Florida Senate - 2025 CS for SB 1490 By the Committee on Health Policy; and Senator Harrell 588-03165-25 20251490c1 1 A bill to be entitled 2 An act relating to the Childrens Medical Services 3 program; transferring operation of the Childrens 4 Medical Services Managed Care Plan from the Department 5 of Health to the Agency for Health Care 6 Administration, effective on a specified date; 7 providing construction as to judicial and 8 administrative actions pending as of a specified date 9 and time; requiring the departments Childrens 10 Medical Services (CMS) program to collaborate with the 11 agency in the care of children and youth with special 12 health care needs; requiring the CMS program to 13 conduct certain clinical eligibility screenings and 14 provide ongoing consultation to the agency for a 15 specified purpose; amending s. 409.974, F.S.; 16 requiring the CMS program to transfer operation of 17 certain managed care contracts from the department to 18 the agency effective on a specified date; requiring 19 the CMS program to conduct clinical eligibility 20 screening for certain children and youth with special 21 health care needs; requiring the program to provide 22 ongoing consultation to the agency for a specified 23 purpose; requiring the agency to establish specific 24 measures for evaluation of services provided to 25 children and youth with special health care needs; 26 requiring the agency to contract with an independent 27 evaluator to conduct the evaluation of services 28 provided; specifying requirements for the evaluation; 29 requiring the agency to submit the results of the 30 evaluation to the Governor and the Legislature by a 31 specified date; amending s. 391.016, F.S.; revising 32 the purposes and functions of the CMS program; 33 amending s. 391.021, F.S.; revising definitions; 34 amending s. 391.025, F.S.; revising the scope of the 35 CMS program; amending s. 391.026, F.S.; revising the 36 powers and duties of the department to conform to 37 changes made by the act; providing for the future 38 repeal of s. 391.026(8) through (11), F.S., relating 39 to the departments oversight and administration of 40 the CMS program; repealing s. 391.028, F.S., relating 41 to administration of the program; amending s. 391.029, 42 F.S.; revising program eligibility requirements; 43 conforming provisions to changes made by the act; 44 amending s. 391.0315, F.S.; conforming provisions to 45 changes made by the act; providing for future repeal 46 of specified provisions; repealing ss. 391.035, 47 391.037, 391.045, 391.047, 391.055, and 391.071, F.S., 48 relating to provider qualifications, physicians and 49 private sector services, provider reimbursements, 50 third-party payments, service delivery systems under 51 the program, and quality of care requirements, 52 respectively; amending s. 391.097, F.S.; conforming a 53 provision to changes made by the act; repealing part 54 II of ch. 391, F.S., consisting of ss. 391.221 and 55 391.223, F.S., relating to Childrens Medical Services 56 councils and panels; amending ss. 409.166, 409.811, 57 409.813, 409.8134, 409.814, 409.815, 409.8177, 58 409.818, 409.912, 409.9126, 409.9131, 409.920, and 59 409.962, F.S.; conforming provisions to changes made 60 by the act; requiring the agency to develop a 61 comprehensive plan to redesign the Florida Medicaid 62 Model Waiver for home and community-based services to 63 include children who receive private duty nursing 64 services; providing requirements for the redesign of 65 the waiver plan; requiring the agency to submit a 66 report to the Governor and the Legislature by a 67 specified date; providing requirements for the report; 68 providing effective dates. 69 70 Be It Enacted by the Legislature of the State of Florida: 71 72 Section 1.Transfer of operation of the Childrens Medical 73 Services Managed Care Plan. 74 (1)Effective July 1, 2025, all statutory powers, duties, 75 functions, records, personnel, pending issues, existing 76 contracts, administrative authority, administrative rules, and 77 unexpended balances of appropriations, allocations, and other 78 funds for the operation of the Department of Healths Childrens 79 Medical Services Managed Care Plan are transferred to the Agency 80 for Health Care Administration. 81 (2)The transfer of operations of the Childrens Medical 82 Services Managed Care Plan does not affect the validity of any 83 judicial or administrative action pending as of 11:59 p.m. on 84 the day before the effective date of the transfer to which the 85 Department of Healths Childrens Medical Services Managed Care 86 Plan is at that time a party, and the Agency for Health Care 87 Administration shall be substituted as a party in interest in 88 any such action. 