H 5301

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1
2An act relating to health care; amending s. 381.4015,
3F.S.; providing that a specified loan program
4administered by the Department of Health is subject to
5appropriation; amending s. 383.14, F.S.; providing
6that, beginning on a specified date, the department
7must require newborns to be screened for infantile
8Krabbe disease and metachromatic leukodystrophy;
9creating s. 383.1401, F.S.; authorizing the department
10to create an educational pamphlet on the nutritional
11needs of preterm infants; requiring the department to
12provide the pamphlet electronically by a specified
13date; providing requirements for such pamphlet;
14amending s. 393.066, F.S.; requiring the Agency for
15Persons with Disabilities to reimburse certain
16providers using monthly and hourly rates for certain
17recipients; amending s. 395.4025, F.S.; providing
18requirements for specified designation of certain
19specialty licensed children's hospitals; amending s.
20395.902, F.S.; removing a specified allocation for
21specified positions at behavioral health teaching
22hospitals; amending s. 395.903, F.S.; revising uses
23for certain grant funding for behavioral health
24teaching hospitals; amending s. 409.145, F.S.;
25revising the monthly room and board rates the
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26department is required to pay to certain foster
27parents and caregivers; amending s. 409.1455, F.S.;
28renaming the Step into Success Workforce Education and
29Internship Pilot Program as the Step into Success
30Workforce Education and Internship Program; removing a
31provision limiting the duration of the program;
32requiring the Office of Continuing Care within the
33Department of Children and Families to develop certain
34cohorts within specified regions, to collaborate with
35certain organizations to recruit mentors and
36organizations, and to provide eligible former foster
37youth with internship placement opportunities;
38removing a provision requiring that the program be
39administered in a certain manner; requiring the office
40to develop trauma-informed training for mentors of
41certain former foster youth; providing requirements
42for the training; authorizing the office to provide
43certain additional trainings on mentorship of special
44populations; revising the amount of monthly financial
45assistance that the office provides to participating
46former foster youth; requiring the office to assign
47experienced staff to serve as program liaisons for a
48specified purpose; revising qualifications to serve as
49a mentor; authorizing the department to offer certain
50training to mentors; authorizing an employee who
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51serves as a mentor to participate in certain
52additional trainings; removing a provision authorizing
53the offset of a reduction in or loss of certain
54benefits due to receipt of a Step into Success stipend
55by an additional stipend payment; creating s.
56409.1475, F.S.; providing legislative findings and
57intent; creating the Foster and Family Support Grant
58Program within the department; requiring the
59department to award grants to not-for-profit, faith-
60based organizations for specified purposes; requiring
61that the program emphasize certain support; specifying
62authorized uses for awarded grant funds; requiring
63grant recipients to submit reports to the department
64in a format and at intervals prescribed by the
65department; authorizing the department to adopt rules;
66amending s. 409.908, F.S.; revising specified rate
67setting parameters for a specified reimbursement
68payment methodology; amending s. 409.909, F.S.;
69revising and providing allocation requirements for the
70Slots for Doctors Program; defining the term "Medicaid
71payments"; amending s. 409.91195, F.S.; revising the
72purpose of the Medicaid Pharmaceutical and
73Therapeutics Committee to include creation of a
74Medicaid preferred product list; requiring the Agency
75for Health Care Administration to adopt such list upon
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76recommendation of the committee; specifying the
77frequency with which the committee must review such
78list for certain recommendations; specifying
79parameters for such recommendations; providing that
80reimbursement for products not included on such list
81is subject to prior authorization; requiring the
82agency to publish and disseminate such list to all
83Medicaid providers in the state by posting on the
84agency's website or in other media; providing
85requirements for public testimony relating to proposed
86inclusions on or exclusions from such list; amending
87s. 409.912, F.S.; revising Medicaid preferred drug
88coverage guidelines; requiring the agency to implement
89a Medicaid therapeutic supplies spending-control
90program; authorizing the agency to negotiate with
91manufacturers for rebates and participate in
92multistate organizations negotiating for such rebates;
93requiring the agency to establish a preferred product
94list; providing requirements for such list; exempting
95the agency from the rulemaking procedures of ch. 120,
96F.S., when publishing such lists and updates; creating
97s. 409.9207, F.S.; providing legislative intent;
98providing definitions; creating the Eligibility
99Assistance Program within the department; providing
100program requirements; requiring the department to be
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101operated by an independent contractor that shall be
102selected based on specified criteria; amending s.
103409.967, F.S.; revising the maximum term for Medicaid
104managed care contracts; requiring the agency to
105establish by contract a quality withhold incentive for
106certain purposes; providing requirements for such
107incentive; amending s. 409.968, F.S.; providing
108adjustment requirements for specified payments made to
109managed care plans; amending s. 409.982, F.S.;
110authorizing the agency to establish a provider
111reimbursement fee schedule for certain purposes;
112amending s. 409.9855, F.S.; providing waiver transfer
113funding requirements for specified individuals;
114amending s. 409.986, F.S.; defining the term
115"qualified provider"; amending s. 409.990, F.S.;
116revising the amount of documented unexpended state
117funds a lead agency may carry forward; amending s.
118409.996, F.S.; authorizing the department to establish
119a standard statewide provider contract for certain
120purposes; providing contract requirements; requiring
121the department to publish such contract on its
122website; authorizing lead agencies to establish
123additional contract terms under certain circumstances;
124amending s. 414.56, F.S.; conforming a provision to
125changes made by the act; reenacting ss. 409.978(2) and
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126409.9855(1)(b), F.S., relating to the long-term care
127managed care program and the pilot program for
128individuals with developmental disabilities,
129respectively; amending ss. 409.91196 and 393.065,
130F.S.; conforming cross-references; providing effective
131dates.
132
133    Be It Enacted by the Legislature of the State of Florida:
134
135Section 1.  Subsection (7) of section 381.4015, Florida
136    Statutes, is amended to read:
137381.4015  Florida health care innovation.—
138(7)      REVOLVING LOAN PROGRAM.—The department shall, subject
139    to appropriation, administer a revolving loan program for
140    applicants seeking to implement innovative solutions in this
141    state.
142(a)      Administration.—The council may make recommendations
143    to the department for the administration of the loans. The
144    department shall adopt rules:
1451.      Establishing an application process to submit and
146    review funding proposals for loans. Such rules must also include
147    the process for the council to review applications to ensure
148    compliance with applicable laws, including those related to
149    discrimination and conflicts of interest. If a council member
150    participated in the vote of the council recommending an award
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151    for a proposal with which the council member has a conflict of
152    interest, the division may not award the loan to that entity.
1532.      Establishing eligibility criteria to be applied by the
154    council in recommending applications for the award of loans
155    which:
156a.      Incorporate the recommendations of the council. The
157    council shall recommend to the department criteria based upon
158    input received and the focus areas developed. The council may
159    recommend updated criteria as necessary, based upon the most
160    recent input, best practice recommendations, or focus areas
161    list.
162b.      Determine which proposals are likely to provide the
163    greatest return to the state if funded, taking into
164    consideration, at a minimum, the degree to which the proposal
165    would increase efficiency in the health care system in this
166    state, reduce strain on the state's health care workforce,
167    improve patient outcomes, increase public access to health care
168    in this state, or provide cost savings to patients or the state
169    without reducing the quality of patient care.
1703.      It deems necessary to administer the program,
171    including, but not limited to, rules for application
172    requirements, the ability of the applicant to properly
173    administer funds, the professional excellence of the applicant,
174    the fiscal stability of the applicant, the state or regional
175    impact of the proposal, matching requirements for the proposal,
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176    and other requirements to further the purposes of the program.
177(b)      Eligibility.—
1781.      The following entities may apply for a revolving loan:
179a.      Entities licensed, registered, or certified by the
180    Agency for Health Care Administration as provided under s.
181    408.802, except for those specified in s. 408.802(1), (3), (13),
182    (23), or (25).
183b.      An education or clinical training provider in
184    partnership with an entity under sub-subparagraph a.
1852.a.        Council members may not receive loans under the
186    program.
187b.      An entity that has a conflict-of-interest relationship
188    with a council member as described in sub-subparagraph
189    (3)(c)1.b. or sub-subparagraph (3)(c)1.c. may not receive a loan
190    under the program unless that council member recused himself or
191    herself from consideration of the entity's application.
1923.      Priority must be given to applicants located in a rural
193    or medically underserved area as designated by the department
194    which are:
195a.      Rural hospitals as defined in s. 395.602(2).
196b.      Nonprofit entities that accept Medicaid patients.
1974.      The department may award a loan for up to 50 percent of
198    the total projected implementation costs, or up to 80 percent of
199    total projected implementation costs for an applicant under
200    subparagraph 3. The applicant must demonstrate the source of
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201    funding it will use to cover the remainder of the total
202    projected implementation costs, which funding must be from
203    nonstate sources.
204(c)      Applications.—
2051.      The department shall set application periods to apply
206    for loans. The department may set multiple application periods
207    in a fiscal year, with up to four periods per year. The
208    department shall coordinate with the council when establishing
209    application periods to establish separate priority, in addition
210    to eligibility, within the loan applications for defined
211    categories based on the current focus area list. The department
212    shall publicize the availability of loans under the program to
213    stakeholders, education or training providers, and others.
2142.      Upon receipt of an application, the department shall
215    determine whether the application is complete and the applicant
216    has demonstrated the ability to repay the loan. Within 30 days
217    after the close of the application period, the department shall
218    forward all completed applications to the council for
219    consideration.
2203.      The council shall review applications for loans under
221    the criteria and pursuant to the processes and format adopted by
222    the department. The council shall submit to the department for
223    approval lists of applicants that it recommends for funding,
224    arranged in order of priority and as required for the
225    application period.
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2264.      A loan applicant must demonstrate plans to use the
227    funds to implement one or more innovative technologies,
228    workforce pathways, service delivery models, or other solutions
229    in order to fill a demonstrated need; obtain or upgrade
230    necessary equipment, hardware, and materials; adopt new
231    technologies or systems; or a combination thereof which will
232    improve the quality and delivery of health care in measurable
233    and sustainable ways and which will lower costs and allow
234    savings to be passed on to health care consumers.
235(d)      Awards.—
2361.      The amount of each loan must be based upon demonstrated
237    need and availability of funds. The department may not award
238    more than 10 percent of the total allocated funds for the fiscal
239    year to a single loan applicant.
2402.      The interest rate for each loan may not exceed 1
241    percent.
2423.      The term of each loan is up to 10 years.
2434.      In order to equitably distribute limited state funding,
244    applicants may apply for and be awarded only one loan per fiscal
245    year. If a loan recipient has one or more outstanding loans at
246    any time, the recipient may apply for funding for a new loan if
247    the current loans are in good standing.
248(e)      Written agreement.—
2491.      Each loan recipient must enter into a written agreement
250    with the department to receive the loan. At a minimum, the
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251    agreement with the applicant must specify all of the following:
252a.      The total amount of the award.
253b.      The performance conditions that must be met, based upon
254    the submitted proposal and the defined category or focus area,
255    as applicable.
256c.      The information to be reported on actual implementation
257    costs, including the share from nonstate resources.
258d.      The schedule for payment.
259e.      The data and progress reporting requirements and
260    schedule.
261f.      Any sanctions that would apply for failure to meet
262    performance conditions.
2632.      The department shall develop uniform data reporting
264    requirements for loan recipients to evaluate the performance of
265    the implemented proposals. Such data must be shared with the
266    council.
2673.      If requested, the department shall provide technical
268    assistance to loan recipients under the program.
269(f)      Loan repayment.—Loans become due and payable in
270    accordance with the terms of the written agreement. All
271    repayments of principal received by the department in a fiscal
272    year shall be returned to the revolving loan fund and made
273    available for loans to other applicants.
274(g)      Revolving loan fund.—The department shall create and
275    maintain a separate account in the Grants and Donations Trust
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276    Fund within the department as a fund for the program. All
277    repayments of principal must be returned to the revolving loan
278    fund and made available as provided in this section.
279    Notwithstanding s. 216.301, funds appropriated for the revolving
280    loan program are not subject to reversion. The department may
281    contract with a third-party administrator to administer the
282    program, including loan servicing, and manage the revolving loan
283    fund. A contract for a third-party administrator which includes
284    management of the revolving loan fund must, at a minimum,
285    require maintenance of the revolving loan fund to ensure that
286    the program may operate in a revolving manner.
287Section 2.  Paragraph (a) of subsection (2) of section
288    383.14, Florida Statutes, is amended to read:
289383.14       Screening for metabolic disorders, other hereditary
290    and congenital disorders, and environmental risk factors.—
291(2)      RULES.—
292(a)      After consultation with the Genetics and Newborn
293    Screening Advisory Council, the department shall adopt and
294    enforce rules requiring that every newborn in this state shall:
2951.      Before becoming 1 week of age, have a blood specimen
296    collected for newborn screenings;
2972.      Be tested for any condition included on the federal
298    Recommended Uniform Screening Panel which the council advises
299    the department should be included under the state's screening
300    program. After the council recommends that a condition be
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301    included, the department shall submit a legislative budget
302    request to seek an appropriation to add testing of the condition
303    to the newborn screening program. The department shall expand
304    statewide screening of newborns to include screening for such
305    conditions within 18 months after the council renders such
306    advice, if a test approved by the United States Food and Drug
307    Administration or a test offered by an alternative vendor is
308    available. If such a test is not available within 18 months
309    after the council makes its recommendation, the department shall
310    implement such screening as soon as a test offered by the United
311    States Food and Drug Administration or by an alternative vendor
312    is available;
3133.      At the appropriate age, be tested for such other
314    metabolic diseases and hereditary or congenital disorders as the
315    department may deem necessary; and
3164.      Subject to legislative appropriation, Beginning January
317    1, 2027, be screened for all of the following:
318a.      Duchenne muscular dystrophy.
