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Florida Senate
-
2026
SB 740
By
Senator Osgood
32-00791-26 2026740__
1 A bill to be entitled
2 An act relating to comprehensive health care for
3 residents; creating part IV of ch. 641, F.S., entitled
4 the “Healthy Florida Act”; creating s. 641.71, F.S.;
5 providing a short title; creating s. 641.72, F.S.;
6 providing the purpose of the Florida Health Plan;
7 creating s. 641.73, F.S.; defining terms; creating s.
8 641.74, F.S.;
providing for eligibility for and
9 coverage of the plan; authorizing the Florida Health
10 Board to establish certain financial arrangements with
11 other states and foreign countries under certain
12 circumstances; providing reimbursement rates;
13 prohibiting healthcare providers from billing the
14 patient for covered services under certain
15 circumstances; providing duties of the board relating
16 to plan enrollment; providing enrollment requirements;
17 providing that certain data collected through plan
18 applications and enrollment is private data;
19 authorizing such data to be released to certain
20 persons for specified purposes; creating s. 641.755,
21 F.S.; authorizing plan enrollees to choose to receive
22 services from certain health care providers; providing
23 covered health care benefits; authorizing the board to
24 expand health care benefits under certain
25 circumstances; specifying health care services that
26 are not covered by the plan; requiring enrollees to
27 have primary care providers and access to care
28 coordination; authorizing enrollees to see health care
29 specialists without referral; authorizing the board to
30 establish a computerized registry; authorizing the
31 plan employees to assist enrollees in choosing primary
32 care providers; prohibiting cost-sharing requirements
33 from being imposed on enrollees; creating s. 641.77,
34 F.S.; requiring the board to secure repeals and
35 waivers of certain provisions of federal law;
36 requiring the Department of Health and the Agency for
37 Health Care Administration to provide assistance to
38 the board; requiring the board to adopt rules under
39 certain circumstances; providing that the plan’s
40 responsibility for providing health care is secondary
41 to existing Federal Government programs under certain
42 circumstances; creating s. 641.78, F.S.; defining the
43 term “collateral source”; requiring the plan to
44 collect health care costs from collateral sources
45 under certain circumstances; requiring the board to
46 negotiate waivers, seek federal legislation, and make
47 arrangements to incorporate collateral sources into
48 the plan; requiring plan enrollees to notify health
49 care providers of collateral sources and health care
50 providers to forward such information to the board;
51 authorizing the board to take appropriate actions to
52 recover reimbursement from collateral sources;
53 requiring collateral sources to pay for health care
54 services under certain circumstances; providing
55 specified authority and rights to the board relating
56 to collateral sources; creating s. 641.791, F.S.;
57 providing that defaults, underpayments, and late
58 payments of certain obligations result in certain
59 remedies and penalties; prohibiting eligibility for
60 health care benefits from being impaired by such
61 defaults, underpayments, and late payments; creating
62 s. 641.792, F.S.; providing for eligible health care
63 providers to participate in the plan; requiring
64 participating providers to comply with certain federal
65 laws and regulations; providing that patient care may
66 not be affected by fee schedules and financial
67 incentives; providing requirements for the payment
68 system for noninstitutional providers; providing
69 requirements for the annual budgets for institutional
70 providers; requiring the board to develop a capital
71 investment plan; prohibiting noninstitutional and
72 institutional providers that accept payments from the
73 plan from billing patients; providing requirements for
74 capital expenditures by institutional and
75 noninstitutional providers which exceed a specified
76 amount; requiring the board to establish payment
77 criteria and payment methods for care coordination;
78 creating s. 641.793, F.S.; establishing the Florida
79 Health Board by a specified date; providing the
80 purpose of the board; providing for board membership,
81 terms, and compensation; providing duties of the
82 board; providing reporting requirements; creating s.
83 641.794, F.S.; requiring the Secretary of Health Care
84 Administration to designate health planning regions by
85 a specified date; providing considerations for such
86 designations; requiring health planning regions to be
87 administered by a regional health planning board;
88 providing requirements for regional planning boards;
89 providing board membership, terms, compensation, and
90 first meetings of regional planning boards with the
91 Florida Health Board; providing duties of the regional
92 planning boards; creating s. 641.795, F.S.; creating
93 the Office of Health Quality and Planning; providing
94 the purpose and duties of the office; authorizing the
95 Florida Health Board to convene advisory panels for
96 certain purposes; creating s. 641.796, F.S.; providing
97 applicability of the Code of Ethics for Public
98 Officers and Employees; providing for disciplinary
99 actions for failure to comply with the code of ethics;
100 prohibiting certain persons from engaging in specified
101 acts or from being employed by specified entities;
102 creating the Conflict-of-Interest Committee; providing
103 the duties of the committee; creating s. 641.797,
104 F.S.; creating the Ombudsman Office for Patient
105 Advocacy; providing the purpose of the office;
106 providing for appointment and qualifications of the
107 ombudsman; providing the duties and authority of the
108 ombudsman; providing that data collected on plan
109 enrollees in their complaints to the ombudsman is
110 private data; authorizing such data to be released to
111 certain persons and to the board for specified
112 purposes; providing requirements for the office
113 budget; requiring the ombudsman to establish specified
114 offices; creating s. 641.798, F.S.; creating the
115 position of auditor for the plan; providing the
116 purpose, appointment, and duties of the auditor;
117 creating s. 641.799, F.S.; providing that the plan
118 policies and procedures are exempt from the
119 Administrative Procedure Act; providing procedures and
120 requirements for adoption of certain rules on plan
121 policies and procedures; requiring specified persons
122 to regularly update the Legislature on certain
123 information; providing a timeline for the operation of
124 the plan; prohibiting certain health insurance
125 policies and contracts from being sold in this state
126 on and after a specified date; requiring an analysis
127 of specified capital expenditure needs; providing
128 reporting requirements; providing an effective date.
129
130 Be It Enacted by the Legislature of the State of Florida:
131
132 Section 1.
Part IV of chapter 641, Florida Statutes,
133
consisting of ss. 641.71-641.799, Florida Statutes, is created
134
and entitled the “Healthy Florida Act.”