89 (3)The Department of Healths Childrens Medical Services 90 program shall collaborate with the Agency for Health Care 91 Administration in the care of children and youth with special 92 health care needs. The Department of Healths Childrens Medical 93 Services program shall do all of the following: 94 (a)Conduct clinical eligibility screening for children and 95 youth with special health care needs who are eligible for or 96 enrolled in Medicaid or the Childrens Health Insurance Program. 97 (b)Provide ongoing consultation to the Agency for Health 98 Care Administration to ensure high-quality, family-centered, 99 coordinated health services within an effective system of care 100 for children and youth with special health care needs. 101 Section 2.Subsection (4) of section 409.974, Florida 102 Statutes, is amended to read: 103 409.974Eligible plans. 104 (4)CHILDRENS MEDICAL SERVICES NETWORK. 105 (a)The Department of Healths Childrens Medical Services 106 program shall do all of the following: 107 1.Effective July 1, 2025, transfer to the agency the 108 operation of managed care contracts procured by the department 109 for Medicaid and Childrens Health Insurance Program services 110 provided to children and youth with special health care needs 111 who are enrolled in the Childrens Medical Services Managed Care 112 Plan. 113 2.Conduct clinical eligibility screening for children and 114 youth with special health care needs who are eligible for or are 115 enrolled in Medicaid or the Childrens Health Insurance Program. 116 3.Provide ongoing consultation to the agency to ensure 117 high-quality, family-centered, coordinated health services are 118 provided within an effective system of care for children and 119 youth with special health care needs. 120 (b)The agency shall establish specific measures of access, 121 quality, and costs of providing health care services to children 122 and youth with special health care needs. The agency shall 123 contract with an independent evaluator to conduct an evaluation 124 of services provided. The evaluation must include, but need not 125 be limited to, all of the following: 126 1.A performance comparison of plans contracted to provide 127 services to children and youth with special health care needs as 128 well as plans contracted to serve a broader population of 129 Managed Medical Assistance enrollees. The performance comparison 130 must be based on the measures established by the agency and 131 differentiated based on the age and medical condition or 132 diagnosis of patients receiving services under each plan. 133 2.For each plan, an assessment of cost savings, patient 134 choice, access to services, coordination of care, person 135 centered planning, health and quality-of-life outcomes, patient 136 and provider satisfaction, and provider networks and quality of 137 care. 138 139 The agency shall submit the results of the evaluation to the 140 Governor, the President of the Senate, and the Speaker of the 141 House of Representatives by January 15, 2028 Participation by 142 the Childrens Medical Services Network shall be pursuant to a 143 single, statewide contract with the agency that is not subject 144 to the procurement requirements or regional plan number limits 145 of this section. The Childrens Medical Services Network must 146 meet all other plan requirements for the managed medical 147 assistance program. 148 Section 3.Subsection (1) of section 391.016, Florida 149 Statutes, is amended to read: 150 391.016Purposes and functions.The Childrens Medical 151 Services program is established for the following purposes and 152 authorized to perform the following functions: 153 (1)Provide to children and youth with special health care 154 needs a family-centered, comprehensive, and coordinated 155 statewide managed system of care that links community-based 156 health care with multidisciplinary, regional, and tertiary 157 pediatric specialty care. The program shall coordinate and 158 maintain a consistent medical home for participating children. 159 Section 4.Subsections (1), (2), and (4) of section 160 391.021, Florida Statutes, are reordered and amended to read: 161 391.021Definitions.When used in this act, the term: 162 (2)(1)Childrens Medical Services Managed Care Plan 163 network or plan network means a statewide managed care 164 service system that includes health care providers, as defined 165 in this section. 166 (1)(2)Children and youth with special health care needs 167 means those children and youth younger than 21 years of age who 168 have chronic and serious physical, developmental, behavioral, or 169 emotional conditions and who require health care and related 170 services of a type or amount beyond that which is generally 171 required by children and youth. 