319b.      Infantile Krabbe disease.
320c.      Metachromatic leukodystrophy.
321Section 3.  Section 383.1401, Florida Statutes, is created
322    to read:
323383.1401  Neonatal Nutrition.—The Department of Health
324    shall create an evidence-based, educational pamphlet on the
325    nutritional needs of preterm infants. By January 1, 2027, the
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326    department shall make the pamphlet available electronically to
327    hospitals licensed under chapter 395 to provide neonatal
328    intensive care services. Such hospitals may provide the pamphlet
329    to parents and guardians of infants receiving care in a neonatal
330    intensive care unit. The pamphlet must include, but need not be
331    limited to, information on preterm infants relating to all of
332    the following:
333(1)     The specific nutritional needs of preterm infants;
334(2)     The health risks associated with nutritional deficits
335    and the potential need for nutritional supplementation;
336(3)     Different nutritional sources for infants, including
337    maternal breast milk, pasteurized human donor milk, infant
338    formula, human-milk-derived fortifiers, and bovine-milk-derived
339    fortifiers, and the recommended uses for each type of
340    nutritional source;
341(4)     The importance of maternal breast milk for meeting the
342    nutritional and developmental needs of infants, and the
343    alternative of pasteurized human donor milk if maternal breast
344    milk is not available;
345(5)     The importance of having a physician discuss with
346    family members the risks and benefits of all nutritional sources
347    available, based on the preterm infant's individual situation;
348    and
349(6)     Necrotizing enterocolitis, the risk factors for
350    necrotizing enterocolitis, and the potential for a human-milk-
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351    based diet, including maternal and pasteurized donor breast
352    milk, to reduce the risk of necrotizing enterocolitis.
353Section 4.  Subsection (9) of section 393.066, Florida
354    Statutes, is renumbered as subsection (10), and a new subsection
355    (9) is added to that section to read:
356393.066       Community services and treatment.—
357(9)     The agency shall utilize a monthly reimbursement rate,
358    developed by the Agency for Health Care Administration in
359    consultation with the agency, for Life Skills Development Level
360    3 and Level 4 services. The monthly reimbursement rate shall
361    apply to services for clients who receive at least 80 hours of
362    such services during a calendar month. For clients who receive
363    less than 80 hours of services during a calendar month,
364    providers shall be reimbursed using an hourly reimbursement
365    rate.
366Section 5.  Paragraph (g) of subsection (16) of section
367    395.4025, Florida Statutes, is redesignated as paragraph (h),
368    and a new paragraph (g) is added to that subsection to read:
369395.4025  Trauma centers; selection; quality assurance;
370    records.—
371(16)
372(g)     Notwithstanding the statutory capacity limits
373    established in s. 395.402(1), the provisions of subsection (8),
374    or any other provision of this part, specialty licensed
375    children's hospitals licensed by the agency shall be designated
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376    by the department as a Level I or Level II pediatric trauma
377    center based on documentation of a valid certification of trauma
378    center verification by the American College of Surgeons.
379Section 6.  Subsection (6) of section 395.902, Florida
380    Statutes, is amended to read:
381395.902       Behavioral health teaching hospitals.—
382(6)     Upon designating a behavioral health teaching hospital
383    under this section, the agency shall award the hospital funds as
384    follows:
385(a)     For up to 10 resident positions through the Slots for
386    Doctors Program established in s. 409.909. Notwithstanding that
387    section, the agency shall allocate $150,000 for each such
388    position.
389(b)     Through the Training, Education, and Clinicals in
390    Health Funding Program established in s. 409.91256 to offset a
391    portion of the costs of maintaining integrated workforce
392    development programs.
393Section 7.  Section 395.903, Florida Statutes, is amended
394    to read:
395395.903       Behavioral Health Teaching Hospital grant
396    program.—
397(1)     There is established within the agency a grant program
398    for the purpose of funding designated behavioral health teaching
399    hospitals, subject to legislative appropriation. Grant funding
400    may be used for operational expenses for the delivery of
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401    comprehensive wrap-around rehabilitative services for behavioral
402    health patients operations and expenses and for fixed capital
403    outlay expenses that are directly related to the provision of
404    behavioral health services by the behavioral health teaching
405    hospital or its subcontracted behavioral health care provider,
406    including, but not limited to:,
407(a)     Facility renovation and upgrades, as necessary, to:
4081.      Establish new beds for patients requiring behavioral
409    health services; or
4102.      Enhance a facility's treatment environment specific to
411    the provision of behavioral health services.
412(b)      Establishing new or increasing the capacity of
413    existing behavioral health services provided by the behavioral
414    health teaching hospital or its subcontracted behavioral health
415    care provider; and
416(c)      Creating and maintaining an integrated workforce
417    development program pursuant to s. 395.902(2)(d).
418(2)(a)1.  For the 2024-2025 fiscal year, the agency shall
419    hold a 30-day, open application period beginning November 1,
420    2024, to accept applications from the behavioral health teaching
421    hospitals designated under s. 395.902(4), in a manner determined
422    by the agency. Applicants must include a detailed spending plan
423    with the application.
424(b)2.       For the 2025-2026 and 2026-2027 fiscal years, the
425    agency shall hold a 30-day, open application period beginning
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426    October 1 of each year to accept applications from behavioral
427    health teaching hospitals designated under s. 395.902, in a
428    manner determined by the agency. Applicants must include a
429    detailed spending plan with the application. On or before
430    January 1, 2025, and January 1, 2026, hospitals desiring to
431    apply for designation in the next fiscal year shall submit
432    letters of intent to the agency.
433(3)(b)       The agency, in consultation with the department,
434    shall evaluate and rank grant applications based on compliance
435    with s. 395.902(2) and the quality of the plan submitted under
436    s. 395.902(2)(e) or plan implementation, as applicable, related
437    to achieving the purposes of the behavioral health teaching
438    hospital program. The agency, in consultation with the
439    department, shall make recommendations for grant awards and
440    distribution of available funding for such awards. The agency
441    shall submit the evaluation and grant award recommendations to
442    the President of the Senate and the Speaker of the House of
443    Representatives within 90 days after the open application period
444    closes.
445(4)(c)       Notwithstanding ss. 216.181 and 216.292, the agency
446    may submit budget amendments, subject to the notice, review, and
447    objection procedures under s. 216.177, requesting the release of
448    the funds to make awards. The agency is authorized to submit
449    budget amendments relating to expenses under this subsection
450    under the grant program only within the 90 days after the open
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451    application period closes.
452(5)(2)       Notwithstanding s. 216.301 and pursuant to s.
453    216.351, the balance of any appropriation from the General
454    Revenue Fund for the program which is not disbursed but which is
455    obligated pursuant to contract or committed to be expended by
456    June 30 of the fiscal year for which the funds are appropriated
457    may be carried forward for up to 8 years after the effective
458    date of the original appropriation.
459(6)(3)       The agency may adopt rules necessary to implement
460    this section.
461Section 8.  Subsection (3) of section 409.145, Florida
462    Statutes, is amended to read:
463409.145       Care of children; "reasonable and prudent parent"
464    standard.—The child welfare system of the department shall
465    operate as a coordinated community-based system of care which
466    empowers all caregivers for children in foster care to provide
467    quality parenting, including approving or disapproving a child's
468    participation in activities based on the caregiver's assessment
469    using the "reasonable and prudent parent" standard.
470(3)     ROOM AND BOARD RATES.—
471(a)     Effective July 1, 2026 2022, room and board rates
472    shall be paid to foster parents, including relative and
473    nonrelative caregivers who are licensed as a level I child-
474    specific foster placement, and to relative and nonrelative
475    caregivers who are participating in the Relative Caregiver
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476    Program and receiving payments pursuant to s. 39.5085(2)(d)1. or
477    2., as follows:
478
                             Monthly Room and Board Rate
479
              0-5 Years  6-12 Years  13-21 Years
                   Age  Age  Age
480
      $663.03 $517.94  $680.01 $531.21  $795.94 $621.77
481
482(b)       Each January, foster parents, including relative and
483    nonrelative caregivers who are licensed as a level I child-
484    specific foster placement and relative and nonrelative
485    caregivers who are participating in the Relative Caregiver
486    Program and receiving payments pursuant to s. 39.5085(2)(d)1. or
487    2., shall receive an annual cost of living increase. The
488    department shall calculate the new room and board rate increase
489    equal to the percentage change in the Consumer Price Index for
490    All Urban Consumers, U.S. City Average, All Items, not
491    seasonally adjusted, or successor reports, for the preceding
492    December compared to the prior December as initially reported by
493    the United States Department of Labor, Bureau of Labor
494    Statistics. The department shall make available the adjusted
495    room and board rates annually.
496(c)       The amount of the monthly room and board rate may be
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497    increased upon agreement among the department, the community-
498    based care lead agency, and the foster parent.
499(d)     Effective July 1, 2022, community-based care lead
500    agencies providing care under contract with the department shall
501    pay a supplemental room and board payment to foster parents,
502    including relative and nonrelative caregivers who are licensed
503    as a level I child-specific foster placement and relative and
504    nonrelative caregivers who are participating in the Relative
505    Caregiver Program and receiving payments pursuant to s.
506    39.5085(2)(d)1. or 2., on a per-child basis, for providing
507    independent life skills and normalcy supports to children who
508    are 13 through 17 years of age placed in their care. The
509    supplemental payment must be paid monthly in addition to the
510    current monthly room and board rate payment. The supplemental
511    monthly payment shall be based on 10 percent of the monthly room
512    and board rate for children 13 through 21 years of age as
513    provided under this section and adjusted annually.
514Section 9.  Section 409.1455, Florida Statutes, is amended
515    to read:
516409.1455  Step into Success Workforce Education and
517    Internship Pilot Program for foster youth and former foster
518    youth.—
519(1)     SHORT TITLE.—This section may be cited as the "Step
520    into Success Act."
521(2)     CREATION.—The department shall establish the 3-year
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522    Step into Success Workforce Education and Internship Pilot
523    Program to give eligible foster youth and former foster youth an
524    opportunity to learn and develop essential workforce and
525    professional skills, to transition from the custody of the
526    department to independent living, and to become better prepared
527    for an independent and successful future. The pilot program must
528    consist of an independent living professionalism and workforce
529    education component and, for youth who complete that component,
530    an onsite workforce training internship component. In
531    consultation with subject-matter experts and the community-based
532    care lead agencies, the office shall develop and administer the
533    pilot program for interested foster youth and former foster
534    youth; however, the department may contract with entities that
535    have demonstrable subject-matter expertise in the transition to
536    adulthood for foster youth, workforce training and preparedness,
537    professional skills, and related subjects to collaborate with
538    the office in the development and administration of the pilot
539    program. The independent living professionalism and workforce
540    education component of the program must culminate in a
541    certificate that allows a former foster youth to participate in
542    the onsite workforce training internship.
543(3)     DEFINITIONS.—For purposes of this section, the term:
544(a)     "Community-based care lead agency" has the same
545    meaning as in s. 409.986(3).
546(b)     "Former foster youth" means an individual 18 years of
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547    age or older but younger than 26 years of age who is currently
548    or was previously placed in licensed care, excluding Level I
549    licensed placements pursuant to s. 409.175(5)(a)1., for at least
550    60 days within this state.
551(c)     "Foster youth" means an individual older than 16 years
552    of age but younger than 18 years of age who is currently in
553    licensed care, excluding Level I licensed placements pursuant to
554    s. 409.175(5)(a)1.
555(d)     "Office" means the department's Office of Continuing
556    Care.
557(e)     "Participating organization" means a state agency, a
558    corporation under chapter 607 or chapter 617, or another
559    relevant entity that has agreed to collaborate with the office
560    in the development and implementation of a trauma-informed
561    onsite workforce training internship program pursuant to
562    subsections (6) and (7).
563(4)     REQUIREMENTS OF THE DEPARTMENT AND OFFICE.—The
564    department shall establish and the office shall develop and
565    administer the pilot program for eligible foster youth and
566    former foster youth. The office shall do all of the following:
567(a)     Develop eligible foster youth and former foster youth
568    cohorts within the department's regions.
569(b)     Collaborate with local chambers of commerce and
570    recruit mentors and organizations within the department's
571    regions, emphasizing recruitment of mentors and organizations in
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572    the following counties:
5731.      Duval.
5742.      Escambia.
5753.      Hillsborough.
5764.      Palm Beach.
5775.      Polk.
578(c)      Provide eligible former foster youth with a variety of
579    internship placement opportunities, including by connecting
580    existing third-party mentorship organizations that focus on
581    former foster youth with eligible former foster youth who have
582    an interest in such organizations' programs The pilot program
583    must be administered as part of an eligible foster youth's
584    regular transition planning under s. 39.6035 or as a post-
585    transition service for eligible former foster youth. The office
586    must begin the professionalism and workforce education component
587    of the program on or before January 1, 2024, and the onsite
588    workforce training internship component of the program on or
589    before July 1, 2024.
590(5)      INDEPENDENT LIVING PROFESSIONALISM AND WORKFORCE
591    EDUCATION COMPONENT REQUIREMENTS.—The office shall do all of the
592    following in connection with the independent living
593    professionalism and workforce education component for eligible
594    foster youth and former foster youth:
595(a)      Designate and ensure that the number of qualified
596    staff is sufficient to implement and administer the component,
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597    which may be part of a larger independent living or life skills
598    training program if the larger program meets the requirements of
599    this subsection.
