HB 1489 full text · Session Watch

1 A bill to be entitled

2 An act relating to medical debt protection and

3 comprehensive health care for residents; providing a

4 short title; creating s. 381.4011, F.S.; providing a

5 short title; providing purpose; providing

6 construction; providing definitions; requiring large

7 health care facilities to develop written financial

8 assistance policies; providing requirements for such

9 policies; providing procedures for determining

10 eligibility for financial assistance; providing

11 eligibility criteria; providing publication and notice

12 requirements relating to financial assistance

13 policies; providing requirements for translations for

14 notices relating to such policies; providing billing

15 and collections rules and prohibitions; providing

16 requirements for price information; providing

17 liability for medical debt; providing requirements for

18 itemized bills; prohibiting information relating to

19 medical debt from being included in consumer reports,

20 communicated with and reported to consumer reporting

21 agencies, and used for certain decisions; prohibiting

22 medical creditors and medical debt collectors from

23 engaging in certain acts during health insurance

24 appeals; limiting interest on medical debt under

25 certain circumstances; providing applicability;

26 requiring written copies of payment plans under

27 certain circumstances; providing requirements before

28 payment plans may be declared terminated; requiring

29 receipts of payment; providing violations; providing

30 private remedies for patients; prohibiting waivers of

31 patients' rights; providing for enforcement and

32 complaint process; providing reporting requirements;

33 requiring the Office of the Attorney General to post

34 certain information in a database and publish an

35 annual consolidated report; providing severability;

36 creating part IV of ch. 641, F.S., entitled the

37 "Florida Health Plan"; creating s. 641.71, F.S.;

38 providing a short title; creating s. 641.72, F.S.;

39 creating the Florida Health Plan; providing purpose of

40 the plan; creating s. 641.73, F.S.; providing

41 definitions; creating s. 641.74, F.S.; providing

42 eligibility for and coverage of the plan; authorizing

43 the Florida Health Board to establish financial

44 arrangements with other states and foreign countries

45 under certain circumstances; providing duties of the

46 board relating to plan enrollment; providing

47 enrollment requirements; creating s. 641.755, F.S.;

48 authorizing plan enrollees to choose certain health

49 care providers; providing covered health care

50 benefits; authorizing the board to expand health care

51 benefits under certain circumstances; providing health

52 care services that are excluded from the plan;

53 requiring enrollees to have primary care providers and

54 access to care coordination; authorizing enrollees to

55 see health care specialists without referral;

56 authorizing the board to establish a computerized

57 registry; authorizing the plan to assist enrollees in

58 choosing primary care providers; prohibiting cost-

59 sharing requirements from being imposed on enrollees;

60 creating s. 641.77, F.S.; requiring the board to

61 secure repeals and waivers of certain provisions of

62 federal law; requiring the Department of Health and

63 the Agency for Health Care Administration to provide

64 assistance to the board; requiring the board to adopt

65 rules under certain circumstances; providing that the

66 plan's responsibility for providing health care is

67 secondary to existing federal programs under certain

68 circumstances; creating s. 641.78, F.S.; defining the

69 term "collateral source"; requiring the plan to

70 collect health care costs from collateral sources

71 under certain circumstances; requiring the board to

72 negotiate waivers, seek federal legislation, and make

73 arrangements to incorporate collateral sources into

74 the plan; requiring plan enrollees to notify health

75 care providers of collateral sources and health care

76 providers to forward such information to the board;

77 authorizing the board to take appropriate actions to

78 recover reimbursement from collateral sources;

79 requiring collateral sources to pay for health care

80 services under certain circumstances; providing

81 specified authority and rights to the board relating

82 to collateral sources; providing construction;

83 creating s. 641.791, F.S.; providing that defaults,

84 underpayments, and late payments of certain

85 obligations shall result in remedies and penalties;

86 prohibiting eligibility for health care benefits from

87 being impaired by such defaults, underpayments, and

88 late payments; creating s. 641.792, F.S.; providing

89 eligibility of health care providers for the plan;

90 prohibiting patient care from being affected by fee

91 schedules and financial incentives; providing

92 requirements for the payment system for

93 noninstitutional providers; providing requirements for

94 the annual budgets for institutional providers;

95 prohibiting noninstitutional and institutional

96 providers that accept payments from the plan from

97 billing patients; providing requirements for capital

98 expenditures by noninstitutional and institutional

99 providers which exceed a specified amount; requiring

100 the board to establish payment criteria and payment

101 methods for care coordination; creating s. 641.793,

102 F.S.; establishing the Florida Health Board by a

103 specified date; providing purpose of the board;

104 providing board membership, terms, and compensation;

105 providing duties of the board; providing reporting

106 requirements; creating s. 641.794, F.S.; requiring the

107 Secretary of Health Care Administration to designate

108 health planning regions; providing considerations for

109 such designations; providing requirements for regional

110 planning boards; providing board membership, terms,

111 and first meetings with the Florida Health Board;

112 providing duties of the board; creating s. 641.795,

113 F.S.; establishing the Office of Health Quality and

114 Planning; providing purpose and duties of the office;

115 authorizing the Florida Health Board to convene

116 advisory panels under certain circumstances; creating

117 s. 641.796, F.S.; creating the Ombudsman Office for

118 Patient Advocacy; providing purpose of the office;

119 providing appointment and qualifications of the

120 ombudsman; providing duties and authority of the

121 ombudsman; providing requirements for the office

122 budget; creating s. 641.797, F.S.; creating the

123 position of auditor for the plan; providing purpose,

124 appointment, and duties of the auditor; creating s.

125 641.798, F.S.; providing applicability of the Code of

126 Ethics for Public Officers and Employees; providing

127 disciplinary actions for failure to comply with the

128 code of ethics; prohibiting certain persons from

129 engaging in specified acts or from being employed by

130 specified entities; creating the Conflict-of-Interest

131 Committee; providing duties of the committee; creating

132 s. 641.799, F.S.; providing that the plan policies and

133 procedures are exempt from the Administrative

134 Procedure Act; providing procedures and requirements

135 for adoption of certain rules on plan policies and

136 procedures; requiring specified persons to regularly

137 update the Legislature on certain information;

138 providing a timeline for the operation of the plan;

139 prohibiting certain health insurance policies and

140 contracts from being sold in this state on and after a

141 specified date; requiring an analysis of specified

142 capital expenditure needs; providing reporting

143 requirements; providing a contingent effective date.

145 Be It Enacted by the Legislature of the State of Florida:

147 Section 1. This act may be cited as the "Healthy Florida

148 Act."

149 Section 2. Section 381.4011, Florida Statutes, is created

150 to read:

151 381.4011 Financial assistance for patients of large health

152 care facilities.—

153 (1) SHORT TITLE.—This section may be cited as the "Medical

154 Debt Protection Act."

155 (2) PURPOSE.—The purpose of this section is to reduce

156 burdensome medical debt and to protect patients in their

157 dealings with medical creditors, medical debt buyers, and

158 medical debt collectors with respect to such debt. This section

159 shall be construed as a consumer protection statute and shall be

160 liberally and remedially construed to carry out its purposes.

161 (3) DEFINITIONS.—As used in this section, the term:

162 (a) "Consumer" means a natural person.

163 (b) "Consumer reporting agency" means a person or entity

164 that, for monetary fees or dues or on a cooperative nonprofit

165 basis, regularly engages in whole or in part in the practice of

166 assembling or evaluating consumer credit information or other

167 information on consumers for the purpose of furnishing consumer

168 reports to third parties.

169 (c) "External review" means a review of an adverse benefit

170 determination, including, but not limited to, a final internal

171 adverse benefit determination, conducted pursuant to an

172 applicable state external review process, a federal external

173 review process as described in 42 U.S.C. s. 300gg-19, a review

174 pursuant to 29 U.S.C. s. 1133, a Medicare appeals process, a

175 Medicaid appeals process, or another applicable appeals process.

176 (d) "Extraordinary collection action" means any of the

177 following:

178 1. Selling a consumer's debt to another party, except if,

179 before the sale, the medical creditor has entered into a legally

180 binding written agreement with the medical debt buyer of the

181 debt pursuant to which:

182 a. The medical debt buyer or medical debt collector is

183 prohibited from engaging in any prohibited collection actions

184 listed in subsection (8) to obtain payment for the care;

185 b. The medical debt buyer may not charge interest on the

186 debt in excess of that described in subsection (14);

187 c. The debt is returnable to or recallable by the medical

188 creditor upon a determination by the medical creditor or medical

189 debt buyer that the consumer is eligible for financial

190 assistance; and

191 d. If the consumer is determined to be eligible for

192 financial assistance and the debt is not returned to or recalled

193 by the medical creditor, the medical debt buyer is required to

194 adhere to the procedures specified in the agreement that ensures

195 that the consumer does not pay, and has no obligation to pay,

196 the medical debt buyer and the medical creditor together more

197 than the consumer is personally responsible for paying in

198 compliance with this section.

199 2. Filing a debt collection lawsuit.

200 3. Any prohibited collection action.

201 (e) "Financial assistance policy" means a written

202 financial assistance policy that includes:

203 1. Eligibility criteria for financial assistance,

204 including when such assistance covers free or discounted care.

205 2. The basis for calculating amounts charged to patients.

206 3. The method for applying for financial assistance.

207 4. The billing and collections policy containing the

208 actions the covered health care provider may take in the event

209 of nonpayment, including collections action.

210 5. Measures to widely publicize the policy within the

211 community to be served by the covered health care provider.

212 (f) "Gross charges" means a covered health care provider's

213 full, established price for health care services that the

214 covered health care provider charges uninsured patients before

215 applying any contractual allowances, discounts, or deductions.

216 Such price may be referred to elsewhere as standard charges, as

217 provided in 42 U.S.C.A. s. 300gg-18, or chargemaster rates.

218 (g) "Health care services" means services for the

219 diagnosis, prevention, treatment, cure, or relief of a physical,

220 dental, behavioral, substance use disorder, or mental health

221 condition, illness, injury, or disease. These services include,

222 but are not limited to, any procedures, products, devices, or

223 medications.

