S 1758

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
1A bill to be entitled
2An act relating to public assistance; amending s.
3409.904, F.S.; authorizing the Agency for Health Care
4Administration to conduct retrospective reviews and
5audits of certain claims under the state Medicaid
6program for a specified purpose; creating s. 409.9041,
7F.S.; providing legislative findings; requiring the
8agency to seek federal approval to implement mandatory
9work and community engagement requirements for able
10bodied adults as a condition of obtaining and
11maintaining Medicaid coverage; prohibiting the agency
12from implementing such requirements until certain
13conditions are met; requiring the agency, in
14consultation with the Department of Children and
15Families, to develop a business plan to implement
16specified provisions; specifying requirements for the
17plan; requiring the agency to submit the plan to the
18Governor and the Legislature by a specified date;
19specifying populations that are subject to such work
20and community engagement requirements; providing
21exceptions; defining the term “family caregiver”;
22specifying the types of activities which may satisfy
23the work and community engagement requirements;
24providing that a certain population is required to
25engage in work or community engagement activities only
26during standard school hours; requiring persons
27eligible for Medicaid to demonstrate compliance with
28the work and community engagement requirements at
29specified times as a condition of maintaining Medicaid
30coverage; requiring the agency to develop a process
31for ensuring compliance with the work and community
32engagement requirements; requiring that such process
33align, to the extent possible, with certain existing
34processes; requiring the department to verify
35compliance with the work and community engagement
36requirements at specified intervals; requiring the
37agency, in coordination with the department, to
38conduct outreach regarding implementation of the work
39and community engagement requirements; specifying
40requirements for such outreach; specifying procedures
41in the event of noncompliance; requiring the agency,
42in coordination with the department, to notify a
43Medicaid recipient of a finding of noncompliance and
44the impact to eligibility for continued receipt of
45services; specifying requirements for such notice;
46amending s. 409.905, F.S.; deleting a requirement that
47the agency discontinue its hospital retrospective
48review program under certain circumstances; revising
49construction; requiring the agency to maintain cost
50effective purchasing practices in its coverage of
51hospital inpatient services rendered to Medicaid
52recipients; amending s. 409.906, F.S.; requiring the
53agency to seek federal approval to implement a program
54for expanded coverage of home- and community-based
55behavioral health services for a specified population;
56specifying the goal of the program; requiring the
57agency to work in coordination with the department to
58develop the program; requiring the agency and the
59department to develop certain estimates and submit
60them to the Legislature in a specified manner before
61the program may be implemented; amending s. 409.91195,
62F.S.; revising the purpose of the Medicaid
63Pharmaceutical and Therapeutics Committee to include
64creation of a Medicaid preferred physician
65administered drug list, a Medicaid preferred product
66list, and a high-cost drug list; requiring the agency
67to adopt such lists upon recommendation of the
68committee; specifying the frequency with which the
69committee must review such lists for any recommended
70additions or deletions; specifying parameters for such
71recommended additions and deletions; providing that
72reimbursement for drugs not included on such lists is
73subject to prior authorization, with an exception;
74requiring the agency to publish and disseminate such
75lists to all Medicaid providers in the state by
76posting on the agency’s website or in other media;
77providing requirements for public testimony related to
78proposed inclusions on or exclusions from certain
79lists; requiring the committee to consider certain
80factors when developing such recommended additions and
81deletions; amending s. 409.912, F.S.; revising the
82components of the Medicaid prescribed-drug spending
83control program to include the preferred physician
84administered drug list, the preferred product list,
85and the high-cost drug list; providing requirements
86for such lists; providing that the agency does not
87need to follow rulemaking procedures of ch. 120, F.S.,
88when posting updates to such lists; requiring the
89agency to establish certain procedures relating to
90prior authorization requests for drugs on the high
91cost drug list; establishing an alternative
92reimbursement methodology for long-acting injectables
93administered for severe mental illness in a hospital
94facility setting; requiring the agency to contract
95with a vendor to perform a fiscal impact study of the
96federal 340B Drug Pricing Program; providing
97requirements for the study; requiring specified
98entities to submit certain data to the agency for
99purposes of the study; providing that noncompliance
100with such requirement may result in sanctions from the
101agency or the Board of Pharmacy, as applicable;
102requiring the agency to submit the results of the
103study to the Governor and the Legislature by a
104specified date; providing construction; amending s.
105409.913, F.S.; revising the definition of the term
106“overpayment”; providing that determinations of an
107overpayment under the Medicaid program may be based
108upon retrospective reviews, investigations, analyses,
109or audits conducted by the agency to determine
110possible fraud, abuse, overpayment, or recipient
111neglect; providing that certain notices may be
112provided using other common carriers, as well as
113through the United States Postal Service; creating s.
114414.321, F.S.; requiring the department to limit
115eligibility for food assistance to individuals meeting
116specified criteria; requiring that food assistance
117recipients provide certain documentation for purposes
118of eligibility redeterminations; prohibiting the
119department from relying solely on an individual’s
120self-attestations to determine certain expenses;
121authorizing the department to adopt policies and
122procedures to accommodate certain applicants and
123recipients; creating s. 414.332, F.S.; requiring the
124department to develop and implement a food assistance
125payment accuracy improvement plan for a specified
126purpose; requiring the department to reduce the
127payment error rate to below a specified percentage;
128providing requirements for the plan; requiring the
129department to submit the plan to the Governor and the
130Legislature by a specified date; requiring the
131department, by a specified date, to submit quarterly
132progress reports of specified information to the
133Governor and the Legislature; providing for future
134repeal; amending s. 414.39, F.S.; requiring the
135department to require photographic identification on
136the front of electronic benefits transfer (EBT) cards,
137to the extent allowable under federal law; amending s.
