Managed Care Plans

Plain English Breakdown

The official status metadata shows conflicting information: one label says 'Passed Legislature' while another states 'Died in Health Care Facilities & Systems Subcommittee'. The bill text itself includes an effective date of July 1, 2026, suggesting it may have passed despite the subcommittee note.

Managed Care Plans: Equipment Choice and Review Limits

This bill stops Medicaid managed care plans from re-checking the medical necessity of equipment they already approved and requires them to cover durable medical equipment chosen by patients from in-network providers.

What This Bill Does

• Prohibits managed care plans from reviewing claims for medical necessity if prior authorization was already given before payment or after payment.
• Requires plans to provide coverage for durable medical equipment and complex rehabilitation technology selected by the patient from a qualified provider within the network.
• Directs the Agency for Health Care Administration (AHCA) to create rules allowing patients to choose their in-network providers for these items.
• Creates a process within the existing grievance system for patients to file complaints if they are not allowed to pick their chosen in-network provider.

Who It Names or Affects

• Medicaid managed care plans and their subcontractors
• Patients enrolled in Medicaid who need durable medical equipment or complex rehabilitation technology
• Qualified providers of durable medical equipment within the plan's network
• The Agency for Health Care Administration (AHCA)

Terms To Know

Prior authorization

Approval given by a health plan before they pay for specific services or items.

Durable medical equipment

Medical tools and devices that can be used repeatedly, such as wheelchairs or hospital beds.

Complex rehabilitation technology

Advanced medical devices designed to help people recover from injuries or disabilities.

Limits and Unknowns

• The bill does not list specific examples of what counts as complex rehabilitation technology.
• The exact details of the complaint process depend on rules that AHCA must write later.
• The text does not explain how plans will handle costs if a patient chooses a more expensive provider within the network.

Official Summary Text

Managed Care Plans; Revises Medicaid managed care contract requirements to prohibit managed care plans from reviewing certain prior authorization claims for medical necessity; requires that managed care plans provide coverage for durable medical equipment & complex rehabilitation technology from qualified provider, from within provider network, of enrollee's choosing; requires AHCA to adopt certain rules.

Current Bill Text

HB 531 2026

CODING: Words stricken are deletions; words underlined are additions.
hb531-00
Page 1 of 2
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 managed care plans; amending s. 2
409.967, F.S.; revising Medicaid managed care contract 3
requirements to prohibit managed care plans from 4
reviewing certain prior authorization claims for 5
medical necessity; requiring that managed care plans 6
provide coverage for durable medical equipment and 7
complex rehabilitation technology from a qualified 8
provider, from within the provider network, of the 9
enrollee's choosing; requiring the Agency for Health 10
Care Administration to adopt certain rules; providing 11
an effective date. 12
13
Be It Enacted by the Legislature of the State of Florida: 14
15
Section 1. Paragraphs (p) and (q) are added to subsection 16
(2) of section 409.967, Florida Statutes, to read: 17
409.967 Managed care plan accountability.— 18
(2) The agency shall establish such contract requirements 19
as are necessary for the operation of the statewide managed care 20
program. In addition to any other provisions the agency may deem 21
necessary, the contract must require: 22
(p) Prior authorization reviews.—For any claims in which a 23
Medicaid managed care plan has given prior authorization, 24
prepayment or postpayment review may not include review for 25

HB 531 2026

CODING: Words stricken are deletions; words underlined are additions.
hb531-00
Page 2 of 2
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

medical necessity for the previously approved equipment, 26
supplies, or services. 27
(q) Durable medical equipment.—Managed care plans, or 28
their subcontractors, shall provide coverage for durable medical 29
equipment or complex rehabilitation technology from any 30
qualified durable medical equipment or complex rehabilitation 31
technology provider within the provider network which the 32
enrollee chooses. The agency shall adopt rules to implement this 33
paragraph, including, but not limited to: 34
1. Authorizing enrollees to choose the provider, within 35
the provider network, from which they can receive eligible 36
durable medical equipment or complex rehabilitation technology. 37
2. Providing a procedure within the grievance resolution 38
process adopted under paragraph (h) for enrollees to file a 39
complaint if they believe they were not granted authority to 40
choose their provider from within the provider network, as 41
authorized under this paragraph. 42
Section 2. This act shall take effect July 1, 2026. 43