135 Section 2. Section 641.71, Florida Statutes, is created to
136 read:
137
641.71
Short title.—This part may be cited as the “Florida
138
Health Plan.”
139 Section 3. Section 641.72, Florida Statutes, is created to
140 read:
141
641.72
Purpose.—The purpose of the Florida Health Plan is
142
to keep residents of this state healthy and to provide the best
143
quality of health care by:
144
(1)
Ensuring that all residents of this state, regardless
145
of immigration status, have access to health care.
146
(2)
Covering all necessary care, including dental; vision;
147
hearing; mental health; reproductive care, including abortion
148
services and prenatal and postpartum care; gender-affirming
149
health care, including medication and treatment; substance use
150
disorder treatment; prescription drugs; durable medical
151
equipment and supplies; and long-term care and home care,
152
including long-term services and supports in home- and
153
community-based settings.
154
(3)
Allowing patients to choose their health care
155
providers.
156
(4)
Reducing costs by negotiating fair prices and cutting
157
administrative bureaucracy, through measures such as a global
158
budget approach to institutional providers, rather than by
159
restricting or denying care.
160
(5)
Being affordable to all patients through financing
161
based on a patient’s ability to pay and the elimination of
162
premiums, copayments, deductibles, and out-of-pocket expenses at
163
the point of service.
164
(6)
Focusing on preventive care and early intervention to
165
improve health.
166
(7)
Ensuring that there are enough health care providers to
167
guarantee timely access to care.
168
(8)
Continuing this state’s leadership in medical
169
education, research, and technology.
170
(9)
Providing adequate and timely payments to health care
171
providers.
172
(10)
Using a simple funding and payment system.
173
(11)
Providing a just transition for a displaced workforce
174
affected by changes.
175 Section 4. Section 641.73, Florida Statutes, is created to
176 read:
177
641.73
Definitions.—As used in this part, the term:
178
(1)
“Board” means the Florida Health Board established in
179
s. 641.793.
180
(2)
“Institutional provider” means an inpatient hospital,
181
nursing facility, rehabilitation facility, or any other health
182
care facility that provides overnight care.
183
(3)
“Medically necessary” means comprehensive services or
184
supplies needed to promote health and to prevent, diagnose, or
185
treat a particular patient’s medical condition. The
186
comprehensive services and supplies must meet accepted standards
187
of medical practice within a health care provider’s professional
188
peer group.
189
(4)
“Noninstitutional provider” means an individual
190
provider, group practice, clinic, outpatient surgical center,
191
imaging center, or any other health care facility that does not
192
provide overnight care.
193
(5)
“Plan” means the Florida Health Plan.
194
(6)
“Resident of this state” means an individual who has
195
had a principal place of domicile in this state for more than 6
196
consecutive months, who has registered to vote in this state,
197
who has made a statement of domicile pursuant to s. 222.17, or
198
who has filed for homestead tax exemption on property in this
199
state.
200 Section 5. Section 641.74, Florida Statutes, is created to
201 read:
202
641.74
Eligibility for and enrollment in the Florida Health
203
Plan.—
204
(1)
ELIGIBILITY.—
205
(a)
All residents of this state, regardless of immigration
206
status, are eligible for the Florida Health Plan.
207
(b)
Coverage for emergency care for a resident of this
208
state which is obtained out of state must be at prevailing local
209
rates where the care is provided. Coverage for nonemergency care
210
obtained out of state must be according to rates and conditions
211
established by the Florida Health Board. The board may require
212
that a resident of this state be transported back to this state
213
when prolonged treatment of an emergency condition is necessary
214
and when such transport will not adversely affect the patient’s
215
care or condition.
216
(c)
A nonresident visiting this state shall be billed by
217
the board for all services received under the plan. The board
218
may enter into intergovernmental arrangements or contracts with
219
other states and foreign countries to provide reciprocal
220
coverage for temporary visitors.
221
(d)
The board shall extend eligibility to nonresidents
222
employed in this state under a premium schedule set by the
223
board.
224
(e)
For a business outside of this state which employs
225
residents of this state, the board shall apply for a federal
226
waiver to collect the employer contribution mandated by federal
227
law.
228
(f)
A retiree who is covered under the plan and who elects
229
to reside outside of this state is eligible for benefits under
230
the terms and conditions of the retiree’s employer-employee
231
contract.
232
(g)
The board may establish financial arrangements with
233
other states and foreign countries in order to facilitate
234
meeting the terms of the contracts described in paragraph (f).
235
Payments for care provided by non-Florida health care providers
236
to retirees who are covered under the plan shall be reimbursed
237
at rates established by the board. Health care providers who
238
accept any payment from the plan for a covered service may not
239
bill the patient for the covered service.
240
(h)1.
A person is presumed eligible for coverage under the
241
plan, and a health care provider shall provide health care
242
services as if the person is eligible for coverage under the
243
plan, if the person:
244
a.
Is a minor;
245
b.
Arrives at a health care facility unconscious, comatose,
246
or otherwise unable to document eligibility or to act on the
247
person’s own behalf because of the person’s physical or mental
248
condition; or
249
c.
Is involuntarily committed to an acute psychiatric
250
facility or to a hospital with psychiatric beds which provides
251
for involuntary commitment.
252
2.
All health care facilities subject to state and federal
253
provisions governing emergency medical treatment must comply
254
with subparagraph 1.
255
(2)
ENROLLMENT.—
256
(a)
The board shall establish a procedure to enroll
257
residents of this state and provide each with identification
258
that may be used by health care providers to confirm eligibility
259
for services. The application for enrollment may not be more
260
than two pages.
261
(b)
Data collected from a person through application for
262
and enrollment in the plan is private data; however, the data
263
may be released to:
264
1.
A health care provider for purposes of confirming
265
enrollment and processing payments for benefits; and
266
2.
The ombudsman of the Ombudsman Office for Patient
267
Advocacy and the auditor for the Florida Health Plan for
268
purposes of performing their duties under ss. 641.797 and
269
641.798, respectively.