172 (4)Eligible individual means a child or youth with a 173 special health care need or a female with a high-risk pregnancy, 174 who meets the financial and medical eligibility standards 175 established in s. 391.029. 176 Section 5.Subsection (1) of section 391.025, Florida 177 Statutes, is amended to read: 178 391.025Applicability and scope. 179 (1)The Childrens Medical Services program consists of the 180 following components: 181 (a)The newborn screening program established in s. 383.14 182 and the newborn, infant, and toddler hearing screening program 183 established in s. 383.145. 184 (b)The regional perinatal intensive care centers program 185 established in ss. 383.15-383.19. 186 (c)The developmental evaluation and intervention program, 187 including the Early Steps Program established in ss. 391.301 188 391.308. 189 (d)The Childrens Medical Services Managed Care Plan 190 through the end of June 30, 2025 network. 191 (e)The Childrens Multidisciplinary Assessment Team. 192 (f)The Medical Foster Care Program. 193 (g)The Title V Children and Youth with Special Health Care 194 Needs program. 195 (h)The Safety Net Program. 196 (i)Child Protection Teams and sexual abuse treatment 197 programs established under s. 39.303. 198 (j)The State Child Abuse Death Review Committee and local 199 child abuse death review committees established in s. 383.402. 200 Section 6.Section 391.026, Florida Statutes, is amended to 201 read: 202 391.026Powers and duties of the department.The department 203 shall have the following powers, duties, and responsibilities: 204 (1)To provide or contract for the provision of health 205 services to eligible individuals. 206 (2)To provide services to abused and neglected children 207 through Child Protection Teams pursuant to s. 39.303. 208 (3)To determine the medical and financial eligibility of 209 individuals seeking health services from the program. 210 (4)To coordinate a comprehensive delivery system for 211 eligible individuals to take maximum advantage of all available 212 funds. 213 (5)To coordinate with programs relating to childrens 214 medical services in cooperation with other public and private 215 agencies. 216 (6)To initiate and coordinate applications to federal 217 agencies and private organizations for funds, services, or 218 commodities relating to childrens medical programs. 219 (7)To sponsor or promote grants for projects, programs, 220 education, or research in the field of children and youth with 221 special health care needs, with an emphasis on early diagnosis 222 and treatment. 223 (8)To oversee and operate the Childrens Medical Services 224 Managed Care Plan through the end of June 30, 2025 network. 225 (9)To establish reimbursement mechanisms for the 226 Childrens Medical Services network. 227 (10)To establish Childrens Medical Services network 228 standards and credentialing requirements for health care 229 providers and health care services. 230 (11)To serve as a provider and principal case manager for 231 children with special health care needs under Titles XIX and XXI 232 of the Social Security Act. 233 (12)To monitor the provision of health services in the 234 program, including the utilization and quality of health 235 services. 236 (10)(13)To administer the Children and Youth with Special 237 Health Care Needs program in accordance with Title V of the 238 Social Security Act. 239 (14)To establish and operate a grievance resolution 240 process for participants and health care providers. 241 (15)To maintain program integrity in the Childrens 242 Medical Services program. 243 (11)(16)To receive and manage health care premiums, 244 capitation payments, and funds from federal, state, local, and 245 private entities for the program. The department may contract 246 with a third-party administrator for processing claims, 247 monitoring medical expenses, and other related services 248 necessary to the efficient and cost-effective operation of the 249 Childrens Medical Services Managed Care Plan through the end of 250 June 30, 2025 network. The department is authorized to maintain 251 a minimum reserve for the Childrens Medical Services network in 252 an amount that is the greater of: 253 (a)Ten percent of total projected expenditures for Title 254 XIX-funded and Title XXI-funded children; or 255 (b)Two percent of total annualized payments from the 256 Agency for Health Care Administration for Title XIX and Title 257 XXI of the Social Security Act. 258 (12)(17)To provide or contract for peer review and other 259 quality-improvement activities. 