138414.455, F.S.; revising criteria for individuals
139required to participate in an employment and training
140program to receive food assistance from the
141Supplemental Nutrition Assistance Program; requiring
142the department to apply and comply with certain work
143requirements in accordance with federal law for food
144assistance; amending s. 409.91196, F.S.; conforming a
145cross-reference; providing an effective date.
146
147Be It Enacted by the Legislature of the State of Florida:
148
149Section 1. Subsection (4) of section 409.904, Florida
150Statutes, is amended to read:
151409.904 Optional payments for eligible persons.—The agency
152may make payments for medical assistance and related services on
153behalf of the following persons who are determined to be
154eligible subject to the income, assets, and categorical
155eligibility tests set forth in federal and state law. Payment on
156behalf of these Medicaid eligible persons is subject to the
157availability of moneys and any limitations established by the
158General Appropriations Act or chapter 216.
159(4) A low-income person who meets all other requirements
160for Medicaid eligibility except citizenship and who is in need
161of emergency medical services. The eligibility of such a
162recipient is limited to the period of the emergency, in
163accordance with federal regulations. The agency may conduct
164retrospective reviews or audits of services rendered to the
165individual and claims submitted by the provider to validate the
166existence and duration of the emergency medical condition and
167whether the services rendered were necessary to treat the
168emergency medical condition, regardless of whether the provider
169obtained prior authorization for the services.
170Section 2. Section 409.9041, Florida Statutes, is created
171to read:
172409.9041 Medicaid work and community engagement
173requirements.—
174(1)The Legislature finds that assisting able-bodied adult
175Medicaid recipients in achieving self-sufficiency through
176meaningful work and community engagement is essential to
177ensuring that the state Medicaid program remains a sustainable
178resource for residents who are most in need of such assistance.
179(2)(a)The agency shall seek federal approval to implement
180mandatory work and community engagement requirements for able
181bodied adults, as specified in this section, as a condition of
182obtaining and maintaining coverage under the state Medicaid
183program.The agency may not implement the mandatory work and
184community engagement requirements until it receives federal
185approval through a Medicaid waiver andthe agency’s business
186plan submitted under paragraph (b) is specifically approved by
187the Legislature.
188(b) The agency shall, in consultation with the Department
189of Children and Families and the Department of Commerce, develop
190a business plan to implement this section. The plan must include
191methods for determining Medicaid eligibility and the
192applicability of exemptions under subsections (3) and (4) on an
193ongoing basis and an analysis representing the potential effects
194that implementing this section will have on Medicaid enrollment
195and expenditures. The plan must also include a methodology to
196provide those Medicaid recipients who stand to lose Medicaid
197eligibility due to earning income under the requirements of
198subsection (3) with a transition period to temporarily maintain
199eligibility, under parameters similar to those that enable a
200family eligible for temporary cash assistance to temporarily
201maintain Medicaid eligibility under s. 445.029. The agency shall
202submit the plan to the Governor, the President of the Senate,
203and the Speaker of the House of Representatives no later than
204December 1, 2026.
205(3)(a)Medicaid recipients between the ages of 19 and 64
206years, inclusive, must meet the work or community engagement
207requirements of this section, unless they are one of the
208following:
2091.Indian as defined under 42 C.F.R. s. 438.14(a).
2102.A parent, guardian, caretaker relative, or family
211caregiver of a dependent child younger than14 years of age or
212of a disabled individual. For purposes of this paragraph, the
213term “family caregiver” means an adult family member or other
214individual who has a significant relationship with, and who
215provides a broad range of assistance to, an individual with a
216chronic or other health condition, disability, or functional
217limitation.
2183.Former foster youth younger than 26 years of age.
2194.A veteranwith a total disability, as specified under 38
220C.F.R. s. 3.340or as specified by a Veteran Affairs Disability
221Ratings Letter issued by the United States Department of
222Veterans Affairs.
2235.An individual classified as medically frail under the
224Medicaid Institutionalized Care Program; categorized as aged,
225blind, or disabled under the state Medicaid program; or who has
226a developmental disability as defined in s. 393.063.
2276.An individual living in a household that receives
228Supplemental Nutrition Assistance Program benefits and who is
229already in compliance with work requirements pursuant to s.
230445.024.
2317.An individual participating in a residential substance
232use treatment program.
2338.An inmate of a public institution.
2349.A woman eligible for Medicaid coverage in a pregnancy
235related or postpartum care category.
23610. A person receiving hospice services under part IV of
237chapter 400 who has a medical prognosis that his or her life
238expectancy is 6 months or less if his or her illness runs its
239normal course.
240(b)A person may satisfy the work or community engagement
241requirements of this section by participating in one or more of
242the following activities for at least 80 hours per month:
2431.Paid employment.
2442.On-the-job-training.
2453.Vocational educational training.
2464.Job skills training directly related to employment.
2475.Education directly related to employment.
2486.Satisfactory attendance at a secondary school or in a
249course of study leading to a high school equivalency diploma.
2507.Enrollment at least half-time as defined in 34 C.F.R. s.
251668.2(b) in a postsecondary education program to obtain a
252credential on the Master Credentials List as maintained pursuant
253to s. 445.004(6)(e).
2548.Any other work activity designated as such by the
255Department of Commerce and provided by a local workforce
256development board pursuant to s. 445.024.
257(c)Parents with children ages 14 through 18 are required
258to engage in work or community engagement activities only during
259standard school hours.
260(4)(a)Notwithstanding any other statutory provision, in
261order to maintain Medicaid coverage, an eligible Medicaid
262recipient must, before enrollment and upon any redetermination
263for coverage, demonstrate compliance with the work or community
264engagement requirements of this section.
265(b)The agency shall develop a process for ensuring
266compliance with this section which aligns, to the extent
267possible, with the processes currently in place relating to work
268and community engagement requirements authorized under the
269state’s Supplemental Nutrition Assistance Program, including,
270but not limited to, participant registration with a local
271CareerSource center, employment and training programs, and
272collaboration with the state’s local workforce boards.
