The bill amends section 409.967 of the Florida Statutes to enhance the requirements for Medicaid managed care plans, specifically focusing on access to care for enrollees. It mandates that the Agency for Health Care Administration establish standards to ensure that enrollees have access to network providers during state holidays and outside of regular business hours, defined as Monday through Friday between 5 p.m. and 8 a.m. local time, as well as all day Saturday and Sunday. Additionally, at least 50 percent of primary care providers in a plan's network must offer appointment availability during these times. The bill also requires managed care plans to maintain an accurate electronic database of contracted providers and submit quarterly reports on enrollee assignments to primary care providers.

Further provisions include systematic testing of provider network databases to confirm accuracy and access to behavioral health services, as well as the requirement for managed care plans to publish their drug formularies online and ensure electronic acceptance of prior authorization requests. The bill also clarifies that managed care plans serving children in the custody of the Department of Children and Families must maintain comprehensive health encounter information and participate in sharing this data for coordinated case management. The effective date for this act is set for July 1, 2026.

Statutes affected:
S 40 Filed: 409.967