Fla. Stat. 409.9127
Preauthorization and concurrent utilization review; conflict-of-interest standards

(1)

The Agency for Health Care Administration shall be solely responsible for developing and enforcing standards to prohibit financial and other conflicts of interest among vendors selected to provide preauthorization and concurrent utilization review management with direct-service organizations providing substance abuse, mental health, or related services to clients or services to disabled persons who have services authorized through the preauthorization and concurrent utilization review management system established to achieve cost savings in the provision of substance abuse, mental health, or related services or services to disabled persons. The agency may require the posting of a surety bond to guarantee that no financial or other conflicts of interest exist or will exist among vendors selected to provide preauthorization and concurrent utilization review management services.

(2)

Vendors selected to conduct preauthorization or concurrent utilization review management, or both, may be peer-review organizations, qualified licensed clinical practitioners, or public or private organizations that demonstrate the ability to conduct such reviews according to criteria developed by the agency and that have no financial or other conflict of interest with any direct-service organization providing substance abuse, mental health, or related services or services to disabled persons. Selection of vendors shall be accomplished through a competitive process.

(3)

The agency shall help the Agency for Persons with Disabilities meet the requirements of s. 393.065(4). Only admissions approved pursuant to such assessments are eligible for reimbursement under this chapter.

Source: Section 409.9127 — Preauthorization and concurrent utilization review; conflict-of-interest standards, https://www.­flsenate.­gov/Laws/Statutes/2024/0409.­9127 (accessed Aug. 7, 2025).

409.901
Definitions 409.902
Designated single state agency 409.903
Mandatory payments for eligible persons 409.904
Optional payments for eligible persons 409.905
Mandatory Medicaid services 409.906
Optional Medicaid services 409.907
Medicaid provider agreements 409.908
Reimbursement of Medicaid providers 409.909
Statewide Medicaid Residency Program 409.910
Responsibility for payments on behalf of Medicaid-eligible persons when other parties are liable 409.911
Disproportionate share program 409.912
Cost-effective purchasing of health care 409.913
Oversight of the integrity of the Medicaid program 409.914
Assistance for the uninsured 409.915
County contributions to Medicaid 409.916
Grants and Donations Trust Fund 409.918
Public Medical Assistance Trust Fund 409.919
Rules 409.920
Medicaid provider fraud 409.9021
Forfeiture of eligibility agreement 409.9025
Eligibility while an inmate 409.9062
Lung transplant services for Medicaid recipients 409.9063
Coverage of continuous glucose monitors for Medicaid recipients 409.9066
Medicare prescription discount program 409.9071
Medicaid provider agreements for school districts certifying state match 409.9072
Medicaid provider agreements for charter schools and private schools 409.9081
Copayments 409.9082
Quality assessment on nursing home facility providers 409.9083
Quality assessment on privately operated intermediate care facilities for the developmentally disabled 409.9101
Recovery for payments made on behalf of Medicaid-eligible persons 409.9102
A qualified state Long-Term Care Insurance Partnership Program in Florida 409.9113
Disproportionate share program for teaching hospitals 409.9115
Disproportionate share program for mental health hospitals 409.9116
Disproportionate share/financial assistance program for rural hospitals 409.9118
Disproportionate share program for specialty hospitals 409.9119
Disproportionate share program for specialty hospitals for children 409.9121
Legislative findings and intent 409.9122
Medicaid managed care enrollment 409.9123
Quality-of-care reporting 409.9126
Children with special health care needs 409.9127
Preauthorization and concurrent utilization review 409.9128
Requirements for providing emergency services and care 409.9131
Special provisions relating to integrity of the Medicaid program 409.9132
Pilot project to monitor home health services 409.9133
Pilot project for home health care management 409.9134
Agency to distinguish certain services as to skilled home health services 409.9201
Medicaid fraud 409.9203
Rewards for reporting Medicaid fraud 409.9205
Medicaid Fraud Control Unit 409.90201
Recipient address update process 409.90637
Agency to seek federal approval for coverage and reimbursement authority for mobile crisis response services 409.90638
Agency to seek federal approval to implement acute hospital care at home program in state Medicaid program 409.91151
Expenditure of funds generated through mental health disproportionate share program 409.91188
Specialty prepaid health plans for Medicaid recipients with HIV or AIDS 409.91195
Medicaid Pharmaceutical and Therapeutics Committee 409.91196
Supplemental rebate agreements 409.91206
Alternatives for health and long-term care reforms 409.91212
Medicaid managed care fraud 409.91235
Agency review and report on medications, treatments, and services for sickle cell disease 409.91255
Federally qualified health center access program 409.91256
Training, Education, and Clinicals in Health (TEACH) Funding Program

Current through Fall 2025

§ 409.9127. Preauthorization & concurrent utilization review; conflict-of-interest standards's source at flsenate​.gov