273(c)The department shall verify, in accordance with its
274procedures, that an individual subject to the work and community
275engagement requirements of this section demonstrates compliance
276during the individual’s regularly scheduled redetermination of
277eligibilityand at least every 6 months thereafter.
278(5)The agency, in coordination with the department, shall
279conduct outreach regarding the implementation of the work and
280community engagement requirements of this section. The outreach
281must include, at a minimum, notification to impacted
282individuals, including timelines for implementation,
283requirements for compliance, penalties for noncompliance, and
284information on how to request an exemption.
285(6)If a recipient subject to the work and community
286engagement requirements of this section is determined to be in
287noncompliance with such requirements, the agency, in
288coordination with the department, must notify the recipient of
289the finding of noncompliance and the impact to his or her
290eligibility for continued receipt of Medicaid services. The
291notice must include, at a minimum, notification of all of the
292following:
293(a)That the recipient is eligible for a grace period of 30
294days to either come into compliance with the requirements or
295request an exemption from the requirements and that Medicaid
296coverage of services will continue during the grace period.
297(b)That if, following the 30-day period, the individual
298has not come into compliance with or requested an exemption from
299the work and community engagement requirements, his or her
300application for assistance will be denied and services
301terminated at the end of the month following the month in which
302such 30-calendar-day period ends.
303(c)The right of the individual to request a fair hearing
304if he or she is determined to be noncompliant with program
305requirements and disenrolled from the state Medicaid program.
306(d)The manner in whichhe or she can reapply for medical
307assistance under the state Medicaid program.
308Section 3. Paragraph (a) of subsection (5) of section
309409.905, Florida Statutes, is amended, and paragraph (f) is
310added to that subsection, to read:
311409.905 Mandatory Medicaid services.—The agency may make
312payments for the following services, which are required of the
313state by Title XIX of the Social Security Act, furnished by
314Medicaid providers to recipients who are determined to be
315eligible on the dates on which the services were provided. Any
316service under this section shall be provided only when medically
317necessary and in accordance with state and federal law.
318Mandatory services rendered by providers in mobile units to
319Medicaid recipients may be restricted by the agency. Nothing in
320this section shall be construed to prevent or limit the agency
321from adjusting fees, reimbursement rates, lengths of stay,
322number of visits, number of services, or any other adjustments
323necessary to comply with the availability of moneys and any
324limitations or directions provided for in the General
325Appropriations Act or chapter 216.
326(5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
327all covered services provided for the medical care and treatment
328of a recipient who is admitted as an inpatient by a licensed
329physician or dentist to a hospital licensed under part I of
330chapter 395. However, the agency shall limit the payment for
331inpatient hospital services for a Medicaid recipient 21 years of
332age or older to 45 days or the number of days necessary to
333comply with the General Appropriations Act.
334(a)1. The agency may implement reimbursement and
335utilization management reforms in order to comply with any
336limitations or directions in the General Appropriations Act,
337which may include, but are not limited to: prior authorization
338for inpatient psychiatric days; prior authorization for
339nonemergency hospital inpatient admissions for individuals 21
340years of age and older; authorization of emergency and urgent
341care admissions within 24 hours after admission; enhanced
342utilization and concurrent review programs for highly utilized
343services; reduction or elimination of covered days of service;
344adjusting reimbursement ceilings for variable costs; adjusting
345reimbursement ceilings for fixed and property costs; and
346implementing target rates of increase.
3472. The agency may limit prior authorization for hospital
348inpatient services to selected diagnosis-related groups, based
349on an analysis of the cost and potential for unnecessary
350hospitalizations represented by certain diagnoses. Admissions
351for normal delivery and newborns are exempt from requirements
352for prior authorization.
3533. In implementing the provisions of this section related
354to prior authorization, the agency shall ensure that the process
355for authorization is accessible 24 hours per day, 7 days per
356week and authorization is automatically granted when not denied
357within 4 hours after the request. Authorization procedures must
358include steps for review of denials.
3594. [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
363conducting retrospective reviews under s. 409.913, including,
364but not limited to, reviews of prior-authorized claims and
365reviews in which an overpayment is suspected due to a mistake or
366submission of an improper claim or for other reasons that do not
367rise to the level of fraud or abuse.
368(f) In its coverage of services under this subsection, the
369agency shall maintain cost-effective purchasing practices as
370required by s. 409.912.
371Section 4. Present subsections (14) through (29) of section
372409.906, Florida Statutes, are redesignated as subsections (15)
373through (30), respectively, and a new subsection (14) is added
374to that section, to read:
375409.906 Optional Medicaid services.—Subject to specific
376appropriations, the agency may make payments for services which
377are optional to the state under Title XIX of the Social Security
378Act and are furnished by Medicaid providers to recipients who
379are determined to be eligible on the dates on which the services
380were provided. Any optional service that is provided shall be
381provided only when medically necessary and in accordance with
382state and federal law. Optional services rendered by providers
383in mobile units to Medicaid recipients may be restricted or
384prohibited by the agency. Nothing in this section shall be
385construed to prevent or limit the agency from adjusting fees,
386reimbursement rates, lengths of stay, number of visits, or
387number of services, or making any other adjustments necessary to
388comply with the availability of moneys and any limitations or
389directions provided for in the General Appropriations Act or
390chapter 216. If necessary to safeguard the state’s systems of
391providing services to elderly and disabled persons and subject
392to the notice and review provisions of s. 216.177, the Governor
393may direct the Agency for Health Care Administration to amend
394the Medicaid state plan to delete the optional Medicaid service
395known as “Intermediate Care Facilities for the Developmentally
396Disabled.” Optional services may include:
397(14) HOME- AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES.
