Public Assistance

Florida Senate
-
2026

CS for CS for SB 1758

By
the Committees on Appropriations; and Health Policy; and
Senators Gaetz, Brodeur, and Massullo

576-03342-26 20261758c2
1 A bill to be entitled
2 An act relating to public assistance; amending s.
3 409.904, F.S.; authorizing the Agency for Health Care
4 Administration to conduct retrospective reviews and
5 audits of certain claims under the state Medicaid
6 program for a specified purpose; creating s. 409.9041,
7 F.S.; providing legislative findings; requiring the
8 agency to seek federal approval to implement mandatory
9 work and community engagement requirements for able
10 bodied adults as a condition of obtaining and
11 maintaining Medicaid coverage; prohibiting the agency
12 from implementing such requirements until certain
13 conditions are met; requiring the agency, in
14 consultation with the Department of Children and
15 Families, to develop a business plan to implement
16 specified provisions; specifying requirements for the
17 plan; requiring the agency to submit the plan to the
18 Governor and the Legislature by a specified date;
19 specifying populations that are subject to such work
20 and community engagement requirements; providing
21 exceptions; defining the term “family caregiver”;
22 specifying the types of activities which may satisfy
23 the work and community engagement requirements;
24 providing that a certain population is required to
25 engage in work or community engagement activities only
26 during standard school hours; requiring persons
27 eligible for Medicaid to demonstrate compliance with
28 the work and community engagement requirements at
29 specified times as a condition of maintaining Medicaid
30 coverage; requiring the agency to develop a process
31 for ensuring compliance with the work and community
32 engagement requirements; requiring that such process
33 align, to the extent possible, with certain existing
34 processes; requiring the department to verify
35 compliance with the work and community engagement
36 requirements at specified intervals; requiring the
37 agency, in coordination with the department, to
38 conduct outreach regarding implementation of the work
39 and community engagement requirements; specifying
40 requirements for such outreach; specifying procedures
41 in the event of noncompliance; requiring the agency,
42 in coordination with the department, to notify a
43 Medicaid recipient of a finding of noncompliance and
44 the impact to eligibility for continued receipt of
45 services; specifying requirements for such notice;
46 amending s. 409.905, F.S.; deleting a requirement that
47 the agency discontinue its hospital retrospective
48 review program under certain circumstances; revising
49 construction; requiring the agency to maintain cost
50 effective purchasing practices in its coverage of
51 hospital inpatient services rendered to Medicaid
52 recipients; amending s. 409.906, F.S.; requiring the
53 agency to seek federal approval to implement a program
54 for expanded coverage of home- and community-based
55 behavioral health services for a specified population;
56 specifying the goal of the program; requiring the
57 agency to work in coordination with the department to
58 develop the program; requiring the agency and the
59 department to develop certain estimates and submit
60 them to the Legislature in a specified manner before
61 the program may be implemented; amending s. 409.91195,
62 F.S.; revising the purpose of the Medicaid
63 Pharmaceutical and Therapeutics Committee to include
64 creation of a Medicaid preferred physician
65 administered drug list, a Medicaid preferred product
66 list, and a high-cost drug list; requiring the agency
67 to adopt such lists upon recommendation of the
68 committee; specifying the frequency with which the
69 committee must review such lists for any recommended
70 additions or deletions; specifying parameters for such
71 recommended additions and deletions; providing that
72 reimbursement for drugs not included on such lists is
73 subject to prior authorization, with an exception;
74 requiring the agency to publish and disseminate such
75 lists to all Medicaid providers in the state by
76 posting on the agency’s website or in other media;
77 providing requirements for public testimony related to
78 proposed inclusions on or exclusions from certain
79 lists; requiring the committee to consider certain
80 factors when developing such recommended additions and
81 deletions; amending s. 409.912, F.S.; revising the
82 components of the Medicaid prescribed-drug spending
83 control program to include the preferred physician
84 administered drug list, the preferred product list,
85 and the high-cost drug list; providing requirements
86 for such lists; providing that the agency does not
87 need to follow rulemaking procedures of ch. 120, F.S.,
88 when posting updates to such lists; requiring the
89 agency to establish certain procedures relating to
90 prior authorization requests for drugs on the high
91 cost drug list; establishing an alternative
92 reimbursement methodology for long-acting injectables
93 administered for severe mental illness in a hospital
94 facility setting; requiring the agency to contract
95 with a vendor to perform a fiscal impact study of the
96 federal 340B Drug Pricing Program; providing
97 requirements for the study; requiring specified
98 entities to submit certain data to the agency for
99 purposes of the study; providing that noncompliance
100 with such requirement may result in sanctions from the
101 agency or the Board of Pharmacy, as applicable;
102 requiring the agency to submit the results of the
103 study to the Governor and the Legislature by a
104 specified date; providing construction; amending s.
105 409.913, F.S.; revising the definition of the term
106 “overpayment”; providing that determinations of an
107 overpayment under the Medicaid program may be based
108 upon retrospective reviews, investigations, analyses,
109 or audits conducted by the agency to determine
110 possible fraud, abuse, overpayment, or recipient
111 neglect; providing that certain notices may be
112 provided using other common carriers, as well as
113 through the United States Postal Service; creating s.
114 414.321, F.S.; requiring the department to limit
115 eligibility for food assistance to individuals meeting
116 specified criteria; requiring that food assistance
117 recipients provide certain documentation for purposes
118 of eligibility redeterminations; prohibiting the
119 department from relying solely on an individual’s
120 self-attestations to determine certain expenses;
121 authorizing the department to adopt policies and
122 procedures to accommodate certain applicants and
123 recipients; creating s. 414.332, F.S.; requiring the
124 department to develop and implement a food assistance
125 payment accuracy improvement plan for a specified
126 purpose; requiring the department to reduce the
127 payment error rate to below a specified percentage;
128 providing requirements for the plan; requiring the
129 department to submit the plan to the Governor and the
130 Legislature by a specified date; requiring the
131 department, by a specified date, to submit quarterly
132 progress reports of specified information to the
133 Governor and the Legislature; providing for future
134 repeal; amending s. 414.39, F.S.; requiring the
135 department to require photographic identification on
136 the front of electronic benefits transfer (EBT) cards,
137 to the extent allowable under federal law; amending s.
138 414.455, F.S.; revising criteria for individuals
139 required to participate in an employment and training
140 program to receive food assistance from the
141 Supplemental Nutrition Assistance Program; requiring
142 the department to apply and comply with certain work
143 requirements in accordance with federal law for food
144 assistance; amending s. 409.91196, F.S.; conforming a
145 cross-reference; providing an effective date.
146
147 Be It Enacted by the Legislature of the State of Florida:
148
149 Section 1. Subsection (4) of section 409.904, Florida
150 Statutes, is amended to read:
151 409.904 Optional payments for eligible persons.—The agency
152 may make payments for medical assistance and related services on
153 behalf of the following persons who are determined to be
154 eligible subject to the income, assets, and categorical
155 eligibility tests set forth in federal and state law. Payment on
156 behalf of these Medicaid eligible persons is subject to the
157 availability of moneys and any limitations established by the
158 General Appropriations Act or chapter 216.
159 (4) A low-income person who meets all other requirements
160 for Medicaid eligibility except citizenship and who is in need
161 of emergency medical services. The eligibility of such a
162 recipient is limited to the period of the emergency, in
163 accordance with federal regulations.
The
a
gency may conduct

164
retrospective reviews or audits of services rendered to the

165
individual and claims submitted by the provider to validate the

166
existence and duration of the emergency medical condition and

167
whether the services rendered were necessary to treat the

168
emergency medical condition
,
regardless of whether the provider

169
obtained prior authorization for the services.

