THE BILL ITSELF
CS/HB 1449
Statewide Provider and Health Plan Claim Dispute Resolution Program
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A bill to be entitled
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An act relating to the statewide provider and health
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plan claim dispute resolution program; amending s.
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408.7057, F.S.; providing an exemption from review for
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certain disputed claims; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Paragraph (b) of subsection (2) of section
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408.7057, Florida Statutes, is amended to read:
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408.7057 Statewide provider and health plan claim dispute
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resolution program.—
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(2)
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(b) The resolution organization shall review claim
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disputes filed by contracted and noncontracted providers and
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health plans unless the disputed claim:
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1. Is related to interest payment;
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2. Does not meet the jurisdictional amounts or the methods
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of aggregation established by agency rule, as provided in
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paragraph (a);
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3. Is part of an internal grievance in a Medicare managed
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care organization or a reconsideration appeal through the
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Medicare appeals process;
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4. Is related to a health plan that is not regulated by
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the state;
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5. Is part of a Medicaid fair hearing pursued under 42
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C.F.R. ss. 431.220 et seq.;
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6. Is the basis for an action pending in state or federal
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court; or
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7. Is subject to a binding claim-dispute-resolution
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process provided by contract entered into prior to October 1,
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2000, between the provider and the managed care organization; or
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8. Is related to out-of-network hospital services
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initiated pursuant to s. 395.1041 or 42 U.S.C. s. 1395dd and has
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been submitted for resolution through the federal independent
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dispute resolution process, provided that such claim is less
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than or equal to $50,000.
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Section 2. This act shall take effect July 1, 2026.