398The agency shall seek federal approval to implement a program
399that covers an expanded array of home- and community-based
400services for adults 18 years of age and older diagnosed with a
401serious mental illness who are high utilizers of behavioral
402health services in an institutional setting. The program must be
403designed to reduce the need for institutional levels of care for
404adults with a serious mental illness. The agency shall work in
405coordination with the Department of Children and Families to
406develop the program. The agency and the department shall produce
407estimates of the program′s potential costs to the Medicaid
408program and cost-savings for the department. Such estimates must
409be submitted to the Legislature as legislative budget requests
410and appropriated in the General Appropriations Act before the
411program may be implemented.
412Section 5. Section 409.91195, Florida Statutes, is amended
413to read:
414409.91195 Medicaid Pharmaceutical and Therapeutics
415Committee.—There is created a Medicaid Pharmaceutical and
416Therapeutics Committee within the agency for the purpose of
417developing a Medicaid preferred drug list, a Medicaid preferred
418physician-administered drug list, a Medicaid preferred product
419list, and a high-cost drug list.
420(1) The committee shall be composed of 11 members appointed
421by the Governor. Four members shall be physicians, licensed
422under chapter 458; one member licensed under chapter 459; five
423members shall be pharmacists licensed under chapter 465; and one
424member shall be a consumer representative. The members shall be
425appointed to serve for terms of 2 years from the date of their
426appointment. Members may be appointed to more than one term. The
427agency shall serve as staff for the committee and assist them
428with all ministerial duties. The Governor shall ensure that at
429least some of the members of the committee represent Medicaid
430participating physicians and pharmacies serving all segments and
431diversity of the Medicaid population, and have experience in
432either developing or practicing under a preferred drug list. At
433least one of the members shall represent the interests of
434pharmaceutical manufacturers.
435(2) Committee members shall select a chairperson and a vice
436chairperson each year from the committee membership.
437(3) The committee shall meet at least quarterly and may
438meet at other times at the discretion of the chairperson and
439members. The committee shall comply with rules adopted by the
440agency, including notice of any meeting of the committee
441pursuant to the requirements of the Administrative Procedure
442Act.
443(4) Upon recommendation of the committee, the agency shall
444adopt a preferred drug list, a preferred physician-administered
445drug list, a preferred product list, and a high-cost drug list
446as described in s. 409.912(5). To the extent feasible, the
447committee shall review all drug or product classes included on
448the preferred drug list, the preferred physician-administered
449drug list, the preferred product list, and the high-cost drug
450list every 6 [12] months[,] and may recommend additions to and
451deletions from the lists [preferred drug ][list], such that the
452lists provide [preferred drug list][ provides] for medically
453appropriate drug and product therapies for Medicaid patients
454which achieve cost savings contained in the General
455Appropriations Act.
456(5) Except for antiretroviral drugs, reimbursement of drugs
457not included on the preferred drug list, preferred physician
458administered drug list, preferred product list, or high-cost
459drug list is subject to prior authorization.
460(6) The agency shall publish and disseminate the preferred
461drug list, preferred physician-administered drug list, preferred
462product list, andhigh-cost drug list to all Medicaid providers
463in the state by Internet posting on the agency’s website or in
464other media.
465(7) The committee shall ensure that interested parties,
466including pharmaceutical manufacturers agreeing to provide a
467supplemental rebate as outlined in this chapter, have an
468opportunity to present public testimony to the committee with
469information or evidence supporting inclusion of a drug or
470product on the preferred drug list, preferred physician
471administered drug list, preferred product list, or high-cost
472drug list. Such public testimony must [shall] occur before [prior]
473[to] any recommendations made by the committee for inclusion or
474exclusion from the preferred drug list, preferred physician
475administered drug list, preferred product list, or high-cost
476drug list. Upon timely notice, the agency shall ensure that any
477drug that has been approved or had any of its particular uses
478approved by the United States Food and Drug Administration under
479a priority review classification will be reviewed by the
480committee at the next regularly scheduled meeting following 3
481months of distribution of the drug to the general public.
482(8) The committee shall develop its preferred drug list,
483preferred physician-administered drug list, preferred product
484list, and high-cost drug list recommendations by considering the
485clinical efficacy, safety, and cost-effectiveness of a product.
486(9) The Medicaid Pharmaceutical and Therapeutics Committee
487may also make recommendations to the agency regarding the prior
488authorization of any prescribed drug covered by Medicaid.
489(10) Medicaid recipients may appeal agency preferred drug
490formulary decisions using the Medicaid fair hearing process
491administered by the Agency for Health Care Administration.
492Section 6. Paragraph (a) of subsection (5) of section
493409.912, Florida Statutes, is amended, and subsection (14) is
494added to that section, to read:
495409.912 Cost-effective purchasing of health care.—The
496agency shall purchase goods and services for Medicaid recipients
497in the most cost-effective manner consistent with the delivery
498of quality medical care. To ensure that medical services are
499effectively utilized, the agency may, in any case, require a
500confirmation or second physician’s opinion of the correct
501diagnosis for purposes of authorizing future services under the
502Medicaid program. This section does not restrict access to
503emergency services or poststabilization care services as defined
504in 42 C.F.R. s. 438.114. Such confirmation or second opinion
505shall be rendered in a manner approved by the agency. The agency
506shall maximize the use of prepaid per capita and prepaid
507aggregate fixed-sum basis services when appropriate and other
508alternative service delivery and reimbursement methodologies,
509including competitive bidding pursuant to s. 287.057, designed
510to facilitate the cost-effective purchase of a case-managed
511continuum of care. The agency shall also require providers to
512minimize the exposure of recipients to the need for acute
513inpatient, custodial, and other institutional care and the
514inappropriate or unnecessary use of high-cost services. The
515agency shall contract with a vendor to monitor and evaluate the
516clinical practice patterns of providers in order to identify
517trends that are outside the normal practice patterns of a
518provider’s professional peers or the national guidelines of a
519provider’s professional association. The vendor must be able to
520provide information and counseling to a provider whose practice
521patterns are outside the norms, in consultation with the agency,
522to improve patient care and reduce inappropriate utilization.
