Florida Senate - 2026                                     SB 568
       
       
        
       By Senator Harrell
       
       
       
       
       
       31-00890-26                                            2026568__
    1                        A bill to be entitled                      
    2         An act relating to managed care plans; amending s.
    3         409.967, F.S.; revising Medicaid managed care contract
    4         requirements to prohibit managed care plans from
    5         reviewing certain prior authorization claims for
    6         medical necessity; requiring that managed care plans
    7         provide coverage for durable medical equipment and
    8         complex rehabilitation technology from a qualified
    9         provider, from within the provider network, of the
   10         enrollee’s choosing; requiring the Agency for Health
   11         Care Administration to adopt certain rules; providing
   12         an effective date.
   13          
   14  Be It Enacted by the Legislature of the State of Florida:
   15  
   16         Section 1. Paragraphs (p) and (q) are added to subsection
   17  (2) of section 409.967, Florida Statutes, to read:
   18         409.967 Managed care plan accountability.—
   19         (2) The agency shall establish such contract requirements
   20  as are necessary for the operation of the statewide managed care
   21  program. In addition to any other provisions the agency may deem
   22  necessary, the contract must require:
   23         (p) Prior authorization reviews.—For any claims in which a
   24  Medicaid managed care plan has given prior authorization,
   25  prepayment or postpayment review may not include review for
   26  medical necessity for the previously approved equipment,
   27  supplies, or services.
   28         (q) Durable medical equipment.—Managed care plans, or their
   29  subcontractors, shall provide coverage for durable medical
   30  equipment or complex rehabilitation technology from any
   31  qualified durable medical equipment or complex rehabilitation
   32  technology provider within the provider network which the
   33  enrollee chooses. The agency shall adopt rules to implement this
   34  paragraph, including, but not limited to:
   35         1. Authorizing enrollees to choose the provider, within the
   36  provider network, from which they can receive eligible durable
   37  medical equipment or complex rehabilitation technology.
   38         2. Providing a procedure within the grievance resolution
   39  process adopted under paragraph (h) for enrollees to file a
   40  complaint if they believe they were not granted authority to
   41  choose their provider from within the provider network, as
   42  authorized under this paragraph.
   43         Section 2. This act shall take effect July 1, 2026.