270 Section 6. Section 641.755, Florida Statutes, is created to
271 read:
272
641.755
Benefits.—
273
(1)
A person covered under the Florida Health Plan may
274
choose to receive services from any qualified, licensed health
275
care provider that participates in the plan.
276
(2)
Except for the exclusions provided in subsection (4),
277
covered health care benefits under the plan include all
278
prescribed medically necessary care
, including, but not limited
279
to
:
280
(a)
Inpatient and outpatient health care facility services.
281
(b)
Inpatient and outpatient licensed health care provider
282
services.
283
(c)
Diagnostic imaging, laboratory services, and other
284
diagnostic and evaluative services.
285
(d)
Durable medical equipment, appliances, and assistive
286
technology, including, but not limited to, prescribed
287
prosthetics, eye care, and hearing aids and their repair,
288
technical support, and customization required for individual
289
use.
290
(e)
Inpatient and outpatient rehabilitative care.
291
(f)
Emergency care services.
292
(g)
Necessary transportation for health care services:
293
1.
As covered under Medicaid or Medicare; or
294
2.
For persons with disabilities, older persons with
295
functional limitations, and low-income persons.
296
(h)
Child and adult immunizations and preventive care.
297
(i)
Health and wellness education for chronic or
298
preventative care as provided by licensed health care providers.
299
(j)
Reproductive health care, including abortion services,
300
contraceptives, and prenatal and postpartum care.
301
(k)
Childbirth and maternity care, including doula services
302
and care in freestanding childbirth centers.
303
(l)
Gender-affirming health care, including medication and
304
treatment.
305
(m)
Holistic licensed health care services such as
306
chiropractic, acupressure, acupuncture, massage, and nutritional
307
services.
308
(n)
Mental health services, including substance use
309
disorder treatment, services in substance use disorder treatment
310
facilities, and mental health care provided by licensed or
311
certified mental health providers such as licensed
312
psychologists, licensed mental health counselors, licensed
313
professional counselors, licensed clinical social workers,
314
certified master social workers, rehabilitation support service
315
providers, and any providers that the board deems eligible.
316
(o)
Dental care, including diagnostics and restoration and
317
durable equipment such as braces and mouthguards.
318
(p)
Vision care.
319
(q)
Hearing care.
320
(r)
Prescription drugs.
321
(s)
Podiatric care.
322
(t)
Therapies that are shown by the National Center for
323
Complementary and Integrative Health to be safe and effective.
324
(u)
Blood and blood products.
325
(v)
Dialysis.
326
(w)
Licensed qualified adult day care.
327
(x)
Rehabilitative and habilitative services.
328
(y)
Ancillary health care or social services previously
329
covered by this state’s qualified public health programs.
330
(z)
Case management and care coordination.
331
(aa)
Language interpretation and translation for health
332
care services, including sign language and braille or other
333
services needed for persons with communication barriers.
334
(bb)
Services provided by qualified community health
335
workers.
336
(cc)
Health care and long-term supportive services,
337
including in a home- or community-based setting, assisted living
338
facility, and nursing home, with home health care providers,
339
home health aides, and palliative and hospice care.
340
(dd)
Any item or service described in this subsection which
341
is furnished using telehealth, to the extent practicable.
342
(3)
The Florida Health Board may expand health care
343
benefits beyond the minimum benefits described in subsection (2)
344
if such expansion meets the intent of this part and when there
345
are sufficient funds to cover the expansion.
346
(4)
The following health care services are excluded from
347
coverage by the plan:
348
(a)
Treatments and procedures primarily for cosmetic
349
purposes, unless required to correct a congenital defect or to
350
restore or correct a part of the body that has been altered as a
351
result of an injury, a disease, or a surgery or unless
352
determined to be medically necessary by a qualified, licensed
353
health care provider in the plan.
354
(b)
Services of a health care provider or facility that is
355
not licensed, certified, or accredited by this state. The
356
licensure, certification, or accreditation requirements do not
357
apply to health care providers or facilities that provide
358
services to residents of this state who require medical
359
attention while traveling out of state.
360
(5)(a)
All plan enrollees must have a primary care provider
361
and must have access to care coordination.
362
(b)
A plan enrollee does not need a referral to see a
363
health care specialist.
364
(c)
The board may establish a computerized registry to
365
assist patients in identifying appropriate providers, and the
366
plan employees may assist an enrollee with choosing a primary
367
care provider if the enrollee so chooses.
368
(6)
The plan may not impose a deductible, copayment,
369
coinsurance, or any other cost-sharing requirement on an
370
enrollee with respect to a covered benefit.
371 Section 7. Section 641.77, Florida Statutes, is created to
372 read:
373
641.77
Federal preemption.—
374
(1)
The board shall secure a repeal or a waiver of any
375
provision of federal law that preempts any provision of this
376
part. The Department of Health and the Agency for Health Care
377
Administration shall provide all necessary assistance to the
378
board to secure any repeal or waiver.
379
(2)(a)
The board shall, under the section 1332 waivers of
380
the Patient Protection and Affordable Care Act, request to
381
repeal or waive any of the following provisions to the extent
382
necessary to implement this part:
383
1.
Title 42 of the United States Code, ss. 18021-18024.
384
2.
Title 42 of the United States Code, ss. 18031-18033.
385
3.
Title 42 of the United States Code, s. 18071.
386
4.
Section 5000A of the Internal Revenue Code of 1986, as
387
amended.
388
(b)
If a repeal or a waiver of a federal law or regulation
389
cannot be secured, the board shall adopt rules, or seek
390
conforming state legislation, consistent with federal law, in an
391
effort to best fulfill the purposes of this part.
392
(c)
The plan’s responsibility for providing health care is
393
secondary to existing Federal Government programs for health
394
care services to the extent that funding for these programs is
395
not transferred or that the transfer is delayed beyond the date
396
on which initial benefits are provided under the plan.
397 Section 8. Section 641.78, Florida Statutes, is created to
398 read:
399
641.78
Subrogation.—
400
(1)(a)
As used in this section, the term “collateral
401
source” includes all of the following:
402
1.