600(b)      Develop all workshops, presentations, and curricula
601    for the component, including, but not limited to, all written
602    educational and training materials for foster youth and former
603    foster youth. Resources may include, but are not limited to,
604    workshops and materials to assist with preparing résumés, mock
605    interviews, experiential training, and assistance with securing
606    an internship or employment. The office must review and update
607    these materials as necessary. The training materials must
608    address, but are not limited to, the following:
6091.      Interview skills;
6102.      Professionalism;
6113.      Teamwork;
6124.      Leadership;
6135.      Problem solving; and
6146.      Conflict resolution in the workplace.
615(c)      Require that the training provided be in addition to
616    any other life skills or employment training required by law.
617    The training may be developed or administered by the department,
618    community-based care lead agencies, or the lead agencies'
619    subcontracted providers, or in collaboration with colleges or
620    universities or other nonprofit organizations in the community
621    with workforce education and training resources.
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622(d)     Provide relevant written materials from the component
623    and any relevant tools developed to ensure participants'
624    successful transition to internships to all participating
625    organizations that offer workforce training internship
626    opportunities.
627(e)     Provide materials to inform eligible foster youth and
628    former foster youth of the program, the requirements for
629    participation, and contact information for enrollment. The
630    community-based care lead agencies shall ensure that any
631    subcontracted providers that directly serve youth receive this
632    information.
633(f)     Advertise and promote the availability of the
634    education and internship program to engage as many eligible
635    foster youth and former foster youth as possible.
636(g)     Assess the career interests of each eligible foster
637    youth and former foster youth who expresses interest in
638    participating in the program and determine the most appropriate
639    internship and post-internship opportunities for that youth
640    based on his or her expressed interests.
641(6)     ONSITE WORKFORCE TRAINING INTERNSHIP COMPONENT
642    REQUIREMENTS.—The office shall do all of the following in
643    connection with the onsite workforce training internship program
644    for eligible former foster youth:
645(a)     Develop processes and procedures to implement a
646    trauma-informed onsite workforce training internship component.
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647    The processes and procedures of the internship component must be
648    designed so that they can be replicated and scaled to meet
649    various organizational structures and sizes. The component must
650    include:
6511.      Recruitment of agencies, corporations, and other
652    entities to host interns as participating organizations;
6532.      Assisting participating organizations with mentor
654    recruitment, training, and matching;
6553.      Mentor-led performance reviews, including a review of
656    the intern's work product, professionalism, time management,
657    communication style, and stress-management strategies;
6584.      Daily mentorship and coaching on topics such as:
659a.      Professionalism;
660b.      Teamwork;
661c.      Leadership;
662d.      Problem solving; and
663e.      Conflict resolution in the workplace;
6645.      Development of opportunities for interns to become
665    employees of the participating organization; and
6666.      Reporting requirements specified in subsection (11).
667(b)      Develop a minimum of 1 hour of required trauma-
668    informed training for mentors to satisfy the requirements of
669    sub-subparagraph (7)(b)1.e. Such training must include
670    interactive or experiential components, such as role-playing,
671    scenario discussion, or case studies. The office may provide at
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672    least four additional 1-hour trainings on mentorship of special
673    populations as optional training opportunities, which must be
674    asynchronous and accessible to mentors online at their
675    convenience, and must inform participating organizations of
676    these optional training opportunities teach the skills necessary
677    to engage with participating eligible former foster youth.
678(c)     Provide assistance to eligible foster youth and former
679    foster youth interested in participating in the internship
680    component, including, but not limited to, identifying and
681    monitoring internship opportunities, being knowledgeable of the
682    training and skills needed to match eligible foster youth and
683    former foster youth with appropriate internships, and assisting
684    eligible foster youth and former foster youth with applying for
685    post-internship employment opportunities.
686(d)     Publicize specific internship positions in an easily
687    accessible manner and inform eligible foster youth and former
688    foster youth of where to locate such information.
689(e)     Provide a participating former foster youth with
690    financial assistance in the amount of $1,717 $1,517 monthly and
691    develop a process and schedule for the distribution of payments
692    to former foster youth participating in the component, subject
693    to the availability of funds.
694(f)     Distribute funds appropriated for the compensation of
695    mentors who are participating in the component as provided in
696    paragraph (7)(b).
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697(g)      By May 1, 2024, provide to the Board of Governors and
698    the State Board of Education all relevant internship information
699    necessary to support the award of postsecondary credit or career
700    education clock hours for internship positions held by former
701    foster youth participating in the onsite workforce training
702    internship component.
703(h)      Develop and conduct follow-up surveys with:
7041.      Former foster youth within 3 months after their
705    internship start date to ensure successful transition into the
706    work environment and to gather feedback on how to improve the
707    experience for future participants.
7082.      Mentors assigned to participating former foster youth.
709    Such data must be collected by October 1, 2024, and by October 1
710    annually thereafter, for inclusion in the independent living
711    services annual report.
7123.      Any other persons the office deems relevant for
713    purposes of continued improvement of the internship component.
714(i)      Assign experienced staff to serve as program liaisons
715    who are available for mentors to contact whenever the mentors
716    need to debrief or have questions concerning a former foster
717    youth.
718(7)      REQUIREMENTS FOR PARTICIPATING ORGANIZATIONS.—Each
719    organization participating in the onsite workforce training
720    internship component shall:
721(a)      Collaborate with the office to implement a trauma-
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722    informed approach to mentoring and training former foster youth.
723(b)      Recruit employees to serve as mentors for former
724    foster youth interning with such organizations.
7251.      To serve as a mentor, an employee must:
726a.      Have worked in his or her career field or area for the
727    participating organization for at least 1 year;
728b.      Have experience relevant to the job and task
729    responsibilities of the intern;
730c.      Sign a monthly hour statement for the intern;
731d.      Allocate at least 1 hour per month to conduct mentor-
732    led performance reviews, to include a review of the intern's
733    work product, professionalism, time management, communication
734    style, and stress-management strategies; and
735e.      Complete a minimum of 1 hour of trauma-informed
736    training to gain and maintain skills critical for successfully
737    engaging former foster youth. Before being matched with a former
738    foster youth, the employee must complete a 1-hour training that
739    covers core topics, including, but not limited to:
740(I)      Understanding trauma and its impacts.
741(II)        Recognizing and responding to trauma-related
742    behaviors.
743(III)       De-escalation strategies and crisis response.
744(IV)        Boundaries and mentor self-care.
745(V)      Communication skills.
746
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747    The department may offer a 1-hour training to review topics
748    covered by the training required under this sub-subparagraph
749    every subsequent year that the employee chooses to serve as a
750    mentor.
7512.      Subject to available funding, an employee who serves as
752    a mentor and receives the required trauma-informed training is
753    eligible for a maximum payment of $1,200 per intern per fiscal
754    year, to be issued as a $100 monthly payment for every month of
755    service as a mentor.
7563.      An employee may serve as a mentor for a maximum of
757    three interns at one time and may not receive more than $3,600
758    in compensation per fiscal year for serving as a mentor. Any
759    time spent serving as a mentor to an intern under this section
760    counts toward the minimum service required for eligibility for
761    payments pursuant to subparagraph 2. and this subparagraph.
7624.      An employee who serves as a mentor may participate in
763    additional trainings on the mentorship of special populations as
764    made available by the office.
765(c)      When necessary, have a discussion with an intern's
766    assigned mentor, the participating organization's internship
767    program liaison, and the office about the creation of a
768    corrective action plan to address issues related to the intern's
769    professionalism, work product, or performance and, if
770    applicable, after giving the intern a reasonable opportunity to
771    comply with the corrective action plan, document the intern's
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772    failure to do so before discharging him or her.
773(d)     Provide relevant feedback to the office at least
774    annually for the office to comply with paragraph (6)(h).
775(e)     Collaborate with the department to provide any
776    requested information necessary to prepare the annual report
777    required under subsection (11).
778(8)     TIME LIMITATIONS FOR PARTICIPATION.—A former foster
779    youth who obtains an internship with a participating
780    organization may participate in the internship component for no
781    more than 1 year, calculated as 12 monthly stipend periods. The
782    year begins on his or her start date with a participating
783    organization. A former foster youth may intern under the
784    internship program with more than one participating
785    organization, but may not intern with more than one
786    participating organization at the same time. A participating
787    organization may hire the intern as an employee, but the hiring
788    of a former foster youth may not be for an internship under this
789    section.
790(9)     AWARD OF POSTSECONDARY CREDIT.—The Board of Governors
791    and the State Board of Education shall adopt regulations and
792    rules, respectively, to award postsecondary credit or career
793    education clock hours for eligible former foster youth
794    participating in the internship component pursuant to subsection
795    (4). The regulations and rules must include procedures for the
796    award of postsecondary credit or career education clock hours,
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797    including, but not limited to, equivalency and alignment of the
798    internship component with appropriate postsecondary courses and
799    course descriptions.
800(10)        CONDITIONS OF PARTICIPATION IN THE INTERNSHIP
801    COMPONENT.—
802(a)     To become a participant in the internship component of
803    the program, the applicant must be a foster youth or a former
804    foster youth as those terms are defined in subsection (3) at the
805    time such youth applies for an internship position with a
806    participating organization. A foster youth or former foster
807    youth who has completed the training component with the
808    department may apply for a position with a participating
809    organization but may not begin an internship until attaining the
810    age of 18 years.
811(b)     If offered an internship, a former foster youth must
812    be classified as an intern and must work 80 hours per month to
813    be eligible for the stipend payment.
814(c)     A former foster youth must spend any stipend funds
815    specified for clothing on clothing that is in compliance with
816    the dress code requirements of the participating organization
817    with which the former foster youth is interning. Notwithstanding
818    any limitation on funds provided to purchase clothing, the
819    former foster youth must comply with any dress code requirements
820    of the participating organization with which he or she is
821    interning.
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822(d)     Stipend money earned pursuant to the internship
823    component may not be considered earned income for purposes of
824    computing eligibility for federal or state benefits, including,
825    but not limited to, the Supplemental Nutrition Assistance
826    Program, a housing choice assistance voucher program, the
827    Temporary Cash Assistance Program, the Medicaid program, or the
828    school readiness program. Notwithstanding this paragraph, any
829    reduction in the amount of benefits or loss of benefits due to
830    receipt of the Step into Success stipend may be offset by an
831    additional stipend payment equal to the value of the maximum
832    benefit amount for a single person allowed under the
833    Supplemental Nutrition Assistance Program.
834(e)     A former foster youth may, at the discretion of a
835    postsecondary educational institution within this state in which
836    such youth is enrolled, earn postsecondary credit or career
837    education clock hours for work performed as an intern under the
838    internship component. Postsecondary credit and career education
839    clock hours earned for work performed under the internship
840    component may be in addition to any compensation earned for the
841    same work performed under the internship component and may be
842    awarded for completion of all or any part of the internship
843    component. Participating organizations shall cooperate with
844    postsecondary educational institutions to provide any
845    information about internship positions which is necessary to
846    enable the institutions to determine whether to grant the
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847    participating former foster youth postsecondary credit or career
848    education clock hours toward his or her degree.
849(f)     A former foster youth who accepts an internship with a
850    participating organization pursuant to this section may only be
851    discharged from the internship component after the participating
852    organization engages the intern's assigned mentor and the
853    participating organization's internship program staff to assist
854    the intern in performing the duties of the internship. Before
855    discharging the former foster youth, the participating
856    organization must also document the intern's failure to comply
857    with a corrective action plan after being given a reasonable
858    opportunity to do so.
859(11)        REPORT.—The department shall include a section on the
860    Step into Success Workforce Education and Internship Pilot
861    Program in the independent living annual report prepared
862    pursuant to s. 409.1451(6) which includes, but is not limited
863    to, all of the following:
864(a)     Whether the pilot program is in compliance with this
865    section, and if not, barriers to compliance.
866(b)     A list of participating organizations and the number
867    of interns.
868(c)     A summary of recruitment efforts to increase the
869    number of participating organizations.
870(d)     A summary of the feedback and surveys received
871    pursuant to paragraph (6)(h) from participating former foster
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872    youth, mentors, and others who have participated in the pilot
873    program.
874(e)     Recommendations, if any, for actions necessary to
875    improve the quality, effectiveness, and outcomes of the pilot
876    program.
877(f)     Employment outcomes of former foster youth who
878    participated in the pilot program, including employment status
879    after completion of the program, whether he or she is employed
880    by the participating organization in which he or she interned or
881    by another entity, and job description and salary information,
882    if available.
883(12)        RULEMAKING.—The department shall adopt rules to
884    implement this section.
885Section 10.  Section 409.1475, Florida Statutes, is created
886    to read:
887409.1475  Foster and Family Support Grant Program.—
888(1)     The Legislature recognizes that children and families
889    thrive when caregivers are engaged, supported, and equipped to
890    meet their responsibilities. It is the intent of the Legislature
891    to strengthen community-based support that promotes stable
892    caregiving relationships, responsible parenting, and improved
893    outcomes for vulnerable children. Therefore, the Foster and
894    Family Support Grant Program is created within the department.
895(2)     The department shall award grants to not-for-profit,
896    faith-based organizations to support their efforts in the
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897    recruitment of foster and adoptive families through faith-based
898    organizations and strengthening local capacity to support
899    foster, adoptive, and kinship families and families caring for
900    vulnerable children in underserved and rural communities. The
901    program shall emphasize sustained, community-based support
902    beyond initial licensure or training in order to improve
903    caregiver retention and outcomes for children.
