Florida SB 152: Public Records/Safe-school Officer at a Private School

Bill Text

152 
Medicaid Provider Networks 
2025-10-09T06:01:26Z 
Requiring Medicaid managed care plans and providers to negotiate mutually acceptable rates, methods, and terms of payment for purposes of Medicaid reimbursements; requiring plans to pay dentists at certain rates; specifying additional requirements for the provider network contracts under the statewide managed care program, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 152 

 By Senator Harrell 

 31-00500-26 2026152__ 
 1 A bill to be entitled 
 2 An act relating to Medicaid provider networks; 
 3 amending s. 409.908, F.S.; requiring Medicaid managed 
 4 care plans and providers to negotiate mutually 
 5 acceptable rates, methods, and terms of payment for 
 6 purposes of Medicaid reimbursements; requiring plans 
 7 to pay dentists at certain rates; amending s. 409.967, 
 8 F.S.; specifying additional requirements for the 
 9 provider network contracts under the statewide managed 
 10 care program; amending ss. 409.9071, 427.0135, and 
 11 1011.70, F.S.; conforming cross-references; reenacting 
 12 ss. 409.966(3)(c), 409.975(1), and 409.9855(4)(b), 
 13 F.S., relating to eligible managed care plans, managed 
 14 care plan accountability, and the pilot program for 
 15 individuals with developmental disabilities, 
 16 respectively, to incorporate the amendment made to s. 
 17 409.967, F.S., in references thereto; providing an 
 18 effective date. 
 19 
 20 Be It Enacted by the Legislature of the State of Florida: 
 21 
 22 Section 1. Present subsections (11) through (26) of section 
 23 409.908, Florida Statutes, are redesignated as subsections (12) 
 24 through (27), respectively, and a new subsection (11) is added 
 25 to that section, to read: 
 26 409.908 Reimbursement of Medicaid providers.—Subject to 
 27 specific appropriations, the agency shall reimburse Medicaid 
 28 providers, in accordance with state and federal law, according 
 29 to methodologies set forth in the rules of the agency and in 
 30 policy manuals and handbooks incorporated by reference therein. 
 31 These methodologies may include fee schedules, reimbursement 
 32 methods based on cost reporting, negotiated fees, competitive 
 33 bidding pursuant to s. 287.057, and other mechanisms the agency 
 34 considers efficient and effective for purchasing services or 
 35 goods on behalf of recipients. If a provider is reimbursed based 
 36 on cost reporting and submits a cost report late and that cost 
 37 report would have been used to set a lower reimbursement rate 
 38 for a rate semester, then the provider’s rate for that semester 
 39 shall be retroactively calculated using the new cost report, and 
 40 full payment at the recalculated rate shall be effected 
 41 retroactively. Medicare-granted extensions for filing cost 
 42 reports, if applicable, shall also apply to Medicaid cost 
 43 reports. Payment for Medicaid compensable services made on 
 44 behalf of Medicaid-eligible persons is subject to the 
 45 availability of moneys and any limitations or directions 
 46 provided for in the General Appropriations Act or chapter 216. 
 47 Further, nothing in this section shall be construed to prevent 
 48 or limit the agency from adjusting fees, reimbursement rates, 
 49 lengths of stay, number of visits, or number of services, or 
 50 making any other adjustments necessary to comply with the 
 51 availability of moneys and any limitations or directions 
 52 provided for in the General Appropriations Act, provided the 
 53 adjustment is consistent with legislative intent. 
 54 (11) Managed care plans and providers shall negotiate 
 55 mutually acceptable rates, methods, and terms of payment. Plans 
 56 shall pay dentists an amount equal to or higher than the dental 
 57 payment rates set by the agency. 
 58 Section 2. Paragraph (c) of subsection (2) of section 
 59 409.967, Florida Statutes, is amended to read: 
 60 409.967 Managed care plan accountability.— 
 61 (2) The agency shall establish such contract requirements 
 62 as are necessary for the operation of the statewide managed care 
 63 program. In addition to any other provisions the agency may deem 
 64 necessary, the contract must require: 
 65 (c) Access.— 
 66 1. The agency shall establish specific standards for the 
 67 number, type, and regional distribution of providers in managed 
 68 care plan networks to ensure access to care for both adults and 
 69 children. Each plan must maintain a regionwide network of 
 70 providers in sufficient numbers to meet the access standards for 
 71 specific medical services for all recipients enrolled in the 
 72 plan. The exclusive use of mail-order pharmacies may not be 
 73 sufficient to meet network access standards. Consistent with the 
 74 standards established by the agency, provider networks may 
 75 include providers located outside the region. Each plan shall 
 76 establish and maintain an accurate and complete el