A health insurance policy, health maintenance contract,
403
continuing care contract, and prepaid health clinic contract,
404
and the medical components of motor vehicle insurance,
405
homeowner’s insurance, and other forms of insurance.
406
2.
The medical components of worker’s compensation.
407
3.
A pension plan and retiree health care benefits.
408
4.
An employer plan.
409
5.
An employee benefit contract.
410
6.
A government benefit program.
411
7.
A judgment for damages for personal injury.
412
8.
The state of last domicile for individuals moving to
413
this state for medical care who have extraordinary medical
414
needs.
415
9.
Any third party who is or may be liable to an individual
416
for health care services or costs.
417
(b)
The term does not include:
418
1.
A contract or plan that is subject to federal
419
preemption.
420
2.
Any governmental unit, agency, or service to the extent
421
that subrogation is prohibited by law. An entity described in
422
paragraph (a) is not excluded from the obligations imposed by
423
this section by virtue of a contract or relationship with a
424
governmental unit, agency, or service.
425
(2)
When other payers for health care have been terminated,
426
the plan shall collect health care costs from a collateral
427
source if health care services provided to a patient are, or may
428
be, covered services under the collateral source available to
429
the patient, or if the patient has a right of action for
430
compensation permitted under law.
431
(3)
The board shall negotiate waivers, seek federal
432
legislation, or make other arrangements to incorporate
433
collateral sources into the plan.
434
(4)
If a person who receives health care services under the
435
plan is entitled to coverage, reimbursement, indemnity, or other
436
compensation from a collateral source, the person must notify
437
the health care provider and provide information identifying the
438
collateral source, the nature and extent of coverage or
439
entitlement, and other relevant information. The health care
440
provider shall forward this information to the board. The person
441
entitled to coverage, reimbursement, indemnity, or other
442
compensation from a collateral source must provide additional
443
information as requested by the board.
444
(a)
The plan shall seek reimbursement from the collateral
445
source for services provided to the person and may take
446
appropriate action, including legal proceedings, to recover the
447
reimbursement. Upon demand, the collateral source must pay the
448
sum that it would have paid or spent on behalf of the person for
449
the health care services provided by the plan.
450
(b)
In addition to any other right to recovery provided in
451
this section, the board has the same right to recover the
452
reasonable value of health care benefits from the collateral
453
source.
454
(c)
If the collateral source is exempt from subrogation or
455
the obligation to reimburse the plan, the board may require that
456
the person who is entitled to health care services from the
457
collateral source first seek those services from the collateral
458
source before seeking the services from the plan.
459
(5)
To the extent permitted by federal law, the board has
460
the same right of subrogation over contractual retiree health
461
care benefits provided by employers as other contracts, allowing
462
the plan to recover the cost of health care services provided to
463
a person covered by the retiree health care benefits, unless
464
arrangements are made to transfer the revenues of the health
465
care benefits directly to the plan.
466 Section 9. Section 641.791, Florida Statutes, is created to
467 read:
468
641.791
Defaults, underpayments, and late payments.—
469
(1)
Defaults, underpayments, or late payments of any
470
premium or other obligation imposed by this part shall result in
471
the remedies and penalties provided by law, except as provided
472
in this part.
473
(2)
Eligibility for health care benefits may not be
474
impaired by any default, underpayment, or late payment of any
475
premium or other obligation imposed by this part.
476 Section 10. Section 641.792, Florida Statutes, is created
477 to read:
478
641.792
Provider payments.—
479
(1)
All health care providers licensed to practice in this
480
state may participate in the plan. The board may determine the
481
eligibility of any other health care providers to participate in
482
the plan.
483
(a)
A participating health care provider shall comply with
484
all federal laws and regulations governing referral fees and fee
485
splitting, including, but not limited to, 42 U.S.C. ss. 1320a-7b
486
and 1395nn, whether reimbursed by federal funds or not.
487
(b)
A fee schedule or financial incentive may not adversely
488
affect the care a patient receives or the care a health provider
489
recommends.
490
(2)
The board shall establish and oversee a fair and
491
efficient payment system for noninstitutional providers.
492
(a)
The board shall pay noninstitutional providers based on
493
rates negotiated with noninstitutional providers. The rates must
494
take into account the need to address the shortage of
495
noninstitutional providers.
496
(b)
Noninstitutional providers that accept any payment from
497
the plan for a covered health care service may not bill the
498
patient for the covered health care service.
499
(c)
Noninstitutional providers shall be paid within 30
500
business days for claims filed following procedures established
501
by the board.
502
(3)
The board shall set an annual budget for each
503
institutional provider which consists of an operating and a
504
capital budget to cover the institutional provider’s anticipated
505
health care services for the following year based on past
506
performance and projected changes in prices and health care
507
service levels.
508
(a)
The annual budget for each individual institutional
509
provider must be set separately. The board may not set a joint
510
budget for a group of more than one institutional provider nor
511
for a parent corporation that owns or operates one or more
512
institutional providers.
513
(b)
Institutional providers that accept any payment from
514
the plan for a covered health care service may not bill the
515
patient for the covered health care service.
516
(4)(a)
The board shall periodically develop a capital
517
investment plan that will serve as a guide in determining the
518
annual budgets of institutional providers and in deciding
519
whether to approve applications for approval of capital
520
expenditures by noninstitutional providers.
521
(b)
Institutional and noninstitutional providers that
522
propose to make capital purchases in excess of $500,000 must
523
obtain board approval. The board may alter the threshold
524
expenditure level that triggers the requirement to submit
525
information on capital expenditures. Institutional providers
526
must propose these expenditures and submit the required
527
information as part of the annual budget they submit to the
528
board. Noninstitutional providers must apply to the board for
529
approval of these expenditures. The board must respond to
530
capital expenditure applications in a timely manner.
531
(5)
The board shall establish payment criteria and payment
532
methods for care coordination for patients, especially those
533
with chronic illness and complex medical needs.
534 Section 11. Section 641.793, Florida Statutes, is created
535 to read:
536
641.793
Florida Health Board.—
537
(1)
By December 1, 2026, the Florida Health Board shall be
538
established to promote the delivery of high-quality, coordinated
539
health care services that enhance health; prevent illness,
540
disease, and disability; slow the progression of chronic
541
diseases; and improve personal health management. The board
542
shall administer the Florida Health Plan. The board shall
543
oversee the Office of Health Quality and Planning established in
544
s. 641.795.
