House Bill 5301 proposes comprehensive reforms to Florida's Medicaid program, including the repeal of section 381.4015 related to health care innovation. The bill introduces the Eligibility Assistance Program within the Department of Children and Families, which will be managed by an independent contractor. It also revises the reimbursement methodologies for Medicaid providers, particularly for nursing home care, and establishes a quality withhold incentive aimed at improving service delivery. Key amendments include changes to the quality incentive program, which now incorporates consumer satisfaction surveys, and the agency's authority to implement cost-effective purchasing strategies for prescribed drugs.

Additionally, the bill enhances the management of Medicaid drug benefits, particularly for vulnerable populations, by mandating enrollment in a drug benefit management program and allowing the agency to limit pharmacy networks. It introduces a new reimbursement structure for hospitals administering long-acting injectables for severe mental illness and modifies the contract duration for managed care plans from six to eight years. The bill also emphasizes the establishment of internal health care quality improvement systems within managed care plans, requiring them to report on various healthcare quality measures. Overall, the bill aims to improve the quality of care, reduce costs, and enhance access to necessary medications for Medicaid recipients, with an effective date set for July 1, 2026.

Statutes affected:
H 5301 Filed: 409.912, 409.91196