224 (h) "Household income" or "income" means income calculated

225 by using the methods used to calculate Medicaid eligibility, as

226 set forth at 42 C.F.R. s. 435.603, or a comparable method

227 designated by the Department of Children and Families.

228 (i) "Internal review" or "internal appeal" means review by

229 a health insurance plan or other insurer of an adverse benefit

230 determination.

231 (j) "Large health care facility" means any the following

232 entities:

233 1. A hospital licensed under chapter 395, whether a

234 nonprofit entity subject to 26 U.S.C. s. 501(c)(3); a hospital

235 owned by a county, a municipality, or this state; or a for-

236 profit entity that provides health care services.

237 2. An outpatient clinic or facility affiliated with a

238 hospital, as described in subparagraph 1., or operating under

239 the license of a hospital, as described in subparagraph 1.

240 3. An ambulatory surgical center licensed under chapter

241 395.

242 4. A practice that provides outpatient medical,

243 behavioral, optical, radiology, laboratory, dental, or other

244 health care services with revenues of at least $20,000,000

245 annually, and that is licensed or permitted under chapter 395,

246 chapter 408, chapter 483, chapter 484, chapter 466, or any other

247 chapter that licenses or permits health care facilities.

248 5. A licensed health care professional who provides health

249 care services in one or more of the settings listed in

250 subparagraphs 1.-4., but bills patients independently.

251 (k) "Medical creditor" means an entity that provides

252 health care services and to which the patient owes money for

253 health care services, or an entity that provided health care

254 services and to which the patient previously owed money if the

255 medical debt has been purchased by one or more debt buyers.

256 (l) "Medical debt" means an obligation or alleged

257 obligation of a patient to pay any amount related to the receipt

258 of health care services, products, or devices. The term does not

259 include debt charged to a credit card or other extension of

260 credit unless the credit card or extension of credit is offered

261 specifically for the payment of health care services, products,

262 or devices.

263 (m) "Medical debt buyer" means a person or entity that is

264 engaged in the business of purchasing medical debts for

265 collection purposes, whether the person or entity collects the

266 debt or hires a third party for collection or an attorney at law

267 for litigation in order to collect such debt.

268 (n) "Medical debt collector" means a person or entity that

269 regularly collects or attempts to collect, directly or

270 indirectly, medical debts originally owed or due or asserted to

271 be owed or due another. The term includes a medical debt buyer

272 for all purposes.

273 (o) "Patient" means the person who received health care

274 services. The term includes a parent if the patient is a minor,

275 or a legal guardian if the patient is an adult under

276 guardianship.

277 (p) "Patient income" means the household income of the

278 patient's family.

279 (q) "Prohibited collection actions" means any of the

280 following activities when used by a medical creditor or medical

281 debt collector to collect debts owed for health care services:

282 1. Causing or threatening to cause a consumer's arrest.

283 2. Causing or threatening to cause a consumer to be

284 subject to a capias or similar warrant.

285 3. Obtaining or threatening to obtain a lien on a

286 consumer's real property.

287 4. Foreclosing or threatening to foreclose on a

288 consumer's real property.

289 5. Garnishing or threatening to garnish wages or state

290 income tax refunds.

291 6. Using state or federal tax offsets to seize tax refunds

292 or tax credits.

293 7. Attaching, seizing, or threatening to attach or seize a

294 consumer's bank account.

295 8. Furnishing or threatening to furnish information about

296 the medical debt to a consumer reporting agency.

297 (4) FINANCIAL ASSISTANCE POLICY FOR LARGE HEALTH CARE

298 FACILITIES.—

299 (a)1. A large health care facility must develop a written

300 financial assistance policy that complies with this section and

301 any implementing regulations.

302 2. The requirement under subparagraph 1. applies whether

303 or not the large health care facility is required to develop a

304 financial assistance policy under 26 U.S.C. s. 501(r)-(4) and

305 implementing regulations.

306 (b) The financial assistance policy required under

307 subparagraph (a)1. must, at a minimum, contain the following:

308 1. A written explanation of the financial assistance that

309 is available for emergency and other medically necessary health

310 care services offered by a covered health care provider.

311 2. A summary, in plain language, of the financial

312 assistance policy which does not exceed two pages in length.

313 3. The eligibility criteria for financial assistance and a

314 summary of the type of assistance that is available as set forth

315 in this section.

316 4. The method and application process that patients are to

317 use to apply for financial assistance.

318 5. The information and documentation the large health care

319 facility may require patients to provide as part of the

320 application.

321 6. The reasonable steps that a health care provider will

322 take to determine whether a patient is eligible for financial

323 assistance.

324 7. The billing and collections policy, including the

325 actions that may be taken in the event of nonpayment, which must

326 comply with all applicable provisions of this section and other

327 applicable municipal, county, state, or federal laws.

328 (c) The financial assistance policy must be approved by

329 the owners or governing body of a health care provider. The

330 financial assistance policy shall be reviewed and approved on an

331 annual basis by the owners or governing board.

332 (d) The financial assistance policy must apply to all

333 patients who are financially eligible based on income as

334 provided in subsection (5). Patients may not be denied financial

335 assistance on the basis of residency, health insurance coverage

336 status, citizenship or immigration status, or assets or

337 prospective assets.

338 (5) IMPLEMENTATION OF THE FINANCIAL ASSISTANCE POLICY.—

339 (a) In addition to any other actions required by

340 applicable municipal, county, state, or federal law, a large

341 health care facility must screen all patients for eligibility

342 for financial assistance by taking all of the following steps

343 before seeking payment for any emergency or medically necessary

344 health care services:

345 1. Determine whether the patient has health insurance. If

346 the patient is uninsured, offer to screen the patient for public

347 or private insurance eligibility and offer assistance if the

348 patient chooses to apply for public or private insurance. A

349 patient's refusal to be screened is not grounds for denying

350 financial assistance.

351 2. Offer to screen the patient for other public programs

352 that may assist with health care costs. However, a patient's

353 refusal to be screened is not grounds for denying financial

354 assistance.

355 3. If the patient submits an application for financial

356 assistance, determine the patient's eligibility for the

357 financial assistance plan within 14 days after the patient

358 applies for financial assistance, suspending any billing or

359 collections actions while eligibility is being determined.

360 (b) The following patients qualify for financial

361 assistance under the financial assistance plan, which applies to

362 any charges for health care services that are not covered by

363 insurance and would otherwise be billed to the patient:

364 1. Patients with household incomes at or below 300 percent

365 of the federal poverty level shall receive free care.

366 2. Patients with household incomes above 300 percent, up

367 to and including 400 percent, of the federal poverty level shall

368 be charged no more than the amount calculated in the following

369 manner:

370 a. The patient's bill shall be recalculated using the

371 Medicare reimbursement rate applicable on the date of service;

372 and

373 b. The patient shall be charged no more than 25 percent of

374 the recalculated bill under sub-subparagraph a.

375 3. Patients with household incomes above 400 percent, up

376 to and including 600 percent, of the federal poverty level shall

377 receive the same discounts as patients with household incomes

378 above 300 percent, up to and including 400 percent, of the

379 federal poverty level if the patient and the patient's household

380 have incurred medical expenses from the current large health

381 care facility's bill and all other medical bills for medically

382 necessary health care services received during the previous 12

383 months which, in total, exceed 5 percent of the household's

384 annual gross income.

385 4. In addition to other financial assistance provided

386 under this section, patients with household incomes at or below

387 400 percent of the federal poverty level may not be required to

388 pay more than $2,300 per year in cumulative medical bills to

389 large health care facilities. Upon patient request and

390 documentation, any health care services that have been delivered

391 by one or more large health care facilities after the $2,300

392 limit has been met must be provided as free care.

393 (c)1. Household income shall be established by the most

394 recent tax return, unless the patient chooses to submit pay

395 stubs, documentation of public assistance, or documentation of

396 household income that the Department of Children and Families

397 has identified as a valid form of documentation for the purposes

398 of this section. Additional documentation other than proof of

399 income may not be required.

400 2. If a large health care facility uses a consumer report,

401 as defined in s. 603(d) of the Fair Credit Reporting Act, 15

402 U.S.C. s. 1681a(d), or any score or rating based on consumer

403 report information, the facility must obtain the consumer's

404 consent for such use and must comply with all applicable

405 provisions of this section.

406 3. A large health care facility may grant financial

407 assistance notwithstanding a patient's failure to provide one of

408 the required forms of documentation described in the financial

409 assistance policy or application form and may rely on, but not

410 require, other evidence of eligibility. Proof that the patient

411 receives a means-tested benefit from the federal, state, or

412 local government is sufficient to establish eligibility for

413 financial assistance without additional documentation of income.

414 4. A large health care facility must screen, under

415 paragraph (a), a patient for presumptive eligibility for

416 financial assistance as set forth in paragraph (b). The rules

417 and process for screening a patient for presumptive eligibility

418 for financial assistance must require a large health care

419 facility to inform any patient who is deemed presumptively

420 eligible for financial assistance that the large health care

421 facility has reduced or eliminated the patient's medical bill,

422 specify if any amount is currently outstanding, and explain how

423 to apply for additional financial assistance for any remaining

424 balance.

425 5. If a large health care provider chooses to use credit

426 reports or scores or similar screening tools when determining

427 eligibility for financial assistance, the large health care

428 provider may:

429 a. Use such tools only to make a positive eligibility

430 determination, and not to deny financial assistance to any

431 patient; and

432 b. Obtain credit reports or scores and use the reports or

433 scores only for screening if the patient consents by signing a

434 stand-alone document granting permission for the credit check,

435 which shall be effective for no more than 30 days.

436 (d) If a large health care facility receives an

437 application for financial assistance from a patient, the

438 facility shall notify the patient in writing within 14 days as

439 to whether the facility has approved or denied the application.

440 The large health care facility shall provide a copy of any

441 recalculated bill and calculation of financial assistance

442 provided to the patient.

443 (e) A large health care facility shall accept and consider

444 a patient's application for financial assistance when the

445 application is submitted within 1 year after the date of the

446 first bill for the provision of the health care services.