545
(2)(a)
The board shall consist of at least 15 members,
546
including the representatives selected by the regional planning
547
boards established in s. 641.794. These representatives shall
548
appoint the following additional members to serve on the board:
549
1.
One patient member and one employer member.
550
2.
Seven representatives of labor organizations that
551
represent health care workers or social workers.
552
3.
Five health care provider members, including one
553
physician, one registered nurse, one mental health provider, one
554
dentist, and one health care facility director.
555
(b)
Each member shall take the oath of office to uphold the
556
Constitution of the United States and the Constitution of the
557
State of Florida and to operate the plan in the public interest
558
by upholding the underlying principles of this part.
559
(c)
Board members shall serve 4 years; however, for the
560
purpose of providing staggered terms, of the initial
561
appointments, those members appointed by the representatives of
562
regional planning boards shall serve 2-year terms.
563
(d)
Board members shall set the board’s compensation, not
564
to exceed the compensation of the Florida Public Service
565
Commission members. The board shall select the chair from among
566
its membership.
567
(e)1.
A board member may be removed by a two-thirds vote of
568
the members voting on removal. After receiving notice and
569
hearing, a member may be removed for malfeasance or nonfeasance
570
in performance of the member’s duties.
571
2.
Conviction of any criminal behavior, regardless of how
572
much time has lapsed, is grounds for immediate removal.
573
(3)
The board shall:
574
(a)
Ensure that all of the requirements of the plan are
575
met.
576
(b)
Hire a chief executive officer for the plan, who must
577
take the oath described in paragraph (2)(b).
578
(c)
Hire a director for the Office of Health Quality and
579
Planning, who must take the oath described in paragraph (2)(b).
580
(d)
Provide technical assistance to the regional planning
581
boards established in s. 641.794.
582
(e)
Conduct investigations and inquiries and require the
583
submission of information, documents, and records that the board
584
considers necessary to carry out the purposes of this part.
585
(f)
Establish a process for the board to receive concerns,
586
opinions, ideas, and recommendations of the public regarding all
587
aspects of the plan and the means of addressing those concerns.
588
(g)
Conduct activities the board considers necessary to
589
carry out the purposes of this part.
590
(h)
Collaborate with the Department of Health and with the
591
Agency for Health Care Administration, which licenses health
592
care facilities, to ensure that facility performance is
593
monitored and deficient practices are recognized and corrected
594
in a timely manner.
595
(i)
Establish conflict-of-interest standards that prohibit
596
health care providers from receiving financial benefit from
597
their medical decisions outside of board reimbursement,
598
including any financial benefit for referring a patient for a
599
service, product, or health care provider or for prescribing,
600
ordering, or recommending a drug, product, or service.
601
(j)
Establish conflict-of-interest standards related to
602
pharmaceuticals and medical equipment, supplies, and devices,
603
and their marketing to a health care provider, so that the
604
health care provider does not receive any incentive to
605
prescribe, administer, or use a product or service.
606
(k)
Require that all electronic health records used by
607
health care providers be fully interoperable with the open
608
source electronic health records system used by the United
609
States Department of Veterans Affairs.
610
(l)
Provide financial help and assistance in retraining and
611
job placement to workers in this state who may be displaced
612
because of the administrative efficiencies of the plan.
613
(m)
Ensure that assistance is provided to all workers and
614
communities that may be affected by provisions in this part.
615
(n)
Work with the Department of Commerce to ensure that
616
funding and program services are promptly and efficiently
617
provided to all affected workers. The Department of Commerce
618
shall monitor and report on a regular basis on the status of
619
displaced workers.
620
(o)
Adopt rules, policies, and procedures as necessary to
621
carry out the duties assigned under this part.
622
(4)
Before submitting a waiver application under section
623
1332 of the Patient Protection and Affordable Care Act, the
624
board must do all of the following, as required by federal law:
625
(a)
Conduct, or contract for, any actuarial analyses and
626
actuarial certifications necessary to support the board’s
627
estimates that the waiver will comply with the comprehensive
628
coverage, affordability, and scope of coverage requirements in
629
federal law.
630
(b)
Conduct or contract for any necessary economic analyses
631
needed to support the board’s estimates that the waiver will
632
comply with the comprehensive coverage, affordability, scope of
633
coverage, and federal deficit requirements in federal law. These
634
analyses must include:
635
1.
A detailed 10-year budget plan.
636
2.
A detailed analysis regarding the estimated impact of
637
the waiver on health insurance coverage in this state.
638
(c)
Establish a detailed draft implementation timeline for
639
the waiver plan.
640
(d)
Establish quarterly, annual, and cumulative targets for
641
the comprehensive coverage, affordability, scope of coverage,
642
and federal deficit requirements in federal law.
643
(5)
The board has the following financial duties:
644
(a)
To approve statewide and regional budgets.
645
(b)
To negotiate and establish payment rates for health
646
care providers through their professional associations.
647
(c)
To monitor compliance with all budgets and payment
648
rates and take action to achieve compliance to the extent
649
authorized by law.
650
(d)
To pay claims for medical products or services as
651
negotiated and, if deemed necessary, issue requests for
652
proposals from nonprofit business corporations in this state for
653
a contract to process claims.
654
(e)
To seek federal approval to bill another state for
655
health care coverage provided to a patient from out of state who
656
comes to this state for long-term care or other costly treatment
657
when the patient’s home state fails to provide such coverage,
658
unless a reciprocal agreement with the patient’s home state to
659
provide similar coverage to residents of this state relocating
660
to that state can be negotiated.
661
(f)
To implement fraud prevention measures necessary to
662
protect the operation of the plan.
663
(g)
To ensure appropriate cost control by:
664
1.
Instituting aggressive public health measures, early
665
intervention and preventive care, health and wellness education,
666
and promotion of personal health improvement.
667
2.
Making changes in the delivery of health care services
668
and administration that improve efficiency and care quality.
