Medical Debt Protection and Comprehensive Health Care for Residents

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A bill to be entitled 1
An act relating to medical debt protection and 2
comprehensive health care for residents; providing a 3
short title; creating s. 381.4011, F.S.; providing a 4
short title; providing purpose; providing 5
construction; providing definitions; requiring large 6
health care facilities to develop written financial 7
assistance policies; providing requirements for such 8
policies; providing procedures for determining 9
eligibility for financial assistance; providing 10
eligibility criteria; providing publication and notice 11
requirements relating to financial assistance 12
policies; providing requirements for translations for 13
notices relating to such policies; providing billing 14
and collections rules and prohibitions; providing 15
requirements for price information; providing 16
liability for medical debt; providing requirements for 17
itemized bills; prohibiting information relating to 18
medical debt from being included in consumer reports, 19
communicated with and reported to consumer reporting 20
agencies, and used for certain decisions; prohibiting 21
medical creditors and medical debt collectors from 22
engaging in certain acts during health insurance 23
appeals; limiting interest on medical debt under 24
certain circumstances; providing applicability; 25

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requiring written copies of payment plans under 26
certain circumstances; providing requirements before 27
payment plans may be declared terminated; requiring 28
receipts of payment; providing violations; providing 29
private remedies for patients; prohibiting waivers of 30
patients' rights; providing for enforcement and 31
complaint process; providing reporting requirements; 32
requiring the Office of the Attorney General to post 33
certain information in a database and publish an 34
annual consolidated report; providing severability; 35
creating part IV of ch. 641, F.S., entitled the 36
"Florida Health Plan"; creating s. 641.71, F.S.; 37
providing a short title; creating s. 641.72, F.S.; 38
creating the Florida Health Plan; providing purpose of 39
the plan; creating s. 641.73, F.S.; providing 40
definitions; creating s. 641.74, F.S.; providing 41
eligibility for and coverage of the plan; authorizing 42
the Florida Health Board to establish financial 43
arrangements with other states and foreign countries 44
under certain circumstances; providing duties of the 45
board relating to plan enrollment; providing 46
enrollment requirements; creating s. 641.755, F.S.; 47
authorizing plan enrollees to choose certain health 48
care providers; providing covered health care 49
benefits; authorizing the board to expand health care 50

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benefits under certain circumstances; providing health 51
care services that are excluded from the plan; 52
requiring enrollees to have primary care providers and 53
access to care coordination; authorizing enrollees to 54
see health care specialists without referral; 55
authorizing the board to establish a computerized 56
registry; authorizing the plan to assist enrollees in 57
choosing primary care providers; prohibiting cost-58
sharing requirements from being imposed on enrollees; 59
creating s. 641.77, F.S.; requiring the board to 60
secure repeals and waivers of certain provisions of 61
federal law; requiring the Department of Health and 62
the Agency for Health Care Administration to provide 63
assistance to the board; requiring the board to adopt 64
rules under certain circumstances; providing that the 65
plan's responsibility for providing health care is 66
secondary to existing federal programs under certain 67
circumstances; creating s. 641.78, F.S.; defining the 68
term "collateral source"; requiring the plan to 69
collect health care costs from collateral sources 70
under certain circumstances; requiring the board to 71
negotiate waivers, seek federal legislation, and make 72
arrangements to incorporate collateral sources into 73
the plan; requiring plan enrollees to notify health 74
care providers of collateral sources and health care 75

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providers to forward such information to the board; 76
authorizing the board to take appropriate actions to 77
recover reimbursement from collateral sources; 78
requiring collateral sources to pay for health care 79
services under certain circumstances; providing 80
specified authority and rights to the board relating 81
to collateral sources; providing construction; 82
creating s. 641.791, F.S.; providing that defaults, 83
underpayments, and late payments of certain 84
obligations shall result in remedies and penalties; 85
prohibiting eligibility for health care benefits from 86
being impaired by such defaults, underpayments, and 87
late payments; creating s. 641.792, F.S.; providing 88
eligibility of health care providers for the plan; 89
prohibiting patient care from being affected by fee 90
schedules and financial incentives; providing 91
requirements for the payment system for 92
noninstitutional providers; providing requirements for 93
the annual budgets for institutional providers; 94
prohibiting noninstitutional and institutional 95
providers that accept payments from the plan from 96
billing patients; providing requirements for capital 97
expenditures by noninstitutional and institutional 98
providers which exceed a specified amount; requiring 99
the board to establish payment criteria and payment 100

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methods for care coordination; creating s. 641.793, 101
F.S.; establishing the Florida Health Board by a 102
specified date; providing purpose of the board; 103
providing board membership, terms, and compensation; 104
providing duties of the board; providing reporting 105
requirements; creating s. 641.794, F.S.; requiring the 106
Secretary of Health Care Administration to designate 107
health planning regions; providing considerations for 108
such designations; providing requirements for regional 109
planning boards; providing board membership, terms, 110
and first meetings with the Florida Health Board; 111
providing duties of the board; creating s. 641.795, 112
F.S.; establishing the Office of Health Quality and 113
Planning; providing purpose and duties of the office; 114
authorizing the Florida Health Board to convene 115
advisory panels under certain circumstances; creating 116
s. 641.796, F.S.; creating the Ombudsman Office for 117
Patient Advocacy; providing purpose of the office; 118
providing appointment and qualifications of the 119
ombudsman; providing duties and authority of the 120
ombudsman; providing requirements for the office 121
budget; creating s. 641.797, F.S.; creating the 122
position of auditor for the plan; providing purpose, 123
appointment, and duties of the auditor; creating s. 124
641.798, F.S.; providing applicability of the Code of 125

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Ethics for Public Officers and Employees; providing 126
disciplinary actions for failure to comply with the 127
code of ethics; prohibiting certain persons from 128
engaging in specified acts or from being employed by 129
specified entities; creating the Conflict-of-Interest 130
Committee; providing duties of the committee; creating 131
s. 641.799, F.S.; providing that the plan policies and 132
procedures are exempt from the Administrative 133
Procedure Act; providing procedures and requirements 134
for adoption of certain rules on plan policies and 135
procedures; requiring specified persons to regularly 136
update the Legislature on certain information; 137
providing a timeline for the operation of the plan; 138
prohibiting certain health insurance policies and 139
contracts from being sold in this state on and after a 140
specified date; requiring an analysis of specified 141
capital expenditure needs; providing reporting 142
requirements; providing a contingent effective date. 143
144
Be It Enacted by the Legislature of the State of Florida: 145
146
Section 1. This act may be cited as the "Healthy Florida 147
Act." 148
Section 2. Section 381.4011, Florida Statutes, is created 149
to read: 150

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381.4011 Financial assistance for patients of large health 151
care facilities.— 152
(1) SHORT TITLE.—This section may be cited as the "Medical 153
Debt Protection Act." 154
(2) PURPOSE.—The purpose of this section is to reduce 155
burdensome medical debt and to protect patients in their 156
dealings with medical creditors, medical debt buyers, and 157
medical debt collectors with respect to such debt. This section 158
shall be construed as a consumer protection statute and shall be 159
liberally and remedially construed to carry out its purposes. 160
(3) DEFINITIONS.—As used in this section, the term: 161
(a) "Consumer" means a natural person. 162
(b) "Consumer reporting agency" means a person or entity 163
that, for monetary fees or dues or on a cooperative nonprofit 164
basis, regularly engages in whole or in part in the practice of 165
assembling or evaluating consumer credit information or other 166
information on consumers for the purpose of furnishing consumer 167
reports to third parties. 168
(c) "External review" means a review of an adverse benefit 169
determination, including, but not limited to, a final internal 170
adverse benefit determination, conducted pursuant to an 171
applicable state external review process, a federal external 172
review process as described in 42 U.S.C. s. 300gg-19, a review 173
pursuant to 29 U.S.C. s. 1133, a Medicare appeals process, a 174
Medicaid appeals process, or another applicable appeals process. 175

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(d) "Extraordinary collection action" means any of the 176
following: 177
1. Selling a consumer's debt to another party, except if, 178
before the sale, the medical creditor has entered into a legally 179
binding written agreement with the medical debt buyer of the 180
debt pursuant to which: 181
a. The medical debt buyer or medical debt collector is 182
prohibited from engaging in any prohibited collection actions 183
listed in subsection (8) to obtain payment for the care; 184
b. The medical debt buyer may not charge interest on the 185
debt in excess of that described in subsection (14); 186
c. The debt is returnable to or recallable by the medical 187
creditor upon a determination by the medical creditor or medical 188
debt buyer that the consumer is eligible for financial 189
assistance; and 190
d. If the consumer is determined to be eligible for 191
financial assistance and the debt is not returned to or recalled 192
by the medical creditor, the medical debt buyer is required to 193
adhere to the procedures specified in the agreement that ensures 194
that the consumer does not pay, and has no obligation to pay, 195
the medical debt buyer and the medical creditor together more 196
than the consumer is personally responsible for paying in 197
compliance with this section. 198
2. Filing a debt collection lawsuit. 199
3. Any prohibited collection action. 200

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(e) "Financial assistance policy" means a written 201
financial assistance policy that includes: 202
1. Eligibility criteria for financial assistance, 203
including when such assistance covers free or discounted care.204
2. The basis for calculating amounts charged to patients. 205
3. The method for applying for financial assistance. 206
4. The billing and collections policy containing the 207
actions the covered health care provider may take in the event 208
of nonpayment, including collections action. 209
5. Measures to widely publicize the policy within the 210
community to be served by the covered health care provider. 211
(f) "Gross charges" means a covered health care provider's 212
full, established price for health care services that the 213
covered health care provider charges uninsured patients before 214
applying any contractual allowances, discounts, or deductions. 215
Such price may be referred to elsewhere as standard charges, as 216
provided in 42 U.S.C.A. s. 300gg-18, or chargemaster rates. 217
(g) "Health care services" means services for the 218
diagnosis, prevention, treatment, cure, or relief of a physical, 219
dental, behavioral, substance use disorder, or mental health 220
condition, illness, injury, or disease. These services include, 221
but are not limited to, any procedures, products, devices, or 222
medications. 223
(h) "Household income" or "income" means income calculated 224
by using the methods used to calculate Medicaid eligibility, as 225