170 Section 2. Section 409.9041, Florida Statutes, is created
171 to read:
172
409.9041 Medicaid work and community engagement

173
requirements.—

174
(1)

The Legislature finds that assisting able-bodied adult

175
Medicaid recipients in achieving self-sufficiency through

176
meaningful work and community engagement is essential to

177
ensuring that the
state
Medicaid program remains a sustainable

178
resource for residents who are most in need of such assistance.

179
(
2
)
(a)

The
a
gency shall seek federal approval to implement

180
mandatory work and community engagement requirements for
able

181
bodied adults
, as
specified
in this section, as a condition of

182
obtaining and maintaining coverage under the
state
Medicaid

183
program.

The agency
may not
implement
the mandatory work and

184
community engagement requirements until it receives federal

185
approval through a Medicaid waiver and

the agency’s business

186
plan submitted under paragraph (b) is specifically approved by

187
the Legislature
.

188
(b) The agency shall, in consultation with the Department

189
of Children and Families and the Department of Commerce, develop

190
a business plan to implement this section. The plan must include

191
methods for determining Medicaid eligibility and the

192
applicability of exemptions under subsections (3) and (4) on an

193
ongoing basis and an analysis representing the potential effects

194
that implementing this section will have on Medicaid enrollment

195
and expenditures. The plan must also include a methodology to

196
provide those Medicaid recipients who stand to lose Medicaid

197
eligibility due to earning income under the requirements of

198
subsection (3) with a transition period to temporarily maintain

199
eligibility, under p
arameters
similar to those that enable
a

200
family eligible for temporary cash assistance
to temporarily

201
maintain
Medicaid eligib
ility
under s. 445.029
. The agency shall

202
submit the plan to the Governor, the President of the Senate,

203
and the Speaker of the House of Representatives no later than

204
December 1, 2026.

205
(
3
)
(a)

Medicaid recipients between the ages of 1
9
and 64

206
years
, inclusive,
must meet
the
work or community engagement

207
requirements
of this section, unless they are one of the

208
following:

209
1.

I
ndian as defined under 42 C.F.R. s. 438.14(a)
.

210
2.

A parent, guardian, caretaker relative, or family

211
caregiver of a dependent child
younger than

14
years of age or

212
of
a disabled individual
. For purposes of this paragraph, the

213
term “family caregiver” means
an adult family member or other

214
individual who has a significant relationship with, and who

215
provides a broad range of assistance to, an individual with a

216
chronic or other health condition, disability, or functional

217
limitation
.

218
3.

Former foster youth
younger than 26 years of age.

219
4.

A v
eteran

with a total disability, as
specified
under 38

220
C.F.R. s. 3.340

or as specified by a
Veteran Affairs Disability

221
Ratings Letter
issued by the United States Department of

222
Veterans Affairs.

223
5.

An individual classified as m
edically frail
under the

224
Medicaid Institutionalized Care Program; categorized as aged,

225
blind, or disabled under the state Medicaid program; or who has

226
a developmental disability as defined in s. 393.063.

227
6.

An i
ndividual living in a household that receives

228
S
upplemental
N
utrition
A
ssistance
P
rogram benefits and who
is

229
already in compliance with work requirements pursuant to s.

230
445.024
.

231
7.

An i
ndividual participating in a residential substance

232
use treatment program
.

233
8.

An i
nmate of a public institution
.

234
9.

A w
om
a
n
eligible for Medicaid coverage
in a pregnancy

235
related or postpartum care
category
.

236
10. A person receiving hospice services under part IV of

237
chapter 400 who has a medical prognosis that his or her life

238
expectancy is 6 months or less if his or her illness runs its

239
normal course
.

240
(b)

A person may satisfy the work or community engagement

241
requirements of this section
by participating in one or more of

242
the following activities for at least 80 hours per month:

243
1.

Paid employment.

244
2.

On
-
the
-
job-training.

245
3.

Vocational educational training.

246
4.

Job skills training directly related to employment.

247
5.

Education directly related to employment.

248
6.

Satisfactory attendance at a secondary school or in a

249
course of study leading to a high school equivalency diploma.

250
7.

Enrollment at least half-time as defined in 34 C.F.R. s.

251
668.2(b) in a postsecondary education program to obtain a

252
credential on the Master Credentials List as maintained pursuant

253
to s. 445.004(6)(e).

254
8.

Any other work activity designated as such by the

255
Department of Commerce and provided by a local workforce

256
development board pursuant to s. 445.024.

257
(
c
)

Parents with children ages
14
through 18 are required

258
to engage in work
or
community engagement activities
only
during

259
standard school hours.

260
(
4
)
(a)

Notwithstanding any other statutory provision, in

261
order to maintain Medicaid coverage, an eligible Medicaid

262
recipient must, before enrollment and upon any redetermination

263
for coverage, demonstrate compliance with the work or community

264
engagement requirements of this section.

265
(b)

The
a
gency shall develop
a
process for ensuring

266
compliance with this section
which aligns
, to the extent

267
possible, with the processes currently in place relating to work

268
and community engagement requirements authorized under
the

269
state
’s Supplemental Nutrition Assistance Program, including,

270
but not limited to, participant registration with a local

271
CareerSource center, employment and training programs, and

272
collaboration with
the state
’s local workforce boards.

273
(
c
)

The
d
epartment shall verify, in accordance with its

274
procedures, that
an individual
subject to the work and community

275
engagement requirements of this section demonstrate
s
compliance

276
during the individual’s regularly scheduled redetermination of

277
eligibility

and at least every 6 months thereafter
.

278
(
5
)

The
a
gency, in coordination with the
department
, shall

279
conduct outreach regarding the implementation of the work and

280
community engagement requirements
of this section
. The outreach

281
mu
st
include, at a minimum
, n
otification to impacted

282
individuals, including timelines for implementation,

283
requirements for compliance, penalties for noncompliance, and

284
information
on
how to request an exemption
.

285
(
6
)

If a recipient subject to
the
work
and community

286
engagement
requirements
of this section
is determined
to be in

287
noncompliance
with
such
requirements, the
a
gency, in

288
co
ordina
tion with the
department
, must notify the recipient of

289
the finding of noncompliance and the impact to
his or her

290
eligibility for continued receipt of Medicaid services.
The

291
n
otice must include, at a minimum
, notification of all of the

292
following
:

293
(a)

T
hat the recipient is eligible for a grace period of 30

294
days to
either
come into compliance with the requirements or

295
request
an exemption from the requirements and that
Medicaid

296
coverage of
services will continue during the grace period.