447 However, if the patient is the subject of collection activity by

448 the facility or a medical debt collector, including a lawsuit to

449 collect a medical debt, and submits an application for financial

450 assistance, the large health care facility shall accept and

451 process the application at any time. If the patient submits a

452 financial assistance application to a medical debt collector,

453 the medical debt collector shall forward the application to the

454 large health care facility within 2 business days, and shall

455 cease collection activity until notified by the large health

456 care facility of the outcome of the application and any debt

457 forgiven or new repayment terms.

458 (f) A large health care facility and medical debt

459 collector may not charge any interest or late fees to patients

460 who qualify for financial assistance.

461 (g) A large health care facility and medical debt

462 collector shall offer to any patient who qualifies for financial

463 assistance a payment plan of not less than 24 months, and may

464 not require the patient to make monthly payments that exceed 5

465 percent of the household's gross monthly income. Prepayment

466 penalties, early payment penalties, or fees are prohibited.

467 (h) For a patient who has been found to be eligible for

468 financial assistance, the initial payment on a monthly payment

469 plan may not be due within the first 90 days after the health

470 care services are provided.

471 (6) FINANCIAL ASSISTANCE POLICY; PUBLIC EDUCATION AND

472 INFORMATION.—

473 (a) A large health care facility must do all of the

474 following to publicize its financial assistance policy:

475 1. Make the financial assistance policy and the financial

476 assistance application form easily accessible online, through

477 the large health care facility's website and through any patient

478 portal or other online communication portal used by patients of

479 the health care provider.

480 2. In addition to any other requirements in this section,

481 make paper copies of the financial assistance policy and the

482 application form available upon request and without charge, both

483 by mail and in the large health care facility's office. For

484 hospitals, copies should be available, at a minimum, in the

485 emergency room, if there is an emergency room, and admissions

486 areas.

487 3. Notify and inform members of the community served by

488 the large health care facility about the financial assistance

489 policy in a manner reasonably calculated to reach those members

490 who are most likely to require financial assistance with such

491 efforts commensurate to the size and income of the facility.

492 4. Notify and inform patients who receive care from the

493 large health care facility about the financial assistance policy

494 by doing all of the following:

495 a. Offer a paper copy of the financial assistance policy

496 to a patient as part of the patient's first visit or, in the

497 case of a hospital facility, during the intake and discharge

498 process.

499 b. Include a conspicuous written notice on all billing

500 statements, whether sent by the large health care facility or a

501 medical debt collector, which notifies and informs patients

502 about the availability of financial assistance and includes the

503 telephone number of the large health care facility's office or

504 department that can provide information about the financial

505 assistance policy and application process and the direct website

506 address where copies of the financial assistance policy and

507 application form may be obtained.

508 c. Place conspicuous public displays, or other measures

509 reasonably calculated to attract patients' attention, which

510 notify and inform patients about the financial assistance policy

511 in public locations in the large health care facility's office.

512 For hospitals, displays should be posted in the emergency room,

513 if there is an emergency room and admissions areas, at a

514 minimum.

515 (b) In all attempts, whether written or oral, by a medical

516 creditor or medical debt collector to collect a medical debt for

517 health care services provided by a large health care facility,

518 the medical creditor or medical debt collector must inform the

519 patient of any financial assistance policy available through the

520 large health care facility.

521 (7) FINANCIAL ASSISTANCE POLICIES; LANGUAGE ACCESS.—

522 (a) A financial assistance policy must include a notice

523 that states the following or substantially similar language:

524 "This document contains important information about financial

525 assistance for your bill. Contact [insert name and telephone

526 number of large health care facility] for translation

527 assistance." The statement must be translated in the 10

528 languages most frequently spoken by limited English proficient

529 households in the large health care facility's service area, as

530 determined by the United States Census Bureau data.

531 (b) A large health care facility must accommodate all

532 significant populations that have limited English proficiency by

533 translating the financial assistance policy and application form

534 into the primary languages spoken by such populations. A large

535 health care facility satisfies this translation requirement if

536 it makes available translations of its financial assistance

537 policy and application form in the language spoken by each

538 limited English proficiency language group that constitutes the

539 lesser of 1,000 individuals or 5 percent of the community served

540 by the large health care facility or the population likely to be

541 affected or encountered by the large health care facility. A

542 large health care facility may determine the percentage or

543 number of limited English proficiency individuals in the large

544 health care facility's community or likely to be affected or

545 encountered by the large health care facility using any

546 reasonable method.

547 (c) A large health care facility must accommodate any

548 patient with limited English proficiency who is part of a

549 population that falls below the numerical thresholds established

550 in paragraph (b) by providing oral interpretation services to

551 the patient upon request and at no cost to the patient to

552 explain the financial assistance policy and the application

553 form.

554 (d) A large health care facility must accommodate any

555 patient with limited English proficiency in answering questions

556 from the patient regarding the financial assistance policy, the

557 application form, any written determination of eligibility, and

558 any other communication regarding financial assistance from the

559 large health care facility. A large health care facility may

560 accommodate these patients by providing oral interpretation

561 services to the patient upon request and at no cost to the

562 patient.

563 (8) BILLING AND COLLECTIONS RULES, LIMITS ON CREDITORS.—

564 (a) A medical creditor or medical debt collector may not

565 engage in prohibited collection actions to collect medical debts

566 owed for health care services.

567 (b) A medical creditor or medical debt collector may not

568 engage in any extraordinary collection actions until 180 days

569 after the first bill for a medical debt has been sent.

570 (c) At least 30 days before taking any permissible

571 extraordinary collection actions, a medical creditor or medical

572 debt collector must provide to the patient a notice that:

573 1. In the case of large health care facilities and medical

574 debt collectors collecting debt for health care services

575 provided by such facilities, states that financial assistance is

576 available for eligible patients and providing a summary, in

577 plain language, of the financial assistance policy.

578 2. Identifies the extraordinary collection actions that

579 will be initiated in order to obtain payment.

580 3. Provides a deadline after which such extraordinary

581 collection actions will be initiated, which date is no earlier

582 than 30 days after the date of the notice.

583 (d) A medical debt collector collecting debt for health

584 care services provided by such a large health care facility may

585 not engage in extraordinary collection actions during a declared

586 state or federal emergency or a public health emergency.

587 (e) A large health care facility or a medical debt

588 collector collecting debt for health care services provided by

589 such a facility may not use any extraordinary collection actions

590 unless these actions are described in the large health care

591 facility's billing and collections policy.

592 (f) If a large health care facility or a medical debt

593 collector collecting debt for health care services provided by

594 such a facility bills or initiates collection activities and the

595 patient is later found eligible for financial assistance, the

596 large health care facility or medical debt collector shall

597 reverse any permissible extraordinary collection actions or any

598 collection activity that were previously permissible and have

599 since become prohibited, including, but not limited to:

600 1. Deleting any negative reports to consumer reporting

601 agencies.

602 2. Dismissing or vacating any collection lawsuits over the

603 medical debt.

604 3. Removing any wage garnishment orders or state tax

605 refund interception requests.

606 (g) If the patient has paid any part of the medical debt

607 or any of the patient's funds has been seized or levied in

608 excess of the amount that the patient owes after application of

609 financial assistance, the large health care facility or medical

610 debt collector shall refund any excess amount to the patient.

611 (9) PRICE INFORMATION.—A large health care facility must

612 post price information on its website. The price information

613 must be accessible through a link from the website's homepage

614 and, at a minimum, must include the following:

615 (a) A list of gross charges for all health care services.

616 (b) A list of the amount that Medicare would reimburse for

617 the health care service, next to the relevant gross charge.

618 (c) The titles or descriptions of health care services, in

619 plain language that can be understood by an average person.

620 (10) LIABILITY FOR MEDICAL DEBT.—

621 (a) Parents and legal guardians are jointly liable for any

622 medical debt incurred by children under the age of 18.

623 (b) A spouse or person may not be held personally liable

624 for the medical debt or nursing home debt of any other person

625 age 18 or older, or other damages related to the collection of

626 the patient's bill.

627 (c) Any admission agreement must comply with applicable

628 federal and state laws, including the Nursing Home Reform Law,

629 42 U.S.C. s. 1395i-3.

630 (11) VERIFICATION UPON WRITTEN OR ORAL REQUEST.—A medical

631 creditor or medical debt collector shall provide an itemized

632 bill to the patient within 60 days after a request. The itemized

633 bill must state:

634 (a) The name and address of the medical creditor.

635 (b) The date of service.

636 (c) The date the medical debt was incurred, if different

637 from the date of service.

638 (d) A detailed list of the specific health care services

639 provided to the patient.

640 (e) A list of all health care professionals who treated

641 the patient.

642 (f) The amount of principal for any medical debt incurred.

643 (g) Any adjustment to the bill, such as negotiated

644 insurance rates or other discounts.

645 (h) The amount of any payments received, whether from the

646 patient or any other party.

647 (i) Any interest or fees.

648 (j) Whether the patient was screened for financial

649 assistance.

650 (k) Whether the patient was found eligible for financial

651 assistance and, if so, the amount due after all financial

652 assistance has been applied to the itemized bill.

653 (12) MEDICAL DEBT AND CONSUMER REPORTING AGENCIES.—

654 (a) A consumer reporting agency may not make a consumer

655 report containing an item of information that the consumer

656 reporting agency knows or should know concerns medical debt.

657 (b) A person may not communicate with or report any

658 information to any consumer reporting agency regarding a medical

659 debt.

660 (c) A person who uses a consumer report may not use a

661 medical debt listed on the report as a negative factor when

662 making a credit, employment, or housing decision.

663 (d) A medical creditor shall include a provision in any

664 contract entered into with a medical debt collect or for the

665 purchase or collection of medical debt which prohibits the

666 reporting of any portion of such medical debt to a consumer

667 reporting agency.

