CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 1 of 14
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
A bill to be entitled 1
An act relating to dental insurance claims; amending 2
s. 627.6131, F.S.; prohibiting a contract between a 3
health insurer and a dentist from containing certain 4
restrictions on payment methods; requiring a health 5
insurer to make certain notifications before p aying a 6
claim to a dentist through electronic funds transfer; 7
prohibiting a health insurer from charging a fee to 8
transmit a payment to a dentist through ACH transfer 9
unless the dentist has consented to such fee; 10
providing construction; authorizing the Off ice of 11
Insurance Regulation of the Financial Services 12
Commission to enforce certain provisions; authorizing 13
the commission to adopt rules; prohibiting a health 14
insurer from denying claims for procedures included in 15
a prior authorization; providing exceptio ns; providing 16
construction; authorizing the office to enforce 17
certain provisions; authorizing the commission to 18
adopt rules; amending s. 627.6474, F.S.; revising the 19
definition of the term "covered services"; amending s. 20
636.032, F.S.; prohibiting a contra ct between a 21
prepaid limited health service organization and a 22
dentist from containing certain restrictions on 23
payment methods; requiring the prepaid limited health 24
service organization to make certain notifications 25
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 2 of 14
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
before paying a claim to a dentist throu gh electronic 26
funds transfer; prohibiting a prepaid limited health 27
service organization from charging a fee to transmit a 28
payment to a dentist through ACH transfer unless the 29
dentist has consented to such fee; providing 30
construction; authorizing the office to enforce 31
certain provisions; authorizing the commission to 32
adopt rules; amending s. 636.035, F.S.; revising the 33
definition of the term "covered services"; prohibiting 34
a prepaid limited health service organization from 35
denying claims for procedures inclu ded in a prior 36
authorization; providing exceptions; providing 37
construction; authorizing the office to enforce 38
certain provisions; authorizing the commission to 39
adopt rules; amending s. 641.315, F.S.; revising the 40
definition of the term "covered service"; p rohibiting 41
a contract between a health maintenance organization 42
and a dentist from containing certain restrictions on 43
payment methods; requiring the health maintenance 44
organization to make certain notifications before 45
paying a claim to a dentist through el ectronic funds 46
transfer; prohibiting a health maintenance 47
organization from charging a fee to transmit a payment 48
to a dentist through ACH transfer unless the dentist 49
has consented to such fee; providing construction; 50
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 3 of 14
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
authorizing the office to enforce certa in provisions; 51
authorizing the commission to adopt rules; prohibiting 52
a health maintenance organization from denying claims 53
for procedures included in a prior authorization; 54
providing exceptions; providing construction; 55
authorizing the office to enforce ce rtain provisions; 56
authorizing the commission to adopt rules; providing 57
an effective date. 58
59
Be It Enacted by the Legislature of the State of Florida: 60
61
Section 1. Subsections (20) and (21) are added to section 62
627.6131, Florida Statutes, to read: 63
627.6131 Payment of claims. — 64
(20)(a) A contract between a health insurer and a dentist 65
licensed under chapter 466 for the provision of services to an 66
insured may not specify credit card payment as the only 67
acceptable method for payments from the health insurer to the 68
dentist. 69
(b) At least 10 days before a health insurer pays a claim 70
to a dentist through electronic funds transfer, including, but 71
not limited to, virtual credit card payments, the health insurer 72
shall notify the dentist in writing of all o f the following: 73
1. The fees, if any, associated with the electronic funds 74
transfer. 75
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 4 of 14
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
2. The available methods of payment of claims by the 76
health insurer, with clear instructions to the dentist on how to 77
select an alternative payment method. 78
(c) A health insurer that pays a claim to a dentist 79
through Automated Clearing House (ACH) transfer may not charge a 80
fee solely to transmit the payment to the dentist unless the 81
dentist has consented to the fee. 82
(d) This subsection may not be waived, voided, or 83
nullified by contract, and any contractual clause in conflict 84
with this subsection or which purports to waive any requirements 85
of this subsection is null and void. 86
(e) The office has all rights and powers to enforce this 87
subsection as provided by s. 624.3 07. 88
(f) The commission may adopt rules to implement this 89
subsection. 90
