Florida Senate - 2024 SB 1404 By Senator Jones 34-00450A-24 20241404__ Page 1 of 21 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to the Health Care Freedom Act; 2 providing a

short title; repealing ss. 286.31, 3 286.311, and 381.00321, F.S., relating to the 4 prohibited use of state funds for travel to another 5 state for purpose of abortion services, the prohibited 6 use of state funds for sex-reassignment prescriptions 7 or procedures, and the right of medical conscience of 8 health care providers and health care payors, 9 respectively; creating s. 381.027, F.S.; providing a 10

short title; defining terms; requiring a covered 11 entity to adopt a policy relating to providing notice 12 of its refused services by a specified date; providing 13 requirements for such notice; requiring a covered 14 entity to submit a complete list of refused services 15 to the Department of Health by a specified date; 16 requiring a covered entity to notify the department 17 within a specified period after a change is made to 18 such list; requiring a covered entity to submit the 19 list, along with its application, if applying for 20 certain state grants or contracts; providing a civil 21 penalty; requiring the department to adopt rules; 22 requiring the department to publish and maintain on 23 its website a current list of covered entities and 24 their refused services; requiring the department to 25 develop and administer a certain public education and 26 awareness program; providing construction; providing 27 for severability; amending s. 381.96, F.S.; revising 28 the definition of the term “eligible client” and 29

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 2 of 21 CODING: Words stricken are deletions; words underlined are additions. defining the term “pregnancy support services,” rather 30 than “pregnancy and parenting support services”; 31 revising department duties and contract requirements 32 to conform to changes made by the act; repealing ss. 33 4, 6, and 7 of

chapter 2023-21, Laws of Florida, 34 relating to termination of pregnancies, powers of the 35 Agency for Health Care Administration, and the use of 36 telehealth to provide services, respectively; amending 37 s. 390.011, F.S.; deleting the definition of the term 38 “fatal fetal abnormality”; amending s. 390.0111, F.S.; 39 revising the timeframe in which a physician may 40 perform a termination of pregnancy; revising 41 exceptions; repealing s. 395.3027, F.S., relating to 42 patient immigration status data collection in 43 hospitals; amending s. 409.905, F.S.; defining the 44 terms “gender identity” and “transgender individual”; 45 requiring the agency to provide Medicaid reimbursement 46 for medically necessary treatment for or related to 47 gender dysphoria or comparable or equivalent 48 diagnoses; prohibiting the agency from discriminating 49 in its reimbursement on the basis of a recipient’s 50 gender identity or that the recipient is a transgender 51 individual; amending s. 456.001, F.S.; deleting the 52 definition of the terms “sex” and “sex-reassignment 53 prescriptions or procedures”; repealing ss. 456.52 and 54 766.318, F.S., relating to sex-reassignment 55 prescriptions and procedures and civil liability for 56 provision of sex-reassignment prescriptions or 57 procedures to minors, respectively; amending ss. 58

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 3 of 21 CODING: Words stricken are deletions; words underlined are additions. 61.517, 61.534, 409.908, 409.913, 456.074, and 59 636.0145, F.S.; conforming provisions and cross-60 references to changes made by the act; providing an 61 effective date. 62 63 Be It Enacted by the Legislature of the State of Florida: 64 65

Section 1. This act may be cited as the “Health Care 66 Freedom Act.” 67

Section

Section 286.31, Florida Statutes, is repealed. 68

Section

Section 286.311, Florida Statutes, is repealed. 69

Section

Section 381.00321, Florida Statutes, is 70 repealed. 71

Section

Section 381.027, Florida Statutes, is created to 72 read: 73 381.027 Requirements for covered entities; notice of 74 refused services; department duties.— 75

(1) SHORT TITLE.—This

section may be cited as the “Health 76 Care Transparency and Accessibility Act.” 77

(2) DEFINITIONS.—As used in this section, the term: 78 (a) “Covered entity” means any health care facility that 79 uses, plans to use, or relies upon a denial of care provision to 80 refuse to provide a health care service, or referral for a 81 health care service, for any reason. The term does not include a 82 health care practitioner. 83 (b) “Denial of care provision” means any federal or state 84 law that purports or is asserted to allow a health care facility 85 to opt out of providing a health care service, or referral for a 86 health care service, including, but not limited to, ss. 87