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set forth at 42 C.F.R. s. 435.603, or a comparable method 226
designated by the Department of Children and Families. 227
(i) "Internal review" or "internal appeal" means review by 228
a health insurance plan or other insurer of an adverse benefit 229
determination. 230
(j) "Large health care facility" means any the following 231
entities: 232
1. A hospital licensed under chapter 395, whether a 233
nonprofit entity subject to 26 U.S.C. s. 501(c)(3); a hospital 234
owned by a county, a municipality, or this state; or a for-235
profit entity that provides health care services. 236
2. An outpatient clinic or facility affiliated with a 237
hospital, as described in subparagraph 1., or operating under 238
the license of a hospital, as described in subparagraph 1. 239
3. An ambulatory surgical center licensed under chapter 240
395. 241
4. A practice that provides outpatient medical, 242
behavioral, optical, radiology, laboratory, dental, or other 243
health care services with revenues of at least $20,000,000 244
annually, and that is licensed or permitted under chapter 395, 245
chapter 408, chapter 483, chapter 484, chapter 466, or any other 246
chapter that licenses or permits health care facilities. 247
5. A licensed health care professional who provides health 248
care services in one or more of the settings listed in 249
subparagraphs 1.-4., but bills patients independently. 250

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(k) "Medical creditor" means an entity that provides 251
health care services and to which the patient owes money for 252
health care services, or an entity that provided health care 253
services and to which the patient previously owed money if the 254
medical debt has been purchased by one or more debt buyers. 255
(l) "Medical debt" means an obligation or alleged 256
obligation of a patient to pay any amount related to the receipt 257
of health care services, products, or devices. The term does not 258
include debt charged to a credit card or other extension of 259
credit unless the credit card or extension of credit is offered 260
specifically for the payment of health care services, products, 261
or devices. 262
(m) "Medical debt buyer" means a person or entity that is 263
engaged in the business of purchasing medical debts for 264
collection purposes, whether the person or entity collects the 265
debt or hires a third party for collection or an attorney at law 266
for litigation in order to collect such debt. 267
(n) "Medical debt collector" means a person or entity that 268
regularly collects or attempts to collect, directly or 269
indirectly, medical debts originally owed or due or asserted to 270
be owed or due another. The term includes a medical debt buyer 271
for all purposes. 272
(o) "Patient" means the person who received health care 273
services. The term includes a parent if the patient is a minor, 274
or a legal guardian if the patient is an adult under 275

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guardianship. 276
(p) "Patient income" means the household income of the 277
patient's family. 278
(q) "Prohibited collection actions" means any of the 279
following activities when used by a medical creditor or medical 280
debt collector to collect debts owed for health care services: 281
1. Causing or threatening to cause a consumer's arrest. 282
2. Causing or threatening to cause a consumer to be 283
subject to a capias or similar warrant. 284
3. Obtaining or threatening to obtain a lien on a 285
consumer's real property. 286
4. Foreclosing or threatening to foreclose on a 287
consumer's real property. 288
5. Garnishing or threatening to garnish wages or state 289
income tax refunds. 290
6. Using state or federal tax offsets to seize tax refunds 291
or tax credits. 292
7. Attaching, seizing, or threatening to attach or seize a 293
consumer's bank account. 294
8. Furnishing or threatening to furnish information about 295
the medical debt to a consumer reporting agency. 296
(4) FINANCIAL ASSISTANCE POLICY FOR LARGE HEALTH CARE 297
FACILITIES.— 298
(a)1. A large health care facility must develop a written 299
financial assistance policy that complies with this section and 300

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any implementing regulations. 301
2. The requirement under subparagraph 1. applies whether 302
or not the large health care facility is required to develop a 303
financial assistance policy under 26 U.S.C. s. 501(r)-(4) and 304
implementing regulations. 305
(b) The financial assistance policy required under 306
subparagraph (a)1. must, at a minimum, contain the following: 307
1. A written explanation of the financial assistance that 308
is available for emergency and other medically necessary health 309
care services offered by a covered health care provider. 310
2. A summary, in plain language, of the financial 311
assistance policy which does not exceed two pages in length. 312
3. The eligibility criteria for financial assistance and a 313
summary of the type of assistance that is available as set forth 314
in this section. 315
4. The method and application process that patients are to 316
use to apply for financial assistance. 317
5. The information and documentation the large health care 318
facility may require patients to provide as part of the 319
application. 320
6. The reasonable steps that a health care provider will 321
take to determine whether a patient is eligible for financial 322
assistance. 323
7. The billing and collections policy, including the 324
actions that may be taken in the event of nonpayment, which must 325

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comply with all applicable provisions of this section and other 326
applicable municipal, county, state, or federal laws. 327
(c) The financial assistance policy must be approved by 328
the owners or governing body of a health care provider. The 329
financial assistance policy shall be reviewed and approved on an 330
annual basis by the owners or governing board. 331
(d) The financial assistance policy must apply to all 332
patients who are financially eligible based on income as 333
provided in subsection (5). Patients may not be denied financial 334
assistance on the basis of residency, health insurance coverage 335
status, citizenship or immigration status, or assets or 336
prospective assets. 337
(5) IMPLEMENTATION OF THE FINANCIAL ASSISTANCE POLICY.— 338
(a) In addition to any other actions required by 339
applicable municipal, county, state, or federal law, a large 340
health care facility must screen all patients for eligibility 341
for financial assistance by taking all of the following steps 342
before seeking payment for any emergency or medically necessary 343
health care services: 344
1. Determine whether the patient has health insurance. If 345
the patient is uninsured, offer to screen the patient for public 346
or private insurance eligibility and offer assistance if the 347
patient chooses to apply for public or private insurance. A 348
patient's refusal to be screened is not grounds for denying 349
financial assistance. 350

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2. Offer to screen the patient for other public programs 351
that may assist with health care costs. However, a patient's 352
refusal to be screened is not grounds for denying financial 353
assistance. 354
3. If the patient submits an application for financial 355
assistance, determine the patient's eligibility for the 356
financial assistance plan within 14 days after the patient 357
applies for financial assistance, suspending any billing or 358
collections actions while eligibility is being determined. 359
(b) The following patients qualify for financial 360
assistance under the financial assistance plan, which applies to 361
any charges for health care services that are not covered by 362
insurance and would otherwise be billed to the patient: 363
1. Patients with household incomes at or below 300 percent 364
of the federal poverty level shall receive free care. 365
2. Patients with household incomes above 300 percent, up 366
to and including 400 percent, of the federal poverty level shall 367
be charged no more than the amount calculated in the following 368
manner: 369
a. The patient's bill shall be recalculated using the 370
Medicare reimbursement rate applicable on the date of service; 371
and 372
b. The patient shall be charged no more than 25 percent of 373
the recalculated bill under sub-subparagraph a. 374
3. Patients with household incomes above 400 percent, up 375

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to and including 600 percent, of the federal poverty level shall 376
receive the same discounts as patients with household incomes 377
above 300 percent, up to and including 400 percent, of the 378
federal poverty level if the patient and the patient's household 379
have incurred medical expenses from the current large health 380
care facility's bill and all other medical bills for medically 381
necessary health care services received during the previous 12 382
months which, in total, exceed 5 percent of the household's 383
annual gross income. 384
4. In addition to other financial assistance provided 385
under this section, patients with household incomes at or below 386
400 percent of the federal poverty level may not be required to 387
pay more than $2,300 per year in cumulative medical bills to 388
large health care facilities. Upon patient request and 389
documentation, any health care services that have been delivered 390
by one or more large health care facilities after the $2,300 391
limit has been met must be provided as free care. 392
(c)1. Household income shall be established by the most 393
recent tax return, unless the patient chooses to submit pay 394
stubs, documentation of public assistance, or documentation of 395
household income that the Department of Children and Families 396
has identified as a valid form of documentation for the purposes 397
of this section. Additional documentation other than proof of 398
income may not be required. 399
2. If a large health care facility uses a consumer report, 400

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as defined in s. 603(d) of the Fair Credit Reporting Act, 15 401
U.S.C. s. 1681a(d), or any score or rating based on consumer 402
report information, the facility must obtain the consumer's 403
consent for such use and must comply with all applicable 404
provisions of this section. 405
3. A large health care facility may grant financial 406
assistance notwithstanding a patient's failure to provide one of 407
the required forms of documentation described in the financial 408
assistance policy or application form and may rely on, but not 409
require, other evidence of eligibility. Proof that the patient 410
receives a means-tested benefit from the federal, state, or 411
local government is sufficient to establish eligibility for 412
financial assistance without additional documentation of income.413
4. A large health care facility must screen, under 414
paragraph (a), a patient for presumptive eligibility for 415
financial assistance as set forth in paragraph (b). The rules 416
and process for screening a patient for presumptive eligibility 417
for financial assistance must require a large health care 418
facility to inform any patient who is deemed presumptively 419
eligible for financial assistance that the large health care 420
facility has reduced or eliminated the patient's medical bill, 421
specify if any amount is currently outstanding, and explain how 422
to apply for additional financial assistance for any remaining 423
balance. 424
5. If a large health care provider chooses to use credit 425

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reports or scores or similar screening tools when determining 426
eligibility for financial assistance, the large health care 427
provider may: 428
a. Use such tools only to make a positive eligibility 429
determination, and not to deny financial assistance to any 430
patient; and 431
b. Obtain credit reports or scores and use the reports or 432
scores only for screening if the patient consents by signing a 433
stand-alone document granting permission for the credit check, 434
which shall be effective for no more than 30 days. 435
(d) If a large health care facility receives an 436
application for financial assistance from a patient, the 437
facility shall notify the patient in writing within 14 days as 438
to whether the facility has approved or denied the application. 439
The large health care facility shall provide a copy of any 440
recalculated bill and calculation of financial assistance 441
provided to the patient. 442
(e) A large health care facility shall accept and consider 443
a patient's application for financial assistance when the 444
application is submitted within 1 year after the date of the 445
first bill for the provision of the health care services. 446
However, if the patient is the subject of collection activity by 447
the facility or a medical debt collector, including a lawsuit to 448
collect a medical debt, and submits an application for financial 449
assistance, the large health care facility shall accept and 450