260 (13)(18)To adopt rules pursuant to ss. 120.536(1) and 261 120.54 to administer the Childrens Medical Services Act. 262 (14)(19)To serve as the lead agency in administering the 263 Early Steps Program pursuant to part C of the federal 264 Individuals with Disabilities Education Act and part III of this 265 chapter. 266 (15)To administer the Medical Foster Care Program, 267 including all of the following: 268 (a)Recruitment, training, assessment, and monitoring for 269 the Medical Foster Care Program. 270 (b)Monitoring access and facilitating admissions of 271 eligible children and youth to the program and designated 272 medical foster care homes. 273 (c)Coordination with the Department of Children and 274 Families and the Agency for Health Care Administration or their 275 designees. 276 Section 7.Effective July 1, 2025, subsections (8) through 277 (11) of section 391.026, Florida Statutes, as amended by this 278 act, are repealed. 279 Section 8.Effective July 1, 2025, section 391.028, Florida 280 Statutes, is repealed. 281 Section 9.Subsections (2) and (3) of section 391.029, 282 Florida Statutes, are amended to read: 283 391.029Program eligibility. 284 (2)The following individuals are eligible to receive 285 services through the program: 286 (a)Related to the regional perinatal intensive care 287 centers, a high-risk pregnant female who is enrolled in 288 Medicaid. 289 (b)Children and youth with serious special health care 290 needs from birth to 21 years of age who are enrolled in 291 Medicaid. 292 (c)Children and youth with serious special health care 293 needs from birth to 19 years of age who are enrolled in a 294 program under Title XXI of the Social Security Act. 295 (3)Subject to the availability of funds, the following 296 individuals may receive services through the Childrens Medical 297 Services Safety Net program: 298 (a)Children and youth with serious special health care 299 needs from birth to 21 years of age who do not qualify for 300 Medicaid or Title XXI of the Social Security Act but who are 301 unable to access, due to lack of providers or lack of financial 302 resources, specialized services that are medically necessary or 303 essential family support services. Families shall participate 304 financially in the cost of care based on a sliding fee scale 305 established by the department. 306 (b)Children and youth with special health care needs from 307 birth to 21 years of age, as provided in Title V of the Social 308 Security Act. 309 (c)An infant who receives an award of compensation under 310 s. 766.31(1). The Florida Birth-Related Neurological Injury 311 Compensation Association shall reimburse the Childrens Medical 312 Services Network the states share of funding, which must 313 thereafter be used to obtain matching federal funds under Title 314 XXI of the Social Security Act. 315 Section 10.Section 391.0315, Florida Statutes, is amended 316 to read: 317 391.0315Benefits.Benefits provided under the Childrens 318 Medical Services Managed Care Plan program for children with 319 special health care needs shall be equivalent to benefits 320 provided to children as specified in ss. 409.905 and 409.906. 321 The department may offer additional benefits through Childrens 322 Medical Services programs for early intervention services, 323 respite services, genetic testing, genetic and nutritional 324 counseling, and parent support services, if such services are 325 determined to be medically necessary. This section is repealed 326 on January 1, 2026. 327 Section 11.Section 391.035, Florida Statutes, is repealed. 328 Section 12.Effective January 1, 2026, section 391.037, 329 Florida Statutes, is repealed. 330 Section 13.Section 391.045, Florida Statutes, is repealed. 331 Section 14.Effective January 1, 2026, section 391.047, 332 Florida Statutes, is repealed. 333 Section 15.Effective January 1, 2026, section 391.055, 334 Florida Statutes, is repealed. 335 Section 16.Effective January 1, 2026, section 391.071, 336 Florida Statutes, is repealed. 337 Section 17.Section 391.097, Florida Statutes, is amended 338 to read: 339 391.097Research and evaluation. 340 (1)The department may initiate, fund, and conduct research 341 and evaluation projects to improve the delivery of childrens 342 medical services. The department may cooperate with public and 343 private agencies engaged in work of a similar nature. 344 (2)The Childrens Medical Services network shall be 345 included in any evaluation conducted in accordance with the 346 provisions of Title XXI of the Social Security Act as enacted by 347 the Legislature. 