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 4 of 21 CODING: Words stricken are deletions; words underlined are additions. 381.0051(5), 390.0111(8), 483.918, and 765.1105; 42 U.S.C. ss. 88 18023(b)(4) and 18113; 42 U.S.C. s. 300a-7; 42 U.S.C. s. 238n; 89 42 U.S.C. s. 2000bb et seq.; s. 507(

d) of the Departments of 90 Labor, Health and Human Services, and Education, and Related 91 Agencies Appropriations Act of 2019, Division B of Pub. L. No. 92 115-245; and 45 C.F.R.

part 88. 93 (c) “Department” means the Department of Health. 94 (d) “Health care facility” has the same meaning as in s. 95 381.026(2). 96 (e) “Health care practitioner” has the same meaning as in 97 s. 456.001. 98 (f) “Health care services” has the same meaning as in s. 99 624.27(1). 100 (g) “Referral” has the same meaning as in s. 456.053(3). 101 (h) “Refused service” means a health care service that a 102 covered entity chooses not to provide, or not to provide a 103 referral for, based on one or more denials of care provisions. 104 The term includes health care services that the covered entity 105 selectively provides to some, but not all, patients based on 106 their identity, objections to a health care service, or other 107 nonmedical reasons. 108

(3) REQUIREMENTS FOR COVERED ENTITIES; PENALTY.— 109 (

a) By October 1, 2024, each covered entity shall adopt a 110 policy for providing patients with a complete list of its 111 refused services. A covered entity shall: 112 1. Provide written notice to the patient or the patient’s 113 representative which includes the complete list of its refused 114 services before any health care service is initiated. 115 a. In the case of an emergency, the covered entity must 116

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 5 of 21 CODING: Words stricken are deletions; words underlined are additions. promptly provide written notice after the patient is capable of 117 receiving such notice or when the patient’s representative is 118 available. 119 b. The patient or patient’s representative shall 120 acknowledge receipt of the written notice of refused services. 121 2. Retain all acknowledgements of receipt of the written 122 notice of refused services for a period of at least 3 years. 123 3. Provide a complete list of its refused services to any 124 person upon request. 125 (

b) By October 1, 2024, a covered entity shall submit to 126 the department a complete list of its refused services. If any 127 change is made to the list, the covered entity must notify the 128 department within 30 days after making the change. 129 (

c) If applying for any state grant or contract related to 130 providing a health care service, a covered entity must submit, 131 along with its application, a complete list of its refused 132 services. 133 (

d) A covered entity that fails to comply with this 134 subsection is subject to a fine not exceeding $5,000 for each 135 day the covered entity is not in compliance. 136

(4) DEPARTMENT DUTIES.— 137 (

a) The department shall adopt rules to implement this 138 section, which must include a process for receiving and 139 investigating complaints regarding covered entities that fail to 140 comply with this section. 141 (

b) By January 1, 2025, the department shall publish and 142 maintain on its website a current list of covered entities and 143 the refused services for each covered entity. 144 (

c) The department shall develop and administer a public 145

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 6 of 21 CODING: Words stricken are deletions; words underlined are additions. education and awareness program regarding the denial of health 146 care services, including how the denial of health care services 147 can negatively impact health care access and quality, how the 148 denial of health care services may be avoided, and how the 149 denial of health care services affects vulnerable people and 150 communities. 151

(5) CONSTRUCTION.— 152 (

a) This

section does not authorize denials of health care 153 services or discrimination in the provision of health care 154 services. 155 (

b) This

section does not limit any cause of action under 156 state or federal law, or limit any remedy in law or equity, 157 against a health care facility or health care practitioner. 158 (

c) Compliance with this

section does not reduce or limit 159 any potential liability for covered entities associated with the 160 refused services or any violations of state or federal law. 161 (

d) Section 761.03 does not provide a claim relating to, or 162 a defense to a claim under, this section, or provide a basis for 163 challenging the application or enforcement of this

section or 164 the use of funds associated with the application or enforcement 165 of this section. 166

(6) SEVERABILITY.—If any provision of this

section or its 167 application to any person or circumstance is held invalid, the 168 invalidity does not affect other provisions or applications of 169 this

section which can be given effect without the invalid 170 provision or application, and to this end the provisions of this 171

section are severable. 172

Section

Section 381.96, Florida Statutes, is amended to 173 read: 174

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 7 of 21 CODING: Words stricken are deletions; words underlined are additions. 381.96 Pregnancy support and wellness services.— 175

(1) DEFINITIONS.—As used in this section, the term: 176 (a) “Department” means the Department of Health. 177 (b) “Eligible client” means any of the following: 178 1. a pregnant woman or a woman who suspects she is 179 pregnant, and the family of such woman, who voluntarily seeks 180 pregnancy support services and any woman who voluntarily seeks 181 wellness services. 182 2. A woman who has given birth in the previous 12 months 183 and her family. 184 3.