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process the application at any time. If the patient submits a 451
financial assistance application to a medical debt collector, 452
the medical debt collector shall forward the application to the 453
large health care facility within 2 business days, and shall 454
cease collection activity until notified by the large health 455
care facility of the outcome of the application and any debt 456
forgiven or new repayment terms. 457
(f) A large health care facility and medical debt 458
collector may not charge any interest or late fees to patients 459
who qualify for financial assistance. 460
(g) A large health care facility and medical debt 461
collector shall offer to any patient who qualifies for financial 462
assistance a payment plan of not less than 24 months, and may 463
not require the patient to make monthly payments that exceed 5 464
percent of the household's gross monthly income. Prepayment 465
penalties, early payment penalties, or fees are prohibited. 466
(h) For a patient who has been found to be eligible for 467
financial assistance, the initial payment on a monthly payment 468
plan may not be due within the first 90 days after the health 469
care services are provided. 470
(6) FINANCIAL ASSISTANCE POLICY; PUBLIC EDUCATION AND 471
INFORMATION.— 472
(a) A large health care facility must do all of the 473
following to publicize its financial assistance policy: 474
1. Make the financial assistance policy and the financial 475

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assistance application form easily accessible online, through 476
the large health care facility's website and through any patient 477
portal or other online communication portal used by patients of 478
the health care provider. 479
2. In addition to any other requirements in this section, 480
make paper copies of the financial assistance policy and the 481
application form available upon request and without charge, both 482
by mail and in the large health care facility's office. For 483
hospitals, copies should be available, at a minimum, in the 484
emergency room, if there is an emergency room, and admissions 485
areas. 486
3. Notify and inform members of the community served by 487
the large health care facility about the financial assistance 488
policy in a manner reasonably calculated to reach those members 489
who are most likely to require financial assistance with such 490
efforts commensurate to the size and income of the facility.491
4. Notify and inform patients who receive care from the 492
large health care facility about the financial assistance policy 493
by doing all of the following: 494
a. Offer a paper copy of the financial assistance policy 495
to a patient as part of the patient's first visit or, in the 496
case of a hospital facility, during the intake and discharge 497
process. 498
b. Include a conspicuous written notice on all billing 499
statements, whether sent by the large health care facility or a 500

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medical debt collector, which notifies and informs patients 501
about the availability of financial assistance and includes the 502
telephone number of the large health care facility's office or 503
department that can provide information about the financial 504
assistance policy and application process and the direct website 505
address where copies of the financial assistance policy and 506
application form may be obtained. 507
c. Place conspicuous public displays, or other measures 508
reasonably calculated to attract patients' attention, which 509
notify and inform patients about the financial assistance policy 510
in public locations in the large health care facility's office. 511
For hospitals, displays should be posted in the emergency room, 512
if there is an emergency room and admissions areas, at a 513
minimum. 514
(b) In all attempts, whether written or oral, by a medical 515
creditor or medical debt collector to collect a medical debt for 516
health care services provided by a large health care facility, 517
the medical creditor or medical debt collector must inform the 518
patient of any financial assistance policy available through the 519
large health care facility. 520
(7) FINANCIAL ASSISTANCE POLICIES; LANGUAGE ACCESS.— 521
(a) A financial assistance policy must include a notice 522
that states the following or substantially similar language: 523
"This document contains important information about financial 524
assistance for your bill. Contact [insert name and telephone 525

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number of large health care facility] for translation 526
assistance." The statement must be translated in the 10 527
languages most frequently spoken by limited English proficient 528
households in the large health care facility's service area, as 529
determined by the United States Census Bureau data. 530
(b) A large health care facility must accommodate all 531
significant populations that have limited English proficiency by 532
translating the financial assistance policy and application form 533
into the primary languages spoken by such populations. A large 534
health care facility satisfies this translation requirement if 535
it makes available translations of its financial assistance 536
policy and application form in the language spoken by each 537
limited English proficiency language group that constitutes the 538
lesser of 1,000 individuals or 5 percent of the community served 539
by the large health care facility or the population likely to be 540
affected or encountered by the large health care facility. A 541
large health care facility may determine the percentage or 542
number of limited English proficiency individuals in the large 543
health care facility's community or likely to be affected or 544
encountered by the large health care facility using any 545
reasonable method. 546
(c) A large health care facility must accommodate any 547
patient with limited English proficiency who is part of a 548
population that falls below the numerical thresholds established 549
in paragraph (b) by providing oral interpretation services to 550

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the patient upon request and at no cost to the patient to 551
explain the financial assistance policy and the application 552
form. 553
(d) A large health care facility must accommodate any 554
patient with limited English proficiency in answering questions 555
from the patient regarding the financial assistance policy, the 556
application form, any written determination of eligibility, and 557
any other communication regarding financial assistance from the 558
large health care facility. A large health care facility may 559
accommodate these patients by providing oral interpretation 560
services to the patient upon request and at no cost to the 561
patient. 562
(8) BILLING AND COLLECTIONS RULES, LIMITS ON CREDITORS.— 563
(a) A medical creditor or medical debt collector may not 564
engage in prohibited collection actions to collect medical debts 565
owed for health care services. 566
(b) A medical creditor or medical debt collector may not 567
engage in any extraordinary collection actions until 180 days 568
after the first bill for a medical debt has been sent. 569
(c) At least 30 days before taking any permissible 570
extraordinary collection actions, a medical creditor or medical 571
debt collector must provide to the patient a notice that: 572
1. In the case of large health care facilities and medical 573
debt collectors collecting debt for health care services 574
provided by such facilities, states that financial assistance is 575

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available for eligible patients and providing a summary, in 576
plain language, of the financial assistance policy. 577
2. Identifies the extraordinary collection actions that 578
will be initiated in order to obtain payment. 579
3. Provides a deadline after which such extraordinary 580
collection actions will be initiated, which date is no earlier 581
than 30 days after the date of the notice. 582
(d) A medical debt collector collecting debt for health 583
care services provided by such a large health care facility may 584
not engage in extraordinary collection actions during a declared 585
state or federal emergency or a public health emergency. 586
(e) A large health care facility or a medical debt 587
collector collecting debt for health care services provided by 588
such a facility may not use any extraordinary collection actions 589
unless these actions are described in the large health care 590
facility's billing and collections policy. 591
(f) If a large health care facility or a medical debt 592
collector collecting debt for health care services provided by 593
such a facility bills or initiates collection activities and the 594
patient is later found eligible for financial assistance, the 595
large health care facility or medical debt collector shall 596
reverse any permissible extraordinary collection actions or any 597
collection activity that were previously permissible and have 598
since become prohibited, including, but not limited to: 599
1. Deleting any negative reports to consumer reporting 600

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agencies. 601
2. Dismissing or vacating any collection lawsuits over the 602
medical debt. 603
3. Removing any wage garnishment orders or state tax 604
refund interception requests. 605
(g) If the patient has paid any part of the medical debt 606
or any of the patient's funds has been seized or levied in 607
excess of the amount that the patient owes after application of 608
financial assistance, the large health care facility or medical 609
debt collector shall refund any excess amount to the patient. 610
(9) PRICE INFORMATION.—A large health care facility must 611
post price information on its website. The price information 612
must be accessible through a link from the website's homepage 613
and, at a minimum, must include the following: 614
(a) A list of gross charges for all health care services. 615
(b) A list of the amount that Medicare would reimburse for 616
the health care service, next to the relevant gross charge. 617
(c) The titles or descriptions of health care services, in 618
plain language that can be understood by an average person. 619
(10) LIABILITY FOR MEDICAL DEBT.— 620
(a) Parents and legal guardians are jointly liable for any 621
medical debt incurred by children under the age of 18. 622
(b) A spouse or person may not be held personally liable 623
for the medical debt or nursing home debt of any other person 624
age 18 or older, or other damages related to the collection of 625

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the patient's bill. 626
(c) Any admission agreement must comply with applicable 627
federal and state laws, including the Nursing Home Reform Law, 628
42 U.S.C. s. 1395i-3. 629
(11) VERIFICATION UPON WRITTEN OR ORAL REQUEST.—A medical 630
creditor or medical debt collector shall provide an itemized 631
bill to the patient within 60 days after a request. The itemized 632
bill must state: 633
(a) The name and address of the medical creditor. 634
(b) The date of service. 635
(c) The date the medical debt was incurred, if different 636
from the date of service. 637
(d) A detailed list of the specific health care services 638
provided to the patient. 639
(e) A list of all health care professionals who treated 640
the patient. 641
(f) The amount of principal for any medical debt incurred. 642
(g) Any adjustment to the bill, such as negotiated 643
insurance rates or other discounts. 644
(h) The amount of any payments received, whether from the 645
patient or any other party. 646
(i) Any interest or fees. 647
(j) Whether the patient was screened for financial 648
assistance. 649
(k) Whether the patient was found eligible for financial 650

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assistance and, if so, the amount due after all financial 651
assistance has been applied to the itemized bill. 652
(12) MEDICAL DEBT AND CONSUMER REPORTING AGENCIES.— 653
(a) A consumer reporting agency may not make a consumer 654
report containing an item of information that the consumer 655
reporting agency knows or should know concerns medical debt. 656
(b) A person may not communicate with or report any 657
information to any consumer reporting agency regarding a medical 658
debt. 659
(c) A person who uses a consumer report may not use a 660
medical debt listed on the report as a negative factor when 661
making a credit, employment, or housing decision. 662
(d) A medical creditor shall include a provision in any 663
contract entered into with a medical debt collect or for the 664
purchase or collection of medical debt which prohibits the 665
reporting of any portion of such medical debt to a consumer 666
reporting agency. 667
(13) PROHIBITION AGAINST COLLECTION OF MEDICAL DEBT DURING 668
HEALTH INSURANCE APPEALS.— 669
(a) A medical creditor or medical debt collector that 670
knows or should have known about an internal review, external 671
review, or other internal appeal of a health insurance decision 672
that is pending or was pending within the previous 180 days may 673
not: 674
1. Communicate with the patient regarding the unpaid 675

