Florida HB 517: State Employees' Prescription Drug Program

Bill Text

CS/HB 517 2026

CODING: Words stricken are deletions; words underlined are additions.
hb517-01-c1
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A bill to be entitled 1
An act relating to Medicaid provider networks; 2
amending s. 409.967, F.S.; requiring the Agency for 3
Health Care Administration to establish network 4
adequacy standards for prepaid dental plans; providing 5
requirements for such standards; requiring Medicaid 6
managed care plan provider network databases to 7
identify whether providers are accepting new patients; 8
requiring prepaid dental plans to provide specified 9
information on the online provider database; providing 10
an effective date. 11
12
Be It Enacted by the Legislature of the State of Florida: 13
14
Section 1. Paragraph (c) of subsection (2) of section 15
409.967, Florida Statutes, is amended to read: 16
409.967 Managed care plan accountability.— 17
(2) The agency shall establish such contract requirements 18
as are necessary for the operation of the statewide managed care 19
program. In addition to any other provisions the agency may deem 20
necessary, the contract must require: 21
(c) Access.— 22
1. The agency shall establish specific standards for the 23
number, type, and regional distribution of providers in managed 24
care plan networks to ensure access to care for both adults and 25

CS/HB 517 2026

CODING: Words stricken are deletions; words underlined are additions.
hb517-01-c1
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children. 26
a. Each plan must maintain a regionwide network of 27
providers in sufficient numbers to meet the access standards for 28
specific medical services for all recipients enrolled in the 29
plan. The exclusive use of mail-order pharmacies may not be 30
sufficient to meet network access standards. Consistent with the 31
standards established by the agency, provider networks may 32
include providers located outside the region. The agency shall 33
establish a specific network adequacy standard, with time and 34
distance travel standards, for each provider type and specialty 35
service covered by prepaid dental plans, and shall establish a 36
standard for each level of sedation dentistry. The standards for 37
sedation dentistry shall ensure sufficient capacity to ensure 38
all enrollees who require sedation dentistry as medically 39
necessary may access at least two preventive or treatment 40
appointments per year. The time and distance travel standards 41
for sedation dentistry shall be no more than the standards for 42
general dentistry. 43
b. Each plan shall establish and maintain an accurate and 44
complete electronic database of contracted providers, including 45
information about licensure or registration, locations and hours 46
of operation, specialty credentials and other certifications, 47
specific performance indicators, whether the provider is 48
accepting additional Medicaid patients, and such other 49
information as the agency deems necessary. The database must be 50

CS/HB 517 2026

CODING: Words stricken are deletions; words underlined are additions.
hb517-01-c1
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available online to both the agency and the public and have the 51
capability to compare the availability of providers to network 52
adequacy standards and to accept and display feedback from each 53
provider's patients. For prepaid dental plans, the online 54
provider database must clearly identify sedation dentistry 55
providers, list specialty providers separately from general 56
dentists, and specifically identify the specialty services 57
offered by each provider. Each plan shall submit quarterly 58
reports to the agency identifying the number of enrollees 59
assigned to each primary care provider. 60
c. The agency shall conduct, or contract for, systematic 61
and continuous testing of the provider network databases 62
maintained by each plan to confirm accuracy, confirm that 63
behavioral health providers are accepting enrollees, and confirm 64
that enrollees have access to behavioral health services. 65
2. Each managed care plan must publish any prescribed drug 66
formulary or preferred drug list on the plan's website in a 67
manner that is accessible to and searchable by enrollees and 68
providers. The plan must update the list within 24 hours after 69
making a change. Each plan must ensure that the prior 70
authorization process for prescribed drugs is readily accessible 71
to health care providers, including posting appropriate contact 72
information on its website and providing timely responses to 73
providers. For Medicaid recipients diagnosed with hemophilia who 74
have been prescribed anti-hemophilic-factor replacement 75

CS/HB 517 2026

CODING: Words stricken are deletions; words underlined are additions.
hb517-01-c1
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products, the agency shall provide for those product