Florida SB 70: State Investments

Bill Text

70 
Step-therapy Protocols 
2025-09-23T11:07:51Z 
Requiring the Agency for Health Care Administration to approve drug products for Medicaid recipients for the treatment of serious mental illness without step-therapy prior authorization under certain circumstances; directing the agency to include rate impacts resulting from the act in certain rates that become effective on a specified date, etc. 
Original Filed Version 
2026 
S 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 70 

 By Senator Harrell 

 31-00305-26 202670__ 
 1 A bill to be entitled 
 2 An act relating to step-therapy protocols; amending s. 
 3 409.901, F.S.; defining the term “serious mental 
 4 illness”; amending s. 409.912, F.S.; requiring the 
 5 Agency for Health Care Administration to approve drug 
 6 products for Medicaid recipients for the treatment of 
 7 serious mental illness without step-therapy prior 
 8 authorization under certain circumstances; amending s. 
 9 409.910, F.S.; conforming a cross-reference; directing 
 10 the agency to include rate impacts resulting from the 
 11 act in certain rates that become effective on a 
 12 specified date; providing effective dates. 
 13 
 14 Be It Enacted by the Legislature of the State of Florida: 
 15 
 16 Section 1. Present subsections (27) and (28) of section 
 17 409.901, Florida Statutes, are redesignated as subsections (28) 
 18 and (29), respectively, and a new subsection (27) is added to 
 19 that section, to read: 
 20 409.901 Definitions; ss. 409.901-409.920.—As used in ss. 
 21 409.901-409.920, except as otherwise specifically provided, the 
 22 term: 
 23 (27) “Serious mental illness” means any of the following 
 24 psychiatric disorders as defined in the Diagnostic and 
 25 Statistical Manual of Mental Disorders, Fifth Edition, published 
 26 by the American Psychiatric Association: 
 27 (a) Bipolar disorders, including hypomanic, manic, 
 28 depressive, and mixed-feature episodes. 
 29 (b) Depression in childhood or adolescence. 
 30 (c) Major depressive disorders, including single and 
 31 recurrent depressive episodes. 
 32 (d) Obsessive-compulsive disorders. 
 33 (e) Paranoid personality disorder or other psychotic 
 34 disorders. 
 35 (f) Schizoaffective disorders, including bipolar or 
 36 depressive symptoms. 
 37 (g) Schizophrenia. 
 38 Section 2. Paragraph (a) of subsection (5) of section 
 39 409.912, Florida Statutes, is amended to read: 
 40 409.912 Cost-effective purchasing of health care.—The 
 41 agency shall purchase goods and services for Medicaid recipients 
 42 in the most cost-effective manner consistent with the delivery 
 43 of quality medical care. To ensure that medical services are 
 44 effectively utilized, the agency may, in any case, require a 
 45 confirmation or second physician’s opinion of the correct 
 46 diagnosis for purposes of authorizing future services under the 
 47 Medicaid program. This section does not restrict access to 
 48 emergency services or poststabilization care services as defined 
 49 in 42 C.F.R. s. 438.114. Such confirmation or second opinion 
 50 shall be rendered in a manner approved by the agency. The agency 
 51 shall maximize the use of prepaid per capita and prepaid 
 52 aggregate fixed-sum basis services when appropriate and other 
 53 alternative service delivery and reimbursement methodologies, 
 54 including competitive bidding pursuant to s. 287.057, designed 
 55 to facilitate the cost-effective purchase of a case-managed 
 56 continuum of care. The agency shall also require providers to 
 57 minimize the exposure of recipients to the need for acute 
 58 inpatient, custodial, and other institutional care and the 
 59 inappropriate or unnecessary use of high-cost services. The 
 60 agency shall contract with a vendor to monitor and evaluate the 
 61 clinical practice patterns of providers in order to identify 
 62 trends that are outside the normal practice patterns of a 
 63 provider’s professional peers or the national guidelines of a 
 64 provider’s professional association. The vendor must be able to 
 65 provide information and counseling to a provider whose practice 
 66 patterns are outside the norms, in consultation with the agency, 
 67 to improve patient care and reduce inappropriate utilization. 
 68 The agency may mandate prior authorization, drug therapy 
 69 management, or disease management participation for certain 
 70 populations of Medicaid beneficiaries, certain drug classes, or 
 71 particular drugs to prevent fraud, abuse, overuse, and possible 
 72 dangerous drug interactions. The Pharmaceutical and Therapeutics 
 73 Committee shall make recommendations to the agency on drugs for 
 74 which prior authorization is required. The agency shall inform 
 75 the Pharmaceutical and Therapeutics Committee of its decisions 
 76 regarding drugs subject to prior authorization. The agency is 
 77 authorized to limit the entities it contracts with or enrolls as 
 78 Medicaid providers by developing