| 21 | | - | requiring a health insurer or health maintenance 8 |
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| 22 | | - | organization to provide accurate information to a 9 |
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| 23 | | - | provider about an insurer's or a subscriber's grace 10 |
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| 24 | | - | period status; authorizing a health insurer or health 11 |
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| 25 | | - | maintenance organization to recoup payment 12 |
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| 26 | | - | retroactively within a specified timeframe if such 13 |
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| 27 | | - | accurate information is given to the provider; 14 |
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| 28 | | - | providing applicability of the prohibition to policies 15 |
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| 29 | | - | or contracts entered into or renewed on or after a 16 |
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| 30 | | - | specified date; providing nonapplicability of the 17 |
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| 31 | | - | prohibition to Medicaid managed care plans; providing 18 |
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| 32 | | - | an effective date. 19 |
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| 33 | | - | 20 |
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| 34 | | - | Be It Enacted by the Legislature o f the State of Florida: 21 |
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| 35 | | - | 22 |
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| 36 | | - | Section 1. Subsection (11) of section 627.6131, Florida 23 |
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| 37 | | - | Statutes, is amended to read: 24 |
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| 38 | | - | 627.6131 Payment of claims. — 25 |
|---|
| 21 | + | providing applicability of the prohibition to 8 |
|---|
| 22 | + | contracts entered into or renewed on or after a 9 |
|---|
| 23 | + | specified date; providing nonapplicability of the 10 |
|---|
| 24 | + | prohibition to Medicaid managed care plans; providing 11 |
|---|
| 25 | + | an effective date. 12 |
|---|
| 26 | + | 13 |
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| 27 | + | Be It Enacted by the Legislature of the State of Florida: 14 |
|---|
| 28 | + | 15 |
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| 29 | + | Section 1. Subsection (11) of section 627.6131, Florida 16 |
|---|
| 30 | + | Statutes, is amended to read: 17 |
|---|
| 31 | + | 627.6131 Payment of claims. — 18 |
|---|
| 32 | + | (11) A health insurer may not retroactively deny a claim 19 |
|---|
| 33 | + | because of insured ineligibility at any time, except a health 20 |
|---|
| 34 | + | insurer may retroactively deny a claim for insured ineligibility 21 |
|---|
| 35 | + | within 1 year after the da te of payment of the claim if the 22 |
|---|
| 36 | + | provider was convicted of fraud pursuant to s. 817.234. This 23 |
|---|
| 37 | + | subsection applies to policies entered into or renewed on or 24 |
|---|
| 38 | + | after January 1, 2024 more than 1 year after the date of payment 25 |
|---|
| 51 | | - | (11) A health insurer may not retroactively deny a claim 26 |
|---|
| 52 | | - | because of insured ineligibility at any time, except that a 27 |
|---|
| 53 | | - | health insurer may retroactively deny a claim for insured 28 |
|---|
| 54 | | - | ineligibility within 1 year after the date of payment of the 29 |
|---|
| 55 | | - | claim if the provider was convicted of fraud under s. 817.234. A 30 |
|---|
| 56 | | - | health insurer may not retroactively deny a claim because of 31 |
|---|
| 57 | | - | insured ineligibility for services rendered during an applicable 32 |
|---|
| 58 | | - | grace period if the health insurer verified the insured's 33 |
|---|
| 59 | | - | eligibility before or at the time of treatment and provided an 34 |
|---|
| 60 | | - | authorization number. Information regarding whether the insured 35 |
|---|
| 61 | | - | is in a grace period must be readily available at the time the 36 |
|---|
| 62 | | - | health insurer provides authorization. A health insurer may 37 |
