Read the full stored bill text
Florida Senate
-
2026
SB 1648
By
Senator Garcia
36-01064-26 20261648__
1 A bill to be entitled
2 An act relating to access to applied behavior analysis
3 services; creating s. 409.9775, F.S.; defining terms;
4 requiring the Agency for Health Care Administration to
5 consider certain factors when evaluating network
6 adequacy for applied behavior analysis services under
7 the Medicaid program; requiring Medicaid managed care
8 plans to take reasonable steps to support workforce
9 retention and recruitment; requiring managed care
10 plans to use a standardized, consolidated
11 credentialing process; prohibiting managed care plans
12 from requiring duplicative submission of identical
13 documents to multiple portals or entities; requiring
14 managed care plans to notify providers of
15 credentialing deficiencies in a specified manner and
16 timeframe; requiring that initial credentialing and
17 activation be completed within a specified timeframe;
18 prohibiting managed care plans from requiring a
19 provider to undergo the full credentialing process to
20 recredential under certain circumstances; prohibiting
21 managed care plans from imposing a moratorium on
22 applied behavior analysis services providers unless
23 such providers can demonstrate specified criteria to
24 the agency; if the agency approves a moratorium,
25 requiring managed care plans to provide certain notice
26 to providers and recipients and provide an exception
27 process for underserved or rural areas; prohibiting
28 the use of a moratorium to delay or deny continuity of
29 care for existing recipients; requiring managed care
30 plans to provide a specified continuity-of-care period
31 for certain recipients; providing requirements for
32 such period; requiring that coverage and utilization
33 decisions for applied behavior analysis services be
34 based on individualized medical necessity; prohibiting
35 the use of age-based hour targets or incentive
36 benchmarks for certain purposes; specifying
37 requirements for authorization and utilization review
38 decisions for applied behavior analysis services;
39 requiring managed care plans to pay clean claims for
40 applied behavior analysis services in accordance with
41 prompt payment requirements; requiring managed care
42 plans to provide an explanation of benefits in a
43 specified manner for any denial or partial payment;
44 prohibiting managed care plans from issuing recoupment
45 or overpayment demands based solely on certain
46 factors; requiring managed care plans to maintain
47 stable electronic portals capable of certain
48 functions; requiring that providers have access to a
49 defined escalation pathway for issues of
50 credentialing, utilization management, and claims
51 resolution; requiring that notices sent by managed
52 care plans be written in plain language and clearly
53 describe certain information; requiring managed care
54 plans to implement certain safeguards and maintain
55 certain procedures and transmission methods; requiring
56 the agency to amend managed care plan contracts as
57 needed to enforce specified provisions; authorizing
58 the agency to adopt rules; providing an effective
59 date.
60
61 WHEREAS, the Legislature finds that applied behavior
62 analysis services are a medically necessary benefit for Medicaid
63 recipients with autism spectrum disorder and other qualifying
64 conditions, and
65 WHEREAS, access to such services depends on adequate
66 provider networks, timely credentialing, clinically appropriate
67 utilization management, and prompt payment, and
68 WHEREAS, administrative barriers, including roster freezes,
69 duplicative credentialing requirements, inconsistent
70 authorization practices, and payment delays, can result in gaps
71 in care, regression, and harm to recipients and families, and
72 WHEREAS, it is the intent of the Legislature to ensure
73 continuity of care, workforce stability, administrative
74 transparency, and individualized, clinically driven
75 decisionmaking for applied behavior analysis services delivered
76 under the Medicaid program, NOW, THEREFORE,
77
78 Be It Enacted by the Legislature of the State of Florida:
79
80 Section 1. Section 409.9775, Florida Statutes, is created
81 to read:
82
409.97
7
5 Applied behavior analysis services.—
83
(1)
DEFINITIONS.—As used in this section, the term:
84
(a)
“Applied behavior analysis” means
the design,
85
implementation, and evaluation of environmental modifications,
86
using behavioral stimuli and consequences, to produce socially
87
significant improvement
s
in human behavior, including, but not
88
limited to, the use of direct observation, measurement, and
89
functional analysis of the relations between environment and
90
behavior.
91
(b)
“Continuity of care” means the uninterrupted provision
92
of authorized medically necessary services during transitions in
93
coverage, provider status, or plan enrollment.
94
(
c
)
“Moratorium” means any temporary or indefinite
95
suspension o
f
the enrollment or activation of new or existing
96
applied behavior analysis service providers by a managed care
97
plan.
98
(
d
)
“Provider” means an individual or entity enrolled or
99
seeking enrollment to provide applied behavior analysis
100
services, including board
-
certified behavior analysts, assistant
101
behavior analysts, registered behavior technicians, and
102
supervising entities.
103
(
2
)
NETWORK ADEQUACY AND WORKFORCE STABILITY.—
104
(a)
The agency shall consider the impact of credentialing
105
delays,
administrative
bottlenecks, and moratoria
on providers
106
when evaluating network adequacy for applied behavior analysis
107
services.