904(3)     Awarded grant funds must be used to provide education,
905    resources, training, and technical assistance to eligible faith-
906    based organizations involved in foster care, adoption, and
907    family preservation activities and to support the development of
908    trauma-informed, community-based support systems for families
909    throughout the caregiving continuum. Allowable uses of funds
910    include, but are not limited to:
911(a)     Outreach and recruitment activities to increase the
912    number of licensed foster and adoptive families;
913(b)     Training and support for organizations and volunteers
914    assisting foster, adoptive, and kinship families and families;
915(c)     Trauma-informed training, coaching, and counseling
916    services for caregivers, families, and individuals involved in
917    supporting children in out-of-home care or at risk of entry into
918    care;
919(d)     Program support and other activities to strengthen
920    local capacities to support foster, adoptive, and kinship
921    families and families;
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922(e)     Expansion of foster parent training initiatives
923    designed to improve caregiver engagement, retention, and
924    placement stability;
925(f)     Development of volunteer-based wrap-around support
926    services for foster and adoptive families, including kinship
927    caregivers;
928(g)     Assistance with essential family needs for families
929    actively fostering, adopting, or pursuing licensure, consistent
930    with federal and state law; and
931(h)     Ongoing family mentoring and peer support to promote
932    placement stability, permanency, and family well-being.
933(4)     Grant recipients must submit reports to the department
934    in a format and at intervals, at least annually, as prescribed
935    by the department.
936(5)     The department may adopt rules to implement this
937    section.
938Section 11.  Upon the expiration and reversion of the
939    amendments made to s. 409.908, Florida Statutes, pursuant to
940    section 26 of chapter 2025-199, Laws of Florida, paragraph (b)
941    of subsection (2) of section 409.908, Florida Statutes, is
942    amended to read:
943409.908       Reimbursement of Medicaid providers.—Subject to
944    specific appropriations, the agency shall reimburse Medicaid
945    providers, in accordance with state and federal law, according
946    to methodologies set forth in the rules of the agency and in
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947    policy manuals and handbooks incorporated by reference therein.
948    These methodologies may include fee schedules, reimbursement
949    methods based on cost reporting, negotiated fees, competitive
950    bidding pursuant to s. 287.057, and other mechanisms the agency
951    considers efficient and effective for purchasing services or
952    goods on behalf of recipients. If a provider is reimbursed based
953    on cost reporting and submits a cost report late and that cost
954    report would have been used to set a lower reimbursement rate
955    for a rate semester, then the provider's rate for that semester
956    shall be retroactively calculated using the new cost report, and
957    full payment at the recalculated rate shall be effected
958    retroactively. Medicare-granted extensions for filing cost
959    reports, if applicable, shall also apply to Medicaid cost
960    reports. Payment for Medicaid compensable services made on
961    behalf of Medicaid-eligible persons is subject to the
962    availability of moneys and any limitations or directions
963    provided for in the General Appropriations Act or chapter 216.
964    Further, nothing in this section shall be construed to prevent
965    or limit the agency from adjusting fees, reimbursement rates,
966    lengths of stay, number of visits, or number of services, or
967    making any other adjustments necessary to comply with the
968    availability of moneys and any limitations or directions
969    provided for in the General Appropriations Act, provided the
970    adjustment is consistent with legislative intent.
971(2)
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972(b)     Subject to any limitations or directions in the
973    General Appropriations Act, the agency shall establish and
974    implement a state Title XIX Long-Term Care Reimbursement Plan
975    for nursing home care in order to provide care and services in
976    conformance with the applicable state and federal laws, rules,
977    regulations, and quality and safety standards and to ensure that
978    individuals eligible for medical assistance have reasonable
979    geographic access to such care.
9801.      The agency shall amend the long-term care reimbursement
981    plan and cost reporting system to create direct care and
982    indirect care subcomponents of the patient care component of the
983    per diem rate. These two subcomponents together shall equal the
984    patient care component of the per diem rate. Separate prices
985    shall be calculated for each patient care subcomponent,
986    initially based on the September 2016 rate setting cost reports
987    and subsequently based on the most recently audited cost report
988    used during a rebasing year. The direct care subcomponent of the
989    per diem rate for any providers still being reimbursed on a cost
990    basis shall be limited by the cost-based class ceiling, and the
991    indirect care subcomponent may be limited by the lower of the
992    cost-based class ceiling, the target rate class ceiling, or the
993    individual provider target. The ceilings and targets apply only
994    to providers being reimbursed on a cost-based system. Effective
995    October 1, 2018, a prospective payment methodology shall be
996    implemented for rate setting purposes with the following
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997     parameters:
998a.      Peer Groups, including:
999(I)      North-SMMC Regions 1-9, less Palm Beach and Okeechobee
1000      Counties; and
1001  (II)        South-SMMC Regions 10-11, plus Palm Beach and
1002      Okeechobee Counties.
1003  b.      Percentage of Median Costs based on the cost reports
1004      used for September 2016 rate setting:
1005  (I)      Direct Care Costs..........................100 percent.
1006  (II)        Indirect Care Costs........................92 percent.
1007  (III)       Operating Costs...........................86 percent.
1008  c.      Floors:
1009  (I)      Direct Care Component.......................95 percent.
1010  (II)        Indirect Care Component..................92.5 percent.
1011  (III)       Operating Component.............................None.
1012  d.      Pass-through Payments....................Real Estate and
1013  Personal Property
1014  Taxes and Property Insurance.
1015  e.      Quality Incentive Program Payment
1016      Pool 18.1373 10 percent of September
1017  2016 non-property related
1018  payments of included facilities.
1019  f.      Quality Score Threshold to Qualify for Quality
1020      Incentive Payment..............................................33
1021  percent of all available points in
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1022  the Medicaid Quality Incentive Program 20th
1023  percentile of included facilities.
1024  g.      Fair Rental Value System Payment Parameters:
1025  (I)      Building Value per Square Foot based on 2018 RS Means.
1026  (II)        Land Valuation.....10 percent of Gross Building value.
1027  (III)       Facility Square Footage........Actual Square Footage.
1028  (IV)        Movable Equipment Allowance............$8,000 per bed.
1029  (V)      Obsolescence Factor........................1.5 percent.
1030  (VI)        Fair Rental Rate of Return..................8 percent.
1031  (VII)       Minimum Occupancy.........................90 percent.
1032  (VIII)       Maximum Facility Age.......................40 years.
1033  (IX)        Minimum Square Footage per Bed....................350.
1034  (X)      Maximum Square Footage for Bed.....................500.
1035  (XI)        Minimum Cost of a renovation/replacements.....$500 per
1036      bed.
1037  h.      Ventilator Supplemental payment of $200 per Medicaid
1038      day of 40,000 ventilator Medicaid days per fiscal year.
1039  2.      The agency shall revise its methodology for calculating
1040      Quality Incentive Program payments to:
1041  a.      Include the results of consumer satisfaction surveys
1042      conducted pursuant to s. 400.0225 as a measure of nursing home
1043      quality. The agency shall so revise the methodology after the
1044      surveys have been in effect for an amount of time the agency
1045      deems sufficient for statistical and scientific validity as a
1046      meaningful quality measure that may be incorporated into the
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1047      methodology.
1048  b.      During the next rebasing for the Quality Incentive
1049      Program, consider implementing the recommendations proposed in
1050      sections 3.1.1-3.1.5 of the Study of Nursing Home Quality
1051      Incentive Programs Final Report pursuant to section 20 of
1052      chapter 2025-204, Laws of Florida, and presented to the agency
1053      on December 22, 2025.
1054  c.      Delay the effective date of any change made to its
1055      methodology or scoring due to rebasing for 1 year after any
1056      recalculations have been completed and the scores have been made
1057      available to the public.
1058  3.      The direct care subcomponent shall include salaries and
1059      benefits of direct care staff providing nursing services
1060      including registered nurses, licensed practical nurses, and
1061      certified nursing assistants who deliver care directly to
1062      residents in the nursing home facility, allowable therapy costs,
1063      and dietary costs. This excludes nursing administration, staff
1064      development, the staffing coordinator, and the administrative
1065      portion of the minimum data set and care plan coordinators. The
1066      direct care subcomponent also includes medically necessary
1067      dental care, vision care, hearing care, and podiatric care.
1068  4.      All other patient care costs shall be included in the
1069      indirect care cost subcomponent of the patient care per diem
1070      rate, including complex medical equipment, medical supplies, and
1071      other allowable ancillary costs. Costs may not be allocated
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1072      directly or indirectly to the direct care subcomponent from a
1073      home office or management company.
1074  5.      On July 1 of each year, the agency shall report to the
1075      Legislature direct and indirect care costs, including average
1076      direct and indirect care costs per resident per facility and
1077      direct care and indirect care salaries and benefits per category
1078      of staff member per facility.
1079  6.      Every fourth year, the agency shall rebase nursing home
1080      prospective payment rates to reflect changes in cost based on
1081      the most recently audited cost report for each participating
1082      provider.
1083  7.      A direct care supplemental payment may be made to
1084      providers whose direct care hours per patient day are above the
1085      80th percentile and who provide Medicaid services to a larger
1086      percentage of Medicaid patients than the state average.
1087  8.      Pediatric, Florida Department of Veterans Affairs, and
1088      government-owned facilities are exempt from the pricing model
1089      established in this subsection and shall remain on a cost-based
1090      prospective payment system. Effective October 1, 2018, the
1091      agency shall set rates for all facilities remaining on a cost-
1092      based prospective payment system using each facility's most
1093      recently audited cost report, eliminating retroactive
1094      settlements.
1095  9.      By October 1, 2025, and each year thereafter, the
1096      agency shall submit to the Governor, the President of the
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1097      Senate, and the Speaker of the House of Representatives a report
1098      on each Quality Incentive Program payment made pursuant to sub-
1099      subparagraph 1.e. The report must, at a minimum, include all of
1100      the following information:
1101  a.      The name of each facility that received a Quality
1102      Incentive Program payment and the dollar amount of such payment
1103      each facility received.
1104  b.      The total number of quality incentive metric points
1105      awarded by the agency to each facility and the number of points
1106      awarded by the agency for each individual quality metric
1107      measured.
1108  c.      An examination of any trends in the improvement of the
1109      quality of care provided to nursing home residents which may be
1110      attributable to incentive payments received under the Quality
1111      Incentive Program. The agency shall include examination of
1112      trends both for the program as a whole as well as for each
1113      individual quality metric used by the agency to award program
1114      payments.
1115
1116      It is the intent of the Legislature that the reimbursement plan
1117      achieve the goal of providing access to health care for nursing
1118      home residents who require large amounts of care while
1119      encouraging diversion services as an alternative to nursing home
1120      care for residents who can be served within the community. The
1121      agency shall base the establishment of any maximum rate of
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1122      payment, whether overall or component, on the available moneys
1123      as provided for in the General Appropriations Act. The agency
1124      may base the maximum rate of payment on the results of
1125      scientifically valid analysis and conclusions derived from
1126      objective statistical data pertinent to the particular maximum
1127      rate of payment. The agency shall base the rates of payments in
1128      accordance with the minimum wage requirements as provided in the
1129      General Appropriations Act.
1130  Section 12.  Effective July 1, 2027, paragraph (b) of
1131      subsection (2) of section 409.908, Florida Statutes, as amended
1132      by this act, is amended to read:
1133  409.908       Reimbursement of Medicaid providers.—Subject to
1134      specific appropriations, the agency shall reimburse Medicaid
1135      providers, in accordance with state and federal law, according
1136      to methodologies set forth in the rules of the agency and in
1137      policy manuals and handbooks incorporated by reference therein.
1138      These methodologies may include fee schedules, reimbursement
1139      methods based on cost reporting, negotiated fees, competitive
1140      bidding pursuant to s. 287.057, and other mechanisms the agency
1141      considers efficient and effective for purchasing services or
1142      goods on behalf of recipients. If a provider is reimbursed based
1143      on cost reporting and submits a cost report late and that cost
1144      report would have been used to set a lower reimbursement rate
1145      for a rate semester, then the provider's rate for that semester
1146      shall be retroactively calculated using the new cost report, and
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1147      full payment at the recalculated rate shall be effected
1148      retroactively. Medicare-granted extensions for filing cost
1149      reports, if applicable, shall also apply to Medicaid cost
1150      reports. Payment for Medicaid compensable services made on
1151      behalf of Medicaid-eligible persons is subject to the
1152      availability of moneys and any limitations or directions
1153      provided for in the General Appropriations Act or chapter 216.
1154      Further, nothing in this section shall be construed to prevent
1155      or limit the agency from adjusting fees, reimbursement rates,
1156      lengths of stay, number of visits, or number of services, or
1157      making any other adjustments necessary to comply with the
1158      availability of moneys and any limitations or directions
1159      provided for in the General Appropriations Act, provided the
1160      adjustment is consistent with legislative intent.
1161  (2)
1162  (b)     Subject to any limitations or directions in the
1163      General Appropriations Act, the agency shall establish and
1164      implement a state Title XIX Long-Term Care Reimbursement Plan
1165      for nursing home care in order to provide care and services in
1166      conformance with the applicable state and federal laws, rules,
1167      regulations, and quality and safety standards and to ensure that
1168      individuals eligible for medical assistance have reasonable
1169      geographic access to such care.