523The agency may mandate prior authorization, drug therapy
524management, or disease management participation for certain
525populations of Medicaid beneficiaries, certain drug classes, or
526particular drugs to prevent fraud, abuse, overuse, and possible
527dangerous drug interactions. The Pharmaceutical and Therapeutics
528Committee shall make recommendations to the agency on drugs for
529which prior authorization is required. The agency shall inform
530the Pharmaceutical and Therapeutics Committee of its decisions
531regarding drugs subject to prior authorization. The agency is
532authorized to limit the entities it contracts with or enrolls as
533Medicaid providers by developing a provider network through
534provider credentialing. The agency may competitively bid single
535source-provider contracts if procurement of goods or services
536results in demonstrated cost savings to the state without
537limiting access to care. The agency may limit its network based
538on the assessment of beneficiary access to care, provider
539availability, provider quality standards, time and distance
540standards for access to care, the cultural competence of the
541provider network, demographic characteristics of Medicaid
542beneficiaries, practice and provider-to-beneficiary standards,
543appointment wait times, beneficiary use of services, provider
544turnover, provider profiling, provider licensure history,
545previous program integrity investigations and findings, peer
546review, provider Medicaid policy and billing compliance records,
547clinical and medical record audits, and other factors. Providers
548are not entitled to enrollment in the Medicaid provider network.
549The agency shall determine instances in which allowing Medicaid
550beneficiaries to purchase durable medical equipment and other
551goods is less expensive to the Medicaid program than long-term
552rental of the equipment or goods. The agency may establish rules
553to facilitate purchases in lieu of long-term rentals in order to
554protect against fraud and abuse in the Medicaid program as
555defined in s. 409.913. The agency may seek federal waivers
556necessary to administer these policies.
557(5)(a) The agency shall implement a Medicaid prescribed
558drug spending-control program that includes the following
559components:
5601. A Medicaid preferred drug list and a Medicaid physician
561administered drug list. The preferred drug list[, which] shall be
562a listing of cost-effective therapeutic options recommended by
563the Medicaid Pharmacy and Therapeutics Committee established
564pursuant to s. 409.91195 and adopted by the agency for each
565therapeutic class on the preferred drug list. At the discretion
566of the committee, and when feasible, the preferred drug list
567should include at least two products in a therapeutic class. The
568physician-administereddrug list shall be a listing of
569physician-administered drugs covered by the state Medicaid
570program, based on the United States Food and Drug
571Administration’s approved indications and compendia in 42 U.S.C.
572s. 1396r-8(g)(1)(B). Within the preferred physician-administered
573drug list, there must be a section containing a list of
574preferred physician-administered drugs thatare cost-effective
575therapeutic options recommended by the Medicaid Pharmaceutical
576and Therapeutics Committee established pursuant to s.409.91195.
577The physician-administered drug list must be updated at least
578twice a year. The agency may post and update the preferred drug
579list and the preferred physician-administered drug [updates to]
580[the] list on the agency’s [an Internet] website without following
581the rulemaking procedures of chapter 120. Antiretroviral agents
582are excluded from the preferred drug list. The agency shall also
583limit the amount of a prescribed drug dispensed to no more than
584a 34-day supply unless the drug products’ smallest marketed
585package is greater than a 34-day supply, or the drug is
586determined by the agency to be a maintenance drug in which case
587a 100-day maximum supply may be authorized. The agency may seek
588any federal waivers necessary to implement these cost-control
589programs and to continue participation in the federal Medicaid
590rebate program, or alternatively to negotiate state-only
591manufacturer rebates. The agency may adopt rules to administer
592this subparagraph. The agency shall continue to provide
593unlimited contraceptive drugs and items. The agency must
594establish procedures to ensure that:
595a. There is a response to a request for prior authorization
596by telephone or other telecommunication device within 24 hours
597after receipt of a request for prior authorization; and
598b. A 72-hour supply of the drug prescribed is provided in
599an emergency or when the agency does not provide a response
600within 24 hours as required by sub-subparagraph a.
6012. A Medicaid preferred product list, which shall be a
602listing of cost-effective therapeutic supplies recommended by
603the Medicaid Pharmaceutical and Therapeutics Committee
604established pursuant to s. 409.91195 and adopted by the agency
605for each product class listed on the preferred product list and
606reimbursed by the state Medicaid program through the pharmacy
607point-of-sale. The agency may post the preferred product list
608and updates to the list on the agency’s website without
609following the rulemaking procedures of chapter 120.
6103.A list of high-cost drugs recommended by the Medicaid
611Pharmaceutical and Therapeutics Committee established pursuant
612to s. 409.91195 and adopted by the agency, for the purpose of
613coverage, reimbursement, or billing guidance. The agency may
614post the high-cost drug list and updates to the list on the
615agency’s website without following the rulemaking procedures of
616chapter 120. The agency must establish procedures to ensure
617that:
618a. There is a response to a request for prior authorization
619for a high-cost drug by telephone or other telecommunication
620device within 24 hours after receipt of the request for prior
621authorization; and
622b. A 72-hour supply of the high-cost drug prescribed is
623provided in an emergency or when the agency does not provide a
624response to a prior authorization request within 24 hours as
625required by sub-subparagraph a.
6264. A provider of prescribed drugs is reimbursed in an
627amount not to exceed the lesser of the actual acquisition cost
628based on the Centers for Medicare and Medicaid Services National
629Average Drug Acquisition Cost pricing files plus a professional
630dispensing fee, the wholesale acquisition cost plus a
631professional dispensing fee, the state maximum allowable cost
632plus a professional dispensing fee, or the usual and customary
633charge billed by the provider.