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charges for health care services for the purpose of seeking to 676
collect the charges; or 677
2. Initiate a lawsuit or arbitration proceeding against 678
the patient relating to unpaid charges for health care services. 679
(b) A medical creditor that knows or should have known 680
about an internal review, external review, or other internal 681
appeal of a health insurance decision that is pending or was 682
pending within the previous 180 days may not refer, place, or 683
send the unpaid charges for health care services to a medical 684
debt collector, including by selling the debt to a medical debt 685
buyer. 686
(14) INTEREST ON MEDICAL DEBT.— 687
(a) Unless a patient is eligible for financial assistance 688
under paragraph (5)(b), and notwithstanding any agreement to the 689
contrary, interest on medical debt may not exceed 2 percent per 690
annum. Patients eligible for financial assistance may not be 691
charged any interest or late fees. 692
(b) The rate of interest provided in paragraph (a) also 693
applies to any judgments on medical debt, notwithstanding any 694
agreement to the contrary. 695
(15) MEDICAL DEBT PAYMENT PLANS.— 696
(a) A medical creditor or medical debt collector that 697
agrees to a payment plan for a medical debt shall provide a 698
written copy of the payment plan to the patient within 5 699
business days after entering into the payment plan. This plan 700

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must prominently disclose the rate of any interest being applied 701
to the debt in compliance with subsection (14), and the date by 702
which the account will be paid off in full, assuming the 703
payments set by the schedule are made without interruption. 704
(b) A consumer need not make a payment on the payment plan 705
until the written copy has been provided. 706
(c)1. A medical debt payment plan may be accelerated or 707
declared in default or terminated due to nonpayment only after 708
the patient fails to make scheduled payments on the payment plan 709
for at least 3 consecutive months. 710
2. Before declaring the payment plan terminated, the 711
medical creditor or medical debt collector must do all of the 712
following: 713
a. Make at least three reasonable attempts to contact the 714
patient by telephone or by other method preferred by the 715
patient. 716
b. Provide a written notice informing the patient that the 717
payment plan may be terminated and that the patient has the 718
opportunity to renegotiate the payment plan. 719
c. Attempt to renegotiate the terms of the defaulted 720
payment plan, if requested by the patient. 721
3. The medical creditor or medical debt collector may not 722
commence a civil action against the patient or responsible party 723
for nonpayment until at least 90 days after the payment plan is 724
declared to be terminated. For purposes of this section, the 725

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notice and telephone call to the patient may be made to the last 726
known telephone number and address of the patient. 727
(16) RECEIPTS FOR PAYMENTS.—Within 10 business days after 728
receipt of a payment on a medical debt, a medical creditor or 729
medical debt collector, or any agents thereof, receiving the 730
payment shall furnish a receipt to the person that made the 731
payment. The receipt must show all of the following: 732
(a) The date of the provision of the health care service. 733
(b) The amount paid. 734
(c) The date payment was received. 735
(d) The account's balance before the most recent payment.736
(e) The new balance after application of the payment. 737
(f) The interest rate and interest accrued since the 738
patient's last payment. 739
(g) The patient's account number. 740
(h) The name of the current owner of the debt and, if 741
different, the name of the medical creditor. 742
(i) Whether the payment is accepted as payment in full of 743
the debt. 744
(17) DEBT FORGIVEN BY MEDICAL CREDITOR.—Forgiveness of any 745
part of an insured patient's copayment, coinsurance, deductible, 746
facility fees, out-of-network charges, or other cost sharing is 747
not a breach of contract or other violation of an agreement 748
between the medical creditor and the insurer or payor. 749
(18) PRIVATE REMEDY.— 750

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(a) Collection activity against a patient who the large 751
health care facility, medical creditor, or medical debt 752
collector knew or should have known was, or should have been, 753
eligible for financial assistance is an unfair or deceptive 754
trade practice in violation of part II of chapter 501. Any other 755
violation of this section by a medical creditor or medical debt 756
collector is also an unfair or deceptive trade practice in 757
violation of part II of chapter 501. 758
(b) A patient may sue for injunctive or other appropriate 759
equitable relief to enforce this section. 760
(c) The remedies provided in this section are not intended 761
to be the exclusive remedies available to a patient, and the 762
patient is not required to exhaust any administrative remedies 763
provided under this section or any other applicable law. 764
(d) A financial assistance policy or agreement between a 765
patient and a large health care provider or medical debt 766
collector may not contain a provision that, before a dispute 767
arises, waives or has the practical effect of waiving the rights 768
of the patient to resolve that dispute by obtaining: 769
1. Injunctive, declaratory, or other equitable relief;770
2. Multiple or minimum damages as specified by law; 771
3. Attorney fees and costs as specified by law; or 772
4. A hearing at which a party can present evidence in 773
person. 774
(e) Any provision in a financial assistance policy or 775

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other written agreement violating paragraph (d) is void and 776
unenforceable. A court may refuse to enforce other provisions of 777
the financial assistance policy or other written agreement as 778
equity may require. 779
(19) PROHIBITION OF WAIVER OF RIGHTS.—Any waiver by a 780
patient of any protection provided by or any right of the 781
patient or other person under this section is void and may not 782
be enforced by any court or any other person. A large health 783
care facility may not circumvent the responsibilities and 784
protections of this section by requiring prepayment for medical 785
care. 786
(20) ENFORCEMENT.— 787
(a) The Office of the Attorney General may enforce this 788
section and may adopt any regulation or rules necessary or 789
appropriate to carry out the purpose of this section, to provide 790
for the protection of patients, and to assist market 791
participants in interpreting this section. 792
(b) The Office of the Attorney General shall establish a 793
complaint process whereby an aggrieved consumer or any member of 794
the public may file a complaint against a medical creditor or 795
medical debt collector who violates any provision of this 796
section. All complaints shall be considered public records. 797
(21) ANNUAL REPORTS AND DATABASE.— 798
(a) On or before July 1 of each year, beginning July 1, 799
2028, each large health care provider shall file its financial 800

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assistance policy and an annual report with the Legislature and 801
the Office of the Attorney General pursuant to procedures that 802
the Office of the Attorney General shall establish. 803
(b) The Office of the Attorney General shall post each 804
report and financial assistance policy in a searchable database 805
accessible on the Internet. 806
(c) The Office of the Attorney General shall prepare an 807
annual consolidated report and shall make it available to the 808
public. The report must include the following information for 809
the time period of July 1 of the prior year to July of that 810
year: 811
1. The total number of patients who applied for financial 812
assistance. 813
2. The total number of patients who received financial 814
assistance. 815
3. The total number of patients who were denied financial 816
assistance. 817
4. Deidentified demographic information for patients who 818
received financial assistance, including zip code, race, 819
language, gender, and disability status, to the extent that such 820
data is available from the large health care facility. 821
5. The total amount of financial assistance provided to 822
patients. 823
6. The types of collection practices used. 824
7. The amounts of money collected with each of these 825

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collection practices, in dollars and by percentage of the large 826
health care facility's annual revenue. 827
(22) SEVERABILITY.—If any provision of this section or its 828
application to any person or circumstance is held invalid, that 829
provision or its application is severable and does not affect 830
the validity of the other provisions or applications of this 831
section. 832
Section 3. Part IV of chapter 641, Florida Statutes, 833
consisting of ss. 641.71-641.799, Florida Statutes, is created 834
and entitled the "Florida Health Plan." 835
Section 4. Section 641.71, Florida Statutes, is created to 836
read: 837
641.71 Short title.—This part may be cited as the "Florida 838
Health Plan." 839
Section 5. Section 641.72, Florida Statutes, is created to 840
read: 841
641.72 Purpose.—There is created the Florida Health Plan. 842
The purpose of the Florida Health Plan is to keep residents of 843
this state healthy and to provide the best quality of health 844
care by: 845
(1) Ensuring that all residents of this state, regardless 846
of immigration status, are covered. 847
(2) Covering all necessary care, including dental; vision; 848
hearing; mental health; reproductive care, including abortion 849
services and prenatal and postpartum care; gender-affirming 850

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health care, including medication and treatment; substance use 851
disorder treatment; prescription drugs; durable medical 852
equipment and supplies; and long-term care and home care, 853
including long-term services and supports in home and community-854
based settings. 855
(3) Allowing patients to choose their health care 856
providers. 857
(4) Reducing costs by negotiating fair prices and cutting 858
administrative bureaucracy, through measures such as a global 859
budget approach to institutional providers, and not by 860
restricting or denying care. 861
(5) Being affordable to all patients through financing 862
based on a patient's ability to pay and the elimination of 863
premiums, copayments, deductibles, and out-of-pocket expenses at 864
the point of service. 865
(6) Focusing on preventive care and early intervention to 866
improve health. 867
(7) Ensuring that there are enough health care providers 868
to guarantee timely access to care. 869
(8) Continuing this state's leadership in medical 870
education, research, and technology. 871
(9) Providing adequate and timely payments to health care 872
providers. 873
(10) Using a simple funding and payment system. 874
(11) Providing a just transition for a displaced workforce 875

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affected by changes. 876
Section 6. Section 641.73, Florida Statutes, is created to 877
read: 878
641.73 Definitions.—As used in this part, the term: 879
(1) "Board" means the Florida Health Board established in 880
s. 641.793. 881
(2) "Institutional provider" means an inpatient hospital, 882
nursing facility, rehabilitation facility, or any other health 883
care facility that provides overnight care. 884
(3) "Medically necessary" means comprehensive services or 885
supplies needed to promote health and to prevent, diagnose, or 886
treat a particular patient's medical condition. The 887
comprehensive services and supplies must meet accepted standards 888
of medical practice within a health care provider's professional 889
peer group. 890
(4) "Noninstitutional provider" means an individual 891
provider, group practice, clinic, outpatient surgical center, 892
imaging center, or any other health care facility that does not 893
provide overnight care. 894
(5) "Plan" means the Florida Health Plan created in s. 895
641.72. 896
(6) "Resident of this state" means an individual who has 897
had a principal place of domicile in this state for more than 6 898
consecutive months, who has registered to vote in this state, 899
who has made a statement of domicile pursuant to s. 222.17, or 900

