Florida 2025 Regular Session

Florida House Bill H0425 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
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3	3	HB 425 2025
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb425-00
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10	10	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 VE S
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14	14	A bill to be entitled 1
15	15	An act relating to coverage for out -of-network ground 2
16	16	ambulance emergency services; creating s. 627.42398, 3
17	17	F.S.; defining the terms "ambulance service provider" 4
18	18	and "nonparticipating ambulance service provider"; 5
19	19	requiring certain health insurers to reimbur se 6
20	20	nonparticipating ambulance service providers at a 7
21	21	specified rate for providing ground ambulance 8
22	22	services; providing that certain payments by the 9
23	23	insured constitute an accord and satisfaction, and a 10
24	24	release, of certain claims; prohibiting certain cost -11
25	25	sharing responsibilities paid from exceeding a certain 12
26	26	amount; providing that an ambulance service provider 13
27	27	and certain claims are subject to certain provisions; 14
28	28	amending 627.6699, F.S.; requiring a small employer 15
29	29	carrier to comply with certain provisions; c reating s. 16
30	30	641.31078, F.S.; defining the terms "ambulance service 17
31	31	provider" and "out-of-network ambulance service 18
32	32	provider"; requiring certain health maintenance 19
33	33	contracts to require a health maintenance organization 20
34	34	to reimburse out-of-network ambulance service 21
35	35	providers at a specified rate for providing covered 22
36	36	services; providing that certain payments by the 23
37	37	subscriber constitute an accord and satisfaction, and 24
38	38	a release, of certain claims; prohibiting certain 25
39	39
40	40	HB 425 2025
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42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb425-00
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47	47	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 VE S
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49	49
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51	51	cost-sharing responsibilities paid from exce eding a 26
52	52	certain amount; providing that an ambulance service is 27
53	53	considered a provider and certain claims are subject 28
54	54	to certain provisions; providing an effective date. 29
55	55	30
56	56	Be It Enacted by the Legislature of the State of Florida: 31
57	57	32
58	58	Section 1. Section 627.42398, Florida Statutes, is created 33
59	59	to read: 34
60	60	627.42398 Coverage for nonparticipating ambulance 35
61	61	services.— 36
62	62	(1) As used in this section, the term: 37
63	63	(a) "Ambulance service provider" means a ground ambulance 38
64	64	service licensed pursuant to s. 401.25. 39
65	65	(b) "Nonparticipating ambulance service provider" means a 40
66	66	provider that is not a preferred provider as defined in s. 41
67	67	627.6471(1) or a provider that is not an exclusive provider as 42
68	68	defined in s. 627.6472(1)(c). 43
69	69	(2) A health insurer that offers an indiv idual or group 44
70	70	health insurance policy providing major medical coverage that 45
71	71	includes coverage for ground ambulance services must reimburse a 46
72	72	nonparticipating ambulance service provider for providing such 47
73	73	covered ambulance services at a rate that is the lo west of the 48
74	74	following: 49
75	75	(a) The rate set or approved, whether in contract, in 50
76	76
77	77	HB 425 2025
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79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb425-00
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84	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 VE S
85	85
86	86
87	87
88	88	ordinance, or otherwise, by a local governmental entity in the 51
89	89	jurisdiction in which the covered ground ambulance services 52
90	90	originated. 53
91	91	(b) Three hundred twenty -five percent of the current 54
92	92	published rate for ground ambulance services as established by 55
93	93	the Centers for Medicare and Medicaid Services under Title XVIII 56
94	94	of the Social Security Act for the same services provided in the 57
95	95	same geographic area. 58
96	96	(c) The ambulance service provider's billed charges. 59
97	97	(3) Payment in full by the insured of his or her 60
98	98	applicable copayment, coinsurance, or deductible constitutes an 61
99	99	accord and satisfaction, and a release, of any claim for 62
100	100	additional moneys owed by the insured to the health insur er or 63
101	101	to any person or entity in connection with the ground ambulance 64
102	102	services. 65
103	103	(4) Copayment, coinsurance, deductible, and other cost -66
104	104	sharing responsibilities paid for a nonparticipating ambulance 67
105	105	service provider's covered services may not exceed the 68
106	106	copayment, coinsurance, deductible, and other cost -sharing 69
107	107	responsibilities for a preferred provider as defined in s. 70
108	108	627.6471(1) or a provider that is not an exclusive provider as 71
109	109	defined in s. 627.6472(1)(c) for covered services. 72
110	110	(5) An ambulance servic e provider is considered a provider 73
111	111	subject to s. 627.6131, and the claims of the provider are 74
112	112	subject to s. 627.6131. 75
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114	114	HB 425 2025
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117	117
118	118	CODING: Words stricken are deletions; words underlined are additions.
119	119	hb425-00
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121	121	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 VE S
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125	125	Section 2. Paragraph (h) is added to subsection (5) of 76
126	126	section 627.6699, Florida Statutes, to read: 77
127	127	627.6699 Employee Health Care Access Act.— 78
128	128	(5) AVAILABILITY OF COVERAGE. — 79
129	129	(h) A small employer carrier must comply with the 80
130	130	reimbursement provisions of s. 627.42398 relating to 81
131	131	nonparticipating ambulance service providers. 82
132	132	Section 3. Section 641.31078, Florida Statutes, is crea ted 83
133	133	to read: 84
134	134	641.31078 Coverage for out -of-network ambulance services. — 85
135	135	(1) As used in this section, the term: 86
136	136	(a) "Ambulance service provider" means a ground ambulance 87
137	137	service licensed pursuant to s. 401.25. 88
138	138	(b) "Out-of-network ambulance service p rovider" means a 89
139	139	provider that is not under contract with a health maintenance 90
140	140	organization. 91
141	141	(2) A health maintenance contract that offers individual 92
142	142	or group major medical coverage that includes coverage for 93
143	143	ground ambulance services must require a heal th maintenance 94
144	144	organization to reimburse an out -of-network ambulance service 95
145	145	provider for providing covered ambulance services at a rate that 96
146	146	is the lowest of the following: 97
147	147	(a) The rate set or approved, whether in contract, in 98
148	148	ordinance, or otherwise, b y a local governmental entity in the 99
149	149	jurisdiction in which the covered services originated. 100
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151	151	HB 425 2025
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155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb425-00
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158	158	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 VE S
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162	162	(b) Three hundred twenty -five percent of the current 101
163	163	published rate for ground ambulance services as established by 102
164	164	the Centers for Medicare and Medicaid Services under Title XVIII 103
165	165	of the Social Security Act for the same service provided in the 104
166	166	same geographic area. 105
167	167	(c) The ambulance service provider's billed charges. 106
168	168	(3) Payment in full by the subscriber of his or her 107
169	169	applicable copayment, coinsurance, or dedu ctible constitutes an 108
170	170	accord and satisfaction, and a release, of any claim for 109
171	171	additional moneys owed by the subscriber to the health 110
172	172	maintenance organization or to any person or entity in 111
173	173	connection with the ground ambulance services. 112
174	174	(4) Copayment, coinsurance, deductible, and other cost -113
175	175	sharing responsibilities paid for an out -of-network ambulance 114
176	176	service provider's covered services may not exceed the in -115
177	177	network copayment, coinsurance, deductible, and other cost -116
178	178	sharing responsibilities for covered ser vices received by the 117
179	179	subscriber. 118
180	180	(5) An ambulance service provider is considered a 119
181	181	provider, and the claims of the provider are subject to s. 120
182	182	641.3155. 121
183	183	Section 4. This act shall take effect January 1, 2026. 122