348 Section 18.Part II of chapter 391, Florida Statutes, 349 consisting of ss. 391.221 and 391.223, Florida Statutes, is 350 repealed, and part III of that chapter is redesignated as part 351 II. 352 Section 19.Effective July 1, 2025, paragraph (b) of 353 subsection (5) of section 409.166, Florida Statutes, is amended 354 to read: 355 409.166Children within the child welfare system; adoption 356 assistance program. 357 (5)ELIGIBILITY FOR SERVICES. 358 (b)A child who is handicapped at the time of adoption is 359 shall be eligible for services through a plan under contract 360 with the agency to serve children and youth with special heath 361 care needs the Childrens Medical Services network established 362 under part I of chapter 391 if the child was eligible for such 363 services before prior to the adoption. 364 Section 20.Effective July 1, 2025, subsection (7) of 365 section 409.811, Florida Statutes, is amended to read: 366 409.811Definitions relating to Florida Kidcare Act.As 367 used in ss. 409.810-409.821, the term: 368 (7)Childrens Medical Services Network or network 369 means a statewide managed care service system as defined in s. 370 391.021(1). 371 Section 21.Effective July 1, 2025, subsection (1) of 372 section 409.813, Florida Statutes, is amended to read: 373 409.813Health benefits coverage; program components; 374 entitlement and nonentitlement. 375 (1)The Florida Kidcare program includes health benefits 376 coverage provided to children through the following program 377 components, which shall be marketed as the Florida Kidcare 378 program: 379 (a)Medicaid; 380 (b)Medikids as created in s. 409.8132; 381 (c)The Florida Healthy Kids Corporation as created in s. 382 624.91; 383 (d)Employer-sponsored group health insurance plans 384 approved under ss. 409.810-409.821; and 385 (e)Plans under contract with the agency to serve children 386 and youth with special health care needs The Childrens Medical 387 Services network established in chapter 391. 388 Section 22.Effective July 1, 2025, subsection (3) of 389 section 409.8134, Florida Statutes, is amended to read: 390 409.8134Program expenditure ceiling; enrollment. 391 (3)Upon determination by the Social Services Estimating 392 Conference that there are insufficient funds to finance the 393 current enrollment in the Florida Kidcare program within current 394 appropriations, the program shall initiate disenrollment 395 procedures to remove enrollees, except those children enrolled 396 in a plan under contract with the agency to serve children with 397 special health care needs the Childrens Medical Services 398 Network, on a last-in, first-out basis until the expenditure and 399 appropriation levels are balanced. 400 Section 23.Subsection (3) and paragraph (c) of subsection 401 (10) of section 409.814, Florida Statutes, are amended to read: 402 409.814Eligibility.A child who has not reached 19 years 403 of age whose family income is equal to or below 300 percent of 404 the federal poverty level is eligible for the Florida Kidcare 405 program as provided in this section. If an enrolled individual 406 is determined to be ineligible for coverage, he or she must be 407 immediately disenrolled from the respective Florida Kidcare 408 program component. 409 (3)A Title XXI-funded child who is eligible for the 410 Florida Kidcare program who is a child with special health care 411 needs, as determined through a medical or behavioral screening 412 instrument, is eligible for health benefits coverage from and 413 shall be assigned to and may opt out of a plan under contract 414 with the agency to serve children with special health care needs 415 the Childrens Medical Services Network. 416 (10)In determining the eligibility of a child, an assets 417 test is not required. If eligibility for the Florida Kidcare 418 program cannot be verified using reliable data sources in 419 accordance with federal requirements, each applicant shall 420 provide documentation during the application process and the 421 redetermination process, including, but not limited to, the 422 following: 423 (c)To enroll in a plan under contract with the agency to 424 service children with special health care needs the Childrens 425 Medical Services Network, a completed application, including a 426 Childrens Medical Services clinical screening. 427 Section 24.Effective July 1, 2025, paragraph (t) of 428 subsection (2) of section 409.815, Florida Statutes, is amended 429 to read: 430 409.815Health benefits coverage; limitations. 431 (2)BENCHMARK BENEFITS.In order for health benefits 432 coverage to qualify for premium assistance payments for an 433 eligible child under ss. 409.810-409.821, the health benefits 434 coverage, except for coverage under Medicaid and Medikids, must 435 include the following minimum benefits, as medically necessary. 