668 (13) PROHIBITION AGAINST COLLECTION OF MEDICAL DEBT DURING

669 HEALTH INSURANCE APPEALS.—

670 (a) A medical creditor or medical debt collector that

671 knows or should have known about an internal review, external

672 review, or other internal appeal of a health insurance decision

673 that is pending or was pending within the previous 180 days may

674 not:

675 1. Communicate with the patient regarding the unpaid

676 charges for health care services for the purpose of seeking to

677 collect the charges; or

678 2. Initiate a lawsuit or arbitration proceeding against

679 the patient relating to unpaid charges for health care services.

680 (b) A medical creditor that knows or should have known

681 about an internal review, external review, or other internal

682 appeal of a health insurance decision that is pending or was

683 pending within the previous 180 days may not refer, place, or

684 send the unpaid charges for health care services to a medical

685 debt collector, including by selling the debt to a medical debt

686 buyer.

687 (14) INTEREST ON MEDICAL DEBT.—

688 (a) Unless a patient is eligible for financial assistance

689 under paragraph (5)(b), and notwithstanding any agreement to the

690 contrary, interest on medical debt may not exceed 2 percent per

691 annum. Patients eligible for financial assistance may not be

692 charged any interest or late fees.

693 (b) The rate of interest provided in paragraph (a) also

694 applies to any judgments on medical debt, notwithstanding any

695 agreement to the contrary.

696 (15) MEDICAL DEBT PAYMENT PLANS.—

697 (a) A medical creditor or medical debt collector that

698 agrees to a payment plan for a medical debt shall provide a

699 written copy of the payment plan to the patient within 5

700 business days after entering into the payment plan. This plan

701 must prominently disclose the rate of any interest being applied

702 to the debt in compliance with subsection (14), and the date by

703 which the account will be paid off in full, assuming the

704 payments set by the schedule are made without interruption.

705 (b) A consumer need not make a payment on the payment plan

706 until the written copy has been provided.

707 (c)1. A medical debt payment plan may be accelerated or

708 declared in default or terminated due to nonpayment only after

709 the patient fails to make scheduled payments on the payment plan

710 for at least 3 consecutive months.

711 2. Before declaring the payment plan terminated, the

712 medical creditor or medical debt collector must do all of the

713 following:

714 a. Make at least three reasonable attempts to contact the

715 patient by telephone or by other method preferred by the

716 patient.

717 b. Provide a written notice informing the patient that the

718 payment plan may be terminated and that the patient has the

719 opportunity to renegotiate the payment plan.

720 c. Attempt to renegotiate the terms of the defaulted

721 payment plan, if requested by the patient.

722 3. The medical creditor or medical debt collector may not

723 commence a civil action against the patient or responsible party

724 for nonpayment until at least 90 days after the payment plan is

725 declared to be terminated. For purposes of this section, the

726 notice and telephone call to the patient may be made to the last

727 known telephone number and address of the patient.

728 (16) RECEIPTS FOR PAYMENTS.—Within 10 business days after

729 receipt of a payment on a medical debt, a medical creditor or

730 medical debt collector, or any agents thereof, receiving the

731 payment shall furnish a receipt to the person that made the

732 payment. The receipt must show all of the following:

733 (a) The date of the provision of the health care service.

734 (b) The amount paid.

735 (c) The date payment was received.

736 (d) The account's balance before the most recent payment.

737 (e) The new balance after application of the payment.

738 (f) The interest rate and interest accrued since the

739 patient's last payment.

740 (g) The patient's account number.

741 (h) The name of the current owner of the debt and, if

742 different, the name of the medical creditor.

743 (i) Whether the payment is accepted as payment in full of

744 the debt.

745 (17) DEBT FORGIVEN BY MEDICAL CREDITOR.—Forgiveness of any

746 part of an insured patient's copayment, coinsurance, deductible,

747 facility fees, out-of-network charges, or other cost sharing is

748 not a breach of contract or other violation of an agreement

749 between the medical creditor and the insurer or payor.

750 (18) PRIVATE REMEDY.—

751 (a) Collection activity against a patient who the large

752 health care facility, medical creditor, or medical debt

753 collector knew or should have known was, or should have been,

754 eligible for financial assistance is an unfair or deceptive

755 trade practice in violation of part II of chapter 501. Any other

756 violation of this section by a medical creditor or medical debt

757 collector is also an unfair or deceptive trade practice in

758 violation of part II of chapter 501.

759 (b) A patient may sue for injunctive or other appropriate

760 equitable relief to enforce this section.

761 (c) The remedies provided in this section are not intended

762 to be the exclusive remedies available to a patient, and the

763 patient is not required to exhaust any administrative remedies

764 provided under this section or any other applicable law.

765 (d) A financial assistance policy or agreement between a

766 patient and a large health care provider or medical debt

767 collector may not contain a provision that, before a dispute

768 arises, waives or has the practical effect of waiving the rights

769 of the patient to resolve that dispute by obtaining:

770 1. Injunctive, declaratory, or other equitable relief;

771 2. Multiple or minimum damages as specified by law;

772 3. Attorney fees and costs as specified by law; or

773 4. A hearing at which a party can present evidence in

774 person.

775 (e) Any provision in a financial assistance policy or

776 other written agreement violating paragraph (d) is void and

777 unenforceable. A court may refuse to enforce other provisions of

778 the financial assistance policy or other written agreement as

779 equity may require.

780 (19) PROHIBITION OF WAIVER OF RIGHTS.—Any waiver by a

781 patient of any protection provided by or any right of the

782 patient or other person under this section is void and may not

783 be enforced by any court or any other person. A large health

784 care facility may not circumvent the responsibilities and

785 protections of this section by requiring prepayment for medical

786 care.

787 (20) ENFORCEMENT.—

788 (a) The Office of the Attorney General may enforce this

789 section and may adopt any regulation or rules necessary or

790 appropriate to carry out the purpose of this section, to provide

791 for the protection of patients, and to assist market

792 participants in interpreting this section.

793 (b) The Office of the Attorney General shall establish a

794 complaint process whereby an aggrieved consumer or any member of

795 the public may file a complaint against a medical creditor or

796 medical debt collector who violates any provision of this

797 section. All complaints shall be considered public records.

798 (21) ANNUAL REPORTS AND DATABASE.—

799 (a) On or before July 1 of each year, beginning July 1,

800 2028, each large health care provider shall file its financial

801 assistance policy and an annual report with the Legislature and

802 the Office of the Attorney General pursuant to procedures that

803 the Office of the Attorney General shall establish.

804 (b) The Office of the Attorney General shall post each

805 report and financial assistance policy in a searchable database

806 accessible on the Internet.

807 (c) The Office of the Attorney General shall prepare an

808 annual consolidated report and shall make it available to the

809 public. The report must include the following information for

810 the time period of July 1 of the prior year to July of that

811 year:

812 1. The total number of patients who applied for financial

813 assistance.

814 2. The total number of patients who received financial

815 assistance.

816 3. The total number of patients who were denied financial

817 assistance.

818 4. Deidentified demographic information for patients who

819 received financial assistance, including zip code, race,

820 language, gender, and disability status, to the extent that such

821 data is available from the large health care facility.

822 5. The total amount of financial assistance provided to

823 patients.

824 6. The types of collection practices used.

825 7. The amounts of money collected with each of these

826 collection practices, in dollars and by percentage of the large

827 health care facility's annual revenue.

828 (22) SEVERABILITY.—If any provision of this section or its

829 application to any person or circumstance is held invalid, that

830 provision or its application is severable and does not affect

831 the validity of the other provisions or applications of this

832 section.

833 Section 3. Part IV of chapter 641, Florida Statutes,

834 consisting of ss. 641.71-641.799, Florida Statutes, is created

835 and entitled the "Florida Health Plan."

836 Section 4. Section 641.71, Florida Statutes, is created to

837 read:

838 641.71 Short title.—This part may be cited as the "Florida

839 Health Plan." Section 5. Section 641.72, Florida Statutes, is created to

841 read:

842 641.72 Purpose.—There is created the Florida Health Plan.

843 The purpose of the Florida Health Plan is to keep residents of

844 this state healthy and to provide the best quality of health

845 care by:

846 (1) Ensuring that all residents of this state, regardless

847 of immigration status, are covered.

848 (2) Covering all necessary care, including dental; vision;

849 hearing; mental health; reproductive care, including abortion

850 services and prenatal and postpartum care; gender-affirming

851 health care, including medication and treatment; substance use

852 disorder treatment; prescription drugs; durable medical

853 equipment and supplies; and long-term care and home care,

854 including long-term services and supports in home and community-

855 based settings.

856 (3) Allowing patients to choose their health care

857 providers.

858 (4) Reducing costs by negotiating fair prices and cutting

859 administrative bureaucracy, through measures such as a global

860 budget approach to institutional providers, and not by

861 restricting or denying care.

862 (5) Being affordable to all patients through financing

863 based on a patient's ability to pay and the elimination of

864 premiums, copayments, deductibles, and out-of-pocket expenses at

865 the point of service.

866 (6) Focusing on preventive care and early intervention to

867 improve health.

868 (7) Ensuring that there are enough health care providers

869 to guarantee timely access to care.

870 (8) Continuing this state's leadership in medical

871 education, research, and technology.

872 (9) Providing adequate and timely payments to health care

873 providers.

874 (10) Using a simple funding and payment system.

875 (11) Providing a just transition for a displaced workforce

876 affected by changes.

877 Section 6. Section 641.73, Florida Statutes, is created to

878 read:

879 641.73 Definitions.—As used in this part, the term:

880 (1) "Board" means the Florida Health Board established in

881 s. 641.793.

882 (2) "Institutional provider" means an inpatient hospital,

883 nursing facility, rehabilitation facility, or any other health

884 care facility that provides overnight care.

885 (3) "Medically necessary" means comprehensive services or

886 supplies needed to promote health and to prevent, diagnose, or

887 treat a particular patient's medical condition. The

888 comprehensive services and supplies must meet accepted standards

889 of medical practice within a health care provider's professional

890 peer group.

891 (4) "Noninstitutional provider" means an individual

892 provider, group practice, clinic, outpatient surgical center,

893 imaging center, or any other health care facility that does not

894 provide overnight care.

895 (5) "Plan" means the Florida Health Plan created in s.

896 641.72.

