Florida 2025 Regular Session

Florida House Bill H1231 Compare Versions

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

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3	3	HB 1231 2025
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1231-00
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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 V E S
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14	14	A bill to be entitled 1
15	15	An act relating to insurance claims payments to 2
16	16	physicians; amending ss. 627.6131 and 641.315, F.S.; 3
17	17	prohibiting contracts between certain physicians and 4
18	18	health insurers and health maintenance organizations, 5
19	19	respectively, from specifying credit card payments to 6
20	20	physicians as the only acceptable method for payments; 7
21	21	authorizing use of electronic funds transfers by 8
22	22	health insurers and health maintenance organization s, 9
23	23	respectively, for payments to physicians under certain 10
24	24	circumstances; providing notification requirements; 11
25	25	prohibiting health insurers and health maintenance 12
26	26	organizations, respectively, from charging fees for 13
27	27	automated clearinghouse transfers as claims payments 14
28	28	to physicians; providing an exception; providing 15
29	29	applicability; prohibiting health insurers and health 16
30	30	maintenance organizations, respectively, from denying 17
31	31	claims subsequently submitted by physicians for 18
32	32	procedures that were included in prior au thorizations; 19
33	33	providing exceptions; providing applicability; 20
34	34	providing an effective date. 21
35	35	22
36	36	Be It Enacted by the Legislature of the State of Florida: 23
37	37	24
38	38	Section 1. Subsections (20) and (21) of section 627.6131, 25
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40	40	HB 1231 2025
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44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb1231-00
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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 V E S
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51	51	Florida Statutes, are amended to read: 26
52	52	627.6131 Payment of claims. — 27
53	53	(20)(a) A contract between a health insurer and a dentist 28
54	54	licensed under chapter 466 or a physician licensed under chapter 29
55	55	458 or chapter 459 for the provision of services to an insured 30
56	56	may not specify credit card payment as the only acceptable 31
57	57	method for payments from the health insurer to the dentist or 32
58	58	physician. 33
59	59	(b) When a health insurer employs the method of claims 34
60	60	payment to a dentist or physician through electronic funds 35
61	61	transfer, including, but not limited to, virtu al credit card 36
62	62	payment, the health insurer shall notify the dentist or 37
63	63	physician as provided in this paragraph and obtain the dentist's 38
64	64	or physician's consent before employing the electronic funds 39
65	65	transfer. The dentist's or physician's consent described in this 40
66	66	paragraph applies to the dentist's or physician's entire 41
67	67	practice. For the purpose of this paragraph, the dentist's or 42
68	68	physician's consent, which may be given through e -mail, must 43
69	69	bear the signature of the dentist or physician. Such signature 44
70	70	includes an electronic or digital signature if the form of 45
71	71	signature is recognized as a valid signature under applicable 46
72	72	federal law or state contract law or an act that demonstrates 47
73	73	express consent, including, but not limited to, checking a box 48
74	74	indicating consent. The health insurer or the dentist or 49
75	75	physician may not require that a dentist's or physician's 50
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77	77	HB 1231 2025
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81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb1231-00
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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 V E S
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86	86
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88	88	consent as described in this paragraph be made on a patient -by-51
89	89	patient basis. The notification provided by the health insurer 52
90	90	to the dentist or physician must include all of the following: 53
91	91	1. The fees, if any, associated with the electronic funds 54
92	92	transfer. 55
93	93	2. The available methods of payment of claims by the 56
94	94	health insurer, with clear instructions to the dentist or 57
95	95	physician on how to select an alternative payment method. 58
96	96	(c) A health insurer that pays a claim to a dentist or 59
97	97	physician through automated clearinghouse transfer may not 60
98	98	charge a fee solely to transmit the payment to the dentist or 61
99	99	physician unless the dentist or physician has consented to the 62
100	100	fee. 63
101	101	(d) This subsection applies to all contracts: 64
102	102	1. Between a health insurer and a dentist which are 65
103	103	delivered, issued, or renewed on or after January 1, 2025. 66
104	104	2. Between a health insurer and a physician which are 67
105	105	delivered, issued, or renewed on or after January 1, 2026. 68
106	106	(e) The office has all rights and powers to enforce this 69
107	107	subsection as provided by s. 624.307. 70
108	108	(f) The commission may adopt rules to implement this 71
109	109	subsection. 72
110	110	(21)(a) A health insurer may not deny any claim 73
111	111	subsequently submitted by a dentist licensed under chapter 466 74
112	112	or a physician licensed under chapter 458 or chapter 459 for 75
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118	118	CODING: Words stricken are deletions; words underlined are additions.