(21)(a) A health insurer may not deny any claim 91
subsequently submitted by a dentist licensed under chapter 466 92
for procedures specifically included in a prior authorization 93
unless at least one of the following circumstances applies for 94
each procedure denied: 95
1. Benefit limitations, such as annual maximums and 96
frequency limitations not applicable at the time of the prior 97
authorization, are reached subsequent to issuance of the prior 98
authorization. 99
2. The documentation provided by the person submitting the 100
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 5 of 14
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
claim fails to support the claim as originally authorized. 101
3. Subsequent to the issuance of the prior authorization, 102
new procedures are provided to the patient or a change in the 103
condition of the patient occurs such that the prior authorized 104
procedure would no longer be considered medically necessary, 105
based on the prevailing standard of care. 106
4. Subsequent to the issuance of the prior authorization, 107
new procedures are provided to the patient or a change in the 108
patient's condition occurs such that the prior authorized 109
procedure would at that time have required disapproval pursuant 110
to the terms and conditions for coverage under the patient's 111
plan in effect at the time the prior auth orization was issued. 112
5. The denial of the claim was due to one of the 113
following: 114
a. Another payor is responsible for payment. 115
b. The dentist has already been paid for the procedures 116
identified in the claim. 117
c. The claim was submitted fraudulently, or the prior 118
authorization was based in whole or material part on erroneous 119
information provided to the health insurer by the dentist, 120
patient, or other person not related to the insurer. 121
d. The person receiving the procedure was not eligible to 122
receive the procedure on the date of service, and the health 123
insurer did not know, and with the exercise of reasonable care 124
could not have known, of his or her ineligibility. 125
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 6 of 14
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
(b) This subsection may not be waived, voided, or 126
nullified by contract, and any contr actual clause in conflict 127
with this subsection or which purports to waive any requirements 128
of this subsection is null and void. 129
(c) The office has all rights and powers to enforce this 130
subsection as provided by s. 624.307. 131
(d) The commission may adopt rules to implement this 132
subsection. 133
Section 2. Subsection (2) of section 627.6474, Florida 134
Statutes, is amended to read: 135
627.6474 Provider contracts. — 136
(2) A contract between a health insurer and a dentist 137
licensed under chapter 466 for the provisio n of services to an 138
insured may not contain a provision that requires the dentist to 139
provide services to the insured under such contract at a fee set 140
by the health insurer unless such services are covered services 141
under the applicable contract. As used in this subsection, the 142
term "covered services" means dental care services for which a 143
reimbursement is available under the insured's contract, 144
notwithstanding or for which a reimbursement would be available 145
but for the application of contractual limitations , such as 146
deductibles, coinsurance, waiting periods, annual or lifetime 147
maximums, frequency limitations, alternative benefit payments, 148
or any other limitation. 149
Section 3. Section 636.032, Florida Statutes, is amended 150
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 7 of 14
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
to read: 151
636.032 Acceptable paymen ts.— 152
(1) Each prepaid limited health service organization may 153
accept from government agencies, corporations, groups, or 154
individuals payments covering all or part of the cost of 155
contracts entered into between the prepaid limited health 156
service organization and its subscribers. 157
(2)(a) A contract between a prepaid limited health service 158
organization and a dentist licensed under chapter 466 for the 159
provision of services to a subscriber may not specify credit 160
card payment as the only acceptable method for pa yments from the 161
prepaid limited health service organization to the dentist. 162
(b) At least 10 days before a prepaid limited health 163
service organization pays a claim to a dentist through 164
electronic funds transfer, including, but not limited to, 165
virtual credit card payments, the prepaid limited health service 166
organization shall notify the dentist in writing of all of the 167
following: 168
1. The fees, if any, associated with the electronic funds 169
transfer. 170
2. The available methods of payment of claims by the 171
prepaid limited health service organization, with clear 172
instructions to the dentist on how to select an alternative 173
payment method. 174
(c) A prepaid limited health service organization that 175
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 8 of 14