6345.A hospital facility administering long-acting
635injectables for severe mental illness shall be reimbursed
636separately from the diagnosis-related group. Long-acting
637injectables administered for severe mental illness in a hospital
638facility setting shall be reimbursed at no less than the actual
639acquisition cost of the drug.
6406.The agency shall contract with a vendor to perform a
641detailed fiscal impact study to evaluate the 340B Drug Pricing
642Program administered by the Health Resources and Services
643Administration. The study must evaluate 340B compliance, 340B
644drug purchases, and reimbursement methodologies within the fee
645for-service program and Statewide Medicaid Managed Care program.
646Statewide Medicaid Managed Care plans, pharmacy benefit
647managers, and Medicaid providers shall submit to the agency all
648data necessary for the completion of the study, including, but
649not limited to, information related to drug purchasing,
650reimbursement, billing and coding, and dispensing. Noncompliance
651with the 340B data submission requirements of this subparagraph
652may result in sanctions from the agency or the Board of
653Pharmacy, as applicable. The agency shall submit the results of
654the study to the Governor, the President of the Senate, and the
655Speaker of the House of Representatives by June 30, 2027.
6567.[3.] The agency shall develop and implement a process for
657managing the drug therapies of Medicaid recipients who are using
658significant numbers of prescribed drugs each month. The
659management process may include, but is not limited to,
660comprehensive, physician-directed medical-record reviews, claims
661analyses, and case evaluations to determine the medical
662necessity and appropriateness of a patient’s treatment plan and
663drug therapies. The agency may contract with a private
664organization to provide drug-program-management services. The
665Medicaid drug benefit management program shall include
666initiatives to manage drug therapies for HIV/AIDS patients,
667patients using 20 or more unique prescriptions in a 180-day
668period, and the top 1,000 patients in annual spending. The
669agency shall enroll any Medicaid recipient in the drug benefit
670management program if he or she meets the specifications of this
671provision and is not enrolled in a Medicaid health maintenance
672organization.
6738.[4.] The agency may limit the size of its pharmacy network
674based on need, competitive bidding, price negotiations,
675credentialing, or similar criteria. The agency shall give
676special consideration to rural areas in determining the size and
677location of pharmacies included in the Medicaid pharmacy
678network. A pharmacy credentialing process may include criteria
679such as a pharmacy’s full-service status, location, size,
680patient educational programs, patient consultation, disease
681management services, and other characteristics. The agency may
682impose a moratorium on Medicaid pharmacy enrollment if it is
683determined that it has a sufficient number of Medicaid
684participating providers. The agency must allow dispensing
685practitioners to participate as a part of the Medicaid pharmacy
686network regardless of the practitioner’s proximity to any other
687entity that is dispensing prescription drugs under the Medicaid
688program. A dispensing practitioner must meet all credentialing
689requirements applicable to his or her practice, as determined by
690the agency.
6919.[5.] The agency shall develop and implement a program that
692requires Medicaid practitioners who issue written prescriptions
693for medicinal drugs to use a counterfeit-proof prescription pad
694for Medicaid prescriptions. The agency shall require the use of
695standardized counterfeit-proof prescription pads by prescribers
696who issue written prescriptions for Medicaid recipients. The
697agency may implement the program in targeted geographic areas or
698statewide.
69910.[6.] The agency may enter into arrangements that require
700manufacturers of generic drugs prescribed to Medicaid recipients
701to provide rebates of at least 15.1 percent of the average
702manufacturer price for the manufacturer’s generic products.
703These arrangements shall require that if a generic-drug
704manufacturer pays federal rebates for Medicaid-reimbursed drugs
705at a level below 15.1 percent, the manufacturer must provide a
706supplemental rebate to the state in an amount necessary to
707achieve a 15.1-percent rebate level.
70811.[7.] The agency may establish a preferred drug list as
709described in this subsection, and, pursuant to the establishment
710of such preferred drug list, negotiate supplemental rebates from
711manufacturers that are in addition to those required by Title
712XIX of the Social Security Act and at no less than 14 percent of
713the average manufacturer price as defined in 42 U.S.C. s. 1936
714on the last day of a quarter unless the federal or supplemental
715rebate, or both, equals or exceeds 29 percent. There is no upper
716limit on the supplemental rebates the agency may negotiate. The
717agency may determine that specific products, brand-name or
718generic, are competitive at lower rebate percentages. Agreement
719to pay the minimum supplemental rebate percentage guarantees a
720manufacturer that the Medicaid Pharmaceutical and Therapeutics
721Committee will consider a product for inclusion on the preferred
722drug list. However, a pharmaceutical manufacturer is not
723guaranteed placement on the preferred drug list by simply paying
724the minimum supplemental rebate. Agency decisions will be made
725on the clinical efficacy of a drug and recommendations of the
726Medicaid Pharmaceutical and Therapeutics Committee, as well as
727the price of competing products minus federal and state rebates.
728The agency may contract with an outside agency or contractor to
729conduct negotiations for supplemental rebates. For the purposes
730of this section, the term “supplemental rebates” means cash
731rebates. Value-added programs as a substitution for supplemental
732rebates are prohibited. The agency may seek any federal waivers
733to implement this initiative.
73412.a.[8.a.] The agency may implement a Medicaid behavioral
735drug management system. The agency may contract with a vendor
736that has experience in operating behavioral drug management
737systems to implement this program. The agency may seek federal
738waivers to implement this program.
739b. The agency, in conjunction with the Department of
740Children and Families, may implement the Medicaid behavioral
741drug management system that is designed to improve the quality
742of care and behavioral health prescribing practices based on
743best practice guidelines, improve patient adherence to
744medication plans, reduce clinical risk, and lower prescribed
745drug costs and the rate of inappropriate spending on Medicaid
746behavioral drugs. The program may include the following
747elements:
748(I) Provide for the development and adoption of best
749practice guidelines for behavioral health-related drugs such as
750antipsychotics, antidepressants, and medications for treating
751bipolar disorders and other behavioral conditions; translate
752them into practice; review behavioral health prescribers and
753compare their prescribing patterns to a number of indicators
754that are based on national standards; and determine deviations
755from best practice guidelines.