897 (6) "Resident of this state" means an individual who has

898 had a principal place of domicile in this state for more than 6

899 consecutive months, who has registered to vote in this state,

900 who has made a statement of domicile pursuant to s. 222.17, or

901 who has filed for homestead tax exemption on property in this

902 state.

903 Section 7. Section 641.74, Florida Statutes, is created to

904 read:

905 641.74 Eligibility for and enrollment in the Florida

906 Health Plan.—

907 (1) ELIGIBILITY.—

908 (a) All residents of this state, regardless of immigration

909 status, are eligible for the Florida Health Plan.

910 (b) Coverage for emergency care for a resident of this

911 state which is obtained out of state must be at prevailing local

912 rates where the care is provided. Coverage for nonemergency care

913 obtained out of state must be according to rates and conditions

914 established by the Florida Health Board. The board may require

915 that a resident of this state be transported back to this state

916 when prolonged treatment of an emergency condition is necessary

917 and when that transport will not adversely affect the patient's

918 care or condition.

919 (c) A nonresident visiting this state shall be billed by

920 the board for all services received under the plan. The board

921 may enter into intergovernmental arrangements or contracts with

922 other states and foreign countries to provide reciprocal

923 coverage for temporary visitors.

924 (d) The board shall extend eligibility to nonresidents

925 employed in this state under a premium schedule set by the

926 board.

927 (e) For a business outside of this state which employs

928 residents of this state, the board shall apply for a federal

929 waiver to collect the employer contribution mandated by federal

930 law.

931 (f) A retiree who is covered under the plan and who elects

932 to reside outside of this state is eligible for benefits under

933 the terms and conditions of the retiree's employer-employee

934 contract.

935 (g) The board may establish financial arrangements with

936 other states and foreign countries in order to facilitate

937 meeting the terms of the contracts described in paragraph (f).

938 Payments for care provided by non-Florida health care providers

939 to retirees who are covered under the plan shall be reimbursed

940 at rates established by the board. Health care providers who

941 accept any payment from the plan for a covered service may not

942 bill the patient for the covered service.

943 (h)1. A person is presumed eligible for coverage under the

944 plan, and a health care provider shall provide health care

945 services as if the person is eligible for coverage under the

946 plan, if the person:

947 a. Is a minor;

948 b. Arrives at a health care facility unconscious,

949 comatose, or otherwise unable to document eligibility or to act

950 on the person's own behalf because of the person's physical or

951 mental condition; or

952 c. Is involuntarily committed to an acute psychiatric

953 facility or to a hospital with psychiatric beds which provides

954 for involuntary commitment.

955 2. All health care facilities subject to state and federal

956 provisions governing emergency medical treatment must comply

957 with subparagraph 1.

958 (2) ENROLLMENT.—The board shall establish a procedure to

959 enroll residents of this state and provide each with

960 identification that may be used by health care providers to

961 confirm eligibility for services. The application for enrollment

962 may not be more than two pages.

963 Section 8. Section 641.755, Florida Statutes, is created

964 to read:

965 641.755 Benefits.—

966 (1) A person covered under the Florida Health Plan may

967 choose to receive services from any qualified, licensed health

968 care provider that participates in the plan.

969 (2) Except for the exclusions provided in subsection (4),

970 covered health care benefits under the plan include all

971 prescribed medically necessary care, which includes:

972 (a) Inpatient and outpatient health care facility

973 services.

974 (b) Inpatient and outpatient licensed health care provider

975 services.

976 (c) Diagnostic imaging, laboratory services, and other

977 diagnostic and evaluative services.

978 (d) Durable medical equipment, appliances, and assistive

979 technology, including, but not limited to, prescribed

980 prosthetics, eye care, and hearing aids and their repair,

981 technical support, and customization required for individual

982 use.

983 (e) Inpatient and outpatient rehabilitative care.

984 (f) Emergency care services.

985 (g) Necessary transportation for health care services:

986 1. As covered under Medicaid or Medicare; or

987 2. For persons with disabilities, older persons with

988 functional limitations, and low-income persons.

989 (h) Child and adult immunizations and preventive care.

990 (i) Health and wellness education for chronic or

991 preventative care as provided by licensed health care providers.

992 (j) Reproductive health care, including abortion services,

993 contraceptives, and prenatal and postpartum care.

994 (k) Childbirth and maternity care, including doula

995 services and care in freestanding childbirth centers.

996 (l) Gender-affirming health care, including medication and

997 treatment.

998 (m) Holistic licensed health care services such as

999 chiropractic, acupressure, acupuncture, massage, and nutritional

1000 services.

1001 (n) Mental health services, including substance use

1002 disorder treatment, services in substance use disorder treatment

1003 facilities, and mental health care provided by licensed or

1004 certified mental health providers such as licensed

1005 psychologists, licensed mental health counselors, licensed

1006 professional counselors, licensed clinical social workers,

1007 certified master social workers, rehabilitation support service

1008 providers, and any providers that the board deems eligible.

1009 (o) Dental care, including diagnostics and restoration and

1010 durable equipment such as braces and mouthguards.

1011 (p) Vision care.

1012 (q) Hearing care.

1013 (r) Prescription drugs.

1014 (s) Podiatric care.

1015 (t) Therapies that are shown by the National Institutes of

1016 Health National Center for Complementary and Integrative Health

1017 to be safe and effective.

1018 (u) Blood and blood products.

1019 (v) Dialysis.

1020 (w) Licensed qualified adult day care.

1021 (x) Rehabilitative and habilitative services.

1022 (y) Ancillary health care or social services previously

1023 covered by this state's qualified public health programs.

1024 (z) Case management and care coordination.

1025 (aa) Language interpretation and translation for health

1026 care services, including sign language and Braille or other

1027 services needed for persons with communication barriers.

1028 (bb) Services provided by qualified community health

1029 workers.

1030 (cc) Health care and long-term supportive services,

1031 including in a home or community-based setting, assisted living

1032 facility, and nursing home, with home health care providers,

1033 home health aides, and palliative and hospice care.

1034 (dd) Any item or service described in this subsection which

1035 is furnished using telehealth, to the extent practicable.

1036 (3) The Florida Health Board may expand health care

1037 benefits beyond the minimum benefits described in subsection (2)

1038 if the expansion meets the intent of this part and when there

1039 are sufficient funds to cover the expansion.

1040 (4) The following health care services are excluded from

1041 coverage by the plan:

1042 (a) Treatments and procedures primarily for cosmetic

1043 purposes, unless required to correct a congenital defect or to

1044 restore or correct a part of the body that has been altered as a

1045 result of an injury, a disease, or a surgery or unless

1046 determined to be medically necessary by a qualified, licensed

1047 health care provider in the plan.

1048 (b) Services of a health care provider or facility that is

1049 not licensed, certified, or accredited by this state. The

1050 licensure, certification, or accreditation requirements do not

1051 apply to health care providers or facilities that provide

1052 services to residents of this state who require medical

1053 attention while traveling out of state.

1054 (5)(a) All plan enrollees must have a primary care

1055 provider and must have access to care coordination.

1056 (b) A plan enrollee does not need a referral to see a

1057 health care specialist.

1058 (c) The board may establish a computerized registry to

1059 assist enrollees in identifying appropriate providers, and the

1060 plan may assist an enrollee with choosing a primary care

1061 provider if the enrollee so chooses.

1062 (6) The plan may not impose a deductible, copayment,

1063 coinsurance, or any other cost-sharing requirement on an

1064 enrollee with respect to a covered benefit. Section 9. Section 641.77, Florida Statutes, is created to

1066 read:

1067 641.77 Federal preemption.—

1068 (1) The Florida Health Board shall secure a repeal or a

1069 waiver of any provision of federal law that preempts any

1070 provision of this part. The Department of Health and the Agency

1071 for Health Care Administration shall provide all necessary

1072 assistance to the board to secure any repeal or waiver.

1073 (2)(a) The board shall, under the state innovation waivers

1074 under s. 1332 of the federal Patient Protection and Affordable

1075 Care Act, Pub. L. No. 111-148, as amended, request to repeal or

1076 waive any of the following provisions to the extent necessary to

1077 implement this part:

1078 1. Title 42 of the United States Code, ss. 18021-18024.

1079 2. Title 42 of the United States Code, ss. 18031-18033.

1080 3. Title 42 of the United States Code, s. 18071.

1081 4. Section 5000A of the Internal Revenue Code of 1986, as

1082 amended.

1083 (b) If a repeal or a waiver of a federal law or regulation

1084 cannot be secured, the board shall adopt rules, or seek

1085 conforming state legislation, consistent with federal law, in an

1086 effort to best fulfill the purposes of this part.

1087 (c) The Florida Health Plan's responsibility for providing

1088 health care is secondary to existing federal programs for health

1089 care services to the extent that funding for these programs is

1090 not transferred or that the transfer is delayed beyond the date

1091 on which initial benefits are provided under the plan.

1092 Section 10. Section 641.78, Florida Statutes, is created

1093 to read:

1094 641.78 Subrogation.—

1095 (1)(a) As used in this section, the term "collateral

1096 source" includes:

1097 1. A health insurance policy, health maintenance contract,

1098 continuing care contract, and prepaid health clinic contract,

1099 and the medical components of motor vehicle insurance,

1100 homeowner's insurance, and other forms of insurance.

1101 2. The medical components of worker's compensation.

1102 3. A pension plan and retiree health care benefits.

1103 4. An employer plan.

1104 5. An employee benefit contract.

1105 6. A government benefit program.

1106 7. A judgment for damages for personal injury.

1107 8. The state of last domicile for individuals moving to

1108 Florida for medical care who have extraordinary medical needs.

1109 9. Any third party who is or may be liable to an

1110 individual for health care services or costs.

1111 (b) The term does not include:

1112 1. A contract or plan that is subject to federal

1113 preemption.

1114 2. Any governmental unit, agency, or service to the extent

1115 that subrogation is prohibited by law.

1116 (2) When other payers for health care have been

1117 terminated, the plan shall collect health care costs from a

1118 collateral source if health care services provided to a patient

1119 are, or may be, covered services under the collateral source

1120 available to the patient, or if the patient has a right of

1121 action for compensation permitted under law.

