Florida 2025 Regular Session

Florida House Bill H1603 Compare Versions

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

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3	3	HB 1603 2025
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8	8	hb1603-00
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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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12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to comprehensive health care for 2
16	16	residents; creating part IV of ch. 641, F.S., entitled 3
17	17	the "Healthy Florida Act"; creating s. 641.71, F.S.; 4
18	18	providing a short title; creating s. 641.72, F.S.; 5
19	19	providing purpose of the Florida Health Plan; creating 6
20	20	s. 641.73, F.S.; providing definitions; creating s. 7
21	21	641.74, F.S.; providing eligibility for and coverage 8
22	22	of the plan; authorizing the Florida Health B oard to 9
23	23	establish financial arrangements with other states and 10
24	24	foreign countries under certain circumstances; 11
25	25	providing duties of the board relating to plan 12
26	26	enrollment; providing enrollment requirements; 13
27	27	providing that certain data collected through plan 14
28	28	applications and enrollment is private data; 15
29	29	authorizing such data to be released to certain 16
30	30	persons for specified purposes; creating s. 641.755, 17
31	31	F.S.; authorizing plan enrollees to choose certain 18
32	32	health care providers; providing covered health care 19
33	33	benefits; authorizing the board to expand health care 20
34	34	benefits under certain circumstances; providing health 21
35	35	care services that are excluded from the plan; 22
36	36	requiring enrollees to have primary care providers and 23
37	37	access to care coordination; authorizing enrollees t o 24
38	38	see health care specialists without referral; 25
39	39
40	40	HB 1603 2025
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42	42
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45	45	hb1603-00
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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
48	48
49	49
50	50
51	51	authorizing the board to establish a computerized 26
52	52	registry; authorizing the plan to assist enrollees in 27
53	53	choosing primary care providers; prohibiting cost -28
54	54	sharing requirements from being imposed on enrollees; 29
55	55	creating s. 641.77, F.S.; requiring the board to 30
56	56	secure repeals and waivers of certain provisions of 31
57	57	federal law; requiring the Department of Health and 32
58	58	the Agency for Health Care Administration to provide 33
59	59	assistance to the board; requiring the board to ad opt 34
60	60	rules under certain circumstances; providing that the 35
61	61	plan's responsibility for providing health care is 36
62	62	secondary to existing Federal Government programs 37
63	63	under certain circumstances; creating s. 641.78, F.S.; 38
64	64	defining the term "collateral source"; req uiring the 39
65	65	plan to collect health care costs from collateral 40
66	66	sources under certain circumstances; requiring the 41
67	67	board to negotiate waivers, seek federal legislation, 42
68	68	and make arrangements to incorporate collateral 43
69	69	sources into the plan; requiring plan enro llees to 44
70	70	notify health care providers of collateral sources and 45
71	71	health care providers to forward such information to 46
72	72	the board; authorizing the board to take appropriate 47
73	73	actions to recover reimbursement from collateral 48
74	74	sources; requiring collateral sources to pay for 49
75	75	health care services under certain circumstances; 50
76	76
77	77	HB 1603 2025
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79	79
80	80
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82	82	hb1603-00
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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
85	85
86	86
87	87
88	88	providing specified authority and rights to the board 51
89	89	relating to collateral sources; creating s. 641.791, 52
90	90	F.S.; providing that defaults, underpayments, and late 53
91	91	payments of certain obligations shall result in 54
92	92	remedies and penalties; prohibiting eligibility for 55
93	93	health care benefits from being impaired by such 56
94	94	defaults, underpayments, and late payments; creating 57
95	95	s. 641.792, F.S.; providing eligibility of health care 58
96	96	providers for the plan; prohibi ting patient care from 59
97	97	being affected by fee schedules and financial 60
98	98	incentives; providing requirements for the payment 61
99	99	system for noninstitutional providers; providing 62
100	100	requirements for the annual budgets for institutional 63
101	101	providers; prohibiting noninstitu tional and 64
102	102	institutional providers that accept payments from the 65
103	103	plan from billing patients; providing requirements for 66
104	104	capital expenditures by noninstitutional and 67
105	105	institutional providers which exceed a specified 68
106	106	amount; requiring the board to establish p ayment 69
107	107	criteria and payment methods for care coordination; 70
108	108	creating s. 641.793, F.S.; creating the Florida Health 71
