Bill > S1760

Introduced Session

An act relating to health care coverage; amending s. 1.01, F.S.; defining the term “Joint Legislative Committee on Medicaid Oversight”; creating s. 11.405, F.S.; establishing the Joint Legislative Committee on Medicaid Oversight for specified purposes; providing for membership, subcommittees, and meetings of the committee; specifying duties of the committee; authorizing the committee to submit periodic reports to the Legislature; requiring the Auditor General and the Agency for Health Care Administration to enter into and maintain a data sharing agreement for a certain purpose by a specified date; requiring the Auditor General to assist the committee by providing certain staff or consulting services; requiring state agencies, political subdivisions of the state, and entities contracted with state agencies to give the committee access to certain records, papers, and documents; authorizing the committee to compel testimony and evidence according to specified provisions; providing for additional powers of the committee; providing that certain joint rules of the Legislature apply to the proceedings of the committee; requiring the agency to notify the committee of certain changes and provide a report containing specified information to the committee; requiring the agency to submit a copy of certain reports to the committee; amending s. 409.962, F.S.; defining terms; amending s. 409.967, F.S.; revising encounter data reporting requirements for prepaid Medicaid plans; requiring that the agency’s analysis of such encounter data include identification of specified occurrences; requiring the agency to use such analysis in setting managed care plan capitation rates; requiring that managed care plan contracts require any third-party administrative entity contracted with the plan to adhere to specified requirements; specifying additional types of payments which may not be included in calculating income for purposes of the achieved savings rebate; requiring, rather than authorizing, the agency to calculate the medical loss ratio for all managed care plans under certain circumstances; revising requirements for the calculation of medical loss ratios; requiring the agency to report medical loss ratios quarterly and annually for each managed care plan to the Governor and the Legislature within a specified timeframe; requiring the agency to ensure oversight of affiliated entities and related parties paid by managed care plans; requiring the agency to examine specified records and data related to such entities and parties; requiring the agency to consider certain data and findings when developing managed care plan capitation rates; revising the income sharing ratios used to calculate the achieved savings rebate beginning on a specified date; creating s. 409.9675, F.S.; requiring managed care plans to report to the agency and the Office of Insurance Regulation the existence of and specified details relating to certain affiliations by a specified date and annually thereafter; requiring managed care plans to report any change in such information to the agency and the office in writing within a specified timeframe; requiring the agency to calculate, analyze, and publicly report on the agency’s website an assessment of affiliated entity payment transactions in the Medicaid program and certain administrative costs by a specified date and annually thereafter; providing requirements for the assessment; amending s. 626.8825, F.S.; defining the term “affiliated manufacturer”; revising the definition of the term “pharmacy benefits plan or program”; revising requirements for contracts between a pharmacy benefit manager and a participating pharmacy; revising the frequency of and deadlines for certain reports pharmacy benefit managers are required to submit to the office beginning on a specified date; amending s. 626.8827, F.S.; revising and specifying additional practices pharmacy benefit managers are prohibited from engaging in; amending s. 627.42392, F.S.; conforming a cross-reference; providing effective dates.

AI Summary

Committee Categories

Jason Brodeur (R)*,  Alexis Calatayud (R),  Don Gaetz (R),  Ileana Garcia (R),  Gayle Harrell (R),  Ralph Massullo (R),  Darryl Rouson (D), 

Other Sponsors (2)

Laid on Table, refer to CS/HB 697 (on 03/10/2026)

Official Document