Bill > S0568

This bill modifies Florida's Medicaid managed care regulations by introducing two key provisions: First, it prohibits Medicaid managed care plans from conducting additional medical necessity reviews for claims that have already received prior authorization, meaning once a service, equipment, or supply is pre-approved, the plan cannot later challenge its medical necessity during payment processes. Second, the bill requires managed care plans to allow Medicaid enrollees to choose their durable medical equipment (DME) or complex rehabilitation technology provider from within the plan's network, ensuring patients have more flexibility in selecting providers. The Agency for Health Care Administration must develop rules to implement these changes, including creating a grievance process for enrollees who believe they were improperly denied their provider choice. The new regulations will take effect on July 1, 2026, providing managed care plans and the agency time to adjust their processes and implement the required changes. These modifications aim to enhance patient autonomy and streamline medical equipment procurement for Medicaid recipients.

https://www.flsenate.gov/Session/Bill/2026/568