109	109	Board by a specified date; providing purpose of the 72
110	110	board; providing board membership, terms, and 73
111	111	compensation; providing duties of the board; providing 74
112	112	reporting requirements; creating s. 641.794, F.S.; 75
113	113
114	114	HB 1603 2025
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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
122	122
123	123
124	124
125	125	requiring the Secretary of Health Care Administration 76
126	126	to designate health planning regions; providing 77
127	127	considerations for such designations; providing 78
128	128	requirements for regional planning boards; p roviding 79
129	129	board membership, terms, and first meetings with the 80
130	130	Florida Health Board; providing duties of the board; 81
131	131	creating s. 641.795, F.S.; creating the Office of 82
132	132	Health Quality and Planning; providing purpose and 83
133	133	duties of the office; authorizing the Fl orida Health 84
134	134	Board to convene advisory panels under certain 85
135	135	circumstances; creating s. 641.796, F.S.; providing 86
136	136	applicability of the Code of Ethics for Public 87
137	137	Officers and Employees; providing disciplinary actions 88
138	138	for failure to comply with the code of eth ics; 89
139	139	prohibiting certain persons from engaging in specified 90
140	140	acts or from being employed by specified entities; 91
141	141	creating the Conflict -of-Interest Committee; providing 92
142	142	duties of the committee; creating s. 641.797, F.S.; 93
143	143	creating the Ombudsman Office for Pati ent Advocacy; 94
144	144	providing purpose of the office; providing appointment 95
145	145	and qualifications of the ombudsman; providing duties 96
146	146	and authority of the ombudsman; providing that data 97
147	147	collected on plan enrollees in their complaints to the 98
148	148	ombudsman is private data; authorizing such data to be 99
149	149	released to certain persons and to the board for 100
150	150
151	151	HB 1603 2025
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153	153
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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
159	159
160	160
161	161
162	162	specified purposes; providing requirements for the 101
163	163	office budget; creating s. 641.798, F.S.; creating the 102
164	164	position of auditor for the plan; providing purpose, 103
165	165	appointment, and duties of the auditor; creating s. 104
166	166	641.799, F.S.; providing that the plan policies and 105
167	167	procedures are exempt from the Administrative 106
168	168	Procedure Act; providing procedures and requirements 107
169	169	for adoption of certain rules on plan policies and 108
170	170	procedures; requiring specified persons to regularly 109
171	171	update the Legislature on certain information; 110
172	172	providing a timeline for the operation of the plan; 111
173	173	prohibiting certain health insurance policies and 112
174	174	contracts from being sold in this state on and after a 113
175	175	specified date; requ iring an analysis of specified 114
176	176	capital expenditure needs; providing reporting 115
177	177	requirements; providing a contingent effective date. 116
178	178	117
179	179	Be It Enacted by the Legislature of the State of Florida: 118
180	180	119
181	181	Section 1. Part IV of chapter 641, Florida Statutes, 120
182	182	consisting of ss. 641.71 -641.799, Florida Statutes, is created 121
183	183	and entitled the "Healthy Florida Act." 122
184	184	Section 2. Section 641.71, Florida Statutes, is created to 123
185	185	read: 124
186	186	641.71 Short title. —This part may be cited as the "Florida 125
187	187
188	188	HB 1603 2025
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190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb1603-00
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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
196	196
197	197
198	198
199	199	Health Plan." 126
200	200	Section 3. Section 641.72, Florida Statutes, is created to 127
201	201	read: 128
202	202	641.72 Purpose.—The purpose of the Florida Health Plan is 129
203	203	to keep residents of this state healthy and to provide the best 130
204	204	quality of health care by: 131
205	205	(1) Ensuring that all residents of this state, regardless 132
206	206	of immigration status, are covered. 133
207	207	(2) Covering all necessary care, including dental; vision; 134
208	208	hearing; mental health; reproductive care, including abortion 135
209	209	services and prenatal and postpartum care; gender -affirming 136
210	210	health care, including med ication and treatment; substance use 137
211	211	disorder treatment; prescription drugs; durable medical 138
212	212	equipment and supplies; and long -term care and home care, 139
213	213	including long-term services and supports in home - and 140
214	214	community-based settings. 141
215	215	(3) Allowing patients to choose their health care 142
216	216	providers. 143
217	217	(4) Reducing costs by negotiating fair prices and cutting 144
218	218	administrative bureaucracy, through measures such as a global 145
219	219	budget approach to institutional providers, and not by 146
220	220	restricting or denying care. 147
221	221	(5) Being affordable to all patients through financing 148