A parent or parents or a legal guardian or legal 185 guardians, and the families of such parents and legal guardians, 186 for up to 12 months after the birth of a child or the adoption 187 of a child younger than 3 years of age. 188 (c) “Florida Pregnancy Care Network, Inc.,” or “network” 189 means the not-for-profit statewide alliance of pregnancy support 190 organizations that provide pregnancy support and wellness 191 services through a comprehensive system of care to women and 192 their families. 193 (d) “Pregnancy and parenting support services” means 194 services that promote and encourage childbirth, including, but 195 not limited to: 196 1.

Direct client services, such as pregnancy testing, 197 counseling, referral, training, and education for pregnant women 198 and their families. A woman and her family continue to be 199 eligible to receive direct client services for up to 12 months 200 after the birth of the child. 201 2. Nonmedical material assistance that improves the 202 pregnancy or parenting situation of families, including, but not 203

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 8 of 21 CODING: Words stricken are deletions; words underlined are additions. limited to, clothing, car seats, cribs, formula, and diapers. 204 3. Counseling or mentoring, education materials, and 205 classes regarding pregnancy, parenting, adoption, life skills, 206 and employment readiness. 207 4.

Network awareness activities, including a promotional 208 campaign to educate the public about the pregnancy support 209 services offered by the network and a website that provides 210 information on the location of providers in the user’s area and 211 other available community resources. 212 3.5.

Communication activities, including the operation and 213 maintenance of a hotline or call center with a single statewide 214 toll-free number that is available 24 hours a day for an 215 eligible client to obtain the location and contact information 216 for a pregnancy center located in the client’s area. 217 (e) “Wellness services” means services or activities 218 intended to maintain and improve health or prevent illness and 219 injury, including, but not limited to, high blood pressure 220 screening, anemia testing, thyroid screening, cholesterol 221 screening, diabetes screening, and assistance with smoking 222 cessation. 223

(2) DEPARTMENT DUTIES.—The department shall contract with 224 the network for the management and delivery of pregnancy and 225 parenting support services and wellness services to eligible 226 clients. 227

(3) CONTRACT REQUIREMENTS.—The department contract shall 228 specify the contract deliverables, including financial reports 229 and other reports due to the department, timeframes for 230 achieving contractual obligations, and any other requirements 231 the department determines are necessary, such as staffing and 232

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 9 of 21 CODING: Words stricken are deletions; words underlined are additions. location requirements. The contract shall require the network 233 to: 234 (

a) Establish, implement, and monitor a comprehensive 235 system of care through subcontractors to meet the pregnancy and 236 parenting support and wellness needs of eligible clients. 237 (

b) Establish and manage subcontracts with a sufficient 238 number of providers to ensure the availability of pregnancy and 239 parenting support services and wellness services for eligible 240 clients, and maintain and manage the delivery of such services 241 throughout the contract period. 242 (

c) Spend at least 90 85 percent of the contract funds on 243 pregnancy and parenting support services, excluding services 244 specified in subparagraph (1)(d)4., and wellness services. 245 (

d) Offer wellness services through vouchers or other 246 appropriate arrangements that allow the purchase of services 247 from qualified health care providers. 248 (

e) Require a background screening under s. 943.0542 for 249 all paid staff and volunteers of a subcontractor if such staff 250 or volunteers provide direct client services to an eligible 251 client who is a minor or an elderly person or who has a 252 disability. 253 (

f) Annually monitor its subcontractors and specify the 254 sanctions that shall be imposed for noncompliance with the terms 255 of a subcontract. 256 (

g) Subcontract only with providers that exclusively 257 promote and support childbirth. 258 (

h) Ensure that informational materials provided to an 259 eligible client by a provider are current and accurate and cite 260 the reference source of any medical statement included in such 261

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 10 of 21 CODING: Words stricken are deletions; words underlined are additions. materials. 262 (

i) Ensure that the department is provided with all 263 information necessary for the report required under subsection 264 (5). 265