1170  1.      The agency shall amend the long-term care reimbursement
1171      plan and cost reporting system to create direct care and
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1172      indirect care subcomponents of the patient care component of the
1173      per diem rate. These two subcomponents together shall equal the
1174      patient care component of the per diem rate. Separate prices
1175      shall be calculated for each patient care subcomponent,
1176      initially based on the September 2016 rate setting cost reports
1177      and subsequently based on the most recently audited cost report
1178      used during a rebasing year. The direct care subcomponent of the
1179      per diem rate for any providers still being reimbursed on a cost
1180      basis shall be limited by the cost-based class ceiling, and the
1181      indirect care subcomponent may be limited by the lower of the
1182      cost-based class ceiling, the target rate class ceiling, or the
1183      individual provider target. The ceilings and targets apply only
1184      to providers being reimbursed on a cost-based system. Effective
1185      October 1, 2018, a prospective payment methodology shall be
1186      implemented for rate setting purposes with the following
1187      parameters:
1188  a.      Peer Groups, including:
1189  (I)      North-SMMC Regions 1-9, less Palm Beach and Okeechobee
1190      Counties; and
1191  (II)        South-SMMC Regions 10-11, plus Palm Beach and
1192      Okeechobee Counties.
1193  b.      Percentage of Median Costs based on the cost reports
1194      used for September 2016 rate setting:
1195  (I)      Direct Care Costs..........................100 percent.
1196  (II)        Indirect Care Costs........................92 percent.
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1197  (III)       Operating Costs...........................86 percent.
1198  c.      Floors:
1199  (I)      Direct Care Component.......................95 percent.
1200  (II)        Indirect Care Component..................92.5 percent.
1201  (III)       Operating Component.............................None.
1202  d.      Pass-through Payments....................Real Estate and
1203  Personal Property
1204  Taxes and Property Insurance.
1205  e.      Quality Incentive Program Payment
1206      Pool 16.5482 18.1373 percent of September
1207  2016 non-property related
1208  payments of included facilities.
1209  f.      Quality Score Threshold to Qualify for Quality
1210      Incentive Payment..............................................33
1211  percent of all available points in
1212  the Medicaid Quality Incentive Program.
1213  g.      Fair Rental Value System Payment Parameters:
1214  (I)      Building Value per Square Foot based on 2018 RS Means.
1215  (II)        Land Valuation.....10 percent of Gross Building value.
1216  (III)       Facility Square Footage........Actual Square Footage.
1217  (IV)        Movable Equipment Allowance............$8,000 per bed.
1218  (V)      Obsolescence Factor........................1.5 percent.
1219  (VI)        Fair Rental Rate of Return..................8 percent.
1220  (VII)       Minimum Occupancy.........................90 percent.
1221  (VIII)       Maximum Facility Age.......................40 years.
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1222  (IX)        Minimum Square Footage per Bed....................350.
1223  (X)      Maximum Square Footage for Bed.....................500.
1224  (XI)        Minimum Cost of a renovation/replacements.....$500 per
1225      bed.
1226  h.      Ventilator Supplemental payment of $200 per Medicaid
1227      day of 40,000 ventilator Medicaid days per fiscal year.
1228  2.      The agency shall revise its methodology for calculating
1229      Quality Incentive Program payments to:
1230  a.      Include the results of consumer satisfaction surveys
1231      conducted pursuant to s. 400.0225 as a measure of nursing home
1232      quality. The agency shall so revise the methodology after the
1233      surveys have been in effect for an amount of time the agency
1234      deems sufficient for statistical and scientific validity as a
1235      meaningful quality measure that may be incorporated into the
1236      methodology.
1237  b.      During the next rebasing for the Quality Incentive
1238      Program, consider implementing the recommendations proposed in
1239      sections 3.1.1-3.1.5 of the Study of Nursing Home Quality
1240      Incentive Programs Final Report pursuant to section 20 of
1241      chapter 2025-204, Laws of Florida, and presented to the agency
1242      on December 22, 2025.
1243  c.      Delay the effective date of any change made to its
1244      methodology or scoring due to rebasing for 1 year after any
1245      recalculations have been completed and the scores have been made
1246      available to the public.
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1247  3.      The direct care subcomponent shall include salaries and
1248      benefits of direct care staff providing nursing services
1249      including registered nurses, licensed practical nurses, and
1250      certified nursing assistants who deliver care directly to
1251      residents in the nursing home facility, allowable therapy costs,
1252      and dietary costs. This excludes nursing administration, staff
1253      development, the staffing coordinator, and the administrative
1254      portion of the minimum data set and care plan coordinators. The
1255      direct care subcomponent also includes medically necessary
1256      dental care, vision care, hearing care, and podiatric care.
1257  4.      All other patient care costs shall be included in the
1258      indirect care cost subcomponent of the patient care per diem
1259      rate, including complex medical equipment, medical supplies, and
1260      other allowable ancillary costs. Costs may not be allocated
1261      directly or indirectly to the direct care subcomponent from a
1262      home office or management company.
1263  5.      On July 1 of each year, the agency shall report to the
1264      Legislature direct and indirect care costs, including average
1265      direct and indirect care costs per resident per facility and
1266      direct care and indirect care salaries and benefits per category
1267      of staff member per facility.
1268  6.      Every fourth year, the agency shall rebase nursing home
1269      prospective payment rates to reflect changes in cost based on
1270      the most recently audited cost report for each participating
1271      provider.
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1272  7.      A direct care supplemental payment may be made to
1273      providers whose direct care hours per patient day are above the
1274      80th percentile and who provide Medicaid services to a larger
1275      percentage of Medicaid patients than the state average.
1276  8.      Pediatric, Florida Department of Veterans Affairs, and
1277      government-owned facilities are exempt from the pricing model
1278      established in this subsection and shall remain on a cost-based
1279      prospective payment system. Effective October 1, 2018, the
1280      agency shall set rates for all facilities remaining on a cost-
1281      based prospective payment system using each facility's most
1282      recently audited cost report, eliminating retroactive
1283      settlements.
1284  9.      By October 1, 2025, and each year thereafter, the
1285      agency shall submit to the Governor, the President of the
1286      Senate, and the Speaker of the House of Representatives a report
1287      on each Quality Incentive Program payment made pursuant to sub-
1288      subparagraph 1.e. The report must, at a minimum, include all of
1289      the following information:
1290  a.      The name of each facility that received a Quality
1291      Incentive Program payment and the dollar amount of such payment
1292      each facility received.
1293  b.      The total number of quality incentive metric points
1294      awarded by the agency to each facility and the number of points
1295      awarded by the agency for each individual quality metric
1296      measured.
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1297  c.      An examination of any trends in the improvement of the
1298      quality of care provided to nursing home residents which may be
1299      attributable to incentive payments received under the Quality
1300      Incentive Program. The agency shall include examination of
1301      trends both for the program as a whole as well as for each
1302      individual quality metric used by the agency to award program
1303      payments.
1304
1305      It is the intent of the Legislature that the reimbursement plan
1306      achieve the goal of providing access to health care for nursing
1307      home residents who require large amounts of care while
1308      encouraging diversion services as an alternative to nursing home
1309      care for residents who can be served within the community. The
1310      agency shall base the establishment of any maximum rate of
1311      payment, whether overall or component, on the available moneys
1312      as provided for in the General Appropriations Act. The agency
1313      may base the maximum rate of payment on the results of
1314      scientifically valid analysis and conclusions derived from
1315      objective statistical data pertinent to the particular maximum
1316      rate of payment. The agency shall base the rates of payments in
1317      accordance with the minimum wage requirements as provided in the
1318      General Appropriations Act.
1319  Section 13.  Subsection (6) of section 409.909, Florida
1320      Statutes, is amended to read:
1321  409.909       Statewide Medicaid Residency Program.—
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1322  (6)     The Slots for Doctors Program is established to
1323      address the physician workforce shortage by increasing the
1324      supply of highly trained physicians through the creation of new
1325      resident positions, which will increase access to care and
1326      improve health outcomes for Medicaid recipients.
1327  (a)1.       Notwithstanding subsection (4), the agency shall
1328      annually allocate funding $100,000 to hospitals, qualifying
1329      institutions, and behavioral health teaching hospitals
1330      designated under s. 395.902 for each newly created resident
1331      position that is first filled on or after June 1, 2023, and
1332      filled thereafter, and that is accredited by the Accreditation
1333      Council for Graduate Medical Education or the Osteopathic
1334      Postdoctoral Training Institution in an initial or established
1335      accredited training program which is in a physician specialty or
1336      subspecialty in a statewide supply-and-demand deficit.
1337  a.      Beginning in the 2024-2025 fiscal year, for purposes of
1338      distributing funds appropriated in the General Appropriations
1339      Act, the agency shall use exclusively the following formula to
1340      calculate every participating hospital's and qualifying
1341      institution's allocation factor for the funding allocated for
1342      the enumerated statewide specialties and subspecialties as
1343      provided in paragraph (c) and separately calculate every
1344      participating behavioral health teaching hospital's allocation
1345      fraction for the funding allocated for those hospitals
1346      designated under s. 395.902:
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1347  HAF = [0.9 x (HP/TP)] + [0.1 x (HMP/TMP)]
1348      Where:
1349  HAF = A hospital's and qualifying institution's or
1350      behavioral health teaching hospital's allocation fraction.
1351  HP = A hospital's and qualifying institution's or
1352      behavioral health teaching hospital's total number of positions.
1353  TP = The total positions for all participating hospitals
1354      and qualifying institutions or behavioral health teaching
1355      hospitals.
1356  HMP = A hospital's and qualifying institution's or
1357      behavioral health teaching hospital's Medicaid payments.
1358  TMP = The total Medicaid payments for all participating
1359      hospitals and qualifying institutions or behavioral health
1360      teaching hospitals.
1361
1362      As used in this sub-subparagraph, "Medicaid payments" means the
1363      estimated total payments for reimbursing a hospital and
1364      qualifying institutions or behavioral health teaching hospitals
1365      for direct inpatient and outpatient services for the fiscal year
1366      in which the allocation fraction is calculated based on the
1367      hospital inpatient appropriation and outpatient appropriation
1368      and the parameters for the inpatient diagnosis-related group
1369      base rate and the parameters for the outpatient enhanced
1370      ambulatory payment group rate, including applicable
1371      intergovernmental transfers, specified in the General
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1372      Appropriations Act, as determined by the agency.
1373  b.      A hospital's and qualifying institution's or behavioral
1374      health teaching hospital's annual allocation shall be calculated
1375      by multiplying the funds appropriated for the Slots for Doctors
1376      Program in the General Appropriations Act by that hospital's and
1377      qualifying institution's or behavioral health teaching
1378      hospital's allocation fraction. If the calculation results in an
1379      annual allocation that exceeds two times the average per-
1380      position amount for all hospitals and qualifying institutions or
1381      behavioral health teaching hospitals, the hospital's and
1382      qualifying institution's or behavioral health teaching
1383      hospital's annual allocation shall be reduced to a sum equaling
1384      no more than two times the average per position. The funds
1385      calculated for that hospital and qualifying institution or
1386      behavioral health teaching hospital in excess of two times the
1387      average per position amount for all hospitals and qualifying
1388      institutions or behavioral health teaching hospitals shall be
1389      redistributed to participating hospitals and qualifying
1390      institutions; or
1391  2.      Notwithstanding the requirement that a new resident
1392      position be created to receive funding under this subsection,
1393      the agency may allocate funding $100,000 to hospitals and
1394      qualifying institutions, pursuant to subparagraph 1., for up to
1395      100 resident positions that existed before July 1, 2023, if such
1396      resident position:
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1397  a.      Is in a physician specialty or subspecialty
1398      experiencing a statewide supply-and-demand deficit;
1399  b.      Has been unfilled for a period of 3 or more years;
1400  c.      Is subsequently filled on or after June 1, 2024, and
1401      remains filled thereafter; and
1402  d.      Is accredited by the Accreditation Council for Graduate
1403      Medical Education or the Osteopathic Postdoctoral Training
1404      Institution in an initial or established accredited training
1405      program.
1406  3.      If applications for resident positions under this
1407      paragraph exceed the number of authorized resident positions or
1408      the available funding allocated, the agency shall prioritize
1409      applications for resident positions that are in a primary care
1410      specialty as specified in paragraph (2)(a).
1411  (b)      This program is designed to generate matching funds
1412      under Medicaid and distribute such funds to participating
1413      hospitals, qualifying institutions, and behavioral health
1414      teaching hospitals designated under s. 395.902, on a quarterly
1415      basis in each fiscal year for which an appropriation is made.
1416      Resident positions created under this subsection are not
1417      eligible for concurrent funding pursuant to subsection (1).
1418  (c)      For purposes of this subsection, physician specialties
1419      and subspecialties, both adult and pediatric, in statewide
1420      supply-and-demand deficit are those identified as such in the
1421      General Appropriations Act.
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1422  (d)     Funds allocated pursuant to this subsection may not be
1423      used for resident positions that have previously received
1424      funding pursuant to subsection (1).
1425  Section 14.  Section 409.91195, Florida Statutes, is
1426      amended to read:
1427  409.91195  Medicaid Pharmaceutical and Therapeutics
1428      Committee.—There is created a Medicaid Pharmaceutical and
1429      Therapeutics Committee within the agency for the purpose of
1430      developing a Medicaid preferred drug list and a preferred
1431      product list.
1432  (1)     The committee shall be composed of 11 members
1433      appointed by the Governor. Four members shall be physicians,
1434      licensed under chapter 458; one member licensed under chapter
1435      459; five members shall be pharmacists licensed under chapter
1436      465; and one member shall be a consumer representative. The
1437      members shall be appointed to serve for terms of 2 years from
1438      the date of their appointment. Members may be appointed to more
1439      than one term. The agency shall serve as staff for the committee
1440      and assist them with all ministerial duties. The Governor shall
1441      ensure that at least some of the members of the committee
1442      represent Medicaid participating physicians and pharmacies
1443      serving all segments and diversity of the Medicaid population,
1444      and have experience in either developing or practicing under a
1445      preferred drug list. At least one of the members shall represent
1446      the interests of pharmaceutical manufacturers.
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1447  (2)     Committee members shall select a chairperson and a
1448      vice chairperson each year from the committee membership.
