Florida SB 40: Medicaid Providers

Bill Text

40 
Medicaid Providers 
2025-09-08T11:04:42Z 
Requiring the Agency for Health Care Administration to include specified requirements in its contracts with Medicaid managed care plans; defining the term “outside of regular business hours”, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 40 

 By Senator Sharief 

 35-00003-26 202640__ 
 1 A bill to be entitled 
 2 An act relating to Medicaid providers; amending s. 
 3 409.967, F.S.; requiring the Agency for Health Care 
 4 Administration to include specified requirements in 
 5 its contracts with Medicaid managed care plans; 
 6 defining the term “outside of regular business hours”; 
 7 providing an effective date. 
 8 
 9 Be It Enacted by the Legislature of the State of Florida: 
 10 
 11 Section 1. Paragraph (c) of subsection (2) of section 
 12 409.967, Florida Statutes, is amended to read: 
 13 409.967 Managed care plan accountability.— 
 14 (2) The agency shall establish such contract requirements 
 15 as are necessary for the operation of the statewide managed care 
 16 program. In addition to any other provisions the agency may deem 
 17 necessary, the contract must require: 
 18 (c) Access.— 
 19 1. The agency shall establish specific standards for the 
 20 number, type, and regional distribution of providers in managed 
 21 care plan networks to ensure access to care for both adults and 
 22 children. Each plan must maintain a regionwide network of 
 23 providers in sufficient numbers to meet the access standards for 
 24 specific medical services for all recipients enrolled in the 
 25 plan. The exclusive use of mail-order pharmacies may not be 
 26 sufficient to meet network access standards. Consistent with the 
 27 standards established by the agency, provider networks may 
 28 include providers located outside the region. 
 29 2. The agency shall establish specific standards to ensure 
 30 enrollees have access to network providers during state holidays 
 31 and outside of regular business hours. At least 50 percent of 
 32 primary care providers participating in a plan provider network 
 33 must offer appointment availability to Medicaid enrollees 
 34 outside of regular business hours. For the purposes of this 
 35 subparagraph, the term “outside of regular business hours” means 
 36 Monday through Friday between 5 p.m. and 8 a.m. local time and 
 37 all day Saturday and Sunday. 
 38 3. Each plan shall establish and maintain an accurate and 
 39 complete electronic database of contracted providers, including 
 40 information about licensure or registration, locations and hours 
 41 of operation, specialty credentials and other certifications, 
 42 specific performance indicators, and such other information as 
 43 the agency deems necessary. The database must be available 
 44 online to both the agency and the public and have the capability 
 45 to compare the availability of providers to network adequacy 
 46 standards and to accept and display feedback from each 
 47 provider’s patients. 
 48 4. Each plan shall submit quarterly reports to the agency 
 49 identifying the number of enrollees assigned to each primary 
 50 care provider. 
 51 5. The agency shall conduct, or contract for, systematic 
 52 and continuous testing of the provider network databases 
 53 maintained by each plan to confirm accuracy, confirm that 
 54 behavioral health providers are accepting enrollees, and confirm 
 55 that enrollees have access to behavioral health services. 
 56 6.2. Each managed care plan shall must publish any 
 57 prescribed drug formulary or preferred drug list on the plan’s 
 58 website in a manner that is accessible to and searchable by 
 59 enrollees and providers. The plan must update the list within 24 
 60 hours after making a change. Each plan must ensure that the 
 61 prior authorization process for prescribed drugs is readily 
 62 accessible to health care providers, including posting 
 63 appropriate contact information on its website and providing 
 64 timely responses to providers. For Medicaid recipients diagnosed 
 65 with hemophilia who have been prescribed anti-hemophilic-factor 
 66 replacement products, the agency shall provide for those 
 67 products and hemophilia overlay services through the agency’s 
 68 hemophilia disease management program. 
 69 7.3. Managed care plans, and their fiscal agents or 
 70 intermediaries, must accept prior authorization requests for any 
 71 service electronically. 
 72 8.4. Managed care plans serving children in the care and 
 73 custody of the Department of Children and Families must maintain 
 74 complete medical, dental, and behavioral health encounter 
 75 information and participate in making such information available 
 76 to the department or the applicable contracted community-based 
 77 care lead agency for use in providing comprehensive and 
 78 coordinated case management. The agency and the department shall 
 79 establish