(4) SERVICES.—Services provided pursuant to this

section 266 must be provided in a noncoercive manner and may not include any 267 religious content. 268

(5) REPORT.—By July 1, 2024, and each year thereafter, the 269 department shall report to the Governor, the President of the 270 Senate, and the Speaker of the House of Representatives on the 271 amount and types of services provided by the network; the 272 expenditures for such services; and the number of, and 273 demographic information for, women, parents, and families served 274 by the network. 275

Section 7. Sections 4, 6, and 7 of

chapter 2023-21, Laws of 276 Florida, are repealed. 277

Section 8. Subsection (6) of

section 390.011, Florida 278 Statutes, is amended to read: 279 390.011

Definitions.—As used in this chapter, the term: 280 (6) “Fatal fetal abnormality” means a terminal condition 281 that, in reasonable medical judgment, regardless of the 282 provision of life-saving medical treatment, is incompatible with 283 life outside the womb and will result in death upon birth or 284 imminently thereafter. 285

Section 9. Subsection (1) of

section 390.0111, Florida 286 Statutes, is amended to read: 287 390.0111 Termination of pregnancies.— 288

(1) TERMINATION IN THIRD TRIMESTER AFTER GESTATIONAL AGE OF 289 15 WEEKS; WHEN ALLOWED.—A physician may not perform a 290

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 11 of 21 CODING: Words stricken are deletions; words underlined are additions. termination of pregnancy on any human being in the third 291 trimester of pregnancy if the physician determines the 292 gestational age of the fetus is more than 15 weeks unless one of 293 the following conditions is met: 294 (

a) Two physicians certify in writing that, in reasonable 295 medical judgment, the termination of the pregnancy is necessary 296 to save the pregnant woman’s life or avert a serious risk of 297 substantial and irreversible physical impairment of a major 298 bodily function of the pregnant woman other than a psychological 299 condition. 300 (

b) The physician certifies in writing that, in reasonable 301 medical judgment, there is a medical necessity for legitimate 302 emergency medical procedures for termination of the pregnancy to 303 save the pregnant woman’s life or avert a serious risk of 304 imminent substantial and irreversible physical impairment of a 305 major bodily function of the pregnant woman other than a 306 psychological condition, and another physician is not available 307 for consultation. 308 (

c) The fetus has not achieved viability under s. 390.01112 309 and two physicians certify in writing that, in reasonable 310 medical judgment, the fetus has a fatal fetal abnormality. 311

Section

Section 395.3027, Florida Statutes, is 312 repealed. 313

Section 11. Present subsections (4) through (12) of

section 314 409.905, Florida Statutes, are redesignated as subsections (5) 315 through (13), respectively, and a new subsection (4) is added to 316 that section, to read: 317 409.905 Mandatory Medicaid services.—The agency may make 318 payments for the following services, which are required of the 319

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 12 of 21 CODING: Words stricken are deletions; words underlined are additions. state by Title XIX of the Social Security Act, furnished by 320 Medicaid providers to recipients who are determined to be 321 eligible on the dates on which the services were provided. Any 322 service under this

section shall be provided only when medically 323 necessary and in accordance with state and federal law. 324 Mandatory services rendered by providers in mobile units to 325 Medicaid recipients may be restricted by the agency. Nothing in 326 this

section shall be construed to prevent or limit the agency 327 from adjusting fees, reimbursement rates, lengths of stay, 328 number of visits, number of services, or any other adjustments 329 necessary to comply with the availability of moneys and any 330 limitations or directions provided for in the General 331 Appropriations Act or

chapter 216. 332

(4) GENDER-AFFIRMING CARE.— 333 (

a) Definitions.—As used in this section, the term: 334 1. “Gender identity” means an individual’s internal sense 335 of that individual’s gender, regardless of the sex assigned to 336 that individual at birth. 337 2. “Transgender individual” means an individual who 338 identifies as a gender different from the sex assigned to that 339 individual at birth. 340 (

b) Reimbursement.—The agency shall provide reimbursement 341 for medically necessary treatment for or related to gender 342 dysphoria as defined by the Diagnostic and Statistical Manual of 343 Mental Disorders, Fifth Edition, published by the American 344 Psychiatric Association or a comparable or equivalent diagnosis. 345 (

c) Discrimination prohibited.—The agency may not 346 discriminate in its reimbursement of medically necessary 347 treatment on the basis of the recipient’s gender identity or on 348

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 13 of 21 CODING: Words stricken are deletions; words underlined are additions. the basis that the recipient is a transgender individual. 349

Section 12. Subsections (8) and (9) of

section 456.001, 350 Florida Statutes, are amended to read: 351 456.001

Definitions.—As used in this chapter, the term: 352 (8) “Sex” means the classification of a person as either 353 male or female based on the organization of the human body of 354 such person for a specific reproductive role, as indicated by 355 the person’s sex chromosomes, naturally occurring sex hormones, 356 and internal and external genitalia present at birth. 357 (9)(a) “Sex-reassignment prescriptions or procedures” 358 means: 359 1.