1449  (3)     The committee shall meet at least quarterly and may
1450      meet at other times at the discretion of the chairperson and
1451      members. The committee shall comply with rules adopted by the
1452      agency, including notice of any meeting of the committee
1453      pursuant to the requirements of the Administrative Procedure
1454      Act.
1455  (4)     Upon recommendation of the committee, the agency shall
1456      adopt a preferred drug list as described in s. 409.912(5) and a
1457      preferred product list as described in s. 409.912(14). To the
1458      extent feasible, the committee shall review all drug and product
1459      classes included on the preferred drug list or preferred product
1460      list every 12 months, and may recommend additions to and
1461      deletions from the lists preferred drug list, such that the
1462      preferred drug list provides for medically appropriate drug
1463      therapies and products for Medicaid patients which achieve cost
1464      savings contained in the General Appropriations Act.
1465  (5)     Except for antiretroviral drugs, reimbursement of
1466      drugs or products not included on the preferred drug list or
1467      preferred product list are is subject to prior authorization.
1468  (6)     The agency shall publish and disseminate the preferred
1469      drug list and the preferred product list to all Medicaid
1470      providers in the state by Internet posting on the agency's
1471      website or in other media.
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1472  (7)     The committee shall ensure that interested parties,
1473      including pharmaceutical manufacturers agreeing to provide a
1474      supplemental rebate as outlined in this chapter, have an
1475      opportunity to present public testimony to the committee with
1476      information or evidence supporting inclusion of a product on the
1477      preferred drug list or preferred product list. Such public
1478      testimony shall occur before prior to any recommendations made
1479      by the committee for inclusion or exclusion from the preferred
1480      drug list. Upon timely notice, the agency shall ensure that any
1481      drug that has been approved or had any of its particular uses
1482      approved by the United States Food and Drug Administration under
1483      a priority review classification will be reviewed by the
1484      committee at the next regularly scheduled meeting following 3
1485      months of distribution of the drug to the general public.
1486  (8)     The committee shall develop its preferred drug list
1487      and preferred product list recommendations by considering the
1488      clinical efficacy, safety, and cost-effectiveness of a product.
1489  (9)     The Medicaid Pharmaceutical and Therapeutics Committee
1490      may also make recommendations to the agency regarding the prior
1491      authorization of any prescribed drug covered by Medicaid.
1492  (10)        Medicaid recipients may appeal agency preferred drug
1493      formulary decisions using the Medicaid fair hearing process
1494      administered by the Agency for Health Care Administration.
1495  Section 15.  Paragraph (a) of subsection (5) of section
1496      409.912, Florida Statutes, is amended, and subsection (14) is
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1497      added to that section, to read:
1498  409.912       Cost-effective purchasing of health care.—The
1499      agency shall purchase goods and services for Medicaid recipients
1500      in the most cost-effective manner consistent with the delivery
1501      of quality medical care. To ensure that medical services are
1502      effectively utilized, the agency may, in any case, require a
1503      confirmation or second physician's opinion of the correct
1504      diagnosis for purposes of authorizing future services under the
1505      Medicaid program. This section does not restrict access to
1506      emergency services or poststabilization care services as defined
1507      in 42 C.F.R. s. 438.114. Such confirmation or second opinion
1508      shall be rendered in a manner approved by the agency. The agency
1509      shall maximize the use of prepaid per capita and prepaid
1510      aggregate fixed-sum basis services when appropriate and other
1511      alternative service delivery and reimbursement methodologies,
1512      including competitive bidding pursuant to s. 287.057, designed
1513      to facilitate the cost-effective purchase of a case-managed
1514      continuum of care. The agency shall also require providers to
1515      minimize the exposure of recipients to the need for acute
1516      inpatient, custodial, and other institutional care and the
1517      inappropriate or unnecessary use of high-cost services. The
1518      agency shall contract with a vendor to monitor and evaluate the
1519      clinical practice patterns of providers in order to identify
1520      trends that are outside the normal practice patterns of a
1521      provider's professional peers or the national guidelines of a
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1522      provider's professional association. The vendor must be able to
1523      provide information and counseling to a provider whose practice
1524      patterns are outside the norms, in consultation with the agency,
1525      to improve patient care and reduce inappropriate utilization.
1526      The agency may mandate prior authorization, drug therapy
1527      management, or disease management participation for certain
1528      populations of Medicaid beneficiaries, certain drug classes, or
1529      particular drugs to prevent fraud, abuse, overuse, and possible
1530      dangerous drug interactions. The Pharmaceutical and Therapeutics
1531      Committee shall make recommendations to the agency on drugs for
1532      which prior authorization is required. The agency shall inform
1533      the Pharmaceutical and Therapeutics Committee of its decisions
1534      regarding drugs subject to prior authorization. The agency is
1535      authorized to limit the entities it contracts with or enrolls as
1536      Medicaid providers by developing a provider network through
1537      provider credentialing. The agency may competitively bid single-
1538      source-provider contracts if procurement of goods or services
1539      results in demonstrated cost savings to the state without
1540      limiting access to care. The agency may limit its network based
1541      on the assessment of beneficiary access to care, provider
1542      availability, provider quality standards, time and distance
1543      standards for access to care, the cultural competence of the
1544      provider network, demographic characteristics of Medicaid
1545      beneficiaries, practice and provider-to-beneficiary standards,
1546      appointment wait times, beneficiary use of services, provider
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1547      turnover, provider profiling, provider licensure history,
1548      previous program integrity investigations and findings, peer
1549      review, provider Medicaid policy and billing compliance records,
1550      clinical and medical record audits, and other factors. Providers
1551      are not entitled to enrollment in the Medicaid provider network.
1552      The agency shall determine instances in which allowing Medicaid
1553      beneficiaries to purchase durable medical equipment and other
1554      goods is less expensive to the Medicaid program than long-term
1555      rental of the equipment or goods. The agency may establish rules
1556      to facilitate purchases in lieu of long-term rentals in order to
1557      protect against fraud and abuse in the Medicaid program as
1558      defined in s. 409.913. The agency may seek federal waivers
1559      necessary to administer these policies.
1560  (5)(a)       The agency shall implement a Medicaid prescribed-
1561      drug spending-control program that includes the following
1562      components:
1563  1.      A Medicaid preferred drug list, which shall be a
1564      listing of cost-effective therapeutic options recommended by the
1565      Medicaid Pharmacy and Therapeutics Committee established
1566      pursuant to s. 409.91195 and adopted by the agency for each
1567      therapeutic class on the preferred drug list. At the discretion
1568      of the committee, and when feasible, the preferred drug list
1569      should include at least two products in a therapeutic class. The
1570      agency may post the preferred drug list and updates to the list
1571      on an Internet website without following the rulemaking
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1572      procedures of chapter 120. Antiretroviral agents are excluded
1573      from the preferred drug list. The agency shall also limit the
1574      amount of a prescribed drug dispensed to no more than a 34-day
1575      supply unless the drug products' smallest marketed package is
1576      greater than a 34-day supply, or the drug is determined by the
1577      agency to be a maintenance drug in which case a 100-day maximum
1578      supply may be authorized. The agency may seek any federal
1579      waivers necessary to implement these cost-control programs and
1580      to continue participation in the federal Medicaid rebate
1581      program, or alternatively to negotiate state-only manufacturer
1582      rebates. The agency may adopt rules to administer this
1583      subparagraph. The agency shall continue to provide unlimited
1584      contraceptive drugs and items. The agency must establish
1585      procedures to ensure that:
1586  a.      There is a response to a request for prior
1587      authorization by telephone or other telecommunication device
1588      within 24 hours after receipt of a request for prior
1589      authorization; and
1590  b.      A 72-hour supply of the drug prescribed is provided in
1591      an emergency or when the agency does not provide a response
1592      within 24 hours as required by sub-subparagraph a.
1593  2.      A provider of prescribed drugs is reimbursed in an
1594      amount not to exceed the lesser of the actual acquisition cost
1595      based on the Centers for Medicare and Medicaid Services National
1596      Average Drug Acquisition Cost pricing files plus a professional
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1597      dispensing fee, the wholesale acquisition cost plus a
1598      professional dispensing fee, the state maximum allowable cost
1599      plus a professional dispensing fee, or the usual and customary
1600      charge billed by the provider.
1601  3.      The agency shall develop and implement a process for
1602      managing the drug therapies of Medicaid recipients who are using
1603      significant numbers of prescribed drugs each month. The
1604      management process may include, but is not limited to,
1605      comprehensive, physician-directed medical-record reviews, claims
1606      analyses, and case evaluations to determine the medical
1607      necessity and appropriateness of a patient's treatment plan and
1608      drug therapies. The agency may contract with a private
1609      organization to provide drug-program-management services. The
1610      Medicaid drug benefit management program shall include
1611      initiatives to manage drug therapies for HIV/AIDS patients,
1612      patients using 20 or more unique prescriptions in a 180-day
1613      period, and the top 1,000 patients in annual spending. The
1614      agency shall enroll any Medicaid recipient in the drug benefit
1615      management program if he or she meets the specifications of this
1616      provision and is not enrolled in a Medicaid health maintenance
1617      organization.
1618  4.      The agency may limit the size of its pharmacy network
1619      based on need, competitive bidding, price negotiations,
1620      credentialing, or similar criteria. The agency shall give
1621      special consideration to rural areas in determining the size and
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1622      location of pharmacies included in the Medicaid pharmacy
1623      network. A pharmacy credentialing process may include criteria
1624      such as a pharmacy's full-service status, location, size,
1625      patient educational programs, patient consultation, disease
1626      management services, and other characteristics. The agency may
1627      impose a moratorium on Medicaid pharmacy enrollment if it is
1628      determined that it has a sufficient number of Medicaid-
1629      participating providers. The agency must allow dispensing
1630      practitioners to participate as a part of the Medicaid pharmacy
1631      network regardless of the practitioner's proximity to any other
1632      entity that is dispensing prescription drugs under the Medicaid
1633      program. A dispensing practitioner must meet all credentialing
1634      requirements applicable to his or her practice, as determined by
1635      the agency.
1636  5.      A hospital facility administering long-acting
1637      injectables for severe mental illness shall be reimbursed
1638      separately from the diagnosis-related group. Long-acting
1639      injectables administered for severe mental illness in a hospital
1640      facility setting shall be reimbursed at no less than the actual
1641      acquisition cost of the drug.
1642  6.5.        The agency shall develop and implement a program that
1643      requires Medicaid practitioners who issue written prescriptions
1644      for medicinal drugs to use a counterfeit-proof prescription pad
1645      for Medicaid prescriptions. The agency shall require the use of
1646      standardized counterfeit-proof prescription pads by prescribers
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1647      who issue written prescriptions for Medicaid recipients. The
1648      agency may implement the program in targeted geographic areas or
1649      statewide.
1650  7.6.        The agency may enter into arrangements that require
1651      manufacturers of generic drugs prescribed to Medicaid recipients
1652      to provide rebates of at least 15.1 percent of the average
1653      manufacturer price for the manufacturer's generic products.
1654      These arrangements shall require that if a generic-drug
1655      manufacturer pays federal rebates for Medicaid-reimbursed drugs
1656      at a level below 15.1 percent, the manufacturer must provide a
1657      supplemental rebate to the state in an amount necessary to
1658      achieve a 15.1-percent rebate level.
1659  8.7.        The agency may establish a preferred drug list as
1660      described in this subsection, and, pursuant to the establishment
1661      of such preferred drug list, negotiate supplemental rebates from
1662      manufacturers that are in addition to those required by Title
1663      XIX of the Social Security Act and at no less than 14 percent of
1664      the average manufacturer price as defined in 42 U.S.C. s. 1936
1665      on the last day of a quarter unless the federal or supplemental
1666      rebate, or both, equals or exceeds 29 percent. There is no upper
1667      limit on the supplemental rebates the agency may negotiate. The
1668      agency may determine that specific products, brand-name or
1669      generic, are competitive at lower rebate percentages. Agreement
1670      to pay the minimum supplemental rebate percentage guarantees a
1671      manufacturer that the Medicaid Pharmaceutical and Therapeutics
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1672      Committee will consider a product for inclusion on the preferred
1673      drug list. However, a pharmaceutical manufacturer is not
1674      guaranteed placement on the preferred drug list by simply paying
1675      the minimum supplemental rebate. Agency decisions will be made
1676      on the clinical efficacy of a drug and recommendations of the
1677      Medicaid Pharmaceutical and Therapeutics Committee, as well as
1678      the price of competing products minus federal and state rebates.
1679      The agency may contract with an outside agency or contractor to
1680      conduct negotiations for supplemental rebates. For the purposes
1681      of this section, the term "supplemental rebates" means cash
1682      rebates. Value-added programs as a substitution for supplemental
1683      rebates are prohibited. The agency may seek any federal waivers
1684      to implement this initiative.
1685  9.a.8.a.  The agency may implement a Medicaid behavioral
1686      drug management system. The agency may contract with a vendor
1687      that has experience in operating behavioral drug management
1688      systems to implement this program. The agency may seek federal
1689      waivers to implement this program.
1690  b.      The agency, in conjunction with the Department of
1691      Children and Families, may implement the Medicaid behavioral
1692      drug management system that is designed to improve the quality
1693      of care and behavioral health prescribing practices based on
1694      best practice guidelines, improve patient adherence to
1695      medication plans, reduce clinical risk, and lower prescribed
1696      drug costs and the rate of inappropriate spending on Medicaid
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1697      behavioral drugs. The program may include the following
1698      elements:
1699  (I)     Provide for the development and adoption of best
1700      practice guidelines for behavioral health-related drugs such as
1701      antipsychotics, antidepressants, and medications for treating
1702      bipolar disorders and other behavioral conditions; translate
1703      them into practice; review behavioral health prescribers and
1704      compare their prescribing patterns to a number of indicators
1705      that are based on national standards; and determine deviations
1706      from best practice guidelines.