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who has filed for homestead tax exemption on property in this 901
state. 902
Section 7. Section 641.74, Florida Statutes, is created to 903
read: 904
641.74 Eligibility for and enrollment in the Florida 905
Health Plan.— 906
(1) ELIGIBILITY.— 907
(a) All residents of this state, regardless of immigration 908
status, are eligible for the Florida Health Plan. 909
(b) Coverage for emergency care for a resident of this 910
state which is obtained out of state must be at prevailing local 911
rates where the care is provided. Coverage for nonemergency care 912
obtained out of state must be according to rates and conditions 913
established by the Florida Health Board. The board may require 914
that a resident of this state be transported back to this state 915
when prolonged treatment of an emergency condition is necessary 916
and when that transport will not adversely affect the patient's 917
care or condition. 918
(c) A nonresident visiting this state shall be billed by 919
the board for all services received under the plan. The board 920
may enter into intergovernmental arrangements or contracts with 921
other states and foreign countries to provide reciprocal 922
coverage for temporary visitors. 923
(d) The board shall extend eligibility to nonresidents 924
employed in this state under a premium schedule set by the 925

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board. 926
(e) For a business outside of this state which employs 927
residents of this state, the board shall apply for a federal 928
waiver to collect the employer contribution mandated by federal 929
law. 930
(f) A retiree who is covered under the plan and who elects 931
to reside outside of this state is eligible for benefits under 932
the terms and conditions of the retiree's employer-employee 933
contract. 934
(g) The board may establish financial arrangements with 935
other states and foreign countries in order to facilitate 936
meeting the terms of the contracts described in paragraph (f). 937
Payments for care provided by non-Florida health care providers 938
to retirees who are covered under the plan shall be reimbursed 939
at rates established by the board. Health care providers who 940
accept any payment from the plan for a covered service may not 941
bill the patient for the covered service. 942
(h)1. A person is presumed eligible for coverage under the 943
plan, and a health care provider shall provide health care 944
services as if the person is eligible for coverage under the 945
plan, if the person: 946
a. Is a minor; 947
b. Arrives at a health care facility unconscious, 948
comatose, or otherwise unable to document eligibility or to act 949
on the person's own behalf because of the person's physical or 950

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mental condition; or 951
c. Is involuntarily committed to an acute psychiatric 952
facility or to a hospital with psychiatric beds which provides 953
for involuntary commitment. 954
2. All health care facilities subject to state and federal 955
provisions governing emergency medical treatment must comply 956
with subparagraph 1. 957
(2) ENROLLMENT.—The board shall establish a procedure to 958
enroll residents of this state and provide each with 959
identification that may be used by health care providers to 960
confirm eligibility for services. The application for enrollment 961
may not be more than two pages. 962
Section 8. Section 641.755, Florida Statutes, is created 963
to read: 964
641.755 Benefits.— 965
(1) A person covered under the Florida Health Plan may 966
choose to receive services from any qualified, licensed health 967
care provider that participates in the plan. 968
(2) Except for the exclusions provided in subsection (4), 969
covered health care benefits under the plan include all 970
prescribed medically necessary care, which includes: 971
(a) Inpatient and outpatient health care facility 972
services. 973
(b) Inpatient and outpatient licensed health care provider 974
services. 975

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(c) Diagnostic imaging, laboratory services, and other 976
diagnostic and evaluative services. 977
(d) Durable medical equipment, appliances, and assistive 978
technology, including, but not limited to, prescribed 979
prosthetics, eye care, and hearing aids and their repair, 980
technical support, and customization required for individual 981
use. 982
(e) Inpatient and outpatient rehabilitative care. 983
(f) Emergency care services. 984
(g) Necessary transportation for health care services: 985
1. As covered under Medicaid or Medicare; or 986
2. For persons with disabilities, older persons with 987
functional limitations, and low-income persons. 988
(h) Child and adult immunizations and preventive care. 989
(i) Health and wellness education for chronic or 990
preventative care as provided by licensed health care providers. 991
(j) Reproductive health care, including abortion services, 992
contraceptives, and prenatal and postpartum care. 993
(k) Childbirth and maternity care, including doula 994
services and care in freestanding childbirth centers. 995
(l) Gender-affirming health care, including medication and 996
treatment. 997
(m) Holistic licensed health care services such as 998
chiropractic, acupressure, acupuncture, massage, and nutritional 999
services. 1000

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(n) Mental health services, including substance use 1001
disorder treatment, services in substance use disorder treatment 1002
facilities, and mental health care provided by licensed or 1003
certified mental health providers such as licensed 1004
psychologists, licensed mental health counselors, licensed 1005
professional counselors, licensed clinical social workers, 1006
certified master social workers, rehabilitation support service 1007
providers, and any providers that the board deems eligible. 1008
(o) Dental care, including diagnostics and restoration and 1009
durable equipment such as braces and mouthguards. 1010
(p) Vision care. 1011
(q) Hearing care. 1012
(r) Prescription drugs. 1013
(s) Podiatric care. 1014
(t) Therapies that are shown by the National Institutes of 1015
Health National Center for Complementary and Integrative Health 1016
to be safe and effective. 1017
(u) Blood and blood products. 1018
(v) Dialysis. 1019
(w) Licensed qualified adult day care. 1020
(x) Rehabilitative and habilitative services. 1021
(y) Ancillary health care or social services previously 1022
covered by this state's qualified public health programs. 1023
(z) Case management and care coordination. 1024
(aa) Language interpretation and translation for health 1025

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care services, including sign language and Braille or other 1026
services needed for persons with communication barriers. 1027
(bb) Services provided by qualified community health 1028
workers. 1029
(cc) Health care and long-term supportive services, 1030
including in a home or community-based setting, assisted living 1031
facility, and nursing home, with home health care providers, 1032
home health aides, and palliative and hospice care. 1033
(dd) Any item or service described in this subsection which 1034
is furnished using telehealth, to the extent practicable. 1035
(3) The Florida Health Board may expand health care 1036
benefits beyond the minimum benefits described in subsection (2) 1037
if the expansion meets the intent of this part and when there 1038
are sufficient funds to cover the expansion. 1039
(4) The following health care services are excluded from 1040
coverage by the plan: 1041
(a) Treatments and procedures primarily for cosmetic 1042
purposes, unless required to correct a congenital defect or to 1043
restore or correct a part of the body that has been altered as a 1044
result of an injury, a disease, or a surgery or unless 1045
determined to be medically necessary by a qualified, licensed 1046
health care provider in the plan. 1047
(b) Services of a health care provider or facility that is 1048
not licensed, certified, or accredited by this state. The 1049
licensure, certification, or accreditation requirements do not 1050

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apply to health care providers or facilities that provide 1051
services to residents of this state who require medical 1052
attention while traveling out of state. 1053
(5)(a) All plan enrollees must have a primary care 1054
provider and must have access to care coordination. 1055
(b) A plan enrollee does not need a referral to see a 1056
health care specialist. 1057
(c) The board may establish a computerized registry to 1058
assist enrollees in identifying appropriate providers, and the 1059
plan may assist an enrollee with choosing a primary care 1060
provider if the enrollee so chooses. 1061
(6) The plan may not impose a deductible, copayment, 1062
coinsurance, or any other cost-sharing requirement on an 1063
enrollee with respect to a covered benefit. 1064
Section 9. Section 641.77, Florida Statutes, is created to 1065
read: 1066
641.77 Federal preemption.— 1067
(1) The Florida Health Board shall secure a repeal or a 1068
waiver of any provision of federal law that preempts any 1069
provision of this part. The Department of Health and the Agency 1070
for Health Care Administration shall provide all necessary 1071
assistance to the board to secure any repeal or waiver. 1072
(2)(a) The board shall, under the state innovation waivers 1073
under s. 1332 of the federal Patient Protection and Affordable 1074
Care Act, Pub. L. No. 111-148, as amended, request to repeal or 1075

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waive any of the following provisions to the extent necessary to 1076
implement this part: 1077
1. Title 42 of the United States Code, ss. 18021-18024. 1078
2. Title 42 of the United States Code, ss. 18031-18033. 1079
3. Title 42 of the United States Code, s. 18071. 1080
4. Section 5000A of the Internal Revenue Code of 1986, as 1081
amended. 1082
(b) If a repeal or a waiver of a federal law or regulation 1083
cannot be secured, the board shall adopt rules, or seek 1084
conforming state legislation, consistent with federal law, in an 1085
effort to best fulfill the purposes of this part. 1086
(c) The Florida Health Plan's responsibility for providing 1087
health care is secondary to existing federal programs for health 1088
care services to the extent that funding for these programs is 1089
not transferred or that the transfer is delayed beyond the date 1090
on which initial benefits are provided under the plan. 1091
Section 10. Section 641.78, Florida Statutes, is created 1092
to read: 1093
641.78 Subrogation.— 1094
(1)(a) As used in this section, the term "collateral 1095
source" includes: 1096
1. A health insurance policy, health maintenance contract, 1097
continuing care contract, and prepaid health clinic contract, 1098
and the medical components of motor vehicle insurance, 1099
homeowner's insurance, and other forms of insurance. 1100

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2. The medical components of worker's compensation. 1101
3. A pension plan and retiree health care benefits. 1102
4. An employer plan. 1103
5. An employee benefit contract. 1104
6. A government benefit program. 1105
7. A judgment for damages for personal injury. 1106
8. The state of last domicile for individuals moving to 1107
Florida for medical care who have extraordinary medical needs. 1108
9. Any third party who is or may be liable to an 1109
individual for health care services or costs. 1110
(b) The term does not include: 1111
1. A contract or plan that is subject to federal 1112
preemption. 1113
2. Any governmental unit, agency, or service to the extent 1114
that subrogation is prohibited by law. 1115
(2) When other payers for health care have been 1116
terminated, the plan shall collect health care costs from a 1117
collateral source if health care services provided to a patient 1118
are, or may be, covered services under the collateral source 1119
available to the patient, or if the patient has a right of 1120
action for compensation permitted under law. 1121
(3) The board shall negotiate waivers, seek federal 1122
legislation, or make other arrangements to incorporate 1123
collateral sources into the plan. 1124
(4) If a person who receives health care services under 1125

