Bill > S1648

Introduced Session

An act relating to access to applied behavior analysis services; creating s. 409.9775, F.S.; defining terms; requiring the Agency for Health Care Administration to consider certain factors when evaluating network adequacy for applied behavior analysis services under the Medicaid program; requiring Medicaid managed care plans to take reasonable steps to support workforce retention and recruitment; requiring managed care plans to use a standardized, consolidated credentialing process; prohibiting managed care plans from requiring duplicative submission of identical documents to multiple portals or entities; requiring managed care plans to notify providers of credentialing deficiencies in a specified manner and timeframe; requiring that initial credentialing and activation be completed within a specified timeframe; prohibiting managed care plans from requiring a provider to undergo the full credentialing process to recredential under certain circumstances; prohibiting managed care plans from imposing a moratorium on applied behavior analysis services providers unless such providers can demonstrate specified criteria to the agency; if the agency approves a moratorium, requiring managed care plans to provide certain notice to providers and recipients and provide an exception process for underserved or rural areas; prohibiting the use of a moratorium to delay or deny continuity of care for existing recipients; requiring managed care plans to provide a specified continuity-of-care period for certain recipients; providing requirements for such period; requiring that coverage and utilization decisions for applied behavior analysis services be based on individualized medical necessity; prohibiting the use of age-based hour targets or incentive benchmarks for certain purposes; specifying requirements for authorization and utilization review decisions for applied behavior analysis services; requiring managed care plans to pay clean claims for applied behavior analysis services in accordance with prompt payment requirements; requiring managed care plans to provide an explanation of benefits in a specified manner for any denial or partial payment; prohibiting managed care plans from issuing recoupment or overpayment demands based solely on certain factors; requiring managed care plans to maintain stable electronic portals capable of certain functions; requiring that providers have access to a defined escalation pathway for issues of credentialing, utilization management, and claims resolution; requiring that notices sent by managed care plans be written in plain language and clearly describe certain information; requiring managed care plans to implement certain safeguards and maintain certain procedures and transmission methods; requiring the agency to amend managed care plan contracts as needed to enforce specified provisions; authorizing the agency to adopt rules; providing an effective date. WHEREAS, the Legislature finds that applied behavior analysis services are a medically necessary benefit for Medicaid recipients with autism spectrum disorder and other qualifying conditions, and WHEREAS, access to such services depends on adequate provider networks, timely credentialing, clinically appropriate utilization management, and prompt payment, and WHEREAS, administrative barriers, including roster freezes, duplicative credentialing requirements, inconsistent authorization practices, and payment delays, can result in gaps in care, regression, and harm to recipients and families, and WHEREAS, it is the intent of the Legislature to ensure continuity of care, workforce stability, administrative transparency, and individualized, clinically driven decisionmaking for applied behavior analysis services delivered under the Medicaid program, NOW, THEREFORE,

AI Summary

Ileana Garcia (R)*, 

Died in Health Policy (on 03/13/2026)

Official Document