436 (t)Enhancements to minimum requirements. 437 1.This section sets the minimum benefits that must be 438 included in any health benefits coverage, other than Medicaid or 439 Medikids coverage, offered under ss. 409.810-409.821. Health 440 benefits coverage may include additional benefits not included 441 under this subsection, but may not include benefits excluded 442 under paragraph (r). 443 2.Health benefits coverage may extend any limitations 444 beyond the minimum benefits described in this section. 445 446 Except for a plan under contract with the agency to serve 447 children with special health care needs the Childrens Medical 448 Services Network, the agency may not increase the premium 449 assistance payment for either additional benefits provided 450 beyond the minimum benefits described in this section or the 451 imposition of less restrictive service limitations. 452 Section 25.Effective July 1, 2025, paragraph (i) of 453 subsection (1) of section 409.8177, Florida Statutes, is amended 454 to read: 455 409.8177Program evaluation. 456 (1)The agency, in consultation with the Department of 457 Health, the Department of Children and Families, and the Florida 458 Healthy Kids Corporation, shall contract for an evaluation of 459 the Florida Kidcare program and shall by January 1 of each year 460 submit to the Governor, the President of the Senate, and the 461 Speaker of the House of Representatives a report of the program. 462 In addition to the items specified under s. 2108 of Title XXI of 463 the Social Security Act, the report shall include an assessment 464 of crowd-out and access to health care, as well as the 465 following: 466 (i)An assessment of the effectiveness of the Florida 467 Kidcare program, including Medicaid, the Florida Healthy Kids 468 program, Medikids, and the plans under contract with the agency 469 to serve children with special health care needs Childrens 470 Medical Services network, and other public and private programs 471 in the state in increasing the availability of affordable 472 quality health insurance and health care for children. 473 Section 26.Effective July 1, 2025, subsection (4) of 474 section 409.818, Florida Statutes, is amended to read: 475 409.818Administration.In order to implement ss. 409.810 476 409.821, the following agencies shall have the following duties: 477 (4)The Office of Insurance Regulation shall certify that 478 health benefits coverage plans that seek to provide services 479 under the Florida Kidcare program, except those offered through 480 the Florida Healthy Kids Corporation or the Childrens Medical 481 Services Network, meet, exceed, or are actuarially equivalent to 482 the benchmark benefit plan and that health insurance plans will 483 be offered at an approved rate. In determining actuarial 484 equivalence of benefits coverage, the Office of Insurance 485 Regulation and health insurance plans must comply with the 486 requirements of s. 2103 of Title XXI of the Social Security Act. 487 The department shall adopt rules necessary for certifying health 488 benefits coverage plans. 489 Section 27.Effective July 1, 2025, subsection (11) of 490 section 409.912, Florida Statutes, is amended to read: 491 409.912Cost-effective purchasing of health care.The 492 agency shall purchase goods and services for Medicaid recipients 493 in the most cost-effective manner consistent with the delivery 494 of quality medical care. To ensure that medical services are 495 effectively utilized, the agency may, in any case, require a 496 confirmation or second physicians opinion of the correct 497 diagnosis for purposes of authorizing future services under the 498 Medicaid program. This section does not restrict access to 499 emergency services or poststabilization care services as defined 500 in 42 C.F.R. s. 438.114. Such confirmation or second opinion 501 shall be rendered in a manner approved by the agency. The agency 502 shall maximize the use of prepaid per capita and prepaid 503 aggregate fixed-sum basis services when appropriate and other 504 alternative service delivery and reimbursement methodologies, 505 including competitive bidding pursuant to s. 287.057, designed 506 to facilitate the cost-effective purchase of a case-managed 507 continuum of care. The agency shall also require providers to 508 minimize the exposure of recipients to the need for acute 509 inpatient, custodial, and other institutional care and the 510 inappropriate or unnecessary use of high-cost services. The 511 agency shall contract with a vendor to monitor and evaluate the 512 clinical practice patterns of providers in order to identify 513 trends that are outside the normal practice patterns of a 514 providers professional peers or the national guidelines of a 515 providers professional association. The vendor must be able to 516 provide information and counseling to a provider whose practice 517 patterns are outside the norms, in consultation with the agency, 518 to improve patient care and reduce inappropriate utilization. 