1707  (II)        Implement processes for providing feedback to and
1708      educating prescribers using best practice educational materials
1709      and peer-to-peer consultation.
1710  (III)        Assess Medicaid beneficiaries who are outliers in
1711      their use of behavioral health drugs with regard to the numbers
1712      and types of drugs taken, drug dosages, combination drug
1713      therapies, and other indicators of improper use of behavioral
1714      health drugs.
1715  (IV)        Alert prescribers to patients who fail to refill
1716      prescriptions in a timely fashion, are prescribed multiple same-
1717      class behavioral health drugs, and may have other potential
1718      medication problems.
1719  (V)     Track spending trends for behavioral health drugs and
1720      deviation from best practice guidelines.
1721  (VI)        Use educational and technological approaches to
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1722      promote best practices, educate consumers, and train prescribers
1723      in the use of practice guidelines.
1724  (VII)        Disseminate electronic and published materials.
1725  (VIII)        Hold statewide and regional conferences.
1726  (IX)        Implement a disease management program with a model
1727      quality-based medication component for severely mentally ill
1728      individuals and emotionally disturbed children who are high
1729      users of care.
1730  10.9.       The agency shall implement a Medicaid prescription
1731      drug management system.
1732  a.      The agency may contract with a vendor that has
1733      experience in operating prescription drug management systems in
1734      order to implement this system. Any management system that is
1735      implemented in accordance with this subparagraph must rely on
1736      cooperation between physicians and pharmacists to determine
1737      appropriate practice patterns and clinical guidelines to improve
1738      the prescribing, dispensing, and use of drugs in the Medicaid
1739      program. The agency may seek federal waivers to implement this
1740      program.
1741  b.      The drug management system must be designed to improve
1742      the quality of care and prescribing practices based on best
1743      practice guidelines, improve patient adherence to medication
1744      plans, reduce clinical risk, and lower prescribed drug costs and
1745      the rate of inappropriate spending on Medicaid prescription
1746      drugs. The program must:
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1747  (I)     Provide for the adoption of best practice guidelines
1748      for the prescribing and use of drugs in the Medicaid program,
1749      including translating best practice guidelines into practice;
1750      reviewing prescriber patterns and comparing them to indicators
1751      that are based on national standards and practice patterns of
1752      clinical peers in their community, statewide, and nationally;
1753      and determine deviations from best practice guidelines.
1754  (II)        Implement processes for providing feedback to and
1755      educating prescribers using best practice educational materials
1756      and peer-to-peer consultation.
1757  (III)        Assess Medicaid recipients who are outliers in their
1758      use of a single or multiple prescription drugs with regard to
1759      the numbers and types of drugs taken, drug dosages, combination
1760      drug therapies, and other indicators of improper use of
1761      prescription drugs.
1762  (IV)        Alert prescribers to recipients who fail to refill
1763      prescriptions in a timely fashion, are prescribed multiple drugs
1764      that may be redundant or contraindicated, or may have other
1765      potential medication problems.
1766  11.10.       The agency may contract for drug rebate
1767      administration, including, but not limited to, calculating
1768      rebate amounts, invoicing manufacturers, negotiating disputes
1769      with manufacturers, and maintaining a database of rebate
1770      collections.
1771  12.11.       The agency may specify the preferred daily dosing
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1772      form or strength for the purpose of promoting best practices
1773      with regard to the prescribing of certain drugs as specified in
1774      the General Appropriations Act and ensuring cost-effective
1775      prescribing practices.
1776  13.12.       The agency may require prior authorization for
1777      Medicaid-covered prescribed drugs. The agency may prior-
1778      authorize the use of a product:
1779  a.      For an indication not approved in labeling;
1780  b.      To comply with certain clinical guidelines; or
1781  c.      If the product has the potential for overuse, misuse,
1782      or abuse.
1783
1784      The agency may require the prescribing professional to provide
1785      information about the rationale and supporting medical evidence
1786      for the use of a drug. The agency shall post prior
1787      authorization, step-edit criteria and protocol, and updates to
1788      the list of drugs that are subject to prior authorization on the
1789      agency's Internet website within 21 days after the prior
1790      authorization and step-edit criteria and protocol and updates
1791      are approved by the agency. For purposes of this subparagraph,
1792      the term "step-edit" means an automatic electronic review of
1793      certain medications subject to prior authorization.
1794  14.13.       The agency, in conjunction with the Pharmaceutical
1795      and Therapeutics Committee, may require age-related prior
1796      authorizations for certain prescribed drugs. The agency may
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1797      preauthorize the use of a drug for a recipient who may not meet
1798      the age requirement or may exceed the length of therapy for use
1799      of this product as recommended by the manufacturer and approved
1800      by the Food and Drug Administration. Prior authorization may
1801      require the prescribing professional to provide information
1802      about the rationale and supporting medical evidence for the use
1803      of a drug.
1804  15.14.       The agency shall implement a step-therapy prior
1805      authorization approval process for medications excluded from the
1806      preferred drug list. Medications listed on the preferred drug
1807      list must be used within the previous 12 months before the
1808      alternative medications that are not listed. The step-therapy
1809      prior authorization may require the prescriber to use the
1810      medications of a similar drug class or for a similar medical
1811      indication unless contraindicated in the Food and Drug
1812      Administration labeling. The trial period between the specified
1813      steps may vary according to the medical indication. The step-
1814      therapy approval process shall be developed in accordance with
1815      the committee as stated in s. 409.91195(7) and (8). A drug
1816      product may be approved without meeting the step-therapy prior
1817      authorization criteria if the prescribing physician provides the
1818      agency with additional written medical or clinical documentation
1819      that the product is medically necessary because:
1820  a.      There is not a drug on the preferred drug list to treat
1821      the disease or medical condition which is an acceptable clinical
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1822      alternative;
1823  b.      The alternatives have been ineffective in the treatment
1824      of the beneficiary's disease;
1825  c.      The drug product or medication of a similar drug class
1826      is prescribed for the treatment of schizophrenia or schizotypal
1827      or delusional disorders; prior authorization has been granted
1828      previously for the prescribed drug; and the medication was
1829      dispensed to the patient during the previous 12 months; or
1830  d.      Based on historical evidence and known characteristics
1831      of the patient and the drug, the drug is likely to be
1832      ineffective, or the number of doses have been ineffective.
1833
1834      The agency shall work with the physician to determine the best
1835      alternative for the patient. The agency may adopt rules waiving
1836      the requirements for written clinical documentation for specific
1837      drugs in limited clinical situations.
1838  16.15.       The agency shall implement a return and reuse
1839      program for drugs dispensed by pharmacies to institutional
1840      recipients, which includes payment of a $5 restocking fee for
1841      the implementation and operation of the program. The return and
1842      reuse program shall be implemented electronically and in a
1843      manner that promotes efficiency. The program must permit a
1844      pharmacy to exclude drugs from the program if it is not
1845      practical or cost-effective for the drug to be included and must
1846      provide for the return to inventory of drugs that cannot be
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1847      credited or returned in a cost-effective manner. The agency
1848      shall determine if the program has reduced the amount of
1849      Medicaid prescription drugs which are destroyed on an annual
1850      basis and if there are additional ways to ensure more
1851      prescription drugs are not destroyed which could safely be
1852      reused.
1853  (14)        The agency shall implement a Medicaid therapeutic
1854      supplies spending control program. The agency may negotiate and
1855      enter into arrangements with supplies manufacturers which
1856      require manufacturers to provide rebates and may participate in
1857      multistate organizations negotiating for such rebates. The
1858      spending control program shall include a preferred product list,
1859      which shall be a listing of cost-effective therapeutic supplies
1860      recommended by the Medicaid Pharmaceutical and Therapeutics
1861      Committee established pursuant to s. 409.91195 and adopted by
1862      the agency for each product class listed on the preferred
1863      product list. The agency may publish the preferred product list
1864      and updates to the list on the agency website without following
1865      the rulemaking procedures of chapter 120.
1866  Section 16.  Section 409.9207, Florida Statutes, is created
1867      to read:
1868  409.9207  Medicaid eligibility assistance for persons with
1869      disabilities.—
1870  (1)     LEGISLATIVE INTENT.—It is the intent of the
1871      Legislature to create a program that supports and enables
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1872      persons with disabilities to become Medicaid eligible. The
1873      Department of Children and Families shall be responsible for
1874      this program; however, all agencies with any duties related to
1875      Medicaid are responsible for collaborating with the department
1876      and the independent contractor selected to implement the
1877      program.
1878  (2)     DEFINITIONS.—As used in this section, unless otherwise
1879      specified, the term:
1880  (a)     "Agency" means any state or local governmental entity.
1881  (b)     "Independent contractor" means a nonprofit
1882      organization with experience operating an information and
1883      referral program that includes person-centered services to
1884      successfully navigate eligibility procedures for state and
1885      federal assistance.
1886  (c)     "Person with disabilities" means any person who has
1887      one or more permanent physical or mental limitations which
1888      restrict his or her ability to perform the normal activities of
1889      daily living and impede his or her capacity to live
1890      independently with relatives or friends without the provision of
1891      community-based services.
1892  (3)     ELIGIBILITY ASSISTANCE PROGRAM.—
1893  (a)     The Eligibility Assistance Program is created within
1894      the Department of Children and Families to offer information,
1895      referral, and navigation services to persons with disabilities
1896      to initiate and successfully complete the actions required to
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1897      secure eligibility for Medicaid and other community-based
1898      services enabling such persons to remain in their homes and
1899      communities.
1900  (b)      The program shall be operated by an independent
1901      contractor selected based on the following criteria:
1902  1.      A tax-exempt organization incorporated in this state
1903      and in good standing with the Division of Corporations of the
1904      Department of State.
1905  2.      At least 20 years' experience operating local or
1906      regional programs that provide services for persons with
1907      disabilities.
1908  3.      Capability to operate call center and online access
1909      points.
1910  Section 17.  Subsection (1) and paragraph (f) of subsection
1911      (2) of section 409.967, Florida Statutes, are amended to read:
1912  409.967       Managed care plan accountability.—
1913  (1)     Beginning with the contract procurement process
1914      initiated during the 2023 calendar year, The agency shall
1915      establish a 10-year 6-year contract with each managed care plan
1916      selected through the procurement process described in s.
1917      409.966. A plan contract may not be renewed; however, the agency
1918      may extend the term of a plan contract to cover any delays
1919      during the transition to a new plan. The agency shall extend
1920      until January 31, 2035 December 31, 2024, the term of existing
1921      plan contracts awarded pursuant to the invitations invitation to
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1922      negotiate published in 2023 July 2017.
1923  (2)      The agency shall establish such contract requirements
1924      as are necessary for the operation of the statewide managed care
1925      program. In addition to any other provisions the agency may deem
1926      necessary, the contract must require:
1927  (f)      Continuous improvement.—The agency shall establish
1928      specific performance standards and expected milestones or
1929      timelines for improving performance over the term of the
1930      contract.
1931  1.      Each managed care plan shall establish an internal
1932      health care quality improvement system, including enrollee
1933      satisfaction and disenrollment surveys. The quality improvement
1934      system must include incentives and disincentives for network
1935      providers.
1936  2.      Each managed care plan must collect and report the
1937      Healthcare Effectiveness Data and Information Set (HEDIS)
1938      measures, the federal Core Set of Children's Health Care Quality
1939      measures, and the federal Core Set of Adult Health Care Quality
1940      Measures, as specified by the agency. Each plan must collect and
1941      report the Adult Core Set behavioral health measures beginning
1942      with data reports for the 2025 calendar year. Each plan must
1943      stratify reported measures by age, sex, race, ethnicity, primary
1944      language, and whether the enrollee received a Social Security
1945      Administration determination of disability for purposes of
1946      Supplemental Security Income beginning with data reports for the
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1947      2026 calendar year. A plan's performance on these measures must
1948      be published on the plan's website in a manner that allows
1949      recipients to reliably compare the performance of plans. The
1950      agency shall use the measures as a tool to monitor plan
1951      performance.
1952  3.      Each managed care plan must be accredited by the
1953      National Committee for Quality Assurance, the Joint Commission,
1954      or another nationally recognized accrediting body, or have
1955      initiated the accreditation process, within 1 year after the
1956      contract is executed. For any plan not accredited within 18
1957      months after executing the contract, the agency shall suspend
1958      automatic assignment under ss. 409.977 and 409.984.
1959  4.      The agency shall develop a coordinated statewide
1960      initiative of value-based strategies to drive cost-effective
1961      service delivery and improved health outcomes by directing
1962      managed care plans to implement a coordinated program of
1963      rewarding providers who deliver patient-centered, high-quality
1964      services. The initiative shall be predicated on a strategic
1965      plan, submitted to the President of the Senate and the Speaker
1966      of the House of Representatives by December 15, 2026, and
1967      implemented over a multiyear period that begins when the plan is
1968      approved by the Legislature.
1969  a.      The strategic plan must set measurable goals, establish
1970      action plans and timelines, and define evaluation methods. The
1971      strategic plan must include procedures for making implementation
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1972      adjustments necessary due to changing conditions. The agency
1973      shall review value-based payment models in other states with
1974      well-developed programs and incorporate best practices and
1975      elements which contribute to the success of those programs.
1976  b.      The initiative will consist of the following focus area
1977      phases:
1978  (I)      Year 1 will focus on perinatal health.