The prescription or administration of puberty blockers 360 for the purpose of attempting to stop or delay normal puberty in 361 order to affirm a person’s perception of his or her sex if that 362 perception is inconsistent with the person’s sex as defined in 363 subsection (8). 364 2. The prescription or administration of hormones or 365 hormone antagonists to affirm a person’s perception of his or 366 her sex if that perception is inconsistent with the person’s sex 367 as defined in subsection (8). 368 3.

Any medical procedure, including a surgical procedure, 369 to affirm a person’s perception of his or her sex if that 370 perception is inconsistent with the person’s sex as defined in 371 subsection (8). 372 (

b) The term does not include: 373 1. Treatment provided by a physician who, in his or her 374 good faith clinical judgment, performs procedures upon or 375 provides therapies to a minor born with a medically verifiable 376 genetic disorder of sexual development, including any of the 377

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 14 of 21 CODING: Words stricken are deletions; words underlined are additions. following: 378 a. External biological sex characteristics that are 379 unresolvably ambiguous. 380 b. A disorder of sexual development in which the physician 381 has determined through genetic or biochemical testing that the 382 patient does not have a normal sex chromosome structure, sex 383 steroid hormone production, or sex steroid hormone action for a 384 male or female, as applicable. 385 2.

Prescriptions or procedures to treat an infection, an 386 injury, a disease, or a disorder that has been caused or 387 exacerbated by the performance of any sex-reassignment 388 prescription or procedure, regardless of whether such 389 prescription or procedure was performed in accordance with state 390 or federal law. 391 3. Prescriptions or procedures provided to a patient for 392 the treatment of a physical disorder, physical injury, or 393 physical illness that would, as certified by a physician 394 licensed under

chapter 458 or

chapter 459, place the individual 395 in imminent danger of death or impairment of a major bodily 396 function without the prescription or procedure. 397

Section

Section 456.52, Florida Statutes, is repealed. 398

Section

Section 766.318, Florida Statutes, is repealed. 399

Section 15. Subsection (1) of

section 61.517, Florida 400 Statutes, is amended to read: 401 61.517 Temporary emergency jurisdiction.— 402

(1) A court of this state has temporary emergency 403 jurisdiction if the child is present in this state and: 404 (

a) The child has been abandoned; or 405 (

b) It is necessary in an emergency to protect the child 406

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 15 of 21 CODING: Words stricken are deletions; words underlined are additions. because the child, or a sibling or parent of the child, is 407 subjected to or threatened with mistreatment or abuse; or 408 (

c) It is necessary in an emergency to protect the child 409 because the child has been subjected to or is threatened with 410 being subjected to sex-reassignment prescriptions or procedures, 411 as defined in s. 456.001. 412

Section 16. Subsection (1) of

section 61.534, Florida 413 Statutes, is amended to read: 414 61.534 Warrant to take physical custody of child.— 415

(1) Upon the filing of a petition seeking enforcement of a 416 child custody determination, the petitioner may file a verified 417 application for the issuance of a warrant to take physical 418 custody of the child if the child is likely to imminently suffer 419 serious physical harm or removal from this state. Serious 420 physical harm includes, but is not limited to, being subjected 421 to sex-reassignment prescriptions or procedures as defined in s. 422 456.001. 423

Section 17. Paragraph (

a) of subsection (1) of

section 424 409.908, Florida Statutes, is amended to read: 425 409.908 Reimbursement of Medicaid providers.—Subject to 426 specific appropriations, the agency shall reimburse Medicaid 427 providers, in accordance with state and federal law, according 428 to methodologies set forth in the rules of the agency and in 429 policy manuals and handbooks incorporated by reference therein. 430 These methodologies may include fee schedules, reimbursement 431 methods based on cost reporting, negotiated fees, competitive 432 bidding pursuant to s. 287.057, and other mechanisms the agency 433 considers efficient and effective for purchasing services or 434 goods on behalf of recipients.

