This bill amends Florida Statutes concerning Medicaid pharmacy services by eliminating the requirement for Medicaid managed care plans to cover prescription drug services, as indicated by the deletion of relevant language in section 409.973. Starting July 1, 2025, the Agency for Health Care Administration will directly reimburse Medicaid providers for pharmacy services through a fee-for-service system, regardless of prior enrollment in a managed care plan. The agency will also establish reimbursement rates, dispensing fees, and supplemental rebates, as outlined in the new insertions in section 409.908. Additionally, the agency will manage pharmacy services for all Medicaid recipients, including a Medicaid prescribed-drug spending-control program, as specified in the amendments to section 409.912.

The bill also introduces various provisions related to Medicaid reimbursement for nursing home and healthcare services, including a maximum square footage for nursing home beds and a ventilator supplemental payment. It mandates annual reporting of direct and indirect care costs and rebasing of nursing home payment rates every four years. Furthermore, the bill outlines changes to transportation services reimbursement and establishes a Medicaid behavioral drug management system and a prescription drug management system to improve care quality. It includes a step-therapy prior authorization process for certain medications and a return and reuse program for drugs dispensed to institutional recipients. The overall aim of the bill is to enhance the efficiency and effectiveness of Medicaid service delivery while ensuring compliance with federal regulations, with an effective date of July 1, 2025.

Statutes affected:
S 1628 Filed: 409.973, 409.908, 409.912