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the plan is entitled to coverage, reimbursement, indemnity, or 1126
other compensation from a collateral source, the person must 1127
notify the health care provider and provide information 1128
identifying the collateral source, the nature and extent of 1129
coverage or entitlement, and other relevant information. The 1130
health care provider shall forward this information to the 1131
board. The person entitled to coverage, reimbursement, 1132
indemnity, or other compensation from a collateral source must 1133
provide additional information as requested by the board. 1134
(a) The plan shall seek reimbursement from the collateral 1135
source for services provided to the person and may take 1136
appropriate action, including legal proceedings, to recover the 1137
reimbursement. Upon demand, the collateral source shall pay the 1138
sum that it would have paid or spent on behalf of the person for 1139
the health care services provided by the plan. 1140
(b) In addition to any other right to recovery provided in 1141
this section, the board has the same right to recover the 1142
reasonable value of health care benefits from the collateral 1143
source. 1144
(c) If the collateral source is exempt from subrogation or 1145
the obligation to reimburse the plan, the board may require that 1146
the person who is entitled to health care services from the 1147
collateral source first seek those services from the collateral 1148
source before seeking the services from the plan. 1149
(5) To the extent permitted by federal law, the board has 1150

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the same right of subrogation over contractual retiree health 1151
care benefits provided by employers as other contracts allowing 1152
the plan to recover the cost of health care services provided to 1153
a person covered by the retiree health care benefits, unless 1154
arrangements are made to transfer the revenues of the health 1155
care benefits directly to the plan. 1156
(6) A collateral source is not excluded from the 1157
obligations imposed by this section by virtue of a contract or 1158
relationship with a governmental unit, agency, or service. 1159
Section 11. Section 641.791, Florida Statutes, is created 1160
to read: 1161
641.791 Defaults, underpayments, and late payments.— 1162
(1) Defaults, underpayments, or late payments of any 1163
premium or other obligation imposed by this part shall result in 1164
the remedies and penalties provided by law, except as provided 1165
in this part. 1166
(2) Eligibility for health care benefits may not be 1167
impaired by any default, underpayment, or late payment of any 1168
premium or other obligation imposed by this part. 1169
Section 12. Section 641.792, Florida Statutes, is created 1170
to read: 1171
641.792 Provider payments.— 1172
(1) All health care providers licensed to practice in this 1173
state may participate in the Florida Health Plan. The Florida 1174
Health Board may determine the eligibility of any other health 1175

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care providers to participate in the plan. 1176
(a) A participating health care provider shall comply with 1177
all federal laws and regulations governing referral fees and fee 1178
splitting, including, but not limited to, 42 U.S.C. ss. 1320a-7b 1179
and 1395nn, whether reimbursed by federal funds or not. 1180
(b) A fee schedule or financial incentive may not 1181
adversely affect the care a patient receives or the care a 1182
health provider recommends. 1183
(2) The board shall establish and oversee a fair and 1184
efficient payment system for noninstitutional providers. 1185
(a) The board shall pay noninstitutional providers based 1186
on rates negotiated with noninstitutional providers. The rates 1187
must take into account the need to address the shortage of 1188
noninstitutional providers. 1189
(b) Noninstitutional providers that accept any payment 1190
from the plan for a covered health care service may not bill the 1191
patient for the covered health care service. 1192
(c) Noninstitutional providers shall be paid within 30 1193
business days for claims filed following procedures established 1194
by the board. 1195
(3) The board shall set an annual budget for each 1196
institutional provider, which consists of an operating and a 1197
capital budget, to cover the institutional provider's 1198
anticipated health care services for the following year based on 1199
past performance and projected changes in prices and health care 1200

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service levels. 1201
(a) The annual budget for each individual institutional 1202
provider must be set separately. The board may not set a joint 1203
budget for a group of more than one institutional provider nor 1204
for a parent corporation that owns or operates one or more 1205
institutional providers. 1206
(b) Institutional providers that accept any payment from 1207
the plan for a covered health care service may not bill the 1208
patient for the covered health care service. 1209
(4)(a) The board shall periodically develop a capital 1210
investment plan that will serve as a guide in determining the 1211
annual budgets of institutional providers and in deciding 1212
whether to approve applications for approval of capital 1213
expenditures by noninstitutional providers. 1214
(b) Institutional and noninstitutional providers that 1215
propose to make capital purchases in excess of $500,000 must 1216
obtain board approval. The board may alter the threshold 1217
expenditure level that triggers the requirement to submit 1218
information on capital expenditures. Institutional providers 1219
must propose these expenditures and submit the required 1220
information as part of the annual budget they submit to the 1221
board. Noninstitutional providers must apply to the board for 1222
approval of these expenditures. The board must respond to 1223
capital expenditure applications in a timely manner. 1224
(5) The board shall establish payment criteria and payment 1225

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methods for care coordination for patients, especially those 1226
with chronic illness and complex medical needs. 1227
Section 13. Section 641.793, Florida Statutes, is created 1228
to read: 1229
641.793 Florida Health Board.— 1230
(1) By December 1, 2026, the Florida Health Board shall be 1231
established to promote the delivery of high-quality, coordinated 1232
health care services that enhance health; prevent illness, 1233
disease, and disability; slow the progression of chronic 1234
diseases; and improve personal health management. The board 1235
shall administer the Florida Health Plan. The board shall 1236
oversee the Office of Health Quality and Planning established in 1237
s. 641.795. 1238
(2)(a) The board shall consist of at least 15 members, 1239
including the representatives selected by the regional planning 1240
boards established in s. 641.794. These representatives shall 1241
appoint the following additional members to serve on the board: 1242
1. One patient member and one employer member. 1243
2. Seven representatives of labor organizations who 1244
represent health care workers or social workers. 1245
3. Five health care providers consisting of one physician, 1246
one registered nurse, one mental health provider, one dentist, 1247
and one health care facility director. 1248
(b) Each member shall take the oath of office to uphold 1249
the Constitution of the United States and the Constitution of 1250

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the State of Florida and to operate the plan in the public 1251
interest by upholding the underlying principles of this part. 1252
(c) Board members shall serve 4 years; however, for the 1253
purpose of providing staggered terms, of the initial 1254
appointments, those members appointed by the representatives of 1255
regional planning boards shall serve 2-year terms. 1256
(d) The board shall set a board member's compensation, not 1257
to exceed the salary paid under state law to a commissioner on 1258
the Florida Public Service Commission. The board shall select 1259
the chair from among its membership. 1260
(e)1. A board member may be removed by a two-thirds vote 1261
of the members voting on removal. After receiving notice and 1262
hearing, a member may be removed for malfeasance or nonfeasance 1263
in performance of the member's duties. 1264
2. Conviction of any criminal behavior, regardless of how 1265
much time has lapsed, is grounds for immediate removal. 1266
(3) The board shall: 1267
(a) Ensure that all of the requirements of the plan are 1268
met. 1269
(b) Hire a chief executive officer for the plan, who must 1270
take the oath described in paragraph (2)(b). 1271
(c) Hire a director for the Office of Health Quality and 1272
Planning, who must take the oath described in paragraph (2)(b). 1273
(d) Provide technical assistance to the regional planning 1274
boards. 1275

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(e) Conduct investigations and inquiries and require the 1276
submission of information, documents, and records that the board 1277
considers necessary to carry out the purposes of this part. 1278
(f) Establish a process for the board to receive concerns, 1279
opinions, ideas, and recommendations of the public regarding all 1280
aspects of the plan and the means of addressing those concerns. 1281
(g) Conduct activities the board considers necessary to 1282
carry out the purposes of this part. 1283
(h) Collaborate with the Department of Health and with the 1284
Agency for Health Care Administration to ensure that each health 1285
care facility performance is monitored and deficient practices 1286
are recognized and corrected in a timely manner. 1287
(i) Establish conflict-of-interest standards that prohibit 1288
health care providers from receiving financial benefit from 1289
their medical decisions outside of board reimbursement, 1290
including any financial benefit for referring a patient for a 1291
service, product, or health care provider or for prescribing, 1292
ordering, or recommending a drug, product, or service. 1293
(j) Establish conflict-of-interest standards related to 1294
pharmaceuticals and medical equipment, supplies, and devices, 1295
and their marketing to a health care provider, so that the 1296
health care provider does not receive any incentive to 1297
prescribe, administer, or use a product or service. 1298
(k) Require all electronic health records used by health 1299
care providers to be fully interoperable with the open source 1300

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electronic health records system used by the United States 1301
Department of Veterans Affairs. 1302
(l) Provide financial help and assistance in retraining 1303
and job placement to workers in this state who may be displaced 1304
because of the administrative efficiencies of the plan. 1305
(m) Ensure that assistance is provided to all workers and 1306
communities that may be affected by provisions in this part. 1307
(n) Work with the Department of Commerce to ensure that 1308
funding and program services are promptly and efficiently 1309
provided to all affected workers. The Department of Commerce 1310
shall monitor and report on a regular basis on the status of 1311
displaced workers. 1312
(o) Adopt rules, policies, and procedures as necessary to 1313
carry out the duties assigned under this part. 1314
(4) Before submitting a state innovation waivers 1315
application under s. 1332 of the federal Patient Protection and 1316
Affordable Care Act, Pub. L. No. 111-148, as amended, the board 1317
must do all of the following, as required by federal law: 1318
(a) Conduct, or contract for, any actuarial analyses and 1319
actuarial certifications necessary to support the board's 1320
estimates that the waiver will comply with the comprehensive 1321
coverage, affordability, and scope of coverage requirements in 1322
federal law. 1323
(b) Conduct or contract for any necessary economic 1324
analyses needed to support the board's estimates that the waiver 1325