519 The agency may mandate prior authorization, drug therapy 520 management, or disease management participation for certain 521 populations of Medicaid beneficiaries, certain drug classes, or 522 particular drugs to prevent fraud, abuse, overuse, and possible 523 dangerous drug interactions. The Pharmaceutical and Therapeutics 524 Committee shall make recommendations to the agency on drugs for 525 which prior authorization is required. The agency shall inform 526 the Pharmaceutical and Therapeutics Committee of its decisions 527 regarding drugs subject to prior authorization. The agency is 528 authorized to limit the entities it contracts with or enrolls as 529 Medicaid providers by developing a provider network through 530 provider credentialing. The agency may competitively bid single 531 source-provider contracts if procurement of goods or services 532 results in demonstrated cost savings to the state without 533 limiting access to care. The agency may limit its network based 534 on the assessment of beneficiary access to care, provider 535 availability, provider quality standards, time and distance 536 standards for access to care, the cultural competence of the 537 provider network, demographic characteristics of Medicaid 538 beneficiaries, practice and provider-to-beneficiary standards, 539 appointment wait times, beneficiary use of services, provider 540 turnover, provider profiling, provider licensure history, 541 previous program integrity investigations and findings, peer 542 review, provider Medicaid policy and billing compliance records, 543 clinical and medical record audits, and other factors. Providers 544 are not entitled to enrollment in the Medicaid provider network. 545 The agency shall determine instances in which allowing Medicaid 546 beneficiaries to purchase durable medical equipment and other 547 goods is less expensive to the Medicaid program than long-term 548 rental of the equipment or goods. The agency may establish rules 549 to facilitate purchases in lieu of long-term rentals in order to 550 protect against fraud and abuse in the Medicaid program as 551 defined in s. 409.913. The agency may seek federal waivers 552 necessary to administer these policies. 553 (11)The agency shall implement a program of all-inclusive 554 care for children. The program of all-inclusive care for 555 children shall be established to provide in-home hospice-like 556 support services to children diagnosed with a life-threatening 557 illness and enrolled in the Childrens Medical Services network 558 to reduce hospitalizations as appropriate. The agency, in 559 consultation with the Department of Health, may implement the 560 program of all-inclusive care for children after obtaining 561 approval from the Centers for Medicare and Medicaid Services. 562 Section 28.Effective July 1, 2025, subsection (1) of 563 section 409.9126, Florida Statutes, is amended to read: 564 409.9126Children with special health care needs. 565 (1)Except as provided in subsection (4), children eligible 566 for the Childrens Medical Services program who receive Medicaid 567 benefits, and other Medicaid-eligible children with special 568 health care needs, are shall be exempt from the provisions of s. 569 409.9122 and shall be served through the Childrens Medical 570 Services network established in chapter 391. 571 Section 29.Effective July 1, 2025, paragraph (a) of 572 subsection (5) of section 409.9131, Florida Statutes, is amended 573 to read: 574 409.9131Special provisions relating to integrity of the 575 Medicaid program. 576 (5)DETERMINATIONS OF OVERPAYMENT.In making a 577 determination of overpayment to a physician, the agency must: 578 (a)Use accepted and valid auditing, accounting, 579 analytical, statistical, or peer-review methods, or combinations 580 thereof. Appropriate statistical methods may include, but are 581 not limited to, sampling and extension to the population, 582 parametric and nonparametric statistics, tests of hypotheses, 583 other generally accepted statistical methods, review of medical 584 records, and a consideration of the physicians client case mix. 585 Before performing a review of the physicians Medicaid records, 586 however, the agency shall make every effort to consider the 587 physicians patient case mix, including, but not limited to, 588 patient age and whether individual patients are clients of the 589 Childrens Medical Services Network established in chapter 391. 