The bill amends section 409.967 of the Florida Statutes to enhance access to Medicaid providers by requiring the Agency for Health Care Administration to include specific standards in its contracts with Medicaid managed care plans. Notably, the bill mandates 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. At least 50 percent of primary care providers in each plan's network must offer appointment availability during these times. Additionally, the bill 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 ensure accuracy and access to behavioral health services, as well as the requirement for managed care plans to publish their drug formularies online and ensure timely responses to prior authorization requests. The bill also emphasizes the importance of maintaining comprehensive medical, dental, and behavioral health encounter information for children in the care of the Department of Children and Families. The act is set to take effect on July 1, 2026.

Statutes affected:
H 163 Filed: 409.967