 exceptions to peer group norms and shall, using statistical
978 methodologies, provider profiling, and analysis of billing
979 patterns, detect and investigate abnormal or unusual increases
980 in billing or payment of claims for Medicaid services and
981 medically unnecessary provision of services.
982 (6) Any notice required to be given to a provider under
983 this section is presumed to be sufficient notice if sent to the
984 mailing address last shown on the provider enrollment file. It
985 is the responsibility of the provider to furnish and keep the
986 agency informed of the provider’s current mailing and service
987 addresses address. United States Postal Service or other common
988 carrier’s proof of mailing or certified or registered mailing of
989 such notice to the provider at the address shown on the provider
990 enrollment file constitutes sufficient proof of notice. Any
991 notice required to be given to the agency by this section must
992 be sent to the agency at an address designated by rule.
993 Section 8. Section 414.321, Florida Statutes, is created to
994 read:
995 414.321 Food assistance eligibility.—For purposes of
996 eligibility determinations, the department shall:
997 (1) Limit eligibility to individuals who are residents of
998 the United States and:
999 (a) Citizens or nationals of the United States;
1000 (b) Aliens lawfully admitted for permanent residence as
1001 defined in the Immigration and Nationality Act, as amended;
1002 (c) Aliens who have been granted the status of Cuban and
1003 Haitian entrant, as defined in the Refugee Education Assistance
1004 Act of 1980, as amended; or
1005 (d) Individuals who lawfully reside in the United States in
1006 accordance with the Compacts of Free Association referred to in
1007 the Personal Responsibility and Work Opportunity Reconciliation
1008 Act of 1996.
1009 (2) Require each applicant, or recipient for
1010 redetermination purposes, to provide documentation evidencing
1011 his or her shelter or utility expenses.
1012 (a) The department is prohibited from relying solely on an
1013 individual’s self-attestation in determining shelter or utility
1014 expenses.
1015 (b) The department may adopt policies and procedures to
1016 accommodate an applicant or a recipient who, due to recent
1017 residency changes, is temporarily unable to furnish adequate
1018 documentation of shelter or utility expenses.
1019 Section 9. Section 414.332, Florida Statutes, is created to
1020 read:
1021 414.332 Food assistance payment accuracy plan.—
1022 (1) The department shall develop and implement a
1023 comprehensive food assistance payment accuracy improvement plan
1024 to reduce the state’s payment error rate. The department must
1025 reduce the payment error rate to below 6 percent. The plan must
1026 address the root causes of payment errors identified through an
1027 in-depth, data-driven analysis. The plan must include, but need
1028 not be limited to, all of the following:
1029 (a) Enhanced employee training and quality assurance.
1030 1. The department shall administer standardized training
1031 for all economic self-sufficiency program staff at least
1032 annually. Training must, at a minimum, review the most common
1033 reasons for payment errors and methods for preventing such
1034 errors, and include pre- and post-training testing to measure
1035 staff proficiency.
1036 2. The department shall establish a robust quality
1037 assurance review process that frequently reviews a statistically
1038 significant sample of cases before final benefit determination.
1039 This process must incorporate real-time, corrective feedback and
1040 on-the-job training for program staff and may not delay benefit
1041 determinations.
1042 (b) Improvement in data sourcing. In contracting with
1043 entities providing data for verification of applicant and
1044 recipient information, the department shall maximize use of high
1045 quality automated data sources, including, but not limited to,
1046 comparing income and asset data with state, federal, and private
1047 sector data sources.
1048 (2) By July 15, 2026, the department shall submit the food
1049 assistance payment accuracy improvement plan to the Governor,
1050 the President of the Senate, and the Speaker of the House of
1051 Representatives.
1052 (3)(a) Beginning October 1, 2026, the department shall
1053 submit quarterly progress reports to the Governor, the President
1054 of the Senate, and the Speaker of the House of Representatives
1055 detailing:
1056 1. The state’s most recent official and preliminary food
1057 assistance payment error rate.
1058 2. A detailed breakdown of the most frequent and highest
1059 dollar value errors, including categorization by agency or
1060 client error and whether the error resulted in over- or under
1061 payment.
1062 3. Specific actions taken by the department under the food
1063 assistance payment accuracy improvement plan during the
1064 preceding quarter and data demonstrating the results of those
1065 actions.
1066 4. A detailed plan to correct the most recently identified
1067 deficiencies.
1068 (b) This subsection is repealed on October 1, 2028.
1069 Section 10. Present subsections (6) through (11) of section
1070 414.39, Florida Statutes, are redesignated as subsections (7)
1071 through (12), respectively, and a new subsection (6) is added to
1072 that section, to read:
1073 414.39 Fraud.—
1074 (6) The department shall require the use of photographic
1075 identification on the front of each newly issued and reissued
1076 electronic benefits transfer (EBT) card for each cardholder to
1077 the maximum extent allowed by federal laws and regulations.
1078 Section 11. Subsection (2) of section 414.455, Florida
1079 Statutes, is amended to read:
1080 414.455 Supplemental Nutrition Assistance Program;
1081 legislative authorization; mandatory participation in employment
1082 and training programs.—
1083 (2) Unless prohibited by the Federal Government, the
1084 department must require a person who is receiving food
1085 assistance; who is 18 to 64 59 years of age, inclusive; who does
1086 not have children under the age of 14 18 in his or her home; who
1087 does not qualify for an exemption; and who is determined by the
1088 department to be eligible, to participate in an employment and
1089 training program. The department shall apply and comply with
1090 exemptions from work requirements in accordance with applicable
1091 federal law.
1092 Section 12. Subsection (1) of section 409.91196, Florida
1093 Statutes, is amended to read:
1094 409.91196 Supplemental rebate agreements; public records
1095 and public meetings exemption.—
1096 (1) The rebate amount, percent of rebate, manufacturer’s
1097 pricing, and supplemental rebate, and other trade secrets as
1098 defined in s. 688.002 that the agency has identified for use in
1099 negotiations, held by the Agency for Health Care Administration
1100 under s. 409.912(5)(a)11. s. 409.912(5)(a)7. are confidential
1101 and exempt from s. 119.07(1) and s. 24(a), Art. I of the State
1102 Constitution.
1103 Section 13. This act shall take effect July 1, 2026.