This bill amends several sections of Florida Statutes concerning Medicaid pharmacy services, primarily transitioning from a managed care model to a fee-for-service delivery system starting July 1, 2025. The requirement for Medicaid managed care plans to cover prescription drug services is removed, and the Agency for Health Care Administration will directly reimburse Medicaid providers for pharmacy services. The agency will also establish reimbursement rates, dispensing fees, and supplemental rebates. Additionally, the bill mandates the agency to manage pharmacy services for all Medicaid recipients through this new system, which includes implementing a Medicaid prescribed-drug spending-control program and adopting necessary rules to ensure access to pharmacy services.

The bill further outlines provisions for nursing home and healthcare services, including establishing maximum square footage for beds, a minimum renovation cost, and a supplemental payment for ventilator days. It allows for direct care supplemental payments to providers serving a higher percentage of Medicaid patients and exempts certain facilities from the new pricing model. Changes to transportation services reimbursement are also included, allowing the agency to competitively procure services and implement eligibility processes. The bill introduces a Medicaid behavioral drug management system to improve prescribing practices and establishes prior authorization requirements for certain drugs, with the act set to take effect on July 1, 2025.

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