|---|
| 63 | | - | recoup payment for an improperly adjudicated claim arising from 38 |
|---|
| 64 | | - | premium nonpayment if the provider was given accurate 39 |
|---|
| 65 | | - | information regarding t he insured's grace period status and the 40 |
|---|
| 66 | | - | recoupment request is made within 30 days after the end of the 41 |
|---|
| 67 | | - | grace period. This subsection applies to policies entered into 42 |
|---|
| 68 | | - | or renewed on or after January 1, 2024 more than 1 year after 43 |
|---|
| 69 | | - | the date of payment of the claim. 44 |
|---|
| 70 | | - | Section 2. Subsection (10) of section 641.3155, Florida 45 |
|---|
| 71 | | - | Statutes, is amended to read: 46 |
|---|
| 72 | | - | 641.3155 Prompt payment of claims. — 47 |
|---|
| 73 | | - | (10) A health maintenance organization may not 48 |
|---|
| 74 | | - | retroactively deny a claim because of subscriber ineligibility 49 |
|---|
| 75 | | - | at any time, except that a health maintenance organization may 50 |
|---|
| 76 | | - | |
|---|
| 77 | | - | CS/CS/HB 1335 2023 |
|---|
| 78 | | - | |
|---|
| 79 | | - | |
|---|
| 80 | | - | |
|---|
| 81 | | - | CODING: Words stricken are deletions; words underlined are additions. |
|---|
| 82 | | - | hb1335-02-c2 |
|---|
| 83 | | - | Page 3 of 3 |
|---|
| 84 | | - | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
|---|
| 85 | | - | |
|---|
| 86 | | - | |
|---|
| 87 | | - | |
|---|
| 88 | | - | retroactively deny a claim for subscriber ineligibility within 1 51 |
|---|
| 89 | | - | year after the date of payment of the claim if the provider was 52 |
|---|
| 90 | | - | convicted of fraud under s. 817.234. A health maintenance 53 |
|---|
| 91 | | - | organization may not retroactively deny a claim because of 54 |
|---|
| 92 | | - | subscriber ineligibility for services rendered during an 55 |
|---|
| 93 | | - | applicable grace period if the health maintenance organization 56 |
|---|
| 94 | | - | verified the subscriber's eligibility before or at the time of 57 |
|---|
| 95 | | - | treatment and provided an aut horization number. Information 58 |
|---|
| 96 | | - | regarding whether the subscriber is in a grace period must be 59 |
|---|
| 97 | | - | readily available at the time the health maintenance 60 |
|---|
| 98 | | - | organization provides authorization. A health maintenance 61 |
|---|
| 99 | | - | organization may recoup payment for an improperly ad judicated 62 |
|---|
| 100 | | - | claim arising from premium nonpayment if the provider was given 63 |
|---|
| 101 | | - | accurate information regarding the subscriber's grace period 64 |
|---|
| 102 | | - | status and the recoupment request is made within 30 days after 65 |
|---|
| 103 | | - | the end of the grace period. This subsection applies to 66 |
|---|
| 104 | | - | contracts entered into or renewed on or after January 1, 2024. 67 |
|---|
| 105 | | - | This subsection does not apply to Medicaid managed care plans 68 |
|---|
| 106 | | - | under part IV of chapter 409 more than 1 year after the date of 69 |
|---|
| 107 | | - | payment of the claim . 70 |
|---|
| 108 | | - | Section 3. This act shall take effect July 1, 2023. 71 |
|---|
| 51 | + | of the claim. 26 |
|---|
| 52 | + | Section 2. Subsection (10) of section 641.3155, Florida 27 |
|---|
| 53 | + | Statutes, is amended to read: 28 |
|---|
| 54 | + | 641.3155 Prompt payment of claims. — 29 |
|---|
| 55 | + | (10) A health maintenance organization may not 30 |
|---|
| 56 | + | retroactively deny a claim because of subscriber ineligibility 31 |
|---|
| 57 | + | at any time, except a health maintena nce organization may 32 |
|---|
| 58 | + | retroactively deny a claim for subscriber ineligibility within 1 33 |
|---|
| 59 | + | year after the date of payment of the claim if the provider was 34 |
|---|
| 60 | + | convicted of fraud pursuant to s. 817.234. This subsection 35 |
|---|
| 61 | + | applies to contracts entered into or renewed on or after January 36 |
|---|
| 62 | + | 1, 2024. This subsection does not apply to Medicaid managed care 37 |
|---|
| 63 | + | plans under part IV of chapter 409 more than 1 year after the 38 |
|---|
| 64 | + | date of payment of the claim . 39 |
|---|
| 65 | + | Section 3. This act shall take effect July 1, 2023. 40 |
|---|