1122 (3) The board shall negotiate waivers, seek federal

1123 legislation, or make other arrangements to incorporate

1124 collateral sources into the plan.

1125 (4) If a person who receives health care services under

1126 the plan is entitled to coverage, reimbursement, indemnity, or

1127 other compensation from a collateral source, the person must

1128 notify the health care provider and provide information

1129 identifying the collateral source, the nature and extent of

1130 coverage or entitlement, and other relevant information. The

1131 health care provider shall forward this information to the

1132 board. The person entitled to coverage, reimbursement,

1133 indemnity, or other compensation from a collateral source must

1134 provide additional information as requested by the board.

1135 (a) The plan shall seek reimbursement from the collateral

1136 source for services provided to the person and may take

1137 appropriate action, including legal proceedings, to recover the

1138 reimbursement. Upon demand, the collateral source shall pay the

1139 sum that it would have paid or spent on behalf of the person for

1140 the health care services provided by the plan.

1141 (b) In addition to any other right to recovery provided in

1142 this section, the board has the same right to recover the

1143 reasonable value of health care benefits from the collateral

1144 source.

1145 (c) If the collateral source is exempt from subrogation or

1146 the obligation to reimburse the plan, the board may require that

1147 the person who is entitled to health care services from the

1148 collateral source first seek those services from the collateral

1149 source before seeking the services from the plan.

1150 (5) To the extent permitted by federal law, the board has

1151 the same right of subrogation over contractual retiree health

1152 care benefits provided by employers as other contracts allowing

1153 the plan to recover the cost of health care services provided to

1154 a person covered by the retiree health care benefits, unless

1155 arrangements are made to transfer the revenues of the health

1156 care benefits directly to the plan.

1157 (6) A collateral source is not excluded from the

1158 obligations imposed by this section by virtue of a contract or

1159 relationship with a governmental unit, agency, or service.

1160 Section 11. Section 641.791, Florida Statutes, is created

1161 to read:

1162 641.791 Defaults, underpayments, and late payments.—

1163 (1) Defaults, underpayments, or late payments of any

1164 premium or other obligation imposed by this part shall result in

1165 the remedies and penalties provided by law, except as provided

1166 in this part.

1167 (2) Eligibility for health care benefits may not be

1168 impaired by any default, underpayment, or late payment of any

1169 premium or other obligation imposed by this part.

1170 Section 12. Section 641.792, Florida Statutes, is created

1171 to read:

1172 641.792 Provider payments.—

1173 (1) All health care providers licensed to practice in this

1174 state may participate in the Florida Health Plan. The Florida

1175 Health Board may determine the eligibility of any other health

1176 care providers to participate in the plan.

1177 (a) A participating health care provider shall comply with

1178 all federal laws and regulations governing referral fees and fee

1179 splitting, including, but not limited to, 42 U.S.C. ss. 1320a-7b

1180 and 1395nn, whether reimbursed by federal funds or not.

1181 (b) A fee schedule or financial incentive may not

1182 adversely affect the care a patient receives or the care a

1183 health provider recommends.

1184 (2) The board shall establish and oversee a fair and

1185 efficient payment system for noninstitutional providers.

1186 (a) The board shall pay noninstitutional providers based

1187 on rates negotiated with noninstitutional providers. The rates

1188 must take into account the need to address the shortage of

1189 noninstitutional providers.

1190 (b) Noninstitutional providers that accept any payment

1191 from the plan for a covered health care service may not bill the

1192 patient for the covered health care service.

1193 (c) Noninstitutional providers shall be paid within 30

1194 business days for claims filed following procedures established

1195 by the board.

1196 (3) The board shall set an annual budget for each

1197 institutional provider, which consists of an operating and a

1198 capital budget, to cover the institutional provider's

1199 anticipated health care services for the following year based on

1200 past performance and projected changes in prices and health care

1201 service levels.

1202 (a) The annual budget for each individual institutional

1203 provider must be set separately. The board may not set a joint

1204 budget for a group of more than one institutional provider nor

1205 for a parent corporation that owns or operates one or more

1206 institutional providers.

1207 (b) Institutional providers that accept any payment from

1208 the plan for a covered health care service may not bill the

1209 patient for the covered health care service.

1210 (4)(a) The board shall periodically develop a capital

1211 investment plan that will serve as a guide in determining the

1212 annual budgets of institutional providers and in deciding

1213 whether to approve applications for approval of capital

1214 expenditures by noninstitutional providers.

1215 (b) Institutional and noninstitutional providers that

1216 propose to make capital purchases in excess of $500,000 must

1217 obtain board approval. The board may alter the threshold

1218 expenditure level that triggers the requirement to submit

1219 information on capital expenditures. Institutional providers

1220 must propose these expenditures and submit the required

1221 information as part of the annual budget they submit to the

1222 board. Noninstitutional providers must apply to the board for

1223 approval of these expenditures. The board must respond to

1224 capital expenditure applications in a timely manner.

1225 (5) The board shall establish payment criteria and payment

1226 methods for care coordination for patients, especially those

1227 with chronic illness and complex medical needs.

1228 Section 13. Section 641.793, Florida Statutes, is created

1229 to read:

1230 641.793 Florida Health Board.—

1231 (1) By December 1, 2026, the Florida Health Board shall be

1232 established to promote the delivery of high-quality, coordinated

1233 health care services that enhance health; prevent illness,

1234 disease, and disability; slow the progression of chronic

1235 diseases; and improve personal health management. The board

1236 shall administer the Florida Health Plan. The board shall

1237 oversee the Office of Health Quality and Planning established in

1238 s. 641.795.

1239 (2)(a) The board shall consist of at least 15 members,

1240 including the representatives selected by the regional planning

1241 boards established in s. 641.794. These representatives shall

1242 appoint the following additional members to serve on the board:

1243 1. One patient member and one employer member.

1244 2. Seven representatives of labor organizations who

1245 represent health care workers or social workers.

1246 3. Five health care providers consisting of one physician,

1247 one registered nurse, one mental health provider, one dentist,

1248 and one health care facility director.

1249 (b) Each member shall take the oath of office to uphold

1250 the Constitution of the United States and the Constitution of

1251 the State of Florida and to operate the plan in the public

1252 interest by upholding the underlying principles of this part.

1253 (c) Board members shall serve 4 years; however, for the

1254 purpose of providing staggered terms, of the initial

1255 appointments, those members appointed by the representatives of

1256 regional planning boards shall serve 2-year terms.

1257 (d) The board shall set a board member's compensation, not

1258 to exceed the salary paid under state law to a commissioner on

1259 the Florida Public Service Commission. The board shall select

1260 the chair from among its membership.

1261 (e)1. A board member may be removed by a two-thirds vote

1262 of the members voting on removal. After receiving notice and

1263 hearing, a member may be removed for malfeasance or nonfeasance

1264 in performance of the member's duties.

1265 2. Conviction of any criminal behavior, regardless of how

1266 much time has lapsed, is grounds for immediate removal.

1267 (3) The board shall:

1268 (a) Ensure that all of the requirements of the plan are

1269 met.

1270 (b) Hire a chief executive officer for the plan, who must

1271 take the oath described in paragraph (2)(b).

1272 (c) Hire a director for the Office of Health Quality and

1273 Planning, who must take the oath described in paragraph (2)(b).

1274 (d) Provide technical assistance to the regional planning

1275 boards.

1276 (e) Conduct investigations and inquiries and require the

1277 submission of information, documents, and records that the board

1278 considers necessary to carry out the purposes of this part.

1279 (f) Establish a process for the board to receive concerns,

1280 opinions, ideas, and recommendations of the public regarding all

1281 aspects of the plan and the means of addressing those concerns.

1282 (g) Conduct activities the board considers necessary to

1283 carry out the purposes of this part.

1284 (h) Collaborate with the Department of Health and with the

1285 Agency for Health Care Administration to ensure that each health

1286 care facility performance is monitored and deficient practices

1287 are recognized and corrected in a timely manner.

1288 (i) Establish conflict-of-interest standards that prohibit

1289 health care providers from receiving financial benefit from

1290 their medical decisions outside of board reimbursement,

1291 including any financial benefit for referring a patient for a

1292 service, product, or health care provider or for prescribing,

1293 ordering, or recommending a drug, product, or service.

1294 (j) Establish conflict-of-interest standards related to

1295 pharmaceuticals and medical equipment, supplies, and devices,

1296 and their marketing to a health care provider, so that the

1297 health care provider does not receive any incentive to

1298 prescribe, administer, or use a product or service.

1299 (k) Require all electronic health records used by health

1300 care providers to be fully interoperable with the open source

1301 electronic health records system used by the United States

1302 Department of Veterans Affairs.

1303 (l) Provide financial help and assistance in retraining

1304 and job placement to workers in this state who may be displaced

1305 because of the administrative efficiencies of the plan.

1306 (m) Ensure that assistance is provided to all workers and

1307 communities that may be affected by provisions in this part.

1308 (n) Work with the Department of Commerce to ensure that

1309 funding and program services are promptly and efficiently

1310 provided to all affected workers. The Department of Commerce

1311 shall monitor and report on a regular basis on the status of

1312 displaced workers.

1313 (o) Adopt rules, policies, and procedures as necessary to

1314 carry out the duties assigned under this part.

1315 (4) Before submitting a state innovation waivers

1316 application under s. 1332 of the federal Patient Protection and

1317 Affordable Care Act, Pub. L. No. 111-148, as amended, the board

1318 must do all of the following, as required by federal law:

1319 (a) Conduct, or contract for, any actuarial analyses and

1320 actuarial certifications necessary to support the board's

1321 estimates that the waiver will comply with the comprehensive

1322 coverage, affordability, and scope of coverage requirements in

1323 federal law.

1324 (b) Conduct or contract for any necessary economic

1325 analyses needed to support the board's estimates that the waiver

1326 will comply with the comprehensive coverage, affordability,

1327 scope of coverage, and federal deficit requirements in federal

1328 law. These analyses must include:

1329 1. A detailed 10-year budget plan.