222	222	based on a patient's ability to pay and the elimination of 149
223	223	premiums, copayments, deductibles, and out -of-pocket expenses at 150
224	224
225	225	HB 1603 2025
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228	228
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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
233	233
234	234
235	235
236	236	the point of service. 151
237	237	(6) Focusing on preventive care and early intervention to 152
238	238	improve health. 153
239	239	(7) Ensuring that there are enough health care providers 154
240	240	to guarantee timely access to care. 155
241	241	(8) Continuing this state's leadership in medical 156
242	242	education, research, and technology. 157
243	243	(9) Providing adequate and timely payments to health care 158
244	244	providers. 159
245	245	(10) Using a simple funding and payment system. 160
246	246	(11) Providing a just transition for a displaced workforce 161
247	247	affected by changes. 162
248	248	Section 4. Section 641.73, Florida Statutes, is created to 163
249	249	read: 164
250	250	641.73 Definitions. —As used in this part, the term: 165
251	251	(1) "Board" means the Florida Health Board established in 166
252	252	s. 641.793. 167
253	253	(2) "Institutional provider" means an inpatient hospital, 168
254	254	nursing facility, rehabilitation facility, or any other health 169
255	255	care facility that provides overnight care. 170
256	256	(3) "Medically necessary" means comprehensive services or 171
257	257	supplies needed to promote health and to prevent, diagnose, or 172
258	258	treat a particular patient's medical condition. The 173
259	259	comprehensive services and supplies must meet accepted standards 174
260	260	of medical practice wit hin a health care provider's professional 175
261	261
262	262	HB 1603 2025
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267	267	hb1603-00
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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
270	270
271	271
272	272
273	273	peer group. 176
274	274	(4) "Noninstitutional provider" means an individual 177
275	275	provider, group practice, clinic, outpatient surgical center, 178
276	276	imaging center, or any other health care facility that does not 179
277	277	provide overnight care . 180
278	278	(5) "Plan" means the Florida Health Plan established in s. 181
279	279	641.72. 182
280	280	(6) "Resident of this state" means an individual who has 183
281	281	had a principal place of domicile in this state for more than 6 184
282	282	consecutive months, who has registered to vote in this state, 185
283	283	who has made a statement of domicile pursuant to s. 222.17, or 186
284	284	who has filed for homestead tax exemption on property in this 187
285	285	state. 188
286	286	Section 5. Section 641.74, Florida Statutes, is created to 189
287	287	read: 190
288	288	641.74 Eligibility for and enrollment in the Florida 191
289	289	Health Plan.— 192
290	290	(1) ELIGIBILITY.— 193
291	291	(a) All residents of this state, regardless of immigration 194
292	292	status, are eligible for the Florida Health Plan. 195
293	293	(b) Coverage for emergency care for a resident of this 196
294	294	state which is obtained out of state must be at prevai ling local 197
295	295	rates where the care is provided. Coverage for nonemergency care 198
296	296	obtained out of state must be according to rates and conditions 199
297	297	established by the Florida Health Board. The board may require 200
298	298
299	299	HB 1603 2025
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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
307	307
308	308
309	309
310	310	that a resident of this state be transported back to this state 201
311	311	when prolonged treatment of an emergency condition is necessary 202
312	312	and when that transport will not adversely affect the patient's 203
313	313	care or condition. 204
314	314	(c) A nonresident visiting this state shall be billed by 205
315	315	the board for all services received und er the plan. The board 206
316	316	may enter into intergovernmental arrangements or contracts with 207
317	317	other states and foreign countries to provide reciprocal 208
318	318	coverage for temporary visitors. 209
319	319	(d) The board shall extend eligibility to nonresidents 210
320	320	employed in this state under a premium schedule set by the 211
321	321	board. 212
322	322	(e) For a business outside of this state which employs 213
323	323	residents of this state, the board shall apply for a federal 214
324	324	waiver to collect the employer contribution mandated by federal 215
325	325	law. 216
326	326	(f) A retiree who is covered under the plan and who elects 217
327	327	to reside outside of this state is eligible for benefits under 218
328	328	the terms and conditions of the retiree's employer -employee 219
329	329	contract. 220
330	330	(g) The board may establish financial arrangements with 221
331	331	other states and foreign co untries in order to facilitate 222
332	332	meeting the terms of the contracts described in paragraph (f). 223
333	333	Payments for care provided by non -Florida health care providers 224
334	334	to retirees who are covered under the plan shall be reimbursed 225
