Five things Florida physicians should have on their radar this week: CMS prior auth comment window, the Memorial-Florida Blue contract standoff, a Medicaid pediatric pay bump worth claiming, ongoing foreign-physician licensure under Live Healthy, and why Florida is still the largest state sitting outside the Interstate Medical Licensure Compact.
CMS Prior Authorization for Drugs: Comment Window Closes June 15
CMS published the 2026 Interoperability and Prior Authorization for Drugs Proposed Rule (CMS-0062-P) on April 14 in the Federal Register, extending the electronic prior-auth framework to drug coverage under Medicare Advantage, Medicaid managed care, and FFM marketplace plans. The rule sets a 24-hour urgent and 72-hour standard decision ceiling and requires FHIR-based workflow standards, with compliance starting in 2027. Details here.
Memorial Healthcare and Florida Blue Still Out of Network
Memorial Healthcare System remains out-of-network with Florida Blue as of this week, eight months after the September 1, 2025 contract expiration. Broward Health entered a similar stand-off last year. Physicians referring into either system should confirm insurance before scheduling, and practices with mixed commercial coverage should be ready to field patient questions about coverage status. Details here.
Florida Medicaid’s 106.3% Pediatric Rate Is Still Claimable
The Florida Medicaid Physician Incentive Program is paying qualifying providers 106.3% of Medicare-equivalent rates for evaluation-and-management services delivered to members under 21 through September 30, 2026. Eligibility requires board certification in pediatrics, family medicine, or internal medicine, and at least 60% of Medicaid receipts tied to qualifying E&M codes. Out-of-network ER physicians and hospital-based specialists are also covered. Details here.
Live Healthy Act Crosses 300 Foreign-Trained Physicians Licensed
SB 7016’s endorsement pathway for internationally trained physicians has licensed more than 300 doctors since it took effect, with new candidates entering the pipeline monthly. The pathway requires graduation from a WHO-recognized medical school and completion of a residency “substantially similar” to ACGME-accredited programs. For Florida practices managing staffing gaps, the licensure timeline for qualified ECFMG-certified candidates is now reliably under nine months. Details here.
Florida Still Not in the Interstate Medical Licensure Compact
Florida remains the largest state by population not participating in the Interstate Medical Licensure Compact, keeping out-of-state physicians on a slower full-licensure pathway for anything beyond the existing telehealth provider registration. The state does belong to the Nurse Licensure Compact, which has intensified the scope-of-practice asymmetry. No compact legislation has moved this session, and the Board of Medicine has not signaled a change in position. Details here.
Frequently Asked Questions
How do I submit a comment on CMS-0062-P?
Go to regulations.gov, search for CMS-0062-P, and click “Submit a Formal Comment.” Individual physician comments with specific clinical cases carry more weight than generic sign-on letters. The deadline is June 15, 2026.
What should I tell patients asking about Memorial Healthcare and Florida Blue?
Advise them to call Florida Blue member services directly to confirm current network status and to request in-network alternatives if their scheduled care is elective. Urgent and emergent care at an out-of-network hospital is still covered under federal no-surprises protections for emergency services.
How do I qualify my practice for the Florida Medicaid 106.3% pediatric rate?
Your practice must employ board-certified pediatricians, family medicine physicians, or internists, and at least 60% of your Medicaid receipts must come from qualifying E&M codes for members under 21. Emergency room physicians and out-of-network hospital-based specialists are automatically eligible for services rendered to pediatric Medicaid members.
Is the Live Healthy licensure pathway open to any internationally trained physician?
No. Applicants must have graduated from a WHO-recognized medical school, completed an international residency that the Board of Medicine finds “substantially similar” to ACGME accreditation, and hold ECFMG certification. The Board’s assessment of residency equivalence is the most variable part of the process and has been a point of concern for some Board members.
Why isn’t Florida in the Interstate Medical Licensure Compact?
The Florida Board of Medicine has historically taken the position that the state’s existing licensure-by-endorsement and out-of-state telehealth provider registration pathways provide sufficient access without the compact’s reciprocity obligations. Legislative proposals to join have not advanced out of committee in recent sessions.