FL
Florida House Bill H1101

Florida 2025 Regular Session

Florida House Bill H1101 Compare Versions

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1010 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
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1414 A bill to be entitled 1
1515 An act relating to out -of-network providers; amending 2
1616 s. 456.0575, F.S.; requiring a health care 3
1717 practitioner to notify a patient in writing upon 4
1818 referring the patient to certain providers; providing 5
19-requirements for such notice; providing requirements 6
20-for a practitioner to confirm network status; 7
21-providing for health care practitioner disciplinary 8
22-action under certain conditions; amending s. 627.6471, 9
23-F.S.; requiring certain health insurers to apply 10
24-payments for services provided by nonpreferred 11
25-providers toward insureds' deductibles and out -of-12
26-pocket maximums if specified conditions are met; 13
27-providing an effective date. 14
19+requirements for such notice; providing for health 6
20+care practitioner disciplinary action under certain 7
21+conditions; amending s. 627.6471, F.S.; requiring 8
22+certain health insurers to apply payments for services 9
23+provided by nonpreferred providers toward insureds' 10
24+deductibles and out-of-pocket maximums if specified 11
25+conditions are met; providing an effective date. 12
26+ 13
27+Be It Enacted by the Legislature of the State of Florida: 14
2828 15
29-Be It Enacted by the Legislature of t he State of Florida: 16
30- 17
31- Section 1. Subsection (2) of section 456.0575, Florida 18
32-Statutes, is renumbered as subsection (3), and a new subsection 19
33-(2) is added to that section to read: 20
34- 456.0575 Duty to notify patients. — 21
35- (2) A health care practitioner sha ll notify a patient in 22
36-writing upon referring the patient to a nonparticipating 23
37-provider for nonemergency services, as those terms are defined 24
38-in s. 627.64194(1), or to a provider, as defined in s. 641.47, 25
29+ Section 1. Subsection (2) of section 456.05 75, Florida 16
30+Statutes, is renumbered as subsection (3), and a new subsection 17
31+(2) is added to that section to read: 18
32+ 456.0575 Duty to notify patients. — 19
33+ (2) A health care practitioner shall notify a patient in 20
34+writing upon referring the patient to a nonpar ticipating 21
35+provider for nonemergency services, as those terms are defined 22
36+in s. 627.64194(1), or to a provider, as defined in s. 641.47, 23
37+that is not under contract with the patient's health maintenance 24
38+organization. Such notice must state that the services will be 25
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4747 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
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51-that is not under contract with the patient's heal th maintenance 26
52-organization. Such notice must state that the services will be 27
53-provided on an out-of-network basis, which may result in 28
54-additional cost-sharing responsibilities for the patient, and 29
55-such notice must be documented in the patient's medical rec ord. 30
56-The practitioner or his or her employee may confirm the referral 31
57-provider's participation by contacting the referral provider or 32
58-the patient's health insurer or health maintenance organization, 33
59-as necessary, or may rely on the online provider director y of 34
60-the health insurer or health maintenance organization. Failure 35
61-to comply with this subsection, without good cause, shall result 36
62-in disciplinary action against the health care practitioner. 37
63- Section 2. Subsection (7) of section 627.6471, Florida 38
64-Statutes, is renumbered as subsection (8), and a new subsection 39
65-(7) is added to that section to read: 40
66- 627.6471 Contracts for reduced rates of payment; 41
67-limitations; coinsurance and deductibles. — 42
68- (7) Any insurer issuing a policy of health insurance in 43
69-this state shall apply the payment for a service provided to an 44
70-insured by a nonpreferred provider toward the insured's 45
71-deductible and out-of-pocket maximum as if the service had been 46
72-provided by a preferred provider if all of the following apply: 47
73- (a) The insured requests that the insurer apply the 48
74-payment for the service provided to the insured by the 49
75-nonpreferred provider toward the insured's deductible and out -50
51+provided on an out-of-network basis, which may result in 26
52+additional cost-sharing responsibilities for the patient, and 27
53+such notice must be documented in the patient's medical record. 28
54+Failure to comply with this subsection, without good cause, 29
55+shall result in disciplinary action against the health care 30
56+practitioner. 31
57+ Section 2. Subsection (7) of section 627.6471, Florida 32
58+Statutes, is renumbered as subsection (8), and a new subsection 33
59+(7) is added to that section to read: 34
60+ 627.6471 Contracts for reduced rates of payment; 35
61+limitations; coinsurance and deductibles. — 36
62+ (7) Any insurer issuing a policy of health insurance in 37
63+this state shall apply the payment for a service provided to an 38
64+insured by a nonpreferred provider toward the insured's 39
65+deductible and out-of-pocket maximum as if the service had been 40
66+provided by a preferred provider if all of the following apply: 41
67+ (a) The insured requests that the insurer apply the 42
68+payment for the service provided to the insured by the 43
69+nonpreferred provider toward the insured's deductible and out -44
70+of-pocket maximum. 45
71+ (b) The service provided to the insured by the 46
72+nonpreferred provider is within the scope of services covered 47
73+under the insured's policy. 48
74+ (c) The amount that the nonpreferred provider charged the 49
75+insured for the service is the same as or less than: 50
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8484 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
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88-of-pocket maximum. 51
89- (b) The service provided to the insured by the 52
90-nonpreferred provider is withi n the scope of services covered 53
91-under the insured's policy. 54
92- (c) The amount that the nonpreferred provider charged the 55
93-insured for the service is the same as or less than: 56
94- 1. The average amount that the insured's preferred 57
95-provider network charges for t he service; or 58
96- 2. The statewide average amount for the service based on 59
97-data reported on the Florida Health Price Finder website. 60
98- Section 3. This act shall take effect July 1, 2025. 61
88+ 1. The average amount that the insured's preferred 51
89+provider network charges for the service; or 52
90+ 2. The statewide average amount for the service based on 53
91+data reported on the Florida Health Price Finder w ebsite. 54
92+ Section 3. This act shall take effect July 1, 2025. 55