669
3.
Minimizing administrative costs.
670
4.
Ensuring that the delivery system does not contain
671
excess capacity.
672
5.
Negotiating the lowest possible prices for prescription
673
drugs, medical equipment, and health care services.
674
(6)
The board has the following management duties:
675
(a)
To develop and implement enrollment procedures for the
676
plan.
677
(b)
To implement and review eligibility standards for the
678
plan.
679
(c)
To arrange for health care services to be provided at
680
convenient locations to serve communities in need in the same
681
manner as federally qualified health centers, including ensuring
682
the availability of school nurses so that all students have
683
access to health care, immunizations, and preventive care at
684
public schools, and encouraging health care providers to provide
685
services at easily accessible locations.
686
(d)
To make recommendations, when needed, to the
687
Legislature about changes in the geographic boundaries of the
688
health planning regions.
689
(e)
To establish an electronic claim and payment system for
690
the plan.
691
(f)
To monitor the operation of the plan through consumer
692
surveys and regular data collection and evaluation activities,
693
including evaluations of the adequacy and quality of services
694
provided under the plan, the need for changes in the benefit
695
package, the cost of each type of service, and the effectiveness
696
of cost control measures under the plan.
697
(g)
To disseminate information and establish a health care
698
website to provide information to the public about the plan,
699
including health care providers and facilities, and state and
700
regional planning board meetings and activities.
701
(h)
To collaborate with public health agencies, schools,
702
and community clinics.
703
(i)
To ensure that plan policies and health care providers,
704
including public health care providers, support all residents of
705
this state in achieving and maintaining maximum physical and
706
mental health.
707
(7)
The board, in conjunction with the office and
708
administrative staff of the plan’s chief executive officer, has
709
the following policy duties:
710
(a)
To develop and implement cost control and quality
711
assurance procedures.
712
(b)
To ensure strong public health services, including
713
education and community prevention and clinical services.
714
(c)
To
ensure a continuum of coordinated high-quality
715
primary to tertiary care to all residents of this state.
716
(d)
To implement policies to ensure that all residents of
717
this state receive culturally and linguistically competent care.
718
(8)
The board shall determine the feasibility of self
719
insuring health care providers for malpractice and shall
720
establish a self-insurance system and create a special fund for
721
payment of losses incurred if the board determines self-insuring
722
health care providers would reduce costs.
723
(9)
By July 1 of each year, the board shall report to the
724
President of the Senate, the Speaker of the House of
725
Representatives, and ranking members of the committees having
726
cognizance over health care issues on:
727
(a)
The performance of the plan.
728
(b)
The fiscal condition and need for payment adjustment.
729
(c)
Any needed changes in geographic boundaries of the
730
health planning regions.
731
(d)
Any recommendations for statutory changes.
732
(e)
Receipts of revenues from all sources.
733
(f)
Whether current year goals and priorities are met.
734
(g)
Future goals and priorities.
735
(h)
Major new technology and prescription drugs.
736
(i)
Other circumstances that may affect the cost or quality
737
of health care.
738 Section 12. Section 641.794, Florida Statutes, is created
739 to read:
740
641.794
Health planning regions.—
741
(1)
By August 1, 2026, the Secretary of Health Care
742
Administration shall designate health planning regions within
743
this state which are composed of geographically contiguous areas
744
grouped on the basis of the following considerations:
745
(a)
Patterns of use of health care services.
746
(b)
Health care resources, including workforce resources.
747
(c)
Health care needs of the population, including public
748
health needs.
749
(d)
Geography.
750
(e)
Population and demographic characteristics.
751
(f)
Other considerations the board deems appropriate.
752
(2)
Each health planning region is administered by a
753
regional planning board. A minimum of eight regional planning
754
boards shall be created, and all regional planning boards shall
755
be created by October 1, 2026.
756
(a)
Each regional planning board shall consist of:
757
1.
One county commissioner per county, selected by the
758
county commission for each health planning region consisting of
759
at least five counties; or
760
2.
Three county commissioners per county, selected by the
761
county commission for each health planning region consisting of
762
four or fewer counties
.
763
(b)
A county commission may designate a representative to
764
act as a member of the regional planning board in the member’s
765
absence.
766
(c)
Each regional planning board shall select the chair
767
from among its membership.
768
(d)
Regional planning board members shall serve 4-year
769
terms; however, for the purpose of providing staggered terms, of
770
the initial appointments, at least half of the board members
771
shall be appointed to 2-year terms. Board members may receive
772
per diem for meetings.
773
(e)
The Secretary of Health Care Administration, or his or
774
her designee, shall convene the first meeting of each regional
775
planning board with the Florida Health Board within 30 days
776
after the regional planning board is established.
777
(3)
A regional planning board has the following duties:
778
(a)
To recommend health standards, goals, priorities, and
779
guidelines for the health planning region.
780
(b)
To prepare an operating and capital budget for the
781
health planning region to recommend to the Florida Health Board.
782
(c)
To collaborate with local public health care agencies
783
to:
784
1.
Educate consumers and health care providers on public
785
health programs, goals, and the means of reaching those goals.
786
2.
Implement public health and wellness initiatives.
787
(d)
To hire a regional health planning director.
788
(e)
To ensure that all parts of the health planning region
789
have access to a 24-hour nurse hotline and to 24-hour urgent
790
care clinics.
791 Section 13. Section 641.795, Florida Statutes, is created
792 to read:
793
641.795
Office of Health Quality and Planning.—The Florida
794
Health Board shall establish the Office of Health Quality and
795
Planning to assess the quality, access, and funding adequacy of
796
the Florida Health Plan. The Office of Health Quality and
797
Planning shall:
798
(1)
Make annual recommendations to the board on the overall
799
direction of the plan on the following subjects:
800
(a)
Overall effectiveness of the plan in addressing public
801
health and wellness.
802
(b)
Access to health care.
803
(c)
Quality improvement.
804
(d)
Efficiency of administration.
805
(e)
Adequacy of the budget and funding.
806
(f)
Appropriateness of payments to health care providers.
807
(g)
Capital expenditure needs.
808
(h)
Long-term health care.