1330 2. A detailed analysis regarding the estimated impact of

1331 the waiver on health insurance coverage in this state.

1332 (c) Establish a detailed draft implementation timeline for

1333 the waiver plan.

1334 (d) Establish quarterly, annual, and cumulative targets

1335 for the comprehensive coverage, affordability, scope of

1336 coverage, and federal deficit requirements in federal law.

1337 (5) The board has the following financial duties:

1338 (a) Approve statewide and regional budgets.

1339 (b) Negotiate and establish payment rates for health care

1340 providers through their professional associations.

1341 (c) Monitor compliance with all budgets and payment rates

1342 and take action to achieve compliance to the extent authorized

1343 by law.

1344 (d) Pay claims for medical products or services as

1345 negotiated and, if deemed necessary, issue requests for

1346 proposals from nonprofit business corporations in this state for

1347 a contract to process claims.

1348 (e) Seek federal approval to bill another state for health

1349 care coverage provided to a patient from out of state who comes

1350 to this state for long-term care or other costly treatment when

1351 the patient's home state fails to provide such coverage, unless

1352 a reciprocal agreement with the patient's home state to provide

1353 similar coverage to residents of this state relocating to that

1354 state can be negotiated.

1355 (f) Implement fraud prevention measures necessary to

1356 protect the operation of the plan.

1357 (g) Work to ensure appropriate cost control by:

1358 1. Instituting aggressive public health measures, early

1359 intervention and preventive care, health and wellness education,

1360 and promotion of personal health improvement.

1361 2. Making changes in the delivery of health care services

1362 and administration that improve efficiency and care quality.

1363 3. Minimizing administrative costs.

1364 4. Ensuring that the delivery system does not contain

1365 excess capacity.

1366 5. Negotiating the lowest possible prices for prescription

1367 drugs, medical equipment, and health care services.

1368 (6) The board has the following management duties:

1369 (a) Develop and implement enrollment procedures for the

1370 plan.

1371 (b) Implement and review eligibility standards for the

1372 plan.

1373 (c) Arrange for health care services to be provided at

1374 convenient locations to serve communities in need in the same

1375 manner as federally qualified health centers, including ensuring

1376 the availability of school nurses so that all students have

1377 access to health care, immunizations, and preventive care at

1378 public schools and encouraging health care providers to provide

1379 services at easily accessible locations.

1380 (d) Make recommendations, when needed, to the Legislature

1381 about changes in the geographic boundaries of the health

1382 planning regions.

1383 (e) Establish an electronic claim and payment system for

1384 the plan.

1385 (f) Monitor the operation of the plan through consumer

1386 surveys and regular data collection and evaluation activities,

1387 including evaluations of the adequacy and quality of services

1388 provided under the plan, the need for changes in the benefit

1389 package, the cost of each type of service, and the effectiveness

1390 of cost control measures under the plan.

1391 (g) Disseminate information and establish a health care

1392 website to provide information to the public about the plan,

1393 including health care providers and facilities, and state and

1394 regional planning board meetings and activities.

1395 (h) Collaborate with public health agencies, schools, and

1396 community clinics.

1397 (i) Ensure that plan policies and health care providers,

1398 including public health care providers, support all residents of

1399 this state in achieving and maintaining maximum physical and

1400 mental health.

1401 (7) The board, in conjunction with the office and

1402 administrative staff of the plan's chief executive officer, has

1403 the following policy duties:

1404 (a) Develop and implement cost control and quality

1405 assurance procedures.

1406 (b) Ensure strong public health services, including

1407 education and community prevention and clinical services.

1408 (c) Ensure a continuum of coordinated high-quality primary

1409 to tertiary care to all residents of this state.

1410 (d) Implement policies to ensure that all residents of

1411 this state receive culturally and linguistically competent care.

1412 (8) The board shall determine the feasibility of self-

1413 insuring health care providers for malpractice and shall

1414 establish a self-insurance system and create a special fund for

1415 payment of losses incurred if the board determines self-insuring

1416 health care providers would reduce costs.

1417 (9) By July 1 of each year, the board shall report to the

1418 President of the Senate, the Speaker of the House of

1419 Representatives, and ranking members of the committees having

1420 cognizance over health care issues on:

1421 (a) The performance of the plan.

1422 (b) The fiscal condition and need for payment adjustment.

1423 (c) Any needed changes in geographic boundaries of the

1424 health planning regions.

1425 (d) Any recommendations for statutory changes.

1426 (e) Receipts of revenues from all sources.

1427 (f) Whether current year goals and priorities are met.

1428 (g) Future goals and priorities.

1429 (h) Major new technology and prescription drugs.

1430 (i) Other circumstances that may affect the cost or

1431 quality of health care.

1432 Section 14. Section 641.794, Florida Statutes, is created

1433 to read:

1434 641.794 Health planning regions.—

1435 (1) By August 1, 2026, the Secretary of Health Care

1436 Administration shall designate health planning regions within

1437 this state which are composed of geographically contiguous areas

1438 grouped on the basis of the following considerations:

1439 (a) Patterns of use of health care services.

1440 (b) Health care resources, including workforce resources.

1441 (c) Health care needs of the population, including public

1442 health needs.

1443 (d) Geography.

1444 (e) Population and demographic characteristics.

1445 (f) Other considerations the board deems appropriate.

1446 (2) Each health planning region is administered by a

1447 regional planning board. A minimum of eight regional planning

1448 boards shall be created, and all regional planning boards shall

1449 be created by October 1, 2026.

1450 (a) Each regional planning board shall consist of:

1451 1. One county commissioner per county, selected by the

1452 county commission for each health planning region consisting of

1453 at least five counties; or

1454 2. Three county commissioners per county, selected by the

1455 county commission for each health planning region consisting of

1456 four counties or less.

1457 (b) A county commission may designate a representative to

1458 act as a member of the regional planning board in the member's

1459 absence.

1460 (c) Each regional planning board shall select the chair

1461 from among its membership.

1462 (d) Regional planning board members shall serve for 4-year

1463 terms; however, for the purpose of providing staggered terms, of

1464 the initial appointments, at least half of the board members

1465 shall be appointed to 2-year terms. Board members may receive

1466 per diem for meetings.

1467 (e) The Secretary of Health Care Administration, or his or

1468 her designee, shall convene the first meeting of each regional

1469 planning board with the Florida Health Board within 30 days

1470 after the regional planning board is established.

1471 (3) A regional planning board's duties shall consist of:

1472 (a) Recommending health standards, goals, priorities, and

1473 guidelines for the health planning region.

1474 (b) Preparing an operating and capital budget for the

1475 health planning region to recommend to the Florida Health Board.

1476 (c) Collaborating with local public health care agencies

1477 to:

1478 1. Educate consumers and health care providers on public

1479 health programs, goals, and the means of reaching those goals.

1480 2. Implement public health and wellness initiatives.

1481 (d) Hiring a regional health planning director.

1482 (e) Ensuring that all parts of the health planning region

1483 have access to a 24-hour nurse hotline and to 24-hour urgent

1484 care clinics.

1485 Section 15. Section 641.795, Florida Statutes, is created

1486 to read:

1487 641.795 Office of Health Quality and Planning.—The Florida

1488 Health Board shall establish the Office of Health Quality and

1489 Planning to assess the quality, access, and funding adequacy of

1490 the Florida Health Plan. The Office of Health Quality and

1491 Planning shall:

1492 (1) Make annual recommendations to the board on the

1493 overall direction of the plan on the following subjects:

1494 (a) Overall effectiveness of the plan in addressing public

1495 health and wellness.

1496 (b) Access to health care.

1497 (c) Quality improvement.

1498 (d) Efficiency of administration.

1499 (e) Adequacy of the budget and funding.

1500 (f) Appropriateness of payments to health care providers.

1501 (g) Capital expenditure needs.

1502 (h) Long-term health care.

1503 (i) Mental health and substance abuse services.

1504 (j) Staffing levels and working conditions in health care

1505 facilities.

1506 (k) Identification of the number and mix of health care

1507 facilities and providers necessary to meet the needs of the

1508 plan.

1509 (l) Care for chronically ill patients.

1510 (m) Health care provider training on promoting the use of

1511 advance directives with patients to enable patients to obtain

1512 the health care of their choice.

1513 (n) Research needs.

1514 (o) Integration of disease management programs into health

1515 care delivery.

1516 (2) Analyze shortages in the health care workforce that is

1517 required to meet the needs of the population and develop plans

1518 to meet those needs in collaboration with regional planners and

1519 educational institutions.

1520 (3) Analyze methods of paying health care providers and

1521 make recommendations to improve the quality of health care

1522 services and to control costs.

1523 (4) Assist in coordination of the plan and public health

1524 programs.

1525 (5) Assess and evaluate health care benefits by:

1526 (a) Considering health care benefit additions to the plan

1527 and evaluating the additions based on evidence of clinical

1528 efficacy.

1529 (b) Establishing a process and criteria by which health

1530 care providers may request authorization to provide health care

1531 services and treatments that are not included in the plan

1532 benefit set, such as experimental health care treatments.

1533 (c) Evaluating proposals to increase the efficiency and

1534 effectiveness of the health delivery system, and making

1535 recommendations to the board based on the cost-effectiveness of

1536 the proposals.

1537 (d) Identifying complementary and alternative health care

1538 modalities that have been shown to be safe and effective.

1539 (6) The board may convene advisory panels as needed to

1540 assess the quality, access, and funding adequacy of the plan.

1541 Section 16. Section 641.796, Florida Statutes, is created

1542 to read:

1543 641.796 Ombudsman Office for Patient Advocacy.—

1544 (1) The Ombudsman Office for Patient Advocacy is created

1545 to represent the interests of consumers of health care and to

1546 help residents of this state secure the health care services and

1547 health care benefits to which they are entitled under this part.

1548 The Ombudsman Office for Patient Advocacy shall also advocate on

1549 behalf of enrollees of the Florida Health Plan.

