THE BILL ITSELF
HB 577
Continuity of Care in Health Insurance Contracts
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A bill to be entitled
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An act relating to continuity of care in health
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insurance contracts; amending s. 627.6474, F.S.;
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requiring that contracts between an individual health
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insurer and a contracted health care practitioner
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require a specified notice to affected policyholders
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before cancellation or termination of the contracts;
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specifying requirements for such notice; authorizing
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the Financial Services Commission to adopt rules;
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providing administrative penalties; requiring a health
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insurer and a health care practitioner to allow
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certain policyholders to continue coverage and care
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for a specified timeframe; requiring the insurer and
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the health care practitioner to be bound by the
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terminated contract under certain circumstances;
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specifying that changes to the contract made within a
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specified timeframe are effective only under certain
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circumstances; creating s. 627.65713, F.S.; requiring
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that contracts between a group, blanket, and franchise
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health insurer and a contracted health care
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practitioner require a specified notice to affected
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policyholders before cancellation or termination of
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the contracts; specifying requirements for such
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notice; authorizing the commission to adopt rules;
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providing administrative penalties; requiring a group,
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blanket, and health insurer and a health care
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practitioner to allow certain policyholders to
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continue coverage and care for a specified timeframe;
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requiring the insurer and the health care practitioner
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to be bound by the terminated contract under certain
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circumstances; specifying that changes to the contract
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made within a specified timeframe are effective only
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under certain circumstances; amending s. 641.315,
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F.S.; requiring that certain health maintenance
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contracts between a health maintenance organization
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and a provider require a specified notice to affected
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subscribers before cancellation or termination of the
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contracts; specifying requirements for such notice;
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authorizing the commission to adopt rules; providing
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administrative penalties; amending s. 641.51, F.S.;
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requiring a health maintenance organization and a
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treating provider to allow certain subscribers to
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continue coverage and care for a specified timeframe;
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deleting construction; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Subsections (4) and (5) are added to section
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627.6474, Florida Statutes, to read:
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627.6474 Provider contracts.—
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(4)(a) A contract between a health insurer and a
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contracted health care practitioner as defined in s. 456.001
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must require the health insurer and the contracted health care
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practitioner to issue a joint written notice to each affected
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policyholder at least 60 days before the effective date of the
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cancellation or termination of the contract. The notice must be
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written in plain language and include all of the following:
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1. An explanation of the policyholder's rights regarding
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continuation of care and coverage.
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2. Applicable timelines for transition of care.
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3. Contact information for the insurer, the practitioner,
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and the office for questions or complaints.
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(b) The commission may adopt rules to administer paragraph
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(a). The office may impose an administrative fine of up to
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$5,000 for each violation to a health insurer or contracted
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health care practitioner that fails to comply with paragraph
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(a).
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(5) When a contract between an insurer and a treating
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health care practitioner as defined in s. 456.001 is terminated
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for any reason, the insurer and the health care practitioner
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must allow policyholders for whom treatment was active to
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continue coverage and care, through completion of treatment of a
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condition for which the policyholder was receiving care at the
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time of the termination, until the policyholder selects another
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treating health care practitioner, or during the next open
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enrollment period offered by the insurer, whichever is longer,
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but not longer than 6 months after termination of the contract.
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The insurer and the health care practitioner shall allow a
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policyholder who has initiated a course of prenatal care,
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regardless of the trimester in which care was initiated, to
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continue care and coverage until completion of postpartum care.
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For care continued under this subsection, the insurer and the
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health care practitioner shall continue to be bound by the terms
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of the terminated contract. Changes made within 30 days before
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termination of a contract are effective only if agreed to by
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both the insurer and the practitioner.
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Section 2. Section 627.65713, Florida Statutes, is created
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to read:
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627.65713 Provider contracts.—
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(1) A contract between a group, blanket, or franchise
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health insurer and a contracted health care practitioner as
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defined in s. 456.001 must require the health insurer and the
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contracted health care practitioner to issue a joint written
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notice to each affected policyholder at least 60 days before the
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effective date of the cancellation or termination of the
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contract. The notice must be written in plain language and
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include all of the following:
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(a) An explanation of the policyholder's rights regarding
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continuation of care and coverage.
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(b) Applicable timelines for transition of care.
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(c) Contact information for the insurer, the practitioner,
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and the office for questions or complaints.
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(2) The commission may adopt rules to administer
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subsection (1). The office may impose an administrative fine of
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up to $5,000 for each violation to a health insurer or
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contracted health care practitioner that fails to comply with
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subsection (1).
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(3) When a contract between a group, blanket, or franchise
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health insurer and a treating health care practitioner as
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defined in s. 456.001 is terminated for any reason, the insurer
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and the health care practitioner must allow policyholders for
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whom treatment was active to continue coverage and care, through
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completion of treatment of a condition for which the
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policyholder was receiving care at the time of the termination,
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until the policyholder selects another treating health care
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practitioner, or during the next open enrollment period offered
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by the insurer, whichever is longer, but not longer than 6
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months after termination of the contract. The insurer and the
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health care practitioner shall allow a policyholder who has
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initiated a course of prenatal care, regardless of the trimester
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in which care was initiated, to continue care and coverage until
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completion of postpartum care. For care continued under this
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subsection, the insurer and the health care practitioner shall
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continue to be bound by the terms of the terminated contract.
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Changes made within 30 days before termination of a contract are
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effective only if agreed to by both the insurer and the
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practitioner.
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Section 3. Paragraph (a) of subsection (2) of section
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641.315, Florida Statutes, is amended to read:
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641.315 Provider contracts.—
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(2)(a) For all provider contracts executed after October
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1, 1991, and within 180 days after October 1, 1991, for
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contracts in existence as of October 1, 1991:
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1. The contracts must require the provider to give 60
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days' advance written notice to the health maintenance
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organization and the office before canceling the contract with
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the health maintenance organization for any reason.; and
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2. The contracts contract must also provide that
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nonpayment for goods or services rendered by the provider to the
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health maintenance organization is not a valid reason for
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avoiding the 60-day advance notice of cancellation.
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3. The contracts must require the health maintenance
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organization and the provider to issue a joint written notice to
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each affected subscriber at least 60 days before the effective
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date of the cancellation or termination of the provider
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contract. The notice must be written in plain language and
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include all of the following:
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a. An explanation of the subscriber's rights regarding
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continuation of care and coverage.
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b. Applicable timelines for transition of care.
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c. Contact information for the health maintenance
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organization, the provider, and the Office of Insurance
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Regulation for questions or complaints.
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4. The commission may adopt rules to administer
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subparagraph 3. A health maintenance organization or provider
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that fails to comply with subparagraph 3. is subject to an
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administrative fine by the office of up to $5,000 for each
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violation.
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Section 4. Subsection (8) of section 641.51, Florida
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Statutes, is amended to read:
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641.51 Quality assurance program; second medical opinion
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requirement.—
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(8) When a contract between an organization and a treating
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provider is terminated for any reason other than for cause, each
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party shall allow subscribers for whom treatment was active to
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continue coverage and care when medically necessary, through
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completion of treatment of a condition for which the subscriber
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was receiving care at the time of the termination, until the
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subscriber selects another treating provider, or during the next
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open enrollment period offered by the organization, whichever is
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longer, but not longer than 6 months after termination of the
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contract. Each party to the terminated contract shall allow a
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subscriber who has initiated a course of prenatal care,
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regardless of the trimester in which care was initiated, to
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continue care and coverage until completion of postpartum care.
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This does not prevent a provider from refusing to continue to
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provide care to a subscriber who is abusive, noncompliant, or in
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arrears in payments for services provided. For care continued
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under this subsection, the organization and the provider shall
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continue to be bound by the terms of the terminated contract.
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Changes made within 30 days before termination of a contract are
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effective only if agreed to by both parties.
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Section 5. This act shall take effect July 1, 2026.