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will comply with the comprehensive coverage, affordability, 1326
scope of coverage, and federal deficit requirements in federal 1327
law. These analyses must include: 1328
1. A detailed 10-year budget plan. 1329
2. A detailed analysis regarding the estimated impact of 1330
the waiver on health insurance coverage in this state. 1331
(c) Establish a detailed draft implementation timeline for 1332
the waiver plan. 1333
(d) Establish quarterly, annual, and cumulative targets 1334
for the comprehensive coverage, affordability, scope of 1335
coverage, and federal deficit requirements in federal law. 1336
(5) The board has the following financial duties: 1337
(a) Approve statewide and regional budgets. 1338
(b) Negotiate and establish payment rates for health care 1339
providers through their professional associations. 1340
(c) Monitor compliance with all budgets and payment rates 1341
and take action to achieve compliance to the extent authorized 1342
by law. 1343
(d) Pay claims for medical products or services as 1344
negotiated and, if deemed necessary, issue requests for 1345
proposals from nonprofit business corporations in this state for 1346
a contract to process claims. 1347
(e) Seek federal approval to bill another state for health 1348
care coverage provided to a patient from out of state who comes 1349
to this state for long-term care or other costly treatment when 1350

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the patient's home state fails to provide such coverage, unless 1351
a reciprocal agreement with the patient's home state to provide 1352
similar coverage to residents of this state relocating to that 1353
state can be negotiated. 1354
(f) Implement fraud prevention measures necessary to 1355
protect the operation of the plan. 1356
(g) Work to ensure appropriate cost control by: 1357
1. Instituting aggressive public health measures, early 1358
intervention and preventive care, health and wellness education, 1359
and promotion of personal health improvement. 1360
2. Making changes in the delivery of health care services 1361
and administration that improve efficiency and care quality. 1362
3. Minimizing administrative costs. 1363
4. Ensuring that the delivery system does not contain 1364
excess capacity. 1365
5. Negotiating the lowest possible prices for prescription 1366
drugs, medical equipment, and health care services. 1367
(6) The board has the following management duties: 1368
(a) Develop and implement enrollment procedures for the 1369
plan. 1370
(b) Implement and review eligibility standards for the 1371
plan. 1372
(c) Arrange for health care services to be provided at 1373
convenient locations to serve communities in need in the same 1374
manner as federally qualified health centers, including ensuring 1375

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the availability of school nurses so that all students have 1376
access to health care, immunizations, and preventive care at 1377
public schools and encouraging health care providers to provide 1378
services at easily accessible locations. 1379
(d) Make recommendations, when needed, to the Legislature 1380
about changes in the geographic boundaries of the health 1381
planning regions. 1382
(e) Establish an electronic claim and payment system for 1383
the plan. 1384
(f) Monitor the operation of the plan through consumer 1385
surveys and regular data collection and evaluation activities, 1386
including evaluations of the adequacy and quality of services 1387
provided under the plan, the need for changes in the benefit 1388
package, the cost of each type of service, and the effectiveness 1389
of cost control measures under the plan. 1390
(g) Disseminate information and establish a health care 1391
website to provide information to the public about the plan, 1392
including health care providers and facilities, and state and 1393
regional planning board meetings and activities. 1394
(h) Collaborate with public health agencies, schools, and 1395
community clinics. 1396
(i) Ensure that plan policies and health care providers, 1397
including public health care providers, support all residents of 1398
this state in achieving and maintaining maximum physical and 1399
mental health. 1400

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(7) The board, in conjunction with the office and 1401
administrative staff of the plan's chief executive officer, has 1402
the following policy duties: 1403
(a) Develop and implement cost control and quality 1404
assurance procedures. 1405
(b) Ensure strong public health services, including 1406
education and community prevention and clinical services. 1407
(c) Ensure a continuum of coordinated high-quality primary 1408
to tertiary care to all residents of this state. 1409
(d) Implement policies to ensure that all residents of 1410
this state receive culturally and linguistically competent care. 1411
(8) The board shall determine the feasibility of self-1412
insuring health care providers for malpractice and shall 1413
establish a self-insurance system and create a special fund for 1414
payment of losses incurred if the board determines self-insuring 1415
health care providers would reduce costs. 1416
(9) By July 1 of each year, the board shall report to the 1417
President of the Senate, the Speaker of the House of 1418
Representatives, and ranking members of the committees having 1419
cognizance over health care issues on: 1420
(a) The performance of the plan. 1421
(b) The fiscal condition and need for payment adjustment. 1422
(c) Any needed changes in geographic boundaries of the 1423
health planning regions. 1424
(d) Any recommendations for statutory changes. 1425

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(e) Receipts of revenues from all sources. 1426
(f) Whether current year goals and priorities are met. 1427
(g) Future goals and priorities. 1428
(h) Major new technology and prescription drugs. 1429
(i) Other circumstances that may affect the cost or 1430
quality of health care. 1431
Section 14. Section 641.794, Florida Statutes, is created 1432
to read: 1433
641.794 Health planning regions.— 1434
(1) By August 1, 2026, the Secretary of Health Care 1435
Administration shall designate health planning regions within 1436
this state which are composed of geographically contiguous areas 1437
grouped on the basis of the following considerations: 1438
(a) Patterns of use of health care services. 1439
(b) Health care resources, including workforce resources. 1440
(c) Health care needs of the population, including public 1441
health needs. 1442
(d) Geography. 1443
(e) Population and demographic characteristics. 1444
(f) Other considerations the board deems appropriate. 1445
(2) Each health planning region is administered by a 1446
regional planning board. A minimum of eight regional planning 1447
boards shall be created, and all regional planning boards shall 1448
be created by October 1, 2026. 1449
(a) Each regional planning board shall consist of: 1450

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1. One county commissioner per county, selected by the 1451
county commission for each health planning region consisting of 1452
at least five counties; or 1453
2. Three county commissioners per county, selected by the 1454
county commission for each health planning region consisting of 1455
four counties or less. 1456
(b) A county commission may designate a representative to 1457
act as a member of the regional planning board in the member's 1458
absence. 1459
(c) Each regional planning board shall select the chair 1460
from among its membership. 1461
(d) Regional planning board members shall serve for 4-year 1462
terms; however, for the purpose of providing staggered terms, of 1463
the initial appointments, at least half of the board members 1464
shall be appointed to 2-year terms. Board members may receive 1465
per diem for meetings. 1466
(e) The Secretary of Health Care Administration, or his or 1467
her designee, shall convene the first meeting of each regional 1468
planning board with the Florida Health Board within 30 days 1469
after the regional planning board is established. 1470
(3) A regional planning board's duties shall consist of: 1471
(a) Recommending health standards, goals, priorities, and 1472
guidelines for the health planning region. 1473
(b) Preparing an operating and capital budget for the 1474
health planning region to recommend to the Florida Health Board. 1475

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(c) Collaborating with local public health care agencies 1476
to: 1477
1. Educate consumers and health care providers on public 1478
health programs, goals, and the means of reaching those goals. 1479
2. Implement public health and wellness initiatives. 1480
(d) Hiring a regional health planning director. 1481
(e) Ensuring that all parts of the health planning region 1482
have access to a 24-hour nurse hotline and to 24-hour urgent 1483
care clinics. 1484
Section 15. Section 641.795, Florida Statutes, is created 1485
to read: 1486
641.795 Office of Health Quality and Planning.—The Florida 1487
Health Board shall establish the Office of Health Quality and 1488
Planning to assess the quality, access, and funding adequacy of 1489
the Florida Health Plan. The Office of Health Quality and 1490
Planning shall: 1491
(1) Make annual recommendations to the board on the 1492
overall direction of the plan on the following subjects: 1493
(a) Overall effectiveness of the plan in addressing public 1494
health and wellness. 1495
(b) Access to health care. 1496
(c) Quality improvement. 1497
(d) Efficiency of administration. 1498
(e) Adequacy of the budget and funding. 1499
(f) Appropriateness of payments to health care providers. 1500

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(g) Capital expenditure needs. 1501
(h) Long-term health care. 1502
(i) Mental health and substance abuse services. 1503
(j) Staffing levels and working conditions in health care 1504
facilities. 1505
(k) Identification of the number and mix of health care 1506
facilities and providers necessary to meet the needs of the 1507
plan. 1508
(l) Care for chronically ill patients. 1509
(m) Health care provider training on promoting the use of 1510
advance directives with patients to enable patients to obtain 1511
the health care of their choice. 1512
(n) Research needs. 1513
(o) Integration of disease management programs into health 1514
care delivery. 1515
(2) Analyze shortages in the health care workforce that is 1516
required to meet the needs of the population and develop plans 1517
to meet those needs in collaboration with regional planners and 1518
educational institutions. 1519
(3) Analyze methods of paying health care providers and 1520
make recommendations to improve the quality of health care 1521
services and to control costs. 1522
(4) Assist in coordination of the plan and public health 1523
programs. 1524
(5) Assess and evaluate health care benefits by: 1525

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(a) Considering health care benefit additions to the plan 1526
and evaluating the additions based on evidence of clinical 1527
efficacy. 1528
(b) Establishing a process and criteria by which health 1529
care providers may request authorization to provide health care 1530
services and treatments that are not included in the plan 1531
benefit set, such as experimental health care treatments. 1532
(c) Evaluating proposals to increase the efficiency and 1533
effectiveness of the health delivery system, and making 1534
recommendations to the board based on the cost-effectiveness of 1535
the proposals. 1536
(d) Identifying complementary and alternative health care 1537
modalities that have been shown to be safe and effective. 1538
(6) The board may convene advisory panels as needed to 1539
assess the quality, access, and funding adequacy of the plan. 1540
Section 16. Section 641.796, Florida Statutes, is created 1541
to read: 1542
641.796 Ombudsman Office for Patient Advocacy.— 1543
(1) The Ombudsman Office for Patient Advocacy is created 1544
to represent the interests of consumers of health care and to 1545
help residents of this state secure the health care services and 1546
health care benefits to which they are entitled under this part. 1547
The Ombudsman Office for Patient Advocacy shall also advocate on 1548
behalf of enrollees of the Florida Health Plan. 1549
(2) The Ombudsman Office for Patient Advocacy shall be 1550