297
(b)

T
hat if, following the 30-day period,
the individual

298
has not come into
compliance with or
requested an
exemption from

299
the work and community engagement
requirements,
his or her

300
application for assistance will be denied and services

301
terminated
at
the end of the month following the month in which

302
such 30-calendar-day period ends.

303
(
c
)

T
he right
of the individual
to request a
f
air
h
earing

304
if
he or she is
determined
to be
noncompliant with program

305
requirements and disenrolled
from the state Medicaid program
.

306
(
d
)

The manner in which

he or she
can reapply for medical

307
assistance under the
state
Medicaid program.

308 Section 3. Paragraph (a) of subsection (5) of section
309 409.905, Florida Statutes, is amended, and paragraph (f) is
310 added to that subsection, to read:
311 409.905 Mandatory Medicaid services.—The agency may make
312 payments for the following services, which are required of the
313 state by Title XIX of the Social Security Act, furnished by
314 Medicaid providers to recipients who are determined to be
315 eligible on the dates on which the services were provided. Any
316 service under this section shall be provided only when medically
317 necessary and in accordance with state and federal law.
318 Mandatory services rendered by providers in mobile units to
319 Medicaid recipients may be restricted by the agency. Nothing in
320 this section shall be construed to prevent or limit the agency
321 from adjusting fees, reimbursement rates, lengths of stay,
322 number of visits, number of services, or any other adjustments
323 necessary to comply with the availability of moneys and any
324 limitations or directions provided for in the General
325 Appropriations Act or chapter 216.
326 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
327 all covered services provided for the medical care and treatment
328 of a recipient who is admitted as an inpatient by a licensed
329 physician or dentist to a hospital licensed under part I of
330 chapter 395. However, the agency shall limit the payment for
331 inpatient hospital services for a Medicaid recipient 21 years of
332 age or older to 45 days or the number of days necessary to
333 comply with the General Appropriations Act.
334 (a)1. The agency may implement reimbursement and
335 utilization management reforms in order to comply with any
336 limitations or directions in the General Appropriations Act,
337 which may include, but are not limited to: prior authorization
338 for inpatient psychiatric days; prior authorization for
339 nonemergency hospital inpatient admissions for individuals 21
340 years of age and older; authorization of emergency and urgent
341 care admissions within 24 hours after admission; enhanced
342 utilization and concurrent review programs for highly utilized
343 services; reduction or elimination of covered days of service;
344 adjusting reimbursement ceilings for variable costs; adjusting
345 reimbursement ceilings for fixed and property costs; and
346 implementing target rates of increase.
347 2. The agency may limit prior authorization for hospital
348 inpatient services to selected diagnosis-related groups, based
349 on an analysis of the cost and potential for unnecessary
350 hospitalizations represented by certain diagnoses. Admissions
351 for normal delivery and newborns are exempt from requirements
352 for prior authorization.
353 3. In implementing the provisions of this section related
354 to prior authorization, the agency shall ensure that the process
355 for authorization is accessible 24 hours per day, 7 days per
356 week and authorization is automatically granted when not denied
357 within 4 hours after the request. Authorization procedures must
358 include steps for review of denials.
359 4.
Upon implementing the prior authorization program for

360
hospital inpatient services, the agency shall discontinue its

361
hospital retrospective review program. However,
This
paragraph

362
subparagraph
may not be construed to prevent the agency from
363 conducting retrospective reviews under s. 409.913, including,
364 but not limited to,
reviews of prior-authorized claims and

365 reviews in which an overpayment is suspected due to a mistake or
366 submission of an improper claim or for other reasons that do not
367 rise to the level of fraud or abuse.
368
(f)
In its coverage of services under this subsection, t
he

369
agency shall maintain cost-effective
purchasing practices as

370
required by
s. 409.912.

371 Section 4. Present subsections (14) through (29) of section
372 409.906, Florida Statutes, are redesignated as subsections (15)
373 through (30), respectively, and a new subsection (14) is added
374 to that section, to read:
375 409.906 Optional Medicaid services.—Subject to specific
376 appropriations, the agency may make payments for services which
377 are optional to the state under Title XIX of the Social Security
378 Act and are furnished by Medicaid providers to recipients who
379 are determined to be eligible on the dates on which the services
380 were provided. Any optional service that is provided shall be
381 provided only when medically necessary and in accordance with
382 state and federal law. Optional services rendered by providers
383 in mobile units to Medicaid recipients may be restricted or
384 prohibited by the agency. Nothing in this section shall be
385 construed to prevent or limit the agency from adjusting fees,
386 reimbursement rates, lengths of stay, number of visits, or
387 number of services, or making any other adjustments necessary to
388 comply with the availability of moneys and any limitations or
389 directions provided for in the General Appropriations Act or
390 chapter 216. If necessary to safeguard the state’s systems of
391 providing services to elderly and disabled persons and subject
392 to the notice and review provisions of s. 216.177, the Governor
393 may direct the Agency for Health Care Administration to amend
394 the Medicaid state plan to delete the optional Medicaid service
395 known as “Intermediate Care Facilities for the Developmentally
396 Disabled.” Optional services may include:
397
(
14
) HOME
-
AND COMMUNITY-BASED BEHAVIORAL HEALTH
SERVICES.

398
The agency shall seek federal
approval
to implement a program

399
that covers an expanded array of home
-
and community-based

400
services for adults 18 years
of age
and older diagnosed with a

401
serious mental illness who are high utilizers of behavioral

402
health services in an institutional setting. Th
e
program
must
be

403
designed to reduce the need for institutional levels of care for

404
adults with a serious mental illness. The
a
gency shall work in

405
coordination with the Department of Children and Families to

406
develop
the program. The agency and the department shall produce

407
estimates of the program′s potential costs to the Medicaid

408
program and cost-savings for the department. Such estimates must

409
be submitted to the Legislature as legislative budget requests

410
and appropriated in the General Appropriations Act before the

411
program may be implemented.