756(II) Implement processes for providing feedback to and
757educating prescribers using best practice educational materials
758and peer-to-peer consultation.
759(III) Assess Medicaid beneficiaries who are outliers in
760their use of behavioral health drugs with regard to the numbers
761and types of drugs taken, drug dosages, combination drug
762therapies, and other indicators of improper use of behavioral
763health drugs.
764(IV) Alert prescribers to patients who fail to refill
765prescriptions in a timely fashion, are prescribed multiple same
766class behavioral health drugs, and may have other potential
767medication problems.
768(V) Track spending trends for behavioral health drugs and
769deviation from best practice guidelines.
770(VI) Use educational and technological approaches to
771promote best practices, educate consumers, and train prescribers
772in 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
776quality-based medication component for severely mentally ill
777individuals and emotionally disturbed children who are high
778users of care.
77913.[9.] The agency shall implement a Medicaid prescription
780drug management system.
781a. The agency may contract with a vendor that has
782experience in operating prescription drug management systems in
783order to implement this system. Any management system that is
784implemented in accordance with this subparagraph must rely on
785cooperation between physicians and pharmacists to determine
786appropriate practice patterns and clinical guidelines to improve
787the prescribing, dispensing, and use of drugs in the Medicaid
788program. The agency may seek federal waivers to implement this
789program.
790b. The drug management system must be designed to improve
791the quality of care and prescribing practices based on best
792practice guidelines, improve patient adherence to medication
793plans, reduce clinical risk, and lower prescribed drug costs and
794the rate of inappropriate spending on Medicaid prescription
795drugs. The program must:
796(I) Provide for the adoption of best practice guidelines
797for the prescribing and use of drugs in the Medicaid program,
798including translating best practice guidelines into practice;
799reviewing prescriber patterns and comparing them to indicators
800that are based on national standards and practice patterns of
801clinical peers in their community, statewide, and nationally;
802and determine deviations from best practice guidelines.
803(II) Implement processes for providing feedback to and
804educating prescribers using best practice educational materials
805and peer-to-peer consultation.
806(III) Assess Medicaid recipients who are outliers in their
807use of a single or multiple prescription drugs with regard to
808the numbers and types of drugs taken, drug dosages, combination
809drug therapies, and other indicators of improper use of
810prescription drugs.
811(IV) Alert prescribers to recipients who fail to refill
812prescriptions in a timely fashion, are prescribed multiple drugs
813that may be redundant or contraindicated, or may have other
814potential medication problems.
81514.[10.] The agency may contract for drug rebate
816administration, including, but not limited to, calculating
817rebate amounts, invoicing manufacturers, negotiating disputes
818with manufacturers, and maintaining a database of rebate
819collections.
82015.[11.] The agency may specify the preferred daily dosing
821form or strength for the purpose of promoting best practices
822with regard to the prescribing of certain drugs as specified in
823the General Appropriations Act and ensuring cost-effective
824prescribing practices.
82516.[12.] The agency may require prior authorization for
826Medicaid-covered prescribed drugs. The agency may prior
827authorize the use of a product:
828a. For an indication not approved in labeling;
829b. To comply with certain clinical guidelines; or
830c. If the product has the potential for overuse, misuse, or
831abuse.
832
833The agency may require the prescribing professional to provide
834information about the rationale and supporting medical evidence
835for the use of a drug. The agency shall post prior
836authorization, step-edit criteria and protocol, and updates to
837the list of drugs that are subject to prior authorization on the
838agency’s [Internet] website within 21 days after the prior
839authorization and step-edit criteria and protocol and updates
840are approved by the agency. For purposes of this subparagraph,
841the term “step-edit” means an automatic electronic review of
842certain medications subject to prior authorization.
84317.[13.] The agency, in conjunction with the Pharmaceutical
844and Therapeutics Committee, may require age-related prior
845authorizations for certain prescribed drugs. The agency may
846preauthorize the use of a drug for a recipient who may not meet
847the age requirement or may exceed the length of therapy for use
848of this product as recommended by the manufacturer and approved
849by the Food and Drug Administration. Prior authorization may
850require the prescribing professional to provide information
851about the rationale and supporting medical evidence for the use
852of a drug.
85318.[14.] The agency shall implement a step-therapy prior
854authorization approval process for medications excluded from the
855preferred drug list. Medications listed on the preferred drug
856list must be used within the previous 12 months before the
857alternative medications that are not listed. The step-therapy
858prior authorization may require the prescriber to use the
859medications of a similar drug class or for a similar medical
860indication unless contraindicated in the Food and Drug
861Administration labeling. The trial period between the specified
862steps may vary according to the medical indication. The step
863therapy approval process shall be developed in accordance with
864the committee as stated in s. 409.91195(7) and (8). A drug
865product may be approved without meeting the step-therapy prior
866authorization criteria if the prescribing physician provides the
867agency with additional written medical or clinical documentation
868that the product is medically necessary because:
869a. There is not a drug on the preferred drug list to treat
870the disease or medical condition which is an acceptable clinical
871alternative;
872b. The alternatives have been ineffective in the treatment
873of the beneficiary’s disease;
874c. The drug product or medication of a similar drug class
875is prescribed for the treatment of schizophrenia or schizotypal
876or delusional disorders; prior authorization has been granted
877previously for the prescribed drug; and the medication was
878dispensed to the patient during the previous 12 months; or
879d. Based on historical evidence and known characteristics
880of the patient and the drug, the drug is likely to be
881ineffective, or the number of doses have been ineffective.