108
(b)
Managed care p
lans shall take reasonable steps to
109
support workforce retention and recruitment, particularly in
110
rural and underserved areas.
111
(3)
CREDENTIALING AND RECREDENTIALING.—
112
(a)
Managed care plans shall use a standardized,
113
consolidated credentialing process for applied behavior analysis
114
providers and may not require duplicative submission
s
of
115
identical documents
to
multiple portals or entities.
116
(b)
Managed care plans
shall notify a provider of all
117
credentialing deficiencies in a single, comprehensive notice
118
within 15 calendar days after receipt of an application.
119
(c)
Initial credentialing and activation must be completed
120
within 60 calendar days after receipt of a clean application.
121
(d)
Managed care plans
may not require
a provider to
122
undergo the full credentialing process to recredential
solely
123
due to
a
gap in enrollment
if the provider’s licensure and
124
national certification remained continuously active
during such
125
gap
.
126
(
4
)
PROVIDER ROSTERS AND MORATORIA.—
127
(a)
A managed care plan may not impose a moratorium on
128
applied behavior analysis service providers unless the plan
129
demonstrates to the agency, in writing, that:
130
1.
Network adequacy standards are fully met in all affected
131
geographic areas; and
132
2.
The
moratorium
is narrowly tailored, time-limited, and
133
necessary to address a documented administrative or compliance
134
issue.
135
(b)
If the agency approves a moratorium, the managed care
136
plan must provide written notice to the providers and
137
recipients, specifying a definite end date for the moratorium,
138
and provide an exception process for underserved or rural areas.
139
(c)
A managed care plan may not use a moratorium to delay
140
or deny continuity of care for existing recipients.
141
(
5
)
CONTINUITY OF CARE.—
142
(a)
A managed care plan shall provide a continuity-of-care
143
period of no less than 120 days for applied behavior analysis
144
services for a recipient newly enrolled in the plan or
145
transitioning providers.
146
(b)
During the continuity-of-care period, prior
147
authorizations must be honored and backdated as necessary and
148
may not be terminated or reduced due to credentialing,
149
rostering, or other administrative delays.
150
(c)
Services rendered during and immediately after the
151
continuity-of-care period must be reimbursed in accordance with
152
prompt pay
ment
requirements.
153
(6)
INDIVIDUALIZED MEDICAL NECESSITY; AGE-BASED
154
BENCHMARKS.—
155
(a)
Any determinations involving c
overage
and utilization
156
review
for applied behavior analysis services must be based on
157
individualized medical necessity
of the recipient
.
158
(b)
Age-based hour targets or incentive benchmarks may not
159
be used as fixed caps, minimums, or substitutes for
160
individualized clinical determinations.
161
(7) UTILIZATION MANAGEMENT.—
162
(a) Authorization and utilization review decisions for
163
applied behavior analysis services must be conducted by
164
reviewers with demonstrated training and experience in
applied
165
behavior analysis.
166
(b) A managed care plan may not require
a
reauthorization
167
cycle of less than 90 days absent a documented material change
168
in the recipient’s clinical condition.
169
(c) Requests for updated diagnostic evaluations or
170
assessments may not be imposed more frequently than clinically
171
indicated.
172
(d) Peer-to-peer reviews must be scheduled and conducted
173
within required timeframes, and
a
failure attributable to the
174
managed care
plan may not re
set or delay
the timeframe for
175
authorization.
176
(8)
CLAIMS PAYMENT.—
177
(a)
Managed care plans shall pay clean claims for applied
178
behavior analysis services in accordance with prompt
pay
ment
179
requirements.
180
(b)
F
or any denial or partial payment
,
managed care plans
181
shall provide an e
xplanation of benefits
,
includ
ing
clear, code
182
specific, and unit-level reasons
for the denial or partial
183
payment
.
184
(c)
M
anaged care plan
s
may not issue recoupment or
185
overpayment demands based solely on administrative or system
186
errors without documented provider fault.
187
(
9
)
ADMINISTRATIVE COMMUNICATIONS.—
188
(a)
Managed care plans shall maintain stable electronic
189
portals
capable of providing
confirmation of
receipt of
190
document
ation submitted by providers
.
191
(b)
Managed care plans shall give providers access to
a
192
defined escalation pathway with decisio
nmaking
authority for
193
issues involving
credentialing, utilization management, and
194
claims resolution.
195
(c)
Any n
otice
a managed care plan sends
to
a
provider
or
196
recipient must be written in plain language and clearly describe
197
applicable
timelines, next steps, and appeal rights.
198
(10)
PRIVACY AND SECURITY.—Managed care plans shall
199
implement safeguards to prevent the misdirection of protected
200
health information and shall maintain clear breach-response
201
procedures and approved secure transmission methods.
202
(11)
ENFORCEMENT.—
The agency shall amend existing managed
203
care plan contracts as needed to provide for enforcement of this
204
section, including
through existing contract remedies,
such as
205
corrective action plans, liquidated damages, or sanctions.
206
(12)
RULES.—
The agency
may
adopt rules to implement this
207
section
.
208 Section 2. This act shall take effect July 1, 2026.