412 Section 5. Section 409.91195, Florida Statutes, is amended
413 to read:
414 409.91195 Medicaid Pharmaceutical and Therapeutics
415 Committee.—There is created a Medicaid Pharmaceutical and
416 Therapeutics Committee within the agency for the purpose of
417 developing a Medicaid preferred drug list
, a Medicaid preferred

418
physician
-
administered drug list, a Medicaid preferred product

419
list
,
and a high-cost drug list
.
420 (1) The committee shall be composed of 11 members appointed
421 by the Governor. Four members shall be physicians, licensed
422 under chapter 458; one member licensed under chapter 459; five
423 members shall be pharmacists licensed under chapter 465; and one
424 member shall be a consumer representative. The members shall be
425 appointed to serve for terms of 2 years from the date of their
426 appointment. Members may be appointed to more than one term. The
427 agency shall serve as staff for the committee and assist them
428 with all ministerial duties. The Governor shall ensure that at
429 least some of the members of the committee represent Medicaid
430 participating physicians and pharmacies serving all segments and
431 diversity of the Medicaid population, and have experience in
432 either developing or practicing under a preferred drug list. At
433 least one of the members shall represent the interests of
434 pharmaceutical manufacturers.
435 (2) Committee members shall select a chairperson and a vice
436 chairperson each year from the committee membership.
437 (3) The committee shall meet at least quarterly and may
438 meet at other times at the discretion of the chairperson and
439 members. The committee shall comply with rules adopted by the
440 agency, including notice of any meeting of the committee
441 pursuant to the requirements of the Administrative Procedure
442 Act.
443 (4) Upon recommendation of the committee, the agency shall
444 adopt a preferred drug list
, a preferred physician
-
administered

445
drug list, a preferred product list
,
and a high-cost drug list

446 as described in s. 409.912(5). To the extent feasible, the
447 committee shall review all drug
or product
classes included on
448 the preferred drug list
,
the
preferred physician
-
administered

449
drug list, the preferred product list, and the high-cost drug

450
list
every
6

12
months
,
and may recommend additions to and
451 deletions from the
lists

preferred drug
list
, such that the
452
lists provide

preferred drug list
provides
for medically
453 appropriate drug
and product
therapies for Medicaid patients
454 which achieve cost savings contained in the General
455 Appropriations Act.
456 (5) Except for antiretroviral drugs, reimbursement of drugs
457 not included on the preferred drug list
,
preferred
physician

458
administered drug list, preferred product list, or high-cost

459
drug list
is subject to prior authorization.
460 (6) The agency shall publish and disseminate the preferred
461 drug list
,
preferred
physician
-
administered drug list, preferred

462
product list, and

high-cost drug list
to all Medicaid providers
463 in the state by Internet posting on the agency’s website or in
464 other media.
465 (7) The committee shall ensure that interested parties,
466 including pharmaceutical manufacturers agreeing to provide a
467 supplemental rebate as outlined in this chapter, have an
468 opportunity to present public testimony to the committee with
469 information or evidence supporting inclusion of a
drug or

470 product on the preferred drug list
, preferred physician

471
administered drug list, preferred product list
, or high-cost

472
drug list
. Such public testimony
must

shall
occur
before

prior

473
to
any recommendations made by the committee for inclusion or
474 exclusion from the preferred drug list
, preferred physician

475
administered drug list, preferred product list
, or high-cost

476
drug list
. Upon timely notice, the agency shall ensure that any
477 drug that has been approved or had any of its particular uses
478 approved by the United States Food and Drug Administration under
479 a priority review classification will be reviewed by the
480 committee at the next regularly scheduled meeting following 3
481 months of distribution of the drug to the general public.
482 (8) The committee shall develop its preferred drug list
,

483
preferred physician
-
administered drug list, preferred product

484
list, and high-cost drug list
recommendations by considering the
485 clinical efficacy, safety, and cost-effectiveness of a product.
486 (9) The Medicaid Pharmaceutical and Therapeutics Committee
487 may also make recommendations to the agency regarding the prior
488 authorization of any prescribed drug covered by Medicaid.
489 (10) Medicaid recipients may appeal agency preferred drug
490 formulary decisions using the Medicaid fair hearing process
491 administered by the Agency for Health Care Administration.
492 Section 6. Paragraph (a) of subsection (5) of section
493 409.912, Florida Statutes, is amended, and subsection (14) is
494 added to that section, to read:
495 409.912 Cost-effective purchasing of health care.—The
496 agency shall purchase goods and services for Medicaid recipients
497 in the most cost-effective manner consistent with the delivery
498 of quality medical care. To ensure that medical services are
499 effectively utilized, the agency may, in any case, require a
500 confirmation or second physician’s opinion of the correct
501 diagnosis for purposes of authorizing future services under the
502 Medicaid program. This section does not restrict access to
503 emergency services or poststabilization care services as defined
504 in 42 C.F.R. s. 438.114. Such confirmation or second opinion
505 shall be rendered in a manner approved by the agency. The agency
506 shall maximize the use of prepaid per capita and prepaid
507 aggregate fixed-sum basis services when appropriate and other
508 alternative service delivery and reimbursement methodologies,
509 including competitive bidding pursuant to s. 287.057, designed
510 to facilitate the cost-effective purchase of a case-managed
511 continuum of care. The agency shall also require providers to
512 minimize the exposure of recipients to the need for acute
513 inpatient, custodial, and other institutional care and the
514 inappropriate or unnecessary use of high-cost services. The
515 agency shall contract with a vendor to monitor and evaluate the
516 clinical practice patterns of providers in order to identify
517 trends that are outside the normal practice patterns of a
518 provider’s professional peers or the national guidelines of a
519 provider’s professional association. The vendor must be able to
520 provide information and counseling to a provider whose practice
521 patterns are outside the norms, in consultation with the agency,
522 to improve patient care and reduce inappropriate utilization.
523 The agency may mandate prior authorization, drug therapy
524 management, or disease management participation for certain
525 populations of Medicaid beneficiaries, certain drug classes, or
526 particular drugs to prevent fraud, abuse, overuse, and possible
527 dangerous drug interactions. The Pharmaceutical and Therapeutics
528 Committee shall make recommendations to the agency on drugs for
529 which prior authorization is required. The agency shall inform
530 the Pharmaceutical and Therapeutics Committee of its decisions
531 regarding drugs subject to prior authorization. The agency is
532 authorized to limit the entities it contracts with or enrolls as
533 Medicaid providers by developing a provider network through
534 provider credentialing. The agency may competitively bid single
535 source-provider contracts if procurement of goods or services
536 results in demonstrated cost savings to the state without
537 limiting access to care. The agency may limit its network based
538 on the assessment of beneficiary access to care, provider
539 availability, provider quality standards, time and distance
540 standards for access to care, the cultural competence of the
541 provider network, demographic characteristics of Medicaid
542 beneficiaries, practice and provider-to-beneficiary standards,
543 appointment wait times, beneficiary use of services, provider
544 turnover, provider profiling, provider licensure history,
545 previous program integrity investigations and findings, peer
546 review, provider Medicaid policy and billing compliance records,
547 clinical and medical record audits, and other factors. Providers
548 are not entitled to enrollment in the Medicaid provider network.
549 The agency shall determine instances in which allowing Medicaid
550 beneficiaries to purchase durable medical equipment and other
551 goods is less expensive to the Medicaid program than long-term
552 rental of the equipment or goods. The agency may establish rules
553 to facilitate purchases in lieu of long-term rentals in order to
554 protect against fraud and abuse in the Medicaid program as
555 defined in s. 409.913. The agency may seek federal waivers
556 necessary to administer these policies.
557 (5)(a) The agency shall implement a Medicaid prescribed
558 drug spending-control program that includes the following
559 components:
560 1. A Medicaid preferred drug list
and
a Medicaid physician

561
administered drug list. The preferred drug list
, which
shall be
562 a listing of cost-effective therapeutic options recommended by
563 the Medicaid Pharmacy and Therapeutics Committee established
564 pursuant to s. 409.91195 and adopted by the agency for each
565 therapeutic class on the preferred drug list. At the discretion
566 of the committee, and when feasible, the preferred drug list
567 should include at least two products in a therapeutic class.
The

568
physician
-
administered

drug list shall be a listing of

569
physician
-
administered drugs covered by
the state
Medicaid

570
program
, based on the United States Food and Drug

571
Administration
’s
approved indications and compendia in 42 U
.
S
.
C
.

572
s.
1396r-8(g)(1)(B). Within the
preferred
physician
-
administered

573
drug list
, there must
be a section containing a list of

574
preferred physician
-
administered drugs
that

are
cost-effective

575
therapeutic options recommended by the Medicaid Pharmac
eutical

576
and Therapeutics Committee established pursuant to s.