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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 V E S
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125	125	procedures specifically included in a prior authorization unless 76
126	126	at least one of the following circumstances applies for each 77
127	127	procedure denied: 78
128	128	1. Benefit limitations, such as annual maximums and 79
129	129	frequency limitations not applicable at the time of the prior 80
130	130	authorization, are reached subsequent to issuance of the prior 81
131	131	authorization. 82
132	132	2. The documentation provided by the person submitting the 83
133	133	claim fails to support the claim as originally authorized. 84
134	134	3. Subsequent to the issuance of the prior authorization, 85
135	135	new procedures are provided to the patient or a change in the 86
136	136	condition of the patient occurs such that the prior authorized 87
137	137	procedure would no longer be considered medically necessary, 88
138	138	based on the prevailing standard of care. 89
139	139	4. Subsequent to the issuance of the prior authorization, 90
140	140	new procedures are provided to the patient or a change in the 91
141	141	patient's condition occurs such that the prior a uthorized 92
142	142	procedure would at that time have required disapproval pursuant 93
143	143	to the terms and conditions for coverage under the patient's 94
144	144	plan in effect at the time the prior authorization was issued. 95
145	145	5. The denial of the claim was due to one of the 96
146	146	following: 97
147	147	a. Another payor is responsible for payment. 98
148	148	b. The dentist or physician has already been paid for the 99
149	149	procedures identified in the claim. 100
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151	151	HB 1231 2025
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155	155	CODING: Words stricken are deletions; words underlined are additions.
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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 V E S
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162	162	c. The claim was submitted fraudulently, or the prior 101
163	163	authorization was based in whole or material part on erroneous 102
164	164	information provided to the health insurer by the dentist or 103
165	165	physician, patient, or other person not related to the insurer. 104
166	166	d. The person receiving the procedure was not eligible to 105
167	167	receive the procedure on the date of service. 106
168	168	e. The services were provided during the grace period 107
169	169	established under s. 627.608 or applicable federal regulations, 108
170	170	and the dental insurer notified the dentist or physician 109
171	171	provider that the patient was in the grace period when the 110
172	172	dentist or physician provider requested eligibility or 111
173	173	enrollment verification from the dental insurer, if such request 112
174	174	was made. 113
175	175	(b) This subsection applies to all contracts : 114
176	176	1. Between a health insurer and a dentist which are 115
177	177	delivered, issued, or renewed on or after January 1, 2025. 116
178	178	2. Between a health insurer and a physician which are 117
179	179	delivered, issued, or renewed on or after January 1, 2026. 118
180	180	(c) The office has all rights and powers to enforce this 119
181	181	subsection as provided by s. 624.307. 120
182	182	(d) The commission may adopt rules to impl ement this 121
183	183	subsection. 122
184	184	Section 2. Subsections (13) and (14) of section 641.315, 123
185	185	Florida Statutes, are amended to read: 124
186	186	641.315 Provider contracts. — 125
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188	188	HB 1231 2025
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191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
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195	195	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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199	199	(13)(a) A contract between a health maintenance 126
200	200	organization and a dentist licensed under chapter 466 or a 127
201	201	physician licensed under chapter 458 or chapter 459 for the 128
202	202	provision of services to a subscriber of the health maintenance 129
203	203	organization may not spe cify credit card payment as the only 130
204	204	acceptable method for payments from the health maintenance 131
205	205	organization to the dentist or physician. 132
206	206	(b) When a health maintenance organization employs the 133
207	207	method of claims payment to a dentist or physician through 134
208	208	electronic funds transfer, including, but not limited to, 135
209	209	virtual credit card payment, the health maintenance organization 136
210	210	shall notify the dentist or physician as provided in this 137
211	211	paragraph and obtain the dentist's or physician's consent before 138
212	212	employing the electronic funds transfer. The dentist's or 139
213	213	physician's consent described in this paragraph applies to the 140
214	214	dentist's or physician's entire practice. For the purpose of 141
215	215	this paragraph, the dentist's or physician's consent, which may 142
216	216	be given through e-mail, must bear the signature of the dentist 143
217	217	or physician. Such signature includes an electronic or digital 144
218	218	signature if the form of signature is recognized as a valid 145
219	219	signature under applicable federal law or state contract law or 146
220	220	an act that demonstrates ex press consent, including, but not 147
221	221	limited to, checking a box indicating consent. The health 148
222	222	maintenance organization or the dentist or physician may not 149
223	223	require that a dentist's or physician's consent as described in 150
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225	225	HB 1231 2025
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229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb1231-00
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232	232	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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236	236	this paragraph be made on a patient -by-patient basis. The 151
237	237	notification provided by the health maintenance organization to 152
238	238	the dentist or physician must include all of the following: 153
239	239	1. The fees, if any, that are associated with the 154
240	240	electronic funds transfer. 155
241	241	2. The available methods of paym ent of claims by the 156
242	242	health maintenance organization, with clear instructions to the 157
243	243	dentist or physician on how to select an alternative payment 158
244	244	method. 159
245	245	(c) A health maintenance organization that pays a claim to 160
246	246	a dentist or physician through automated clearing house transfer 161
247	247	may not charge a fee solely to transmit the payment to the 162
248	248	dentist or physician unless the dentist or physician has 163
249	249	consented to the fee. 164
250	250	(d) This subsection applies to all contracts: 165
251	251	1. Between a health maintenance organization and a dentist 166
252	252	which are delivered, issued, or renewed on or after January 1, 167
253	253	2025. 168
254	254	2. Between a health maintenance organization and a 169
255	255	physician which are delivered, issued, or renewed on or after 170
256	256	January 1, 2026. 171
257	257	(e) The office has all rights and powe rs to enforce this 172
258	258	subsection as provided by s. 624.307. 173
259	259	(f) The commission may adopt rules to implement this 174
260	260	subsection. 175
261	261
262	262	HB 1231 2025
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266	266	CODING: Words stricken are deletions; words underlined are additions.