335	335
336	336	HB 1603 2025
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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
346	346
347	347	at rates established by the board. Health care providers who 226
348	348	accept any payment from the plan for a covered service may not 227
349	349	bill the patient for the covered service. 228
350	350	(h)1. A person is presumed eligible for coverage under the 229
351	351	plan, and a health care provider shall provide health care 230
352	352	services as if the person is eligible for coverage under the 231
353	353	plan, if the person: 232
354	354	a. Is a minor; 233
355	355	b. Arrives at a health care facility unconscious, 234
356	356	comatose, or otherwise unable to document eligibility or to act 235
357	357	on the person's own behalf because of the pers on's physical or 236
358	358	mental condition; or 237
359	359	c. Is involuntarily committed to an acute psychiatric 238
360	360	facility or to a hospital with psychiatric beds which provides 239
361	361	for involuntary commitment. 240
362	362	2. All health care facilities subject to state and federal 241
363	363	provisions governing emergency medical treatment must comply 242
364	364	with subparagraph 1. 243
365	365	(2) ENROLLMENT.— 244
366	366	(a) The board shall establish a procedure to enroll 245
367	367	residents of this state and provide each with identification 246
368	368	that may be used by health care providers to confi rm eligibility 247
369	369	for services. The application for enrollment may not be more 248
370	370	than two pages. 249
371	371	(b) Data collected from a person through application for 250
372	372
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380	380	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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384	384	and enrollment in the plan is private data; however, the data 251
385	385	may be released to: 252
386	386	1. A health care provider for purposes of confirming 253
387	387	enrollment and processing payments for benefits. 254
388	388	2. The ombudsman of the Ombudsman Office for Patient 255
389	389	Advocacy and the auditor for the Florida Health Plan for 256
390	390	purposes of performing their duties under ss. 641.797 and 257
391	391	641.798, respectively. 258
392	392	Section 6. Section 641.755, Florida Statutes, is created 259
393	393	to read: 260
394	394	641.755 Benefits.— 261
395	395	(1) A person covered under the Florida Health Plan may 262
396	396	choose to receive services from any qualified, licensed health 263
397	397	care provider that part icipates in the plan. 264
398	398	(2) Except for the exclusions provided in subsection (4), 265
399	399	covered health care benefits under the plan include all 266
400	400	prescribed medically necessary care, which includes: 267
401	401	(a) Inpatient and outpatient health care facility 268
402	402	services. 269
403	403	(b) Inpatient and outpatient licensed health care provider 270
404	404	services. 271
405	405	(c) Diagnostic imaging, laboratory services, and other 272
406	406	diagnostic and evaluative services. 273
407	407	(d) Durable medical equipment, appliances, and assistive 274
408	408	technology, including, but not limit ed to, prescribed 275
409	409
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417	417	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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419	419
420	420
421	421	prosthetics, eye care, and hearing aids and their repair, 276
422	422	technical support, and customization required for individual 277
423	423	use. 278
424	424	(e) Inpatient and outpatient rehabilitative care. 279
425	425	(f) Emergency care services. 280
426	426	(g) Necessary transportation for health care services: 281
427	427	1. As covered under Medicaid or Medicare; or 282
428	428	2. For persons with disabilities, older persons with 283
429	429	functional limitations, and low -income persons. 284
430	430	(h) Child and adult immunizations and preventive care. 285
431	431	(i) Health and wellne ss education for chronic or 286
432	432	preventative care as provided by licensed health care providers. 287
433	433	(j) Reproductive health care, including abortion services, 288
434	434	contraceptives, and prenatal and postpartum care. 289
435	435	(k) Childbirth and maternity care, including doula 290
436	436	services and care in freestanding childbirth centers. 291
437	437	(l) Gender-affirming health care, including medication and 292
438	438	treatment. 293
439	439	(m) Holistic licensed health care services such as 294
440	440	chiropractic, acupressure, acupuncture, massage, and nutritional 295
441	441	services. 296
442	442	(n) Mental health services, including substance use 297
443	443	disorder treatment, services in substance use disorder treatment 298
444	444	facilities, and mental health care provided by licensed or 299
445	445	certified mental health providers such as licensed 300
446	446
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454	454	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
455	455
456	456
457	457
458	458	psychologists, licensed ment al health counselors, licensed 301
459	459	professional counselors, licensed clinical social workers, 302
460	460	certified master social workers, rehabilitation support service 303