409.91195.

577
The physician
-
administered drug list
must
be updated at least

578
twice a year.
The agency may post
and update
the preferred drug
579 list and
the
preferred
physician
-
administered drug

updates to

580
the
list on
the agency’s

an Internet
website without following
581 the rulemaking procedures of chapter 120. Antiretroviral agents
582 are excluded from the preferred drug list. The agency shall also
583 limit the amount of a prescribed drug dispensed to no more than
584 a 34-day supply unless the drug products’ smallest marketed
585 package is greater than a 34-day supply, or the drug is
586 determined by the agency to be a maintenance drug in which case
587 a 100-day maximum supply may be authorized. The agency may seek
588 any federal waivers necessary to implement these cost-control
589 programs and to continue participation in the federal Medicaid
590 rebate program, or alternatively to negotiate state-only
591 manufacturer rebates. The agency may adopt rules to administer
592 this subparagraph. The agency shall continue to provide
593 unlimited contraceptive drugs and items. The agency must
594 establish procedures to ensure that:
595 a. There is a response to a request for prior authorization
596 by telephone or other telecommunication device within 24 hours
597 after receipt of a request for prior authorization; and
598 b. A 72-hour supply of the drug prescribed is provided in
599 an emergency or when the agency does not provide a response
600 within 24 hours as required by sub-subparagraph a.
601 2.
A Medicaid preferred product list, which shall be a

602
listing of cost-effective therapeutic supplies recommended by

603
the Medicaid Pharmac
eutical
and Therapeutics Committee

604
established pursuant to s. 409.91195 and adopted by the agency

605
for each product class listed on the preferred product list and

606
reimbursed by
the state
Medicaid
program
through the pharmacy

607
point-of-sale. The agency may post the preferred product list

608
and updates to the list on the agency’s website without

609
following the rulemaking procedures of chapter 120.

610
3.

A list of high-cost drugs recommended by the Medicaid

611
Pharmac
eutical
and Therapeutics Committee established pursuant

612
to s. 409.91195 and adopted by the agency, for the purpose of

613
coverage, reimbursement, or billing guidance. The agency may

614
post the high-cost drug list and updates to the list on
the

615
agency’s
website without following the rulemaking procedures of

616
chapter 120. The agency must establish procedures to ensure

617
that:

618
a. There is a response to a request for prior authorization

619
for a high-cost drug by telephone or other telecommunication

620
device within 24 hours after receipt of the request for prior

621
authorization; and

622
b. A 72-hour supply of the high-cost drug prescribed is

623
provided in an emergency or when the agency does not provide a

624
response to a prior authorization request within 24 hours as

625
required by sub-subparagraph a
.

626
4.
A provider of prescribed drugs is reimbursed in an
627 amount not to exceed the lesser of the actual acquisition cost
628 based on the Centers for Medicare and Medicaid Services National
629 Average Drug Acquisition Cost pricing files plus a professional
630 dispensing fee, the wholesale acquisition cost plus a
631 professional dispensing fee, the state maximum allowable cost
632 plus a professional dispensing fee, or the usual and customary
633 charge billed by the provider.
634
5.

A hospital facility administering long-acting

635
injectables for severe mental illness shall be reimbursed

636
separately
from the diagnosis-related group. Long-acting

637
injectables administered for severe mental illness in
a
hospital

638
facility setting shall be reimbursed at no less than the actual

639
acquisition cost of the drug.

640
6.

The
agency
shall contract with a vendor to perform a

641
detailed fiscal impact study to evaluate the 340B Drug Pricing

642
Progr
am administered by the Health Resources and Services

643
Administration. T
he study
must
evaluate 340B compliance, 340B

644
drug purchase
s
, and reimbursement methodologies within the fee

645
for-service program and Statewide Medicaid Managed Care program.

