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.

Furthermore, the bill introduces several new requirements for managed care plans, including systematic testing of provider network databases to ensure accuracy and access to behavioral health services, as well as the publication of drug formularies on their websites. It also emphasizes the need for electronic acceptance of prior authorization requests and mandates that plans serving children in the custody of the Department of Children and Families maintain comprehensive health encounter information. The effective date for these changes is set for July 1, 2026.

Statutes affected:
S 40 Filed: 409.967