882
883The agency shall work with the physician to determine the best
884alternative for the patient. The agency may adopt rules waiving
885the requirements for written clinical documentation for specific
886drugs in limited clinical situations.
88719.[15.] The agency shall implement a return and reuse
888program for drugs dispensed by pharmacies to institutional
889recipients, which includes payment of a $5 restocking fee for
890the implementation and operation of the program. The return and
891reuse program shall be implemented electronically and in a
892manner that promotes efficiency. The program must permit a
893pharmacy to exclude drugs from the program if it is not
894practical or cost-effective for the drug to be included and must
895provide for the return to inventory of drugs that cannot be
896credited or returned in a cost-effective manner. The agency
897shall determine if the program has reduced the amount of
898Medicaid prescription drugs which are destroyed on an annual
899basis and if there are additional ways to ensure more
900prescription drugs are not destroyed which could safely be
901reused.
902(14) Neither this section nor this chapter prevents the
903agency from conducting retrospective reviews, investigations,
904analyses, audits, or any combination thereof to determine
905possible fraud, abuse, overpayment, or recipient neglect in the
906state Medicaid program pursuant to s. 409.913, including, but
907not limited to, reviews in which the services were the subject
908of a utilization review or prior authorization process.
909Section 7. Paragraph (e) of subsection (1) and subsections
910(2) and (6) of section 409.913, Florida Statutes, are amended to
911read:
912409.913 Oversight of the integrity of the Medicaid
913program.—The agency shall operate a program to oversee the
914activities of Florida Medicaid recipients, and providers and
915their representatives, to ensure that fraudulent and abusive
916behavior and neglect of recipients occur to the minimum extent
917possible, and to recover overpayments and impose sanctions as
918appropriate. Each January 15, the agency and the Medicaid Fraud
919Control Unit of the Department of Legal Affairs shall submit a
920report to the Legislature documenting the effectiveness of the
921state’s efforts to control Medicaid fraud and abuse and to
922recover Medicaid overpayments during the previous fiscal year.
923The report must describe the number of cases opened and
924investigated each year; the sources of the cases opened; the
925disposition of the cases closed each year; the amount of
926overpayments alleged in preliminary and final audit letters; the
927number and amount of fines or penalties imposed; any reductions
928in overpayment amounts negotiated in settlement agreements or by
929other means; the amount of final agency determinations of
930overpayments; the amount deducted from federal claiming as a
931result of overpayments; the amount of overpayments recovered
932each year; the amount of cost of investigation recovered each
933year; the average length of time to collect from the time the
934case was opened until the overpayment is paid in full; the
935amount determined as uncollectible and the portion of the
936uncollectible amount subsequently reclaimed from the Federal
937Government; the number of providers, by type, that are
938terminated from participation in the Medicaid program as a
939result of fraud and abuse; and all costs associated with
940discovering and prosecuting cases of Medicaid overpayments and
941making recoveries in such cases. The report must also document
942actions taken to prevent overpayments and the number of
943providers prevented from enrolling in or reenrolling in the
944Medicaid program as a result of documented Medicaid fraud and
945abuse and must include policy recommendations necessary to
946prevent or recover overpayments and changes necessary to prevent
947and detect Medicaid fraud. All policy recommendations in the
948report must include a detailed fiscal analysis, including, but
949not limited to, implementation costs, estimated savings to the
950Medicaid program, and the return on investment. The agency must
951submit the policy recommendations and fiscal analyses in the
952report to the appropriate estimating conference, pursuant to s.
953216.137, by February 15 of each year. The agency and the
954Medicaid Fraud Control Unit of the Department of Legal Affairs
955each must include detailed unit-specific performance standards,
956benchmarks, and metrics in the report, including projected cost
957savings to the state Medicaid program during the following
958fiscal year.
959(1) For the purposes of this section, the term:
960(e) “Overpayment” includes any amount that is not
961authorized to be paid by the Medicaid program or that should not
962have been paid, including payments made [whether paid] as a result
963of inaccurate or improper cost reporting, improper claiming,
964unacceptable practices, fraud, abuse, or mistake, and may
965include amounts paid for goods or services that were the subject
966of a utilization review or prior authorization process.
967(2) The agency shall conduct, or cause to be conducted by
968contract or otherwise, reviews, investigations, analyses,
969audits, or any combination thereof, to determine possible fraud,
970abuse, overpayment, or recipient neglect in the Medicaid program
971and shall report the findings of any overpayments in audit
972reports as appropriate. An overpayment determination may be
973based upon retrospective reviews, investigations, analyses,
974audits, or any combination thereof to determine possible fraud,
975abuse, overpayment, or recipient neglect in the Medicaid
976program, regardless of whether a prior authorization was issued.
977At least 5 percent of all audits shall be conducted on a random
978basis. As part of its ongoing fraud detection activities, the
979agency shall identify and monitor, by contract or otherwise,
980patterns of overutilization of Medicaid services based on state
981averages. The agency shall track Medicaid provider prescription
982and billing patterns and evaluate them against Medicaid medical
983necessity criteria and coverage and limitation guidelines
984adopted by rule. Medical necessity determination requires that
985service be consistent with symptoms or confirmed diagnosis of
986illness or injury under treatment and not in excess of the
987patient’s needs. The agency shall conduct reviews of provider
988exceptions to peer group norms and shall, using statistical
989methodologies, provider profiling, and analysis of billing
990patterns, detect and investigate abnormal or unusual increases
991in billing or payment of claims for Medicaid services and
992medically unnecessary provision of services.
993(6) Any notice required to be given to a provider under
994this section is presumed to be sufficient notice if sent to the
995mailing address last shown on the provider enrollment file. It
996is the responsibility of the provider to furnish and keep the
997agency informed of the provider’s current mailing and service
998addresses [address]. United States Postal Service or other common
999carrier’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  414.321Food 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  414.332Food 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.