646
Statewide Medicaid Managed Care plans,
p
harmacy benefit

647
managers, and
Medicaid
providers shall submit to the
a
gency all

648
data necessary for the completion of the study, including
,
but

649
not limited to
, information related to
drug purchas
ing,

650
reimbursement, billing and coding, and dispensing. Noncompliance

651
with
the
340B data submission requirements of this
subparagraph

652
may result in sanctions from the
agency or the
Board of

653
Pharmacy
, as applicable
. The
a
gency shall submit the results of

654
the
study
to the Governor, the President of the Senate, and the

655
Speaker of the House of Representatives by June 30, 2027.

656
7.
3.
The agency shall develop and implement a process for
657 managing the drug therapies of Medicaid recipients who are using
658 significant numbers of prescribed drugs each month. The
659 management process may include, but is not limited to,
660 comprehensive, physician-directed medical-record reviews, claims
661 analyses, and case evaluations to determine the medical
662 necessity and appropriateness of a patient’s treatment plan and
663 drug therapies. The agency may contract with a private
664 organization to provide drug-program-management services. The
665 Medicaid drug benefit management program shall include
666 initiatives to manage drug therapies for HIV/AIDS patients,
667 patients using 20 or more unique prescriptions in a 180-day
668 period, and the top 1,000 patients in annual spending. The
669 agency shall enroll any Medicaid recipient in the drug benefit
670 management program if he or she meets the specifications of this
671 provision and is not enrolled in a Medicaid health maintenance
672 organization.
673
8.
4.
The agency may limit the size of its pharmacy network
674 based on need, competitive bidding, price negotiations,
675 credentialing, or similar criteria. The agency shall give
676 special consideration to rural areas in determining the size and
677 location of pharmacies included in the Medicaid pharmacy
678 network. A pharmacy credentialing process may include criteria
679 such as a pharmacy’s full-service status, location, size,
680 patient educational programs, patient consultation, disease
681 management services, and other characteristics. The agency may
682 impose a moratorium on Medicaid pharmacy enrollment if it is
683 determined that it has a sufficient number of Medicaid
684 participating providers. The agency must allow dispensing
685 practitioners to participate as a part of the Medicaid pharmacy
686 network regardless of the practitioner’s proximity to any other
687 entity that is dispensing prescription drugs under the Medicaid
688 program. A dispensing practitioner must meet all credentialing
689 requirements applicable to his or her practice, as determined by
690 the agency.
691
9.
5.
The agency shall develop and implement a program that
692 requires Medicaid practitioners who issue written prescriptions
693 for medicinal drugs to use a counterfeit-proof prescription pad
694 for Medicaid prescriptions. The agency shall require the use of
695 standardized counterfeit-proof prescription pads by prescribers
696 who issue written prescriptions for Medicaid recipients. The
697 agency may implement the program in targeted geographic areas or
698 statewide.
699
10.
6.
The agency may enter into arrangements that require
700 manufacturers of generic drugs prescribed to Medicaid recipients
701 to provide rebates of at least 15.1 percent of the average
702 manufacturer price for the manufacturer’s generic products.
703 These arrangements shall require that if a generic-drug
704 manufacturer pays federal rebates for Medicaid-reimbursed drugs
705 at a level below 15.1 percent, the manufacturer must provide a
706 supplemental rebate to the state in an amount necessary to
707 achieve a 15.1-percent rebate level.
708
11.
7.
The agency may establish a preferred drug list as
709 described in this subsection, and, pursuant to the establishment
710 of such preferred drug list, negotiate supplemental rebates from
711 manufacturers that are in addition to those required by Title
712 XIX of the Social Security Act and at no less than 14 percent of
713 the average manufacturer price as defined in 42 U.S.C. s. 1936
714 on the last day of a quarter unless the federal or supplemental
715 rebate, or both, equals or exceeds 29 percent. There is no upper
716 limit on the supplemental rebates the agency may negotiate. The
717 agency may determine that specific products, brand-name or
718 generic, are competitive at lower rebate percentages. Agreement
719 to pay the minimum supplemental rebate percentage guarantees a
720 manufacturer that the Medicaid Pharmaceutical and Therapeutics
721 Committee will consider a product for inclusion on the preferred
722 drug list. However, a pharmaceutical manufacturer is not
723 guaranteed placement on the preferred drug list by simply paying
724 the minimum supplemental rebate. Agency decisions will be made
725 on the clinical efficacy of a drug and recommendations of the
726 Medicaid Pharmaceutical and Therapeutics Committee, as well as
727 the price of competing products minus federal and state rebates.
728 The agency may contract with an outside agency or contractor to
729 conduct negotiations for supplemental rebates. For the purposes
730 of this section, the term “supplemental rebates” means cash
731 rebates. Value-added programs as a substitution for supplemental
732 rebates are prohibited. The agency may seek any federal waivers
733 to implement this initiative.
734
12.a.
8.a.
The agency may implement a Medicaid behavioral
735 drug management system. The agency may contract with a vendor
736 that has experience in operating behavioral drug management
737 systems to implement this program. The agency may seek federal
738 waivers to implement this program.
739 b. The agency, in conjunction with the Department of
740 Children and Families, may implement the Medicaid behavioral
741 drug management system that is designed to improve the quality
742 of care and behavioral health prescribing practices based on
743 best practice guidelines, improve patient adherence to
744 medication plans, reduce clinical risk, and lower prescribed
745 drug costs and the rate of inappropriate spending on Medicaid
746 behavioral drugs. The program may include the following
747 elements:
748 (I) Provide for the development and adoption of best
749 practice guidelines for behavioral health-related drugs such as
750 antipsychotics, antidepressants, and medications for treating
751 bipolar disorders and other behavioral conditions; translate
752 them into practice; review behavioral health prescribers and
753 compare their prescribing patterns to a number of indicators
754 that are based on national standards; and determine deviations
755 from best practice guidelines.
756 (II) Implement processes for providing feedback to and
757 educating prescribers using best practice educational materials
758 and peer-to-peer consultation.
759 (III) Assess Medicaid beneficiaries who are outliers in
760 their use of behavioral health drugs with regard to the numbers
761 and types of drugs taken, drug dosages, combination drug
762 therapies, and other indicators of improper use of behavioral
763 health drugs.
764 (IV) Alert prescribers to patients who fail to refill
765 prescriptions in a timely fashion, are prescribed multiple same
766 class behavioral health drugs, and may have other potential
767 medication problems.
768 (V) Track spending trends for behavioral health drugs and
769 deviation from best practice guidelines.
770 (VI) Use educational and technological approaches to
771 promote best practices, educate consumers, and train prescribers
772 in the use of practice guidelines.
773 (VII) Disseminate electronic and published materials.
774 (VIII) Hold statewide and regional conferences.
775 (IX) Implement a disease management program with a model
776 quality-based medication component for severely mentally ill
777 individuals and emotionally disturbed children who are high
778 users of care.
779
13.
9.
The agency shall implement a Medicaid prescription
780 drug management system.
781 a. The agency may contract with a vendor that has
782 experience in operating prescription drug management systems in
783 order to implement this system. Any management system that is
784 implemented in accordance with this subparagraph must rely on
785 cooperation between physicians and pharmacists to determine
786 appropriate practice patterns and clinical guidelines to improve
787 the prescribing, dispensing, and use of drugs in the Medicaid
788 program. The agency may seek federal waivers to implement this
789 program.
790 b. The drug management system must be designed to improve
791 the quality of care and prescribing practices based on best
792 practice guidelines, improve patient adherence to medication
793 plans, reduce clinical risk, and lower prescribed drug costs and
794 the rate of inappropriate spending on Medicaid prescription
795 drugs. The program must:
796 (I) Provide for the adoption of best practice guidelines
797 for the prescribing and use of drugs in the Medicaid program,
798 including translating best practice guidelines into practice;
799 reviewing prescriber patterns and comparing them to indicators
800 that are based on national standards and practice patterns of
801 clinical peers in their community, statewide, and nationally;
802 and determine deviations from best practice guidelines.
803 (II) Implement processes for providing feedback to and
804 educating prescribers using best practice educational materials
805 and peer-to-peer consultation.
806 (III) Assess Medicaid recipients who are outliers in their
807 use of a single or multiple prescription drugs with regard to
808 the numbers and types of drugs taken, drug dosages, combination
809 drug therapies, and other indicators of improper use of
810 prescription drugs.
811 (IV) Alert prescribers to recipients who fail to refill
812 prescriptions in a timely fashion, are prescribed multiple drugs
813 that may be redundant or contraindicated, or may have other
814 potential medication problems.
815
14.
10.
The agency may contract for drug rebate
816 administration, including, but not limited to, calculating
817 rebate amounts, invoicing manufacturers, negotiating disputes
818 with manufacturers, and maintaining a database of rebate
819 collections.
820
15.
11.
The agency may specify the preferred daily dosing
821 form or strength for the purpose of promoting best practices
822 with regard to the prescribing of certain drugs as specified in
823 the General Appropriations Act and ensuring cost-effective
824 prescribing practices.
825
16.
12.
The agency may require prior authorization for
826 Medicaid-covered prescribed drugs. The agency may prior
827 authorize the use of a product:
828 a. For an indication not approved in labeling;
829 b. To comply with certain clinical guidelines; or
830 c. If the product has the potential for overuse, misuse, or
831 abuse.
832
833 The agency may require the prescribing professional to provide
834 information about the rationale and supporting medical evidence
835 for the use of a drug. The agency shall post prior
836 authorization, step-edit criteria and protocol, and updates to
837 the list of drugs that are subject to prior authorization on the
838 agency’s
Internet
website within 21 days after the prior
839 authorization and step-edit criteria and protocol and updates
840 are approved by the agency. For purposes of this subparagraph,
841 the term “step-edit” means an automatic electronic review of
842 certain medications subject to prior authorization.
843
17.
13.
The agency, in conjunction with the Pharmaceutical
844 and Therapeutics Committee, may require age-related prior
845 authorizations for certain prescribed drugs. The agency may
846 preauthorize the use of a drug for a recipient who may not meet
847 the age requirement or may exceed the length of therapy for use
848 of this product as recommended by the manufacturer and approved
849 by the Food and Drug Administration. Prior authorization may
850 require the prescribing professional to provide information
851 about the rationale and supporting medical evidence for the use
852 of a drug.
853
18.
14.
The agency shall implement a step-therapy prior
854 authorization approval process for medications excluded from the
855 preferred drug list. Medications listed on the preferred drug
856 list must be used within the previous 12 months before the
857 alternative medications that are not listed. The step-therapy
858 prior authorization may require the prescriber to use the
859 medications of a similar drug class or for a similar medical
860 indication unless contraindicated in the Food and Drug
861 Administration labeling. The trial period between the specified
862 steps may vary according to the medical indication. The step
863 therapy approval process shall be developed in accordance with
864 the committee as stated in s. 409.91195(7) and (8). A drug
865 product may be approved without meeting the step-therapy prior
866 authorization criteria if the prescribing physician provides the
867 agency with additional written medical or clinical documentation
868 that the product is medically necessary because:
869 a. There is not a drug on the preferred drug list to treat
870 the disease or medical condition which is an acceptable clinical
871 alternative;
872 b. The alternatives have been ineffective in the treatment
873 of the beneficiary’s disease;
874 c. The drug product or medication of a similar drug class
875 is prescribed for the treatment of schizophrenia or schizotypal
876 or delusional disorders; prior authorization has been granted
877 previously for the prescribed drug; and the medication was
878 dispensed to the patient during the previous 12 months; or
879 d. Based on historical evidence and known characteristics
880 of the patient and the drug, the drug is likely to be
881 ineffective, or the number of doses have been ineffective.
882
883 The agency shall work with the physician to determine the best
884 alternative for the patient. The agency may adopt rules waiving
885 the requirements for written clinical documentation for specific
886 drugs in limited clinical situations.
887
19.
15.
The agency shall implement a return and reuse
888 program for drugs dispensed by pharmacies to institutional
889 recipients, which includes payment of a $5 restocking fee for
890 the implementation and operation of the program. The return and
891 reuse program shall be implemented electronically and in a
892 manner that promotes efficiency. The program must permit a
893 pharmacy to exclude drugs from the program if it is not
894 practical or cost-effective for the drug to be included and must
895 provide for the return to inventory of drugs that cannot be
896 credited or returned in a cost-effective manner. The agency
897 shall determine if the program has reduced the amount of
898 Medicaid prescription drugs which are destroyed on an annual
899 basis and if there are additional ways to ensure more
900 prescription drugs are not destroyed which could safely be
901 reused.
902
(14)
Neither this section nor this
chapter prevents the

