Florida SB 1760: Health Care Coverage

Bill Text

1760 
Health Care Coverage 
2026-03-04T07:33:42Z 
Establishing the Joint Legislative Committee on Medicaid Oversight for specified purposes; revising encounter data reporting requirements for prepaid Medicaid plans; requiring managed care plans to report to the agency and the Office of Insurance Regulation the existence of and specified details relating to certain affiliations by a specified date and annually thereafter; revising requirements for contracts between a pharmacy benefit manager and a participating pharmacy; revising and specifying additional practices pharmacy benefit managers are prohibited from engaging in, etc. 
Committee Substitute 2 
2026 
S 
GB 
General Bill 
c2 

 Florida Senate - 2026 CS for CS for SB 1760 

 By the Committees on Appropriations; and Health Policy; and 
 Senators Brodeur, Gaetz, Rouson, Massullo, Garcia, and Harrell 

 576-03338-26 20261760c2 
 1 A bill to be entitled 
 2 An act relating to health care coverage; amending s. 
 3 1.01, F.S.; defining the term “Joint Legislative 
 4 Committee on Medicaid Oversight”; creating s. 11.405, 
 5 F.S.; establishing the Joint Legislative Committee on 
 6 Medicaid Oversight for specified purposes; providing 
 7 for membership, subcommittees, and meetings of the 
 8 committee; specifying duties of the committee; 
 9 authorizing the committee to submit periodic reports 
 10 to the Legislature; requiring the Auditor General and 
 11 the Agency for Health Care Administration to enter 
 12 into and maintain a data sharing agreement for a 
 13 certain purpose by a specified date; requiring the 
 14 Auditor General to assist the committee by providing 
 15 certain staff or consulting services; requiring state 
 16 agencies, political subdivisions of the state, and 
 17 entities contracted with state agencies to give the 
 18 committee access to certain records, papers, and 
 19 documents; authorizing the committee to compel 
 20 testimony and evidence according to specified 
 21 provisions; providing for additional powers of the 
 22 committee; providing that certain joint rules of the 
 23 Legislature apply to the proceedings of the committee; 
 24 requiring the agency to notify the committee of 
 25 certain changes and provide a report containing 
 26 specified information to the committee; requiring the 
 27 agency to submit a copy of certain reports to the 
 28 committee; amending s. 409.962, F.S.; defining terms; 
 29 amending s. 409.967, F.S.; revising encounter data 
 30 reporting requirements for prepaid Medicaid plans; 
 31 requiring that the agency’s analysis of such encounter 
 32 data include identification of specified occurrences; 
 33 requiring the agency to use such analysis in setting 
 34 managed care plan capitation rates; requiring that 
 35 managed care plan contracts require any third-party 
 36 administrative entity contracted with the plan to 
 37 adhere to specified requirements; specifying 
 38 additional types of payments which may not be included 
 39 in calculating income for purposes of the achieved 
 40 savings rebate; requiring, rather than authorizing, 
 41 the agency to calculate the medical loss ratio for all 
 42 managed care plans under certain circumstances; 
 43 revising requirements for the calculation of medical 
 44 loss ratios; requiring the agency to report medical 
 45 loss ratios quarterly and annually for each managed 
 46 care plan to the Governor and the Legislature within a 
 47 specified timeframe; requiring the agency to ensure 
 48 oversight of affiliated entities and related parties 
 49 paid by managed care plans; requiring the agency to 
 50 examine specified records and data related to such 
 51 entities and parties; requiring the agency to consider 
 52 certain data and findings when developing managed care 
 53 plan capitation rates; revising the income sharing 
 54 ratios used to calculate the achieved savings rebate 
 55 beginning on a specified date; creating s. 409.9675, 
 56 F.S.; requiring managed care plans to report to the 
 57 agency and the Office of Insurance Regulation the 
 58 existence of and specified details relating to certain 
 59 affiliations by a specified date and annually 
 60 thereafter; requiring managed care plans to report any 
 61 change in such information to the agency and the 
 62 office in writing within a specified timeframe; 
 63 requiring the agency to calculate, analyze, and 
 64 publicly report on the agency’s website an assessment 
 65 of affiliated entity payment transactions in the 
 66 Medicaid program and certain administrative costs by a 
 67 specified date and annually thereafter; providing 
 68 requirements for the assessment; amending s. 626.8825, 
 69 F.S.; defining the term “affiliated manufacturer”; 
 70 revising the definition of the term “pharmacy benefits 
 71 plan or program”; revising requirements for contracts 
 72 between a pharmacy benefit manager and a participating 
 73 pharmacy; revising the frequency of and deadlines for