809
(i)
Mental health and substance abuse services.
810
(j)
Staffing levels and working conditions in health care
811
facilities.
812
(k)
Identification of the number and mix of health care
813
facilities and providers necessary to meet the needs of the
814
plan.
815
(l)
Care for chronically ill patients.
816
(m)
Health care provider training on promoting the use of
817
advance directives with patients to enable patients to obtain
818
the health care of their choice.
819
(n)
Research needs.
820
(o)
Integration of disease management programs into health
821
care delivery.
822
(2)
Analyze shortages in the health care workforce that is
823
required to meet the needs of the population and develop plans
824
to meet those needs in collaboration with regional planners and
825
educational institutions.
826
(3)
Analyze methods of paying health care providers and
827
make recommendations to improve the quality of health care
828
services and to control costs.
829
(4)
Assist in coordination of the plan and public health
830
programs.
831
(5)
Assess and evaluate health care benefits by:
832
(a)
Considering health care benefit additions to the plan
833
and evaluating the additions based on evidence of clinical
834
efficacy.
835
(b)
Establishing a process and criteria by which health
836
care providers may request authorization to provide health care
837
services and treatments that are not included in the plan
838
benefit set, such as experimental health care treatments.
839
(c)
Evaluating proposals to increase the efficiency and
840
effectiveness of the health
care
delivery system and making
841
recommendations to the board based on the cost-effectiveness of
842
the proposals.
843
(d)
Identifying complementary and alternative health care
844
modalities that have been shown to be safe and effective.
845
(6)
The board may convene advisory panels as needed to
846
assess the quality, access, and funding adequacy of the plan.
847 Section 14. Section 641.796, Florida Statutes, is created
848 to read:
849
641.796
Ethics and conflicts of interest; Conflict of
850
Interest Committee.—
851
(1)
The Code of Ethics for Public Officers and Employees
852
under part III of chapter 112 applies to the employees and the
853
chief executive officer of the Florida Health Plan, the
854
employees and members of the Florida Health Board, the employees
855
and members of the regional planning boards and the regional
856
health planning directors, the employees and the director of the
857
Office of Health Quality and Planning, the employees and the
858
ombudsman of the Ombudsman Office for Patient Advocacy, and the
859
auditor for the Florida Health Plan. Failure to comply with the
860
code of ethics under part III of chapter 112 is grounds for
861
disciplinary action, which may include termination of employment
862
or removal from the board.
863
(2)
In order to avoid the appearance of political bias or
864
impropriety, the chief executive officer of the plan may not:
865
(a)
Engage in leadership of, or employment by, a political
866
party or political organization.
867
(b)
Publicly endorse a political candidate.
868
(c)
Contribute to a political candidate, political party,
869
or political organization.
870
(d)
Attempt to avoid compliance with this subsection by
871
making a contribution through a spouse or other family member.
872
(3)
In order to avoid a conflict of interest, a person
873
specified in subsection (1) may not be employed by a health care
874
provider or a pharmaceutical, health insurance, or medical
875
supply company while holding the position specified in
876
subsection (1), except for the five health care provider members
877
appointed to the Florida Health Board by the representatives of
878
regional planning boards under s. 641.793(2)(a)2. These five
879
members may be employed by a health care provider, but not by a
880
pharmaceutical, health insurance, or medical supply company
881
while serving on the board.
882
(4)
The board shall establish a Conflict-of-Interest
883
Committee to develop standards of practice for persons or
884
entities doing business with the plan, including, but not
885
limited to, board members, health care providers, and medical
886
suppliers.
887
(a)
The committee shall establish guidelines on the duty to
888
disclose to the committee the existence of any financial
889
interest and all material facts related to a financial interest.
890
(b)
The committee shall review all proposed transactions
891
and arrangements that involve the plan. In considering a
892
proposed transaction or arrangement, if the committee determines
893
a conflict of interest exists, the committee must investigate
894
alternatives to the proposed transaction or arrangement. After
895
exercising due diligence, the committee shall determine whether
896
the plan can obtain with reasonable efforts a more advantageous
897
transaction or arrangement with a person or entity which would
898
not give rise to a conflict of interest. If the committee
899
determines that a more advantageous transaction or arrangement
900
is not reasonably possible under the circumstances, the
901
committee shall make a recommendation to the board on whether
902
the transaction or arrangement is in the best interest of the
903
plan, and whether the transaction is fair and reasonable. The
904
committee shall provide to the board all material information
905
used to make the recommendation. After reviewing all relevant
906
information, the board shall decide whether to approve the
907
transaction or arrangement.
908 Section 15. Section 641.797, Florida Statutes, is created
909 to read:
910
641.797
Ombudsman Office for Patient Advocacy.—
911
(1)
The Ombudsman Office for Patient Advocacy is created to
912
represent the interests of consumers of health care and to help
913
residents of this state secure the health care services and
914
health care benefits to which they are entitled under this part.
915
The Ombudsman Office for Patient Advocacy shall also advocate on
916
behalf of enrollees of the Florida Health Plan.
917
(2)
The Ombudsman Office for Patient Advocacy shall be
918
headed by the ombudsman, who shall be appointed by the Secretary
919
of Health Care Administration. The ombudsman shall serve in the
920
unclassified service and may be removed only for just cause. The
921
ombudsman must be selected without regard to political
922
affiliation and must be knowledgeable about and have experience
923
in health care services and administration. A person may not
924
serve as ombudsman while holding another public office.
925
(a)
The ombudsman may gather information about decisions
926
and acts of the Florida Health Board and about any matters
927
related to the board, health care providers, and health care
928
programs.
929
(b)
The ombudsman shall:
930
1.
Ensure that patient advocacy services are available to
931
all residents of this state.
932
2.
Establish and maintain the grievance system according to
933
subsection (3).
934
3.
Receive, evaluate, and respond to consumer complaints
935
about the plan.
936
4.
Establish a process to receive recommendations from the
937
public about ways to improve the plan.
938
5.
Develop educational and informational guides that
939
describe consumer rights and responsibilities.
940
6.