If a provider is reimbursed based 435

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 16 of 21 CODING: Words stricken are deletions; words underlined are additions. on cost reporting and submits a cost report late and that cost 436 report would have been used to set a lower reimbursement rate 437 for a rate semester, then the provider’s rate for that semester 438 shall be retroactively calculated using the new cost report, and 439 full payment at the recalculated rate shall be effected 440 retroactively. Medicare-granted extensions for filing cost 441 reports, if applicable, shall also apply to Medicaid cost 442 reports.

Payment for Medicaid compensable services made on 443 behalf of Medicaid-eligible persons is subject to the 444 availability of moneys and any limitations or directions 445 provided for in the General Appropriations Act or

chapter 216. 446 Further, nothing in this

section shall be construed to prevent 447 or limit the agency from adjusting fees, reimbursement rates, 448 lengths of stay, number of visits, or number of services, or 449 making any other adjustments necessary to comply with the 450 availability of moneys and any limitations or directions 451 provided for in the General Appropriations Act, provided the 452 adjustment is consistent with legislative intent. 453

(1) Reimbursement to hospitals licensed under

part I of 454

chapter 395 must be made prospectively or on the basis of 455 negotiation. 456 (

a) Reimbursement for inpatient care is limited as provided 457 in s. 409.905(6) s. 409.905(5), except as otherwise provided in 458 this subsection. 459 1. If authorized by the General Appropriations Act, the 460 agency may modify reimbursement for specific types of services 461 or diagnoses, recipient ages, and hospital provider types. 462 2. The agency may establish an alternative methodology to 463 the DRG-based prospective payment system to set reimbursement 464

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 17 of 21 CODING: Words stricken are deletions; words underlined are additions. rates for: 465 a. State-owned psychiatric hospitals. 466 b. Newborn hearing screening services. 467 c. Transplant services for which the agency has established 468 a global fee. 469 d. Recipients who have tuberculosis that is resistant to 470 therapy who are in need of long-term, hospital-based treatment 471 pursuant to s. 392.62. 472 3.

The agency shall modify reimbursement according to other 473 methodologies recognized in the General Appropriations Act. 474 475 The agency may receive funds from state entities, including, but 476 not limited to, the Department of Health, local governments, and 477 other local political subdivisions, for the purpose of making 478 special exception payments, including federal matching funds, 479 through the Medicaid inpatient reimbursement methodologies. 480 Funds received for this purpose shall be separately accounted 481 for and may not be commingled with other state or local funds in 482 any manner.

The agency may certify all local governmental funds 483 used as state match under Title XIX of the Social Security Act, 484 to the extent and in the manner authorized under the General 485 Appropriations Act and pursuant to an agreement between the 486 agency and the local governmental entity.

In order for the 487 agency to certify such local governmental funds, a local 488 governmental entity must submit a final, executed letter of 489 agreement to the agency, which must be received by October 1 of 490 each fiscal year and provide the total amount of local 491 governmental funds authorized by the entity for that fiscal year 492 under this paragraph, paragraph (b), or the General 493

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 18 of 21 CODING: Words stricken are deletions; words underlined are additions. Appropriations Act. The local governmental entity shall use a 494 certification form prescribed by the agency. At a minimum, the 495 certification form must identify the amount being certified and 496 describe the relationship between the certifying local 497 governmental entity and the local health care provider. The 498 agency shall prepare an annual statement of impact which 499 documents the specific activities undertaken during the previous 500 fiscal year pursuant to this paragraph, to be submitted to the 501 Legislature annually by January 1. 502

Section 18. Subsection (36) of

section 409.913, Florida 503 Statutes, is amended to read: 504 409.913 Oversight of the integrity of the Medicaid 505 program.—The agency shall operate a program to oversee the 506 activities of Florida Medicaid recipients, and providers and 507 their representatives, to ensure that fraudulent and abusive 508 behavior and neglect of recipients occur to the minimum extent 509 possible, and to recover overpayments and impose sanctions as 510 appropriate.