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headed by the ombudsman, who shall be appointed by the Secretary 1551
of Health Care Administration. The ombudsman shall serve in the 1552
unclassified service and may be removed only for just cause. The 1553
ombudsman must be selected without regard to political 1554
affiliation and must be knowledgeable about and have experience 1555
in health care services and administration. A person may not 1556
serve as ombudsman while holding another public office. 1557
(a) The ombudsman may gather information about decisions 1558
and acts of the Florida Health Board and about any matters 1559
related to the board, health care providers, and health care 1560
programs. 1561
(b) The ombudsman shall: 1562
1. Ensure that patient advocacy services are available to 1563
all residents of this state. 1564
2. Establish and maintain the grievance system according 1565
to subsection (3). 1566
3. Receive, evaluate, and respond to consumer complaints 1567
about the plan. 1568
4. Establish a process to receive recommendations from the 1569
public about ways to improve the plan. 1570
5. Develop educational and informational guides that 1571
describe consumer rights and responsibilities. 1572
6. Ensure that the guides described in subparagraph 5. are 1573
widely available to consumers and available in health care 1574
provider offices and facilities. 1575

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7. Prepare an annual report about the consumer's 1576
perspective on the performance of the plan, including 1577
recommendations for needed improvements. 1578
(3) The ombudsman shall establish a grievance system for 1579
complaints. The system must provide a process that ensures 1580
adequate consideration of plan enrollee grievances and 1581
appropriate remedies. 1582
(a) The ombudsman may refer any complaint that does not 1583
pertain to compliance with this part to the federal Centers for 1584
Medicare and Medicaid Services or any other appropriate local, 1585
state, and federal government entity for investigation and 1586
resolution. 1587
(b) A health care provider or an employee of a health care 1588
provider may join with, or otherwise assist, a complainant in 1589
submitting a complaint to the ombudsman. A health care provider 1590
or an employee of a health care provider who, in good faith, 1591
joins with or assists a complainant in submitting a complaint is 1592
subject to protections and remedies under this part or under 1593
general law. 1594
(c) In reviewing a complaint, the ombudsman may require a 1595
health care provider or the board to submit any information the 1596
ombudsman deems necessary. 1597
(d)1. The ombudsman shall send a written notice of the 1598
final disposition of the complaint and the reasons for the 1599
decision to: 1600

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a. The complainant; 1601
b. Any health care provider or employee of a health care 1602
provider who joins with or assists the complainant in submitting 1603
the complaint; and 1604
c. The board, 1605
1606
within 30 calendar days after receipt of the complaint, unless 1607
the ombudsman determines that additional time is reasonably 1608
necessary to fully and fairly evaluate the relevant grievance. 1609
2. The ombudsman's order of corrective action is binding 1610
on the plan. A decision of the ombudsman is subject to de novo 1611
review by the district court. 1612
(4) The budget for the Ombudsman Office for Patient 1613
Advocacy shall be determined by the Legislature and shall be 1614
independent from the board. 1615
(5) The ombudsman shall establish offices to provide 1616
convenient access to residents of this state. 1617
Section 17. Section 641.797, Florida Statutes, is created 1618
to read: 1619
641.797 Auditor for the Florida Health Plan.— 1620
(1) There is created in the Office of the Auditor General 1621
the position of auditor for the Florida Health Plan to prevent 1622
health care fraud and abuse of the plan. The auditor for the 1623
Florida Health Plan shall be appointed by the Auditor General. 1624
(2) The auditor for the Florida Health Plan shall: 1625

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(a) Investigate, audit, and review the financial and 1626
business records of the plan. 1627
(b) Investigate, audit, and review the financial and 1628
business records of individuals, public and private agencies and 1629
institutions, and private corporations that provide services or 1630
products to the plan which are reimbursed by the plan. 1631
(c) Investigate allegations of misconduct on the part of 1632
an employee or appointee of the Florida Health Board and on the 1633
part of any health care provider that is reimbursed by the plan, 1634
and report any findings of misconduct to the Attorney General. 1635
(d) Investigate fraud and abuse. 1636
(e) Arrange for the collection and analysis of data needed 1637
to investigate inappropriate use of a product or service that is 1638
reimbursed by the plan. 1639
(f) Annually report recommendations for improvements to 1640
the plan to the board. 1641
Section 18. Section 641.798, Florida Statutes, is created 1642
to read: 1643
641.798 Ethics and conflicts of interest; Conflict of 1644
Interest Committee.— 1645
(1) The Code of Ethics for Public Officers and Employees 1646
under part III of chapter 112 applies to the employees and the 1647
chief executive officer of the Florida Health Plan, the 1648
employees and members of the Florida Health Board, the employees 1649
and members of the regional planning boards and the regional 1650

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health planning directors, the employees and the director of the 1651
Office of Health Quality and Planning, the employees and the 1652
ombudsman of the Ombudsman Office for Patient Advocacy, and the 1653
auditor for the Florida Health Plan. Failure to comply with the 1654
code of ethics under part III of chapter 112 is grounds for 1655
disciplinary action, which may include termination of employment 1656
or removal from the board. 1657
(2) In order to avoid the appearance of political bias or 1658
impropriety, the chief executive officer of the plan may not: 1659
(a) Engage in leadership of, or employment by, a political 1660
party or political organization. 1661
(b) Publicly endorse a political candidate. 1662
(c) Contribute to a political candidate, political party, 1663
or political organization. 1664
(d) Attempt to avoid compliance with this subsection by 1665
making a contribution through a spouse or other family member. 1666
(3) In order to avoid a conflict of interest, a person 1667
specified in subsection (1) may not be employed by a health care 1668
provider or a pharmaceutical, health insurance, or medical 1669
supply company while holding the position specified in 1670
subsection (1), except for the five health care provider members 1671
appointed to the Florida Health Board by the representatives of 1672
regional planning boards under s. 641.793(2)(a)2. These five 1673
members may be employed by a health care provider, but not by a 1674
pharmaceutical, health insurance, or medical supply company 1675

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while serving on the board. 1676
(4) The board shall establish a Conflict-of-Interest 1677
Committee to develop standards of practice for persons or 1678
entities doing business with the plan, including, but not 1679
limited to, board members, health care providers, and medical 1680
suppliers. 1681
(a) The committee shall establish guidelines on the duty 1682
to disclose to the committee the existence of any financial 1683
interest and all material facts related to a financial interest. 1684
(b) The committee shall review all proposed transactions 1685
and arrangements that involve the plan. In considering a 1686
proposed transaction or arrangement, if the committee determines 1687
a conflict of interest exists, the committee must investigate 1688
alternatives to the proposed transaction or arrangement. After 1689
exercising due diligence, the committee shall determine whether 1690
the plan can obtain with reasonable efforts a more advantageous 1691
transaction or arrangement with a person or entity which would 1692
not give rise to a conflict of interest. If the committee 1693
determines that a more advantageous transaction or arrangement 1694
is not reasonably possible under the circumstances, the 1695
committee shall make a recommendation to the board on whether 1696
the transaction or arrangement is in the best interest of the 1697
plan, and whether the transaction is fair and reasonable. The 1698
committee shall provide to the board all material information 1699
used to make the recommendation. After reviewing all relevant 1700

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information, the board shall decide whether to approve the 1701
transaction or arrangement. 1702
Section 19. Section 641.799, Florida Statutes, is created 1703
to read: 1704
641.799 Florida Health Plan policies and procedures; 1705
rulemaking.— 1706
(1) The Florida Health Plan policies and procedures are 1707
exempt from the Administrative Procedure Act. 1708
(2)(a) If the board determines that a rule should be 1709
adopted under this part to establish, modify, or revoke a policy 1710
or procedure, the board must publish in the state register the 1711
proposed rule and must afford interested persons a period of 30 1712
days after publication to submit written data or comments. 1713
(b) On or before the last day of the 30-day period 1714
provided for the submission of written data or comments under 1715
paragraph (a), any interested person may file with the board 1716
written objections to the proposed rule, stating the grounds for 1717
objection and requesting a public hearing on those objections. 1718
Within 30 days after the last day for submitting written data or 1719
comments, the board shall publish in the state register a notice 1720
specifying the rule to which objections have been filed and a 1721
hearing requested and specifying a time and place for the 1722
hearing. 1723
(c) Within 60 days after the expiration of the period 1724
provided for the submission of written data or comments, or 1725

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within 60 days after the completion of any hearing, the board 1726
shall issue a rule adopting, modifying, or revoking a policy or 1727
procedure, or make a determination that a rule should not be 1728
adopted. The rule may contain a provision delaying its effective 1729
date for such period as the board determines is necessary. 1730
Section 20. (1) The Director of the Office of Financial 1731
Regulation of the Department of Financial Services and the chief 1732
executive officer of the Florida Health Plan shall regularly 1733
update the Legislature on the status of the planning, 1734
implementation, and financing of this act. 1735
(2) The Florida Health Plan must be operational by July 1, 1736
2028. 1737
(3) On and after the day the Florida Health Plan becomes 1738
operational, a health insurance policy, a health maintenance 1739
contract, a continuing care contract, a prepaid health clinic 1740
contract, or any policy or contract that offers coverage for 1741
services covered by the Florida Health Plan may not be sold in 1742
this state. 1743
(4) The Office of the Inspector General of the Agency for 1744
Health Care Administration shall prepare an analysis of this 1745
state's capital expenditure needs for the purpose of assisting 1746
the Florida Health Board in adopting the statewide capital 1747
budget for the year following implementation. The Office of the 1748
Inspector General shall submit this analysis to the board. 1749
(5) By July 1, 2027, the Department of Commerce shall 1750

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provide to the Florida Health Board, the Governor, and the 1751
chairs and ranking members of the legislative committees with 1752
jurisdiction over health, human services, and commerce a report 1753
determining the appropriations and legislation necessary to 1754
assist all affected individuals and communities through the 1755
transition to the Florida Health Plan. 1756
Section 21. This act shall take effect July 1, 2026, but 1757
only if HB 1491 or similar legislation is adopted in the same 1758
legislative session or an extension thereof and becomes a law. 1759