Ensure that the guides described in subparagraph 5. are
941
widely available to consumers and available in health care
942
provider offices and facilities.
943
7.
Prepare an annual report about the consumer’s
944
perspective on the performance of the plan, including
945
recommendations for needed improvements.
946
(3)
The ombudsman shall establish a grievance system for
947
complaints. The system must provide a process that ensures
948
adequate consideration of plan enrollee grievances and
949
appropriate remedies.
950
(a)
The ombudsman may refer any complaint that does not
951
pertain to compliance with this part to the federal Centers for
952
Medicare and Medicaid Services or any other appropriate local,
953
state, and federal government entity for investigation and
954
resolution.
955
(b)
A health care provider or an employee of a health care
956
provider may join with, or otherwise assist, a complainant in
957
submitting a complaint to the ombudsman. A health care provider
958
or an employee of a health care provider who, in good faith,
959
joins with or assists a complainant in submitting a complaint is
960
subject to protections and remedies under this part or under
961
general law.
962
(c)
In reviewing a complaint, the ombudsman may require a
963
health care provider or the board to submit any information the
964
ombudsman deems necessary.
965
(d)1.
The ombudsman shall send a written notice of the
966
final disposition of the complaint and the reasons for the
967
decision to:
968
a.
The complainant;
969
b.
Any health care provider or employee of a health care
970
provider who joins with or assists the complainant in submitting
971
the complaint; and
972
c.
The board,
973
974
within 30 calendar days after receipt of the complaint, unless
975
the ombudsman determines that additional time is reasonably
976
necessary to fully and fairly evaluate the relevant grievance.
977
2.
The ombudsman’s order of corrective action is binding on
978
the plan. A decision of the ombudsman is subject to de novo
979
review by the district court.
980
(4)
Data collected on a plan enrollee in the enrollee’s
981
complaint to the ombudsman is private data; however, the data
982
may be released to a health care provider that is the subject of
983
the complaint or to the board for purposes of this section.
984
(5)
The budget for the Ombudsman Office for Patient
985
Advocacy shall be determined by the Legislature and shall be
986
independent from the board.
987
(6)
The ombudsman shall establish offices to provide
988
convenient access to residents of this state.
989 Section 16. Section 641.798, Florida Statutes, is created
990 to read:
991
641.798
Auditor for the Florida Health Plan.—
992
(1)
There is created in the Office of the Auditor General
993
the position of auditor for the Florida Health Plan to prevent
994
health care fraud and abuse of the plan. The auditor for the
995
Florida Health Plan shall be appointed by the Auditor General.
996
(2)
The auditor for the Florida Health Plan shall:
997
(a)
Investigate, audit, and review the financial and
998
business records of the plan.
999
(b)
Investigate, audit, and review the financial and
1000
business records of individuals, public and private agencies and
1001
institutions, and private corporations that provide services or
1002
products to the plan which are reimbursed by the plan.
1003
(c)
Investigate allegations of misconduct on the part of an
1004
employee or appointee of the Florida Health Board and on the
1005
part of any health care provider that is reimbursed by the plan
1006
and report any findings of misconduct to the Attorney General.
1007
(d)
Investigate fraud and abuse.
1008
(e)
Arrange for the collection and analysis of data needed
1009
to investigate inappropriate use of a product or service that is
1010
reimbursed by the plan.
1011
(f)
Annually report recommendations for improvements to the
1012
plan to the board.
1013 Section 17. Section 641.799, Florida Statutes, is created
1014 to read:
1015
641.799
Florida Health Plan policies and procedures;
1016
rulemaking.—
1017
(1)
The Florida Health Plan policies and procedures are
1018
exempt from the Administrative Procedure Act.
1019
(2)(a)
If the board determines that a rule should be
1020
adopted under this part to establish, modify, or revoke a policy
1021
or procedure, the board must publish in the state register the
1022
proposed rule and must afford interested persons a period of 30
1023
days after publication to submit written data or comments.
1024
(b)
On or before the last day of the 30-day period provided
1025
for the submission of written data or comments under paragraph
1026
(a), any interested person may file with the board written
1027
objections to the proposed rule, stating the grounds for
1028
objection and requesting a public hearing on those objections.
1029
Within 30 days after the last day for submitting written data or
1030
comments, the board shall publish in the state register a notice
1031
specifying the rule to which objections have been filed and a
1032
hearing requested and specifying a time and place for the
1033
hearing.
1034
(c)
Within 60 days after the expiration of the period
1035
provided for the submission of written data or comments, or
1036
within 60 days after the completion of any hearing, the board
1037
shall issue a rule adopting, modifying, or revoking a policy or
1038
procedure, or make a determination that a rule should not be
1039
adopted. The rule may contain a provision delaying its effective
1040
date for such period as the board determines necessary.
1041 Section 18.
(1)
The Director of the Office of Financial
1042
Regulation of the Department of Financial Services and the chief
1043
executive officer of the Florida Health Plan shall regularly
1044
update the Legislature on the status of the planning,
1045
implementation, and financing of this act.
1046
(2)
The Florida Health Plan must be operational within 2
1047
years after July 1, 2026.
1048
(3)
On and after the day the Florida Health Plan becomes
1049
operational, a health insurance policy, a health maintenance
1050
contract, a continuing care contract, a prepaid health clinic
1051
contract, or any policy or contract that offers coverage for
1052
services covered by the Florida Health Plan may not be sold in
1053
this state.
1054
(4)
The Office of the Inspector General of the Agency for
1055
Health Care Administration shall prepare an analysis of this
1056
state’s capital expenditure needs for the purpose of assisting
1057
the Florida Health Board in adopting the statewide capital
1058
budget for the year following implementation. The Office of the
1059
Inspector General shall submit this analysis to the board.
1060
(5)
By July 1, 2027, the Department of Commerce shall
1061
provide to the Florida Health Board, the Governor, and the
1062
chairs and ranking members of the legislative committees with
1063
jurisdiction over health, human services, and commerce a report
1064
determining the appropriations and legislation necessary to
1065
assist all affected individuals and communities through the
1066
transition to the Florida Health Plan.
1067 Section 19. This act shall take effect July 1, 2026.