Bill > H0531

This bill modifies existing Florida Medicaid managed care regulations by introducing two key provisions. First, it prohibits Medicaid managed care plans from re-reviewing the medical necessity of claims for which they have already provided prior authorization, meaning that once a service, equipment, or supply is initially approved, the plan cannot subsequently challenge its medical necessity during pre- or post-payment review. 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 their medical equipment suppliers. The Agency for Health Care Administration is tasked with developing rules to implement this provider choice, including establishing a grievance process for enrollees who believe they were improperly denied the ability to choose their preferred in-network provider. The bill is set to take effect on July 1, 2026, giving health plans and the state agency time to prepare for these changes.

Health and Social Services

https://www.flsenate.gov/Session/Bill/2026/531