267	267	hb1231-00
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269	269	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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273	273	(14)(a) A health maintenance organization may not deny any 176
274	274	claim subsequently submitted by a dentist licensed under chapter 177
275	275	466 or a physician licensed under chapter 458 or chapter 459 for 178
276	276	procedures specifically included in a prior authorization unless 179
277	277	at least one of the following circumstances applies for each 180
278	278	procedure denied: 181
279	279	1. Benefit limitations, such as annual maximums and 182
280	280	frequency limitations not applicable at the time of the prior 183
281	281	authorization, are reached subsequent to issuance of the prior 184
282	282	authorization. 185
283	283	2. The documentation provided by the person submitting the 186
284	284	claim fails to support the claim as originally authorized. 187
285	285	3. Subsequent to the issuance of the prior authorization, 188
286	286	new procedures are provided to the patient or a change in the 189
287	287	condition of the patient occurs such that the prior authorized 190
288	288	procedure would no longer be considered medically necessary , 191
289	289	based on the prevailing standard of care. 192
290	290	4. Subsequent to the issuance of the prior authorization, 193
291	291	new procedures are provided to the patient or a change in the 194
292	292	patient's condition occurs such that the prior authorized 195
293	293	procedure would at that time hav e required disapproval pursuant 196
294	294	to the terms and conditions for coverage under the patient's 197
295	295	plan in effect at the time the prior authorization was issued. 198
296	296	5. The denial of the claim was due to one of the 199
297	297	following: 200
298	298
299	299	HB 1231 2025
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303	303	CODING: Words stricken are deletions; words underlined are additions.
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306	306	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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310	310	a. Another payor is responsible for payment. 201
311	311	b. The dentist or physician has already been paid for the 202
312	312	procedures identified in the claim. 203
313	313	c. The claim was submitted fraudulently, or the prior 204
314	314	authorization was based in whole or material part on erroneous 205
315	315	information provided to the heal th maintenance organization by 206
316	316	the dentist or physician, patient, or other person not related 207
317	317	to the organization. 208
318	318	d. The person receiving the procedure was not eligible to 209
319	319	receive the procedure on the date of service. 210
320	320	e. The services were provided dur ing the grace period 211
321	321	established under s. 627.608 or applicable federal regulations, 212
322	322	and the dental insurer notified the dentist or physician 213
323	323	provider that the patient was in the grace period when the 214
324	324	dentist or physician provider requested eligibility or 215
325	325	enrollment verification from the dental insurer, if such request 216
326	326	was made. 217
327	327	(b) This subsection applies to all contracts : 218
328	328	1. Between a health maintenance organization and a dentist 219
329	329	which are delivered, issued, or renewed on or after January 1, 220
330	330	2025. 221
331	331	2. Between a health maintenance organization and a 222
332	332	physician which are delivered, issued, or renewed on or after 223
333	333	January 1, 2026. 224
334	334	(c) The office has all rights and powers to enforce this 225
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336	336	HB 1231 2025
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338	338
339	339
340	340	CODING: Words stricken are deletions; words underlined are additions.
341	341	hb1231-00
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343	343	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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345	345
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347	347	subsection as provided by s. 624.307. 226
348	348	(d) The commission may adopt rules to implement this 227
349	349	subsection. 228
350	350	Section 3. This act shall take effect July 1, 2025. 229