Bill > S1758

Introduced Session

An act relating to public assistance; amending s. 409.904, F.S.; authorizing the Agency for Health Care Administration to conduct retrospective reviews and audits of certain claims under the state Medicaid program for a specified purpose; creating s. 409.9041, F.S.; providing legislative findings; requiring the agency to seek federal approval to implement mandatory work and community engagement requirements for able bodied adults as a condition of obtaining and maintaining Medicaid coverage; prohibiting the agency from implementing such requirements until certain conditions are met; requiring the agency, in consultation with the Department of Children and Families, to develop a business plan to implement specified provisions; specifying requirements for the plan; requiring the agency to submit the plan to the Governor and the Legislature by a specified date; specifying populations that are subject to such work and community engagement requirements; providing exceptions; defining the term “family caregiver”; specifying the types of activities which may satisfy the work and community engagement requirements; providing that a certain population is required to engage in work or community engagement activities only during standard school hours; requiring persons eligible for Medicaid to demonstrate compliance with the work and community engagement requirements at specified times as a condition of maintaining Medicaid coverage; requiring the agency to develop a process for ensuring compliance with the work and community engagement requirements; requiring that such process align, to the extent possible, with certain existing processes; requiring the department to verify compliance with the work and community engagement requirements at specified intervals; requiring the agency, in coordination with the department, to conduct outreach regarding implementation of the work and community engagement requirements; specifying requirements for such outreach; specifying procedures in the event of noncompliance; requiring the agency, in coordination with the department, to notify a Medicaid recipient of a finding of noncompliance and the impact to eligibility for continued receipt of services; specifying requirements for such notice; amending s. 409.905, F.S.; deleting a requirement that the agency discontinue its hospital retrospective review program under certain circumstances; revising construction; requiring the agency to maintain cost effective purchasing practices in its coverage of hospital inpatient services rendered to Medicaid recipients; amending s. 409.906, F.S.; requiring the agency to seek federal approval to implement a program for expanded coverage of home- and community-based behavioral health services for a specified population; specifying the goal of the program; requiring the agency to work in coordination with the department to develop the program; requiring the agency and the department to develop certain estimates and submit them to the Legislature in a specified manner before the program may be implemented; amending s. 409.91195, F.S.; revising the purpose of the Medicaid Pharmaceutical and Therapeutics Committee to include creation of a Medicaid preferred physician administered drug list, a Medicaid preferred product list, and a high-cost drug list; requiring the agency to adopt such lists upon recommendation of the committee; specifying the frequency with which the committee must review such lists for any recommended additions or deletions; specifying parameters for such recommended additions and deletions; providing that reimbursement for drugs not included on such lists is subject to prior authorization, with an exception; requiring the agency to publish and disseminate such lists to all Medicaid providers in the state by posting on the agency’s website or in other media; providing requirements for public testimony related to proposed inclusions on or exclusions from certain lists; requiring the committee to consider certain factors when developing such recommended additions and deletions; amending s. 409.912, F.S.; revising the components of the Medicaid prescribed-drug spending control program to include the preferred physician administered drug list, the preferred product list, and the high-cost drug list; providing requirements for such lists; providing that the agency does not need to follow rulemaking procedures of ch. 120, F.S., when posting updates to such lists; requiring the agency to establish certain procedures relating to prior authorization requests for drugs on the high cost drug list; establishing an alternative reimbursement methodology for long-acting injectables administered for severe mental illness in a hospital facility setting; requiring the agency to contract with a vendor to perform a fiscal impact study of the federal 340B Drug Pricing Program; providing requirements for the study; requiring specified entities to submit certain data to the agency for purposes of the study; providing that noncompliance with such requirement may result in sanctions from the agency or the Board of Pharmacy, as applicable; requiring the agency to submit the results of the study to the Governor and the Legislature by a specified date; providing construction; amending s. 409.913, F.S.; revising the definition of the term “overpayment”; providing that determinations of an overpayment under the Medicaid program may be based upon retrospective reviews, investigations, analyses, or audits conducted by the agency to determine possible fraud, abuse, overpayment, or recipient neglect; providing that certain notices may be provided using other common carriers, as well as through the United States Postal Service; creating s. 414.321, F.S.; requiring the department to limit eligibility for food assistance to individuals meeting specified criteria; requiring that food assistance recipients provide certain documentation for purposes of eligibility redeterminations; prohibiting the department from relying solely on an individual’s self-attestations to determine certain expenses; authorizing the department to adopt policies and procedures to accommodate certain applicants and recipients; creating s. 414.332, F.S.; requiring the department to develop and implement a food assistance payment accuracy improvement plan for a specified purpose; requiring the department to reduce the payment error rate to below a specified percentage; providing requirements for the plan; requiring the department to submit the plan to the Governor and the Legislature by a specified date; requiring the department, by a specified date, to submit quarterly progress reports of specified information to the Governor and the Legislature; providing for future repeal; amending s. 414.39, F.S.; requiring the department to require photographic identification on the front of electronic benefits transfer (EBT) cards, to the extent allowable under federal law; amending s. 414.455, F.S.; revising criteria for individuals required to participate in an employment and training program to receive food assistance from the Supplemental Nutrition Assistance Program; requiring the department to apply and comply with certain work requirements in accordance with federal law for food assistance; amending s. 409.91196, F.S.; conforming a cross-reference; providing an effective date.

AI Summary

Committee Categories

Don Gaetz (R)*,  Jason Brodeur (R),  Ralph Massullo (R), 

Other Sponsors (2)

In Messages (on 03/09/2026)

Official Document