Each January 15, the agency and the Medicaid Fraud 511 Control Unit of the Department of Legal Affairs shall submit a 512 report to the Legislature documenting the effectiveness of the 513 state’s efforts to control Medicaid fraud and abuse and to 514 recover Medicaid overpayments during the previous fiscal year. 515 The report must describe the number of cases opened and 516 investigated each year; the sources of the cases opened; the 517 disposition of the cases closed each year; the amount of 518 overpayments alleged in preliminary and final audit letters; the 519 number and amount of fines or penalties imposed; any reductions 520 in overpayment amounts negotiated in settlement agreements or by 521 other means; the amount of final agency determinations of 522

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 19 of 21 CODING: Words stricken are deletions; words underlined are additions. overpayments; the amount deducted from federal claiming as a 523 result of overpayments; the amount of overpayments recovered 524 each year; the amount of cost of investigation recovered each 525 year; the average length of time to collect from the time the 526 case was opened until the overpayment is paid in full; the 527 amount determined as uncollectible and the portion of the 528 uncollectible amount subsequently reclaimed from the Federal 529 Government; the number of providers, by type, that are 530 terminated from participation in the Medicaid program as a 531 result of fraud and abuse; and all costs associated with 532 discovering and prosecuting cases of Medicaid overpayments and 533 making recoveries in such cases.

The report must also document 534 actions taken to prevent overpayments and the number of 535 providers prevented from enrolling in or reenrolling in the 536 Medicaid program as a result of documented Medicaid fraud and 537 abuse and must include policy recommendations necessary to 538 prevent or recover overpayments and changes necessary to prevent 539 and detect Medicaid fraud. All policy recommendations in the 540 report must include a detailed fiscal analysis, including, but 541 not limited to, implementation costs, estimated savings to the 542 Medicaid program, and the return on investment.

The agency must 543 submit the policy recommendations and fiscal analyses in the 544 report to the appropriate estimating conference, pursuant to s. 545 216.137, by February 15 of each year. The agency and the 546 Medicaid Fraud Control Unit of the Department of Legal Affairs 547 each must include detailed unit-specific performance standards, 548 benchmarks, and metrics in the report, including projected cost 549 savings to the state Medicaid program during the following 550 fiscal year. 551

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 20 of 21 CODING: Words stricken are deletions; words underlined are additions.

(36) The agency may provide to a sample of Medicaid 552 recipients or their representatives through the distribution of 553 explanations of benefits information about services reimbursed 554 by the Medicaid program for goods and services to such 555 recipients, including information on how to report inappropriate 556 or incorrect billing to the agency or other law enforcement 557 entities for review or investigation, information on how to 558 report criminal Medicaid fraud to the Medicaid Fraud Control 559 Unit’s toll-free hotline number, and information about the 560 rewards available under s. 409.9203.

The explanation of benefits 561 may not be mailed for Medicaid independent laboratory services 562 as described in s. 409.905(8) s. 409.905(7) or for Medicaid 563 certified match services as described in ss. 409.9071 and 564 1011.70. 565

Section 19. Paragraph (

c) of subsection (5) of

section 566 456.074, Florida Statutes, is amended to read: 567 456.074 Certain health care practitioners; immediate 568 suspension of license.— 569

(5) The department shall issue an emergency order 570 suspending the license of any health care practitioner who is 571 arrested for committing or attempting, soliciting, or conspiring 572 to commit any act that would constitute a violation of any of 573 the following criminal offenses in this state or similar 574 offenses in another jurisdiction: 575 (

c) Section 456.52(5)(b), relating to prescribing, 576 administering, or performing sex-reassignment prescriptions or 577 procedures for a patient younger than 18 years of age. 578

Section

Section 636.0145, Florida Statutes, is amended 579 to read: 580

Florida Senate - 2024 SB 1404 34-00450A-24 20241404__ Page 21 of 21 CODING: Words stricken are deletions; words underlined are additions. 636.0145 Certain entities contracting with Medicaid.—An 581 entity that is providing comprehensive inpatient and outpatient 582 mental health care services to certain Medicaid recipients in 583 Hillsborough, Highlands, Hardee, Manatee, and Polk Counties 584 through a capitated, prepaid arrangement pursuant to the federal 585 waiver provided for in s. 409.905(6) s. 409.905(5) must become 586 licensed under this

chapter by December 31, 1998. Any entity 587 licensed under this

chapter which provides services solely to 588 Medicaid recipients under a contract with Medicaid is exempt 589 from ss. 636.017, 636.018, 636.022, 636.028, 636.034, and 590 636.066(1). 591

Section 21. This act shall take effect July 1, 2024. 592