1979  (II)        Year 2 will add a focus on behavioral health to the
1980      Year 1 initiatives.
1981  (III)        Year 3 will add a focus on management of chronic
1982      conditions to the Year 1 and Year 2 initiatives.
1983  c.      The agency shall augment staff expertise for planning
1984      and implementation of this initiative with consultants who
1985      specialize in value-based payment. The agency must ensure active
1986      engagement of both providers and plans in developing the
1987      strategic plan and in implementation of the initiative, in a
1988      manner which fosters collaborative effort and mutual commitment
1989      to achieving goals in each focus area.
1990  d.      Upon legislative approval of the strategic plan, the
1991      agency shall replace all other contractual requirements for
1992      value-based payment set by the agency with those developed
1993      through this initiative.
1994  Section 18.  Subsection (1) of section 409.968, Florida
1995      Statutes, is amended to read:
1996  409.968        Managed care plan payments.—
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1997  (1)(a)       Prepaid plans shall receive per-member, per-month
1998      payments negotiated pursuant to the procurements described in s.
1999      409.966. Payments shall be risk-adjusted rates based on
2000      historical utilization and spending data, projected forward, and
2001      adjusted to reflect the eligibility category, geographic area,
2002      and clinical risk profile of the recipients.
2003  (b)     In negotiating rates with the plans, the agency shall
2004      consider any adjustments necessary to encourage plans to use the
2005      most cost-effective modalities for treatment of chronic disease
2006      such as peritoneal dialysis.
2007  (c)     Per-member, per-month payments made to any managed
2008      care plan contracted under this part or part III that are
2009      subsequently refunded to or recovered by the agency, or
2010      initially withheld by the agency prior to payment and not later
2011      paid to a managed care plan pursuant to the terms of its
2012      contract, shall be adjusted for the Federal Medical Assistance
2013      Percentages. The state share shall be transferred to the General
2014      Revenue Fund, unallocated, and the federal share shall be
2015      transferred to the Medical Care Trust Fund, unallocated.
2016  Section 19.  Subsection (5) of section 409.982, Florida
2017      Statutes, is amended to read:
2018  409.982       Long-term care managed care plan accountability.—
2019      In addition to the requirements of s. 409.967, plans and
2020      providers participating in the long-term care managed care
2021      program must comply with the requirements of this section.
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2022  (5)     PROVIDER PAYMENT.—Managed care plans and providers
2023      shall negotiate mutually acceptable rates, methods, and terms of
2024      payment.
2025  (a)     Plans shall pay nursing homes an amount equal to the
2026      nursing facility-specific payment rates set by the agency;
2027      however, mutually acceptable higher rates may be negotiated for
2028      medically complex care.
2029  (b)     Plans shall pay hospice providers through a
2030      prospective system for each enrollee an amount equal to the per
2031      diem rate set by the agency. For recipients residing in a
2032      nursing facility and receiving hospice services, the plan shall
2033      pay the hospice provider the per diem rate set by the agency
2034      minus the nursing facility component and shall pay the nursing
2035      facility the applicable state rate.
2036  (c)     Plans must ensure that electronic nursing home and
2037      hospice claims that contain sufficient information for
2038      processing are paid within 10 business days after receipt.
2039  (d)     The agency may establish a fee schedule to reimburse
2040      providers for adult day care services.
2041  Section 20.  Subsection (8) is added to section 409.9855,
2042      Florida Statutes, to read:
2043  409.9855  Pilot program for individuals with developmental
2044      disabilities.—
2045  (8)     WAIVER TRANSFER FUNDING.—
2046  (a)     For individuals enrolled in the Medicaid home and
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2047      community-based services waiver program under chapter 393 who
2048      choose to enroll in the pilot program, funding associated with
2049      the individual shall be transferred from the Agency for Persons
2050      with Disabilities to the Agency for Health Care Administration.
2051      The funding shall be equivalent to the total state share cost of
2052      the individual for the remaining months in the fiscal year based
2053      on the pilot program's managed care plan monthly rate.
2054  (b)     For individuals enrolled in the pilot program who
2055      choose to enroll in the Medicaid home and community-based
2056      services waiver program under chapter 393, funding associated
2057      with the individual shall be transferred from the Agency for
2058      Health Care Administration to the Agency for Persons with
2059      Disabilities. The funding shall be equivalent to the total state
2060      share cost of the individual for the remaining months in the
2061      fiscal year based on the pilot program's managed care plan
2062      monthly rate.
2063  (c)     The Agency for Persons with Disabilities and the
2064      Agency for Health Care Administration shall reconcile the
2065      amounts on a quarterly basis. The Agency for Health Care
2066      Administration may submit a budget amendment pursuant to chapter
2067      216 to transfer the funds between the agencies.
2068  Section 21.  Paragraph (e) of subsection (3) of section
2069      409.986, Florida Statutes, is redesignated as paragraph (f), and
2070      a new paragraph (e) is added to that subsection to read:
2071  409.986       Legislative findings and intent; child protection
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2072      and child welfare outcomes; definitions.—
2073  (3)     DEFINITIONS.—As used in this part, except as otherwise
2074      provided, the term:
2075  (e)     "Qualified provider" means an entity that meets the
2076      required regulatory or licensing standards for the service being
2077      procured, that has not had a contract for that service
2078      terminated due to a failure to meet contractual requirements,
2079      and that does not have any active formal corrective action plan
2080      or performance improvement plan associated with a license or
2081      contract for the service being procured.
2082  Section 22.  Subsection (5) of section 409.990, Florida
2083      Statutes, is amended to read:
2084  409.990       Funding for lead agencies.—A contract established
2085      between the department and a lead agency must be funded by a
2086      grant of general revenue, other applicable state funds, or
2087      applicable federal funding sources.
2088  (5)     A lead agency may carry forward documented unexpended
2089      state funds from one fiscal year to the next; however, the
2090      cumulative amount carried forward may not exceed 8 percent of
2091      the annual amount of the total contract. Any unexpended state
2092      funds in excess of that percentage must be returned to the
2093      department.
2094  (a)     The funds carried forward may not be used in any way
2095      that would create increased recurring future obligations, and
2096      such funds may not be used for any type of program or service
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2097      that is not currently authorized by the existing contract with
2098      the department.
2099  (b)     Expenditures of funds carried forward must be
2100      separately reported to the department.
2101  (c)     Any unexpended funds that remain at the end of the
2102      contract period shall be returned to the department.
2103  (d)     Funds carried forward may be retained through any
2104      contract renewals and any new procurements as long as the same
2105      lead agency is retained by the department.
2106  Section 23.  Subsection (2) of section 409.996, Florida
2107      Statutes, is amended to read:
2108  409.996       Duties of the Department of Children and
2109      Families.—The department shall contract for the delivery,
2110      administration, or management of care for children in the child
2111      protection and child welfare system. In doing so, the department
2112      retains responsibility for the quality of contracted services
2113      and programs and shall ensure that, at a minimum, services are
2114      delivered in accordance with applicable federal and state
2115      statutes and regulations and the performance standards and
2116      metrics specified in the strategic plan created under s.
2117      20.19(1).
2118  (2)(a)       The department must adopt written policies and
2119      procedures for monitoring the contract for delivery of services
2120      by lead agencies which must be published on the department's
2121      website. These policies and procedures must, at a minimum,
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2122      address the evaluation of fiscal accountability and program
2123      operations, including provider achievement of performance
2124      standards, provider monitoring of subcontractors, and timely
2125      followup of corrective actions for significant monitoring
2126      findings related to providers and subcontractors. These policies
2127      and procedures must also include provisions for reducing the
2128      duplication of the department's program monitoring activities
2129      both internally and with other agencies, to the extent possible.
2130      The department's written procedures must ensure that the written
2131      findings, conclusions, and recommendations from monitoring the
2132      contract for services of lead agencies are communicated to the
2133      director of the provider agency and the community alliance as
2134      expeditiously as possible.
2135  (b)     The department shall establish a standard statewide
2136      provider contract to reduce administrative burden and expense by
2137      establishing uniform reporting, accounting, billing, and
2138      budgeting requirements. The contract shall establish terms for
2139      the provision of core child welfare services, including case
2140      management, foster home licensing, independent living, and
2141      residential group care, with standardized attachments by
2142      provider type. The standard statewide provider contract shall
2143      include provisions for provider probation, termination for
2144      cause, and emergency termination for actions or inactions of a
2145      provider that pose an immediate and serious danger to the
2146      health, safety, or welfare of children, and shall include
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2147      provider appeal procedures for these actions. During the
2148      pendency of an appeal of an emergency termination, the provider
2149      may not continue to provide services. In developing the
2150      statewide provider contract, the department shall work directly
2151      with both lead agencies and providers of each service type. The
2152      department shall publish the standard statewide provider
2153      contract on its website and require lead agencies to use the
2154      contract, at a minimum, for provider contracting. Lead agencies
2155      may establish additional contract terms to respond to particular
2156      regional needs and circumstances.
2157  Section 24.  Subsection (5) of section 414.56, Florida
2158      Statutes, is amended to read:
2159  414.56       Office of Continuing Care.—The department shall
2160      establish an Office of Continuing Care to ensure young adults
2161      who age out of the foster care system between 18 and 21 years of
2162      age, or 22 years of age with a documented disability, have a
2163      point of contact until the young adult reaches the age of 26 in
2164      order to receive ongoing support and care coordination needed to
2165      achieve self-sufficiency. Duties of the office include, but are
2166      not limited to:
2167  (5)     Developing and administering the Step into Success
2168      Workforce Education and Internship Pilot Program for foster
2169      youth and former foster youth as required under s. 409.1455.
2170  Section 25.  For the purpose of incorporating the amendment
2171      made by this act to section 409.968, Florida Statutes, in a
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2172      reference thereto, subsection (2) of section 409.978, Florida
2173      Statutes, is reenacted to read:
2174  409.978       Long-term care managed care program.—
2175  (2)     The agency shall make payments for long-term care,
2176      including home and community-based services, using a managed
2177      care model. Unless otherwise specified, ss. 409.961-409.969
2178      apply to the long-term care managed care program.
2179  Section 26.  For the purpose of incorporating the amendment
2180      made by this act to section 409.968, Florida Statutes, in a
2181      reference thereto, paragraph (b) of subsection (1) of section
2182      409.9855, Florida Statutes, is reenacted to read:
2183  409.9855  Pilot program for individuals with developmental
2184      disabilities.—
2185  (1)     PILOT PROGRAM IMPLEMENTATION.—
2186  (b)     The agency shall administer the pilot program pursuant
2187      to s. 409.963 and as a component of the Statewide Medicaid
2188      Managed Care model established by this part. Unless otherwise
2189      specified, ss. 409.961-409.969 apply to the pilot program. For
2190      purposes of the pilot program, compliance with s. 409.966 is
2191      deemed satisfied by the competitive procurement procedures
2192      conducted for contracts effective on February 1, 2025.
2193  Section 27.  Subsection (1) of section 409.91196, Florida
2194      Statutes, is amended to read:
2195  409.91196  Supplemental rebate agreements; public records
2196      and public meetings exemption.—
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2197  (1)      The rebate amount, percent of rebate, manufacturer's
2198      pricing, and supplemental rebate, and other trade secrets as
2199      defined in s. 688.002 that the agency has identified for use in
2200      negotiations, held by the Agency for Health Care Administration
2201      under s. 409.912(5)(a)8. s. 409.912(5)(a)7. are confidential and
2202      exempt from s. 119.07(1) and s. 24(a), Art. I of the State
2203      Constitution.
2204  Section 28.  Paragraph (b) of subsection (5) of section
2205      393.065, Florida Statutes, is amended to read:
2206  393.065       Application and eligibility determination.—
2207  (5)      Except as provided in subsections (6) and (7), if a
2208      client seeking enrollment in the developmental disabilities home
2209      and community-based services Medicaid waiver program meets the
2210      level of care requirement for an intermediate care facility for
2211      individuals with intellectual disabilities pursuant to 42 C.F.R.
2212      ss. 435.217(b)(1) and 440.150, the agency must assign the client
2213      to an appropriate preenrollment category pursuant to this
2214      subsection and must provide priority to clients waiting for
2215      waiver services in the following order:
2216  (b)      Category 2, which includes clients in the
2217      preenrollment categories who are:
2218  1.      From the child welfare system with an open case in the
2219      Department of Children and Families' statewide automated child
2220      welfare information system and who are either:
2221  a.      Transitioning out of the child welfare system into
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2222      permanency; or
2223  b.      At least 18 years but not yet 22 years of age and who
2224      need both waiver services and extended foster care services; or
2225  2.      At least 18 years but not yet 22 years of age and who
2226      withdrew consent pursuant to s. 39.6251(5)(c) to remain in the
2227      extended foster care system.
2228
2229      For individuals who are at least 18 years but not yet 22 years
2230      of age and who are eligible under sub-subparagraph 1.b., the
2231      agency must provide waiver services, including residential
2232      habilitation, and must actively participate in transition
2233      planning activities, including, but not limited to,
2234      individualized service coordination, case management support,
2235      and ensuring continuity of care pursuant to s. 39.6035. The
2236      community-based care lead agency must fund room and board at the
2237      rate established in s. 409.145(3) and provide case management
2238      and related services as defined in s. 409.986(3)(f) s.
2239      409.986(3)(e). Individuals may receive both waiver services and
2240      services under s. 39.6251. Services may not duplicate services
2241      available through the Medicaid state plan.
2242
2243      Within preenrollment categories 3, 4, 5, 6, and 7, the agency
2244      shall prioritize clients in the order of the date that the
2245      client is determined eligible for waiver services.
2246  Section 29.  Except as otherwise provided in this act, this
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2247      act shall take effect July 1, 2026.
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