903
agency from conducting retrospective reviews, investigations,

904
analyses, audits, or any combination thereof to determine

905
possible fraud, abuse, overpayment, or recipient neglect in the

906
state
Medicaid program pursuant to s. 409.913, including, but

907
not limited to, reviews in which the services were the subject

908
of a utilization review or prior authorization process.

909 Section 7. Paragraph (e) of subsection (1) and subsections
910 (2) and (6) of section 409.913, Florida Statutes, are amended to
911 read:
912 409.913 Oversight of the integrity of the Medicaid
913 program.—The agency shall operate a program to oversee the
914 activities of Florida Medicaid recipients, and providers and
915 their representatives, to ensure that fraudulent and abusive
916 behavior and neglect of recipients occur to the minimum extent
917 possible, and to recover overpayments and impose sanctions as
918 appropriate. Each January 15, the agency and the Medicaid Fraud
919 Control Unit of the Department of Legal Affairs shall submit a
920 report to the Legislature documenting the effectiveness of the
921 state’s efforts to control Medicaid fraud and abuse and to
922 recover Medicaid overpayments during the previous fiscal year.
923 The report must describe the number of cases opened and
924 investigated each year; the sources of the cases opened; the
925 disposition of the cases closed each year; the amount of
926 overpayments alleged in preliminary and final audit letters; the
927 number and amount of fines or penalties imposed; any reductions
928 in overpayment amounts negotiated in settlement agreements or by
929 other means; the amount of final agency determinations of
930 overpayments; the amount deducted from federal claiming as a
931 result of overpayments; the amount of overpayments recovered
932 each year; the amount of cost of investigation recovered each
933 year; the average length of time to collect from the time the
934 case was opened until the overpayment is paid in full; the
935 amount determined as uncollectible and the portion of the
936 uncollectible amount subsequently reclaimed from the Federal
937 Government; the number of providers, by type, that are
938 terminated from participation in the Medicaid program as a
939 result of fraud and abuse; and all costs associated with
940 discovering and prosecuting cases of Medicaid overpayments and
941 making recoveries in such cases. The report must also document
942 actions taken to prevent overpayments and the number of
943 providers prevented from enrolling in or reenrolling in the
944 Medicaid program as a result of documented Medicaid fraud and
945 abuse and must include policy recommendations necessary to
946 prevent or recover overpayments and changes necessary to prevent
947 and detect Medicaid fraud. All policy recommendations in the
948 report must include a detailed fiscal analysis, including, but
949 not limited to, implementation costs, estimated savings to the
950 Medicaid program, and the return on investment. The agency must
951 submit the policy recommendations and fiscal analyses in the
952 report to the appropriate estimating conference, pursuant to s.
953 216.137, by February 15 of each year. The agency and the
954 Medicaid Fraud Control Unit of the Department of Legal Affairs
955 each must include detailed unit-specific performance standards,
956 benchmarks, and metrics in the report, including projected cost
957 savings to the state Medicaid program during the following
958 fiscal year.
959 (1) For the purposes of this section, the term:
960 (e) “Overpayment” includes any amount that is not
961 authorized to be paid by the Medicaid program
or
that should not

962
have been paid, including payments made

whether paid
as a result
963 of inaccurate or improper cost reporting, improper claiming,
964 unacceptable practices, fraud, abuse, or mistake
, and may

965
include amounts paid for goods or services
that
were the subject

966
of a utilization review or prior authorization process
.
967 (2) The agency shall conduct, or cause to be conducted by
968 contract or otherwise, reviews, investigations, analyses,
969 audits, or any combination thereof, to determine possible fraud,
970 abuse, overpayment, or recipient neglect in the Medicaid program
971 and shall report the findings of any overpayments in audit
972 reports as appropriate.
An overpayment determination may be

973
based upon retrospective reviews, investigations, analys
e
s,

974
audits, or any combination thereof to determine possible fraud,

975
abuse, overpayment, or recipient neglect
in the Medicaid

976
program
, regardless of whether a prior authorization was issued
.