1550 (2) The Ombudsman Office for Patient Advocacy shall be

1551 headed by the ombudsman, who shall be appointed by the Secretary

1552 of Health Care Administration. The ombudsman shall serve in the

1553 unclassified service and may be removed only for just cause. The

1554 ombudsman must be selected without regard to political

1555 affiliation and must be knowledgeable about and have experience

1556 in health care services and administration. A person may not

1557 serve as ombudsman while holding another public office.

1558 (a) The ombudsman may gather information about decisions

1559 and acts of the Florida Health Board and about any matters

1560 related to the board, health care providers, and health care

1561 programs.

1562 (b) The ombudsman shall:

1563 1. Ensure that patient advocacy services are available to

1564 all residents of this state.

1565 2. Establish and maintain the grievance system according

1566 to subsection (3).

1567 3. Receive, evaluate, and respond to consumer complaints

1568 about the plan.

1569 4. Establish a process to receive recommendations from the

1570 public about ways to improve the plan.

1571 5. Develop educational and informational guides that

1572 describe consumer rights and responsibilities.

1573 6. Ensure that the guides described in subparagraph 5. are

1574 widely available to consumers and available in health care

1575 provider offices and facilities.

1576 7. Prepare an annual report about the consumer's

1577 perspective on the performance of the plan, including

1578 recommendations for needed improvements.

1579 (3) The ombudsman shall establish a grievance system for

1580 complaints. The system must provide a process that ensures

1581 adequate consideration of plan enrollee grievances and

1582 appropriate remedies.

1583 (a) The ombudsman may refer any complaint that does not

1584 pertain to compliance with this part to the federal Centers for

1585 Medicare and Medicaid Services or any other appropriate local,

1586 state, and federal government entity for investigation and

1587 resolution.

1588 (b) A health care provider or an employee of a health care

1589 provider may join with, or otherwise assist, a complainant in

1590 submitting a complaint to the ombudsman. A health care provider

1591 or an employee of a health care provider who, in good faith,

1592 joins with or assists a complainant in submitting a complaint is

1593 subject to protections and remedies under this part or under

1594 general law.

1595 (c) In reviewing a complaint, the ombudsman may require a

1596 health care provider or the board to submit any information the

1597 ombudsman deems necessary.

1598 (d)1. The ombudsman shall send a written notice of the

1599 final disposition of the complaint and the reasons for the

1600 decision to:

1601 a. The complainant;

1602 b. Any health care provider or employee of a health care

1603 provider who joins with or assists the complainant in submitting

1604 the complaint; and

1605 c. The board,

1607 within 30 calendar days after receipt of the complaint, unless

1608 the ombudsman determines that additional time is reasonably

1609 necessary to fully and fairly evaluate the relevant grievance.

1610 2. The ombudsman's order of corrective action is binding

1611 on the plan. A decision of the ombudsman is subject to de novo

1612 review by the district court.

1613 (4) The budget for the Ombudsman Office for Patient

1614 Advocacy shall be determined by the Legislature and shall be

1615 independent from the board.

1616 (5) The ombudsman shall establish offices to provide

1617 convenient access to residents of this state.

1618 Section 17. Section 641.797, Florida Statutes, is created

1619 to read:

1620 641.797 Auditor for the Florida Health Plan.—

1621 (1) There is created in the Office of the Auditor General

1622 the position of auditor for the Florida Health Plan to prevent

1623 health care fraud and abuse of the plan. The auditor for the

1624 Florida Health Plan shall be appointed by the Auditor General.

1625 (2) The auditor for the Florida Health Plan shall:

1626 (a) Investigate, audit, and review the financial and

1627 business records of the plan.

1628 (b) Investigate, audit, and review the financial and

1629 business records of individuals, public and private agencies and

1630 institutions, and private corporations that provide services or

1631 products to the plan which are reimbursed by the plan.

1632 (c) Investigate allegations of misconduct on the part of

1633 an employee or appointee of the Florida Health Board and on the

1634 part of any health care provider that is reimbursed by the plan,

1635 and report any findings of misconduct to the Attorney General.

1636 (d) Investigate fraud and abuse.

1637 (e) Arrange for the collection and analysis of data needed

1638 to investigate inappropriate use of a product or service that is

1639 reimbursed by the plan.

1640 (f) Annually report recommendations for improvements to

1641 the plan to the board.

1642 Section 18. Section 641.798, Florida Statutes, is created

1643 to read:

1644 641.798 Ethics and conflicts of interest; Conflict of

1645 Interest Committee.—

1646 (1) The Code of Ethics for Public Officers and Employees

1647 under part III of chapter 112 applies to the employees and the

1648 chief executive officer of the Florida Health Plan, the

1649 employees and members of the Florida Health Board, the employees

1650 and members of the regional planning boards and the regional

1651 health planning directors, the employees and the director of the

1652 Office of Health Quality and Planning, the employees and the

1653 ombudsman of the Ombudsman Office for Patient Advocacy, and the

1654 auditor for the Florida Health Plan. Failure to comply with the

1655 code of ethics under part III of chapter 112 is grounds for

1656 disciplinary action, which may include termination of employment

1657 or removal from the board.

1658 (2) In order to avoid the appearance of political bias or

1659 impropriety, the chief executive officer of the plan may not:

1660 (a) Engage in leadership of, or employment by, a political

1661 party or political organization.

1662 (b) Publicly endorse a political candidate.

1663 (c) Contribute to a political candidate, political party,

1664 or political organization.

1665 (d) Attempt to avoid compliance with this subsection by

1666 making a contribution through a spouse or other family member.

1667 (3) In order to avoid a conflict of interest, a person

1668 specified in subsection (1) may not be employed by a health care

1669 provider or a pharmaceutical, health insurance, or medical

1670 supply company while holding the position specified in

1671 subsection (1), except for the five health care provider members

1672 appointed to the Florida Health Board by the representatives of

1673 regional planning boards under s. 641.793(2)(a)2. These five

1674 members may be employed by a health care provider, but not by a

1675 pharmaceutical, health insurance, or medical supply company

1676 while serving on the board.

1677 (4) The board shall establish a Conflict-of-Interest

1678 Committee to develop standards of practice for persons or

1679 entities doing business with the plan, including, but not

1680 limited to, board members, health care providers, and medical

1681 suppliers.

1682 (a) The committee shall establish guidelines on the duty

1683 to disclose to the committee the existence of any financial

1684 interest and all material facts related to a financial interest.

1685 (b) The committee shall review all proposed transactions

1686 and arrangements that involve the plan. In considering a

1687 proposed transaction or arrangement, if the committee determines

1688 a conflict of interest exists, the committee must investigate

1689 alternatives to the proposed transaction or arrangement. After

1690 exercising due diligence, the committee shall determine whether

1691 the plan can obtain with reasonable efforts a more advantageous

1692 transaction or arrangement with a person or entity which would

1693 not give rise to a conflict of interest. If the committee

1694 determines that a more advantageous transaction or arrangement

1695 is not reasonably possible under the circumstances, the

1696 committee shall make a recommendation to the board on whether

1697 the transaction or arrangement is in the best interest of the

1698 plan, and whether the transaction is fair and reasonable. The

1699 committee shall provide to the board all material information

1700 used to make the recommendation. After reviewing all relevant

1701 information, the board shall decide whether to approve the

1702 transaction or arrangement.

1703 Section 19. Section 641.799, Florida Statutes, is created

1704 to read:

1705 641.799 Florida Health Plan policies and procedures;

1706 rulemaking.—

1707 (1) The Florida Health Plan policies and procedures are

1708 exempt from the Administrative Procedure Act.

1709 (2)(a) If the board determines that a rule should be

1710 adopted under this part to establish, modify, or revoke a policy

1711 or procedure, the board must publish in the state register the

1712 proposed rule and must afford interested persons a period of 30

1713 days after publication to submit written data or comments.

1714 (b) On or before the last day of the 30-day period

1715 provided for the submission of written data or comments under

1716 paragraph (a), any interested person may file with the board

1717 written objections to the proposed rule, stating the grounds for

1718 objection and requesting a public hearing on those objections.

1719 Within 30 days after the last day for submitting written data or

1720 comments, the board shall publish in the state register a notice

1721 specifying the rule to which objections have been filed and a

1722 hearing requested and specifying a time and place for the

1723 hearing.

1724 (c) Within 60 days after the expiration of the period

1725 provided for the submission of written data or comments, or

1726 within 60 days after the completion of any hearing, the board

1727 shall issue a rule adopting, modifying, or revoking a policy or

1728 procedure, or make a determination that a rule should not be

1729 adopted. The rule may contain a provision delaying its effective

1730 date for such period as the board determines is necessary.

1731 Section 20. (1) The Director of the Office of Financial

1732 Regulation of the Department of Financial Services and the chief

1733 executive officer of the Florida Health Plan shall regularly

1734 update the Legislature on the status of the planning,

1735 implementation, and financing of this act.

1736 (2) The Florida Health Plan must be operational by July 1,

1737 2028.

1738 (3) On and after the day the Florida Health Plan becomes

1739 operational, a health insurance policy, a health maintenance

1740 contract, a continuing care contract, a prepaid health clinic

1741 contract, or any policy or contract that offers coverage for

1742 services covered by the Florida Health Plan may not be sold in

1743 this state.

1744 (4) The Office of the Inspector General of the Agency for

1745 Health Care Administration shall prepare an analysis of this

1746 state's capital expenditure needs for the purpose of assisting

1747 the Florida Health Board in adopting the statewide capital

1748 budget for the year following implementation. The Office of the

1749 Inspector General shall submit this analysis to the board.

1750 (5) By July 1, 2027, the Department of Commerce shall

1751 provide to the Florida Health Board, the Governor, and the

1752 chairs and ranking members of the legislative committees with

1753 jurisdiction over health, human services, and commerce a report

1754 determining the appropriations and legislation necessary to

1755 assist all affected individuals and communities through the

1756 transition to the Florida Health Plan.

1757 Section 21. This act shall take effect July 1, 2026, but

1758 only if HB 1491 or similar legislation is adopted in the same

1759 legislative session or an extension thereof and becomes a law.