590 In meeting its burden of proof in any administrative or court 591 proceeding, the agency may introduce the results of such 592 statistical methods and its other audit findings as evidence of 593 overpayment. 594 Section 30.Effective July 1, 2025, paragraph (e) of 595 subsection (1) of section 409.920, Florida Statutes, is amended 596 to read: 597 409.920Medicaid provider fraud. 598 (1)For the purposes of this section, the term: 599 (e)Managed care plans means a health insurer authorized 600 under chapter 624, an exclusive provider organization authorized 601 under chapter 627, a health maintenance organization authorized 602 under chapter 641, the Childrens Medical Services Network 603 authorized under chapter 391, a prepaid health plan authorized 604 under this chapter, a provider service network authorized under 605 this chapter, a minority physician network authorized under this 606 chapter, and an emergency department diversion program 607 authorized under this chapter or the General Appropriations Act, 608 providing health care services pursuant to a contract with the 609 Medicaid program. 610 Section 31.Effective July 1, 2025, subsection (7) of 611 section 409.962, Florida Statutes, is amended to read: 612 409.962Definitions.As used in this part, except as 613 otherwise specifically provided, the term: 614 (7)Eligible plan means a health insurer authorized under 615 chapter 624, an exclusive provider organization authorized under 616 chapter 627, a health maintenance organization authorized under 617 chapter 641, or a provider service network authorized under s. 618 409.912(1) or an accountable care organization authorized under 619 federal law. For purposes of the managed medical assistance 620 program, the term also includes the Childrens Medical Services 621 Network authorized under chapter 391 and entities qualified 622 under 42 C.F.R. part 422 as Medicare Advantage Preferred 623 Provider Organizations, Medicare Advantage Provider-sponsored 624 Organizations, Medicare Advantage Health Maintenance 625 Organizations, Medicare Advantage Coordinated Care Plans, and 626 Medicare Advantage Special Needs Plans, and the Program of All 627 inclusive Care for the Elderly. 628 Section 32.The Agency for Health Care Administration shall 629 develop a comprehensive plan to redesign the Florida Medicaid 630 Model Waiver for home- and community-based services to include 631 children who receive private duty nursing services. The plan 632 must propose an array of tiered services with the goal of 633 ensuring that institutional care is avoided so children can 634 remain in the home or other community setting. The agency shall 635 work with stakeholders in developing the plan, including, but 636 not limited to, families of children who are in the model waiver 637 or receiving private duty nursing, advocates for children, 638 providers of services to children receiving private duty 639 nursing, and Statewide Medicaid Managed Care plans. The agency 640 is authorized to contract with necessary experts to assist in 641 developing the plan. The agency shall submit a report to the 642 Governor, the President of the Senate, and the Speaker of the 643 House of Representatives by September 30, 2025, addressing, at a 644 minimum, all of the following: 645 (1)The purpose, rationale, and expected benefits of the 646 redesigned waiver plan. 647 (2)The proposed eligibility criteria for clients and 648 service benefit packages to be offered through the redesigned 649 waiver plan. Managed care plans participating in the Statewide 650 Medicaid Managed Care program must provide services under the 651 redesigned waiver plan. 652 (3)A proposed implementation plan and timeline, including, 653 but not limited to, recommendations for the number of clients 654 served by the redesigned waiver plan at initial implementation, 655 changes over time, and any per-client benefit caps. 656 (4)The fiscal impact for the implementation year and 657 projections for the next 5 years determined on an actuarially 658 sound basis. 659 (5)An analysis of the availability of services and service 660 providers that would be offered under the redesigned waiver plan 661 and recommendations to increase availability of such services, 662 as applicable. 663 (6)A list of all stakeholders, public and private, who 664 were consulted or contacted during the development of the plan. 665 Section 33.Except as otherwise expressly provided in this 666 act, this act shall take effect upon becoming a law.