461	461	providers, and any providers that the board deems eligible. 304
462	462	(o) Dental care, including diagnostics a nd restoration and 305
463	463	durable equipment such as braces and mouthguards. 306
464	464	(p) Vision care. 307
465	465	(q) Hearing care. 308
466	466	(r) Prescription drugs. 309
467	467	(s) Podiatric care. 310
468	468	(t) Therapies that are shown by the National Institutes of 311
469	469	Health National Center for Complementar y and Integrative Health 312
470	470	to be safe and effective. 313
471	471	(u) Blood and blood products. 314
472	472	(v) Dialysis. 315
473	473	(w) Licensed qualified adult day care. 316
474	474	(x) Rehabilitative and habilitative services. 317
475	475	(y) Ancillary health care or social services previously 318
476	476	covered by this state's qualified public health programs. 319
477	477	(z) Case management and care coordination. 320
478	478	(aa) Language interpretation and translation for health 321
479	479	care services, including sign language and Braille or other 322
480	480	services needed for persons with communication barriers. 323
481	481	(bb) Services provided by qualified community health 324
482	482	workers. 325
483	483
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491	491	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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495	495	(cc) Health care and long -term supportive services, 326
496	496	including in a home or community -based setting, assisted living 327
497	497	facility, and nursing home, with home health care providers, 328
498	498	home health aides, and palliative and hospice care. 329
499	499	(dd) Any item or service described in this subsection which 330
500	500	is furnished using telehealth, to the extent practicable. 331
501	501	(3) The Florida Health Board may expand health care 332
502	502	benefits beyond the minimum benefits described in subsection (2) 333
503	503	if the expansion meets the intent of this part and when there 334
504	504	are sufficient funds to cover the expansion. 335
505	505	(4) The following health care services are excluded from 336
506	506	coverage by the plan: 337
507	507	(a) Treatments and pr ocedures primarily for cosmetic 338
508	508	purposes, unless required to correct a congenital defect or to 339
509	509	restore or correct a part of the body that has been altered as a 340
510	510	result of an injury, a disease, or a surgery or unless 341
511	511	determined to be medically necessary by a qualified, licensed 342
512	512	health care provider in the plan. 343
513	513	(b) Services of a health care provider or facility that is 344
514	514	not licensed, certified, or accredited by this state. The 345
515	515	licensure, certification, or accreditation requirements do not 346
516	516	apply to health care providers or facilities that provide 347
517	517	services to residents of this state who require medical 348
518	518	attention while traveling out of state. 349
519	519	(5)(a) All plan enrollees must have a primary care 350
520	520
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528	528	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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530	530
531	531
532	532	provider and must have access to care coordination. 351
533	533	(b) A plan enrollee does not need a referral to see a 352
534	534	health care specialist. 353
535	535	(c) The board may establish a computerized registry to 354
536	536	assist patients in identifying appropriate providers, and the 355
537	537	plan may assist an enrollee with choosing a primary care 356
538	538	provider if the enrollee so chooses. 357
539	539	(6) The plan may not impose a deductible, copayment, 358
540	540	coinsurance, or any other cost -sharing requirement on an 359
541	541	enrollee with respect to a covered benefit. 360
542	542	Section 7. Section 641.77, Florida Statutes, is created to 361
543	543	read: 362
544	544	641.77 Federal preemption.— 363
545	545	(1) The Florida Health Board shall secure a repeal or a 364
546	546	waiver of any provision of federal law that preempts any 365
547	547	provision of this part. The Department of Health and the Agency 366
548	548	for Health Care Administration shall provide all necessa ry 367
549	549	assistance to the board to secure any repeal or waiver. 368
550	550	(2)(a) The board shall, under the section 1332 waivers of 369
551	551	the Patient Protection and Affordable Care Act, request to 370
552	552	repeal or waive any of the following provisions to the extent 371
553	553	necessary to implement this part: 372
554	554	1. Title 42 of the United States Code, ss. 18021 -18024. 373
555	555	2. Title 42 of the United States Code, ss. 18031 -18033. 374
556	556	3. Title 42 of the United States Code, s. 18071. 375
557	557
558	558	HB 1603 2025
559	559
560	560
561	561
562	562	CODING: Words stricken are deletions; words underlined are additions.
563	563	hb1603-00
564	564	Page 16 of 43
565	565	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
566	566
567	567
568	568
569	569	4. Section 5000A of the Internal Revenue Code of 1986, as 376
570	570	amended. 377
571	571	(b) If a repeal or a waiver of a federal law or regulation 378
572	572	cannot be secured, the board shall