977 At least 5 percent of all audits shall be conducted on a random
978 basis. As part of its ongoing fraud detection activities, the
979 agency shall identify and monitor, by contract or otherwise,
980 patterns of overutilization of Medicaid services based on state
981 averages. The agency shall track Medicaid provider prescription
982 and billing patterns and evaluate them against Medicaid medical
983 necessity criteria and coverage and limitation guidelines
984 adopted by rule. Medical necessity determination requires that
985 service be consistent with symptoms or confirmed diagnosis of
986 illness or injury under treatment and not in excess of the
987 patient’s needs. The agency shall conduct reviews of provider
988 exceptions to peer group norms and shall, using statistical
989 methodologies, provider profiling, and analysis of billing
990 patterns, detect and investigate abnormal or unusual increases
991 in billing or payment of claims for Medicaid services and
992 medically unnecessary provision of services.
993 (6) Any notice required to be given to a provider under
994 this section is presumed to be sufficient notice if sent to the
995
mailing
address last shown on the provider enrollment file. It
996 is the responsibility of the provider to furnish and keep the
997 agency informed of the provider’s current
mailing
and service

998
addresses

address
. United States Postal Service
or other common

999
carrier’s
proof of mailing or certified or registered mailing of
1000 such notice to the provider at the address shown on the provider
1001 enrollment file constitutes sufficient proof of notice. Any
1002 notice required to be given to the agency by this section must
1003 be sent to the agency at an address designated by rule.
1004 Section 8. Section 414.321, Florida Statutes, is created to
1005 read:
1006
414.321

Food assistance eligibility.—For purposes of

1007
eligibility determinations, the department shall:

1008
(1)

Limit eligibility to individuals who are residents of

1009
the United States and:

1010
(a)

Citizens or nationals of the United States;

1011
(b)

Aliens lawfully admitted for permanent residence as

1012
defined in the Immigration and Nationality Act, as amended;

1013
(c)

Aliens who have been granted the status of Cuban and

1014
Haitian entrant, as defined in the Refugee Education Assistance

1015
Act of 1980, as amended; or

1016
(d)

Individuals who lawfully reside in the United States in

1017
accordance with the Compacts of Free Association referred to in

1018
the Personal Responsibility and Work Opportunity Reconciliation

1019
Act of 1996.

1020
(2)

Require each applicant, or recipient for

1021
redetermination purposes, to provide documentation evidencing

1022
his or her shelter or utility expenses.

1023
(a)

The department is prohibited from relying solely on an

1024
individual’s self-attestation in determining shelter or utility

1025
expenses.

1026
(b)

The department may adopt policies and procedures to

1027
accommodate an applicant or a recipient who, due to recent

1028
residency changes, is temporarily unable to furnish adequate

1029
documentation of shelter or utility expenses.

1030 Section 9. Section 414.332, Florida Statutes, is created to
1031 read:
1032
414.332

Food assistance payment accuracy plan.—

1033
(1)

The department shall develop and implement a

1034
comprehensive food assistance payment accuracy improvement plan

1035
to reduce the state’s payment error rate. The department must

1036
reduce the payment error rate to below 6 percent. The plan must

1037
address the root causes of payment errors identified through an

1038
in-depth, data-driven analysis. The plan must include, but need

1039
not be limited to, all of the following:

1040
(a)

Enhanced employee training and quality assurance.

1041
1.

The department shall administer standardized training

1042
for all economic self-sufficiency program staff at least

1043
annually. Training must, at a minimum, review the most common

1044
reasons for payment errors and methods for preventing such

1045
errors, and include pre- and post-training testing to measure

1046
staff proficiency.

1047
2.

The department shall establish a robust quality

1048
assurance review process that frequently reviews a statistically

1049
significant sample of cases before final benefit determination.

1050
This process must incorporate real-time, corrective feedback and

1051
on-the-job training for program staff and may not delay benefit

1052
determinations.

1053
(b)

Improvement in data sourcing. In contracting with

1054
entities providing data for verification of applicant and

1055
recipient information, the department shall maximize use of high

1056
quality automated data sources, including, but not limited to,

1057
comparing income and asset data with state, federal, and private

1058
sector data sources.

1059
(2)

By July 15, 2026, the department shall submit the food

1060
assistance payment accuracy improvement plan to the Governor,

1061
the President of the Senate, and the Speaker of the House of

1062
Representatives.

1063
(3)(a)

Beginning October 1, 2026, the department shall

1064
submit quarterly progress reports to the Governor, the President

1065
of the Senate, and the Speaker of the House of Representatives

1066
detailing:

1067
1.

The state’s most recent official and preliminary food

1068
assistance payment error rate.

1069
2.

A detailed breakdown of the most frequent and highest

1070
dollar value errors, including categorization by agency or

1071
client error and whether the error resulted in over- or under

1072
payment.

1073
3.

Specific actions taken by the department under the food

1074
assistance payment accuracy improvement plan during the

1075
preceding quarter and data demonstrating the results of those

1076
actions.

1077
4.

A detailed plan to correct the most recently identified

1078
deficiencies.

1079
(b)

This subsection is repealed on October 1, 2028.

1080 Section 10. Present subsections (6) through (11) of section
1081 414.39, Florida Statutes, are redesignated as subsections (7)
1082 through (12), respectively, and a new subsection (6) is added to
1083 that section, to read:
1084 414.39 Fraud.—
1085
(6) The department
shall
require the use of photographic

1086
identification on the front of each newly issued and reissued

1087
electronic benefits transfer (EBT) card for each cardholder to

1088
the maximum extent allowed by federal laws and regulations.

1089 Section 11. Subsection (2) of section 414.455, Florida
1090 Statutes, is amended to read:
1091 414.455 Supplemental Nutrition Assistance Program;
1092 legislative authorization; mandatory participation in employment
1093 and training programs.—
1094 (2) Unless prohibited by the Federal Government, the
1095 department must require a person who is receiving food
1096 assistance; who is 18 to
64

59
years of age, inclusive; who does
1097 not have children under the age of
14

18
in his or her home; who
1098 does not qualify for an exemption; and who is determined by the
1099 department to be eligible, to participate in an employment and
1100 training program.
The department shall apply and comply with

1101
exemptions from work requirements in accordance with applicable

1102
federal law.

1103 Section 12. Subsection (1) of section 409.91196, Florida
1104 Statutes, is amended to read:
1105 409.91196 Supplemental rebate agreements; public records
1106 and public meetings exemption.—
1107 (1) The rebate amount, percent of rebate, manufacturer’s
1108 pricing, and supplemental rebate, and other trade secrets as
1109 defined in s. 688.002 that the agency has identified for use in
1110 negotiations, held by the Agency for Health Care Administration
1111 under
s. 409.912(5)(a)11.

s. 409.912(5)(a)7.
are confidential
1112 and exempt from s. 119.07(1) and s. 24(a), Art. I of the State
1113 Constitution.
1114 Section 13. This act shall take effect July 1, 2026.