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
pays a claim to a dentist through Automatic Clearing House (ACH) 176
transfer may not charge a fee solely to transmit the payment to 177
the dentist unless the dentist has consented to the fee. 178
(d) This subsection may not be waived, voided, or 179
nullified by contract, and any contractual clause in conflict 180
with this subsection or whi ch purports to waive any requirements 181
of this subsection is null and void. 182
(e) The office has all rights and powers to enforce this 183
subsection as provided by s. 624.307. 184
(f) The commission may adopt rules to implement this 185
subsection. 186
Section 4. Subsection (13) of section 636.035, Florida 187
Statutes, is amended, and subsection (15) is added to that 188
section, to read: 189
636.035 Provider arrangements. — 190
(13) A contract between a prepaid limited health service 191
organization and a dentist licensed under ch apter 466 for the 192
provision of services to a subscriber of the prepaid limited 193
health service organization may not contain a provision that 194
requires the dentist to provide services to the subscriber of 195
the prepaid limited health service organization at a f ee set by 196
the prepaid limited health service organization unless such 197
services are covered services under the applicable contract. As 198
used in this subsection, the term "covered services" means 199
dental care services for which a reimbursement is available 200
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 9 of 14
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
under the subscriber's contract, notwithstanding or for which a 201
reimbursement would be available but for the application of 202
contractual limitations such as deductibles, coinsurance, 203
waiting periods, annual or lifetime maximums, frequency 204
limitations, alternat ive benefit payments, or any other 205
limitation. 206
(15)(a) A prepaid limited health service organization may 207
not deny any claim subsequently submitted by a dentist licensed 208
under chapter 466 for procedures specifically included in a 209
prior authorization unles s at least one of the following 210
circumstances applies for each procedure denied: 211
1. Benefit limitations, such as annual maximums and 212
frequency limitations not applicable at the time of the prior 213
authorization, are reached subsequent to issuance of the prior 214
authorization. 215
2. The documentation provided by the person submitting the 216
claim fails to support the claim as originally authorized. 217
3. Subsequent to the issuance of the prior authorization, 218
new procedures are provided to the patient or a change in the 219
condition of the patient occurs such that the prior authorized 220
procedure would no longer be considered medically necessary, 221
based on the prevailing standard of care. 222
4. Subsequent to the issuance of the prior authorization, 223
new procedures are prov ided to the patient or a change in the 224
patient's condition occurs such that the prior authorized 225
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 10 of 14
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
procedure would at that time have required disapproval pursuant 226
to the terms and conditions for coverage under the patient's 227
plan in effect at the time the pri or authorization was issued. 228
5. The denial of the dental service claim was due to one 229
of the following: 230
a. Another payor is responsible for payment. 231
b. The dentist has already been paid for the procedures 232
identified in the claim. 233
c. The claim was submitted fraudulently, or the prior 234
authorization was based in whole or material part on erroneous 235
information provided to the prepaid limited health service 236
organization by the dentist, patient, or other person not 237
related to the organization. 238
d. The person receiving the procedure was not eligible to 239
receive the procedure on the date of service, and the prepaid 240
limited health service organization did not know, and with the 241
exercise of reasonable care could not have known, of his or her 242
ineligibility. 243
(b) This subsection may not be waived, voided, or 244
nullified by contract, and any contractual clause in conflict 245
with this subsection or which purports to waive any requirements 246
of this subsection is null and void. 247
(c) The office has all rights and powers to enforce this 248
subsection as provided by s. 624.307. 249
(d) The commission may adopt rules to implement this 250
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 11 of 14
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
subsection. 251
Section 5. Subsection (11) of section 641.315, Florida 252
Statutes, is amended, and subsections (13) and (14) are added to 253
that section, to read: 254
641.315 Provider contracts. — 255
(11) A contract between a health maintenance organization 256
and a dentist licensed under chapter 466 for the provision of 257
services to a subscriber of the health maintenance organization 258
may not contain a provision that requires the dentist to provide 259
services to the subscriber of the health maintenance 260
organization at a fee set by the health maintenance organization 261
unless such services are covered services under the applicable 262
contract. As used in this subsection, the term "covered 263
services" means dental care services for which a reimbursement 264
is available under the subscriber's contract, notwithstanding or 265
for which a reimbursement would be available but for the 266
application of contractual limitations such as deduc tibles, 267
coinsurance, waiting periods, annual or lifetime maximums, 268
frequency limitations, alternative benefit payments, or any 269
other limitation. 270
(13)(a) A contract between a health maintenance 271
organization and a dentist licensed under chapter 466 for the 272
provision of services to a subscriber of the health maintenance 273
organization may not specify credit card payment as the only 274
acceptable method for payments from the health maintenance 275
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 12 of 14
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
organization to the dentist. 276
(b) At least 10 days before a health mai ntenance 277
organization pays a claim to a dentist through electronic funds 278
transfer, including, but not limited to, virtual credit card 279
payments, the health maintenance organization shall notify the 280
dentist in writing of all of the following: 281
1. The fees, if any, associated with the electronic funds 282
transfer. 283
2. The available methods of payment of claims by the 284
health maintenance organization, with clear instructions to the 285
dentist on how to select an alternative payment method. 286
(c) A health maintenance organization that pays a claim to 287
a dentist through Automated Clearing House (ACH) transfer may 288
not charge a fee solely to transmit the payment to the dentist 289
unless the dentist has consented to the fee. 290
(d) This subsection may not be waived, voided, or 291
nullified by contract, and any contractual clause in conflict 292
with this subsection or which purports to waive any requirements 293
of this subsection is null and void. 294
(e) The office has all rights and powers to enforce this 295
subsection as provided by s. 624 .307. 296
(f) The commission may adopt rules to implement this 297
subsection. 298
(14)(a) A health maintenance organization may not deny any 299
claim subsequently submitted by a dentist licensed under chapter 300
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 13 of 14
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
466 for procedures specifically included in a prior 301
authorization unless at least one of the following circumstances 302
applies for each procedure denied: 303
1. Benefit limitations, such as annual maximums and 304
frequency limitations not applicable at the time of the prior 305
authorization, are reached subsequent to issu ance of the prior 306
authorization. 307
2. The documentation provided by the person submitting the 308
claim fails to support the claim as originally authorized. 309
3. Subsequent to the issuance of the prior authorization, 310
new procedures are provided to the patient or a change in the 311
condition of the patient occurs such that the prior authorized 312
procedure would no longer be considered medically necessary, 313
based on the prevailing standard of care. 314
4. Subsequent to the issuance of the prior authorization, 315
new procedures are provided to the patient or a change in the 316
patient's condition occurs such that the prior authorized 317
procedure would at that time have required disapproval pursuant 318
to the terms and conditions for coverage under the patient's 319
plan in effect at the time the prior authorization was issued. 320
5. The denial of the claim was due to one of the 321
following: 322
a. Another payor is responsible for payment. 323
b. The dentist has already been paid for the procedures 324
identified in the claim. 325
CS/HB 1219 2024
CODING: Words stricken are deletions; words underlined are additions.
hb1219-01-c1
Page 14 of 14
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
c. The claim was submitted fraudulently, or the prior 326
authorization was based in whole or material part on erroneous 327
information provided to the health maintenance organization by 328
the dentist, patient, or other person not related to the 329
organization. 330
d. The person receiv ing the procedure was not eligible to 331
receive the procedure on the date of service, and the health 332
maintenance organization did not know, and with the exercise of 333
reasonable care could not have known, of his or her 334
ineligibility. 335
(b) The subsection may n ot be waived, voided, or nullified 336
by contract, and any contractual clause in conflict with this 337
subsection or which purports to waive any requirements of this 338
subsection is null and void. 339
(c) The office has all rights and powers to enforce this 340
subsection as provided by s. 624.307. 341
(d) The commission may adopt rules to implement this 342
subsection. 343
Section 6. This act shall take effect July 1, 2024. 344