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HB 163 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to access to Medicaid providers; 2
amending s. 409.967, F.S.; requiring the Agency for 3
Health Care Administration to include specified 4
requirements in its contracts with Medicaid managed 5
care plans; defining the term "outside of regular 6
business hours"; providing an effective date. 7
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Be It Enacted by the Legislature of the State of Florida: 9
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Section 1. Paragraph (c) of subsection (2) of section 11
409.967, Florida Statutes, is amended to read: 12
409.967 Managed care plan accountability.— 13
(2) The agency shall establish such contract requirements 14
as are necessary for the operation of the statewide managed care 15
program. In addition to any other provisions the agency may deem 16
necessary, the contract must require: 17
(c) Access.— 18
1. The agency shall establish specific standards for the 19
number, type, and regional distribution of providers in managed 20
care plan networks to ensure access to care for both adults and 21
children. Each plan must maintain a regionwide network of 22
providers in sufficient numbers to meet the access standards for 23
specific medical services for all recipients enrolled in the 24
plan. The exclusive use of mail-order pharmacies may not be 25
HB 163 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
sufficient to meet network access standards. Consistent with the 26
standards established by the agency, provider networks may 27
include providers located outside the region. 28
2. The agency shall establish specific standards to ensure 29
enrollees have access to network providers during state holidays 30
and outside of regular business hours. At least 50 percent of 31
primary care providers participating in a plan provider network 32
must offer appointment availability to Medicaid enrollees 33
outside of regular business hours. For the purposes of this 34
subparagraph, the term "outside of regular business hours" means 35
Monday through Friday between 5 p.m. and 8 a.m. local time and 36
all day Saturday and Sunday. 37
3. Each plan shall establish and maintain an accurate and 38
complete electronic database of contracted providers, including 39
information about licensure or registration, locations and hours 40
of operation, specialty credentials and other certifications, 41
specific performance indicators, and such other information as 42
the agency deems necessary. The database must be available 43
online to both the agency and the public and have the capability 44
to compare the availability of providers to network adequacy 45
standards and to accept and display feedback from each 46
provider's patients. 47
4. Each plan shall submit quarterly reports to the agency 48
identifying the number of enrollees assigned to each primary 49
care provider. 50
HB 163 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
5. The agency shall conduct, or contract for, systematic 51
and continuous testing of the provider network databases 52
maintained by each plan to confirm accuracy, confirm that 53
behavioral health providers are accepting enrollees, and confirm 54
that enrollees have access to behavioral health services. 55
6.2. Each managed care plan shall must publish any 56
prescribed drug formulary or preferred drug list on the plan's 57
website in a manner that is accessible to and searchable by 58
enrollees and providers. The plan must update the list within 24 59
hours after making a change. Each plan must ensure that the 60
prior authorization process for prescribed drugs is readily 61
accessible to health care providers, including posting 62
appropriate contact information on its website and providing 63
timely responses to providers. For Medicaid recipients diagnosed 64
with hemophilia who have been prescribed anti-hemophilic-factor 65
replacement products, the agency shall provide for those 66
products and hemophilia overlay services through the agency's 67
hemophilia disease management program. 68
7.3. Managed care plans, and their fiscal agents or 69
intermediaries, must accept prior authorization requests for any 70
service electronically. 71
8.4. Managed care plans serving children in the care and 72
custody of the Department of Children and Families must maintain 73
complete medical, dental, and behavioral health encounter 74
information and participate in making such information available 75
HB 163 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
to the department or the applicable contracted community-based 76
care lead agency for use in providing comprehensive and 77
coordinated case management. The agency and the department shall 78
establish an interagency agreement to provide guidance for the 79
format, confidentiality, recipient, scope, and method of 80
information to be made available and the deadlines for 81
submission of the data. The scope of information available to 82
the department is shall be the data that managed care plans are 83
required to submit to the agency. The agency shall determine the 84
plan's compliance with standards for access to medical, dental, 85
and behavioral health services; the use of medications; and 86
follow up followup on all medically necessary services 87
recommended as a result of early and periodic screening, 88
diagnosis, and treatment. 89
Section 2. This act shall take effect July 1, 2026. 90