Florida Birth-Related Neurological Injury Compensation Association; Requiring the Agency for Health Care Administration to recover from the Florida Birth-Related Neurological Injury Compensation Association specified costs incurred by Medicaid; revising the exclusiveness of rights and remedies of the Florida Birth-Related Neurological Injury Compensation Plan; revising services eligible for compensation under certain annual benefits under the plan; requiring family members of plan participants to continuously maintain certain health insurance coverage for the participant; revising requirements for the administration of assessments and appropriations dedicated to the Florida Birth-Related Neurological Injury Compensation Plan, etc.
Health Insurance Claims; Expanding the scope of the statewide provider and health plan claim dispute resolution program to include resolution of denied prior authorization requests; providing that participation in the program is mandatory and prohibiting providers and health plans from opting out of the claim dispute resolution process; prohibiting contracts between certain physicians and health insurers and health maintenance organizations, respectively, from specifying credit card payments to physicians as the only acceptable method for payments; authorizing use of electronic funds transfers by health insurers and health maintenance organizations, respectively, for payments to physicians under certain circumstances, etc.
HB 1079 removes the Small Employer Health Carrier Reinsurance Program from Florida law. This program helped small employers by enabling health insurers to share the cost of high medical claims with the state, keeping insurance premiums lower. The bill deletes the program's creation, governance structure, and operational rules from state statutes. As a result, small employers and insurers that relied on this cost-sharing mechanism would lose this specific benefit. The bill does not establish a replacement program.
Insurance Regulation; Making clarifying changes regarding the definition of residential coverage; prohibiting insurers from imposing or enforcing certain policy conditions or requirements; revising the conditions under which liability insurers may deny coverage based on a particular coverage defense; revising the timeframe in which insurers must pay or deny claims, etc.
State Group Insurance Program Coverage for Obesity Treatment; Requiring the Department of Management Services to provide coverage for specified strategies for the evidence-based treatment and management of obesity and related conditions for state group health insurance plan policies issued on or after a specified date; prohibiting coverage criteria for weight management medications from being more restrictive than the United States Food and Drug Administration’s indications for such medications, etc.
Pharmacy; Revising the definition of the term “health care facility” to include health care clinics owned by a hospital or physicians who work for a hospital; defining the term “covered prescription drug”; revising requirements for provider contracts between pharmacy benefit managers and certain licensed pharmacies to allow for the administration and dispensing of covered prescription drugs offsite, as well as onsite, as part of outpatient care, etc.
Medical Debt Protection and Comprehensive Health Care for Residents; Requires large health care facilities to develop written financial assistance policies; provides financial assistance eligibility criteria; provides billing & collections rules & prohibitions; prohibits information relating to medical debt from being included in consumer reports, communicated with & reported to consumer reporting agencies, & used for certain decisions; prohibits medical creditors & medical debt collectors from engaging in certain acts during health insurance appeals; limits interest on medical debt under certain circumstances; creates Florida Health Plan; provides eligibility for & coverage of plan; authorizes Florida Health Board to establish financial arrangements with other states & foreign countries; authorizes plan enrollees to choose certain health care providers to have primary care providers & access to care coordination; authorizes enrollees to see health care specialists without referral; requires board to secure repeals & waivers of certain provisions of federal law; provides that plan's responsibility for providing health care is secondary to existing federal programs; requires plan to collect health care costs from collateral sources; prohibits patient care from being affected by fee schedules & financial incentives; prohibits noninstitutional & institutional providers that accept payments from plan from billing patients; provides requirements for capital expenditures by noninstitutional & institutional providers which exceed specified amount; requires Secretary of Health Care Administration to designate health planning regions; provides considerations for such designations; provides requirements for regional planning boards; prohibits certain health insurance policies & contracts from being sold in this state on & after specified date.
Prohibitions Against Discriminatory Practices Relating to 340B Entities and 340B Drugs; Prohibiting drug manufacturers from engaging in certain acts relating to the acquisition of 340B drugs by and the delivery of such drugs to specified pharmacies; prohibiting health insurance issuers, pharmacy benefit managers, and other third-party payors, and agents thereof, from engaging in certain discriminatory acts relating to reimbursement to 340B entities for 340B drugs; prohibiting individual health insurers, group, blanket, and franchise health insurers, and health maintenance organizations, respectively, and pharmacy benefit managers on behalf of such insurers and health maintenance organizations, from engaging in certain discriminatory acts relating to reimbursement to 340B entities for 340B drugs, etc.
Insurance Coverage for Breast Cancer Screening; Requiring that certain health insurance policies issued, amended, delivered, or renewed on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis; requiring that certain health insurance policies issued, amended, delivered, or renewed on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis; requiring that certain health benefit plans issued on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis; requiring that certain health maintenance contracts issued or renewed on or after a specified date provide specified minimum coverage for breast cancer screening and diagnosis, etc.
Government-facilitated Purchases and Sales of Individual and Small Employer Health and Dental Plans; Establishes Florida Health Insurance Exchange within OIR to facilitate purchase & sale of qualified health plans; provides duties of exchange; authorizes exchange to contract with eligible entity to perform exchange's functions; authorizes exchange to enter into agreements with governmental agencies & entities to carry out exchange's responsibilities; provides general requirements & prohibitions for exchange; provides certifications by exchange of health & dental benefit plans; authorizes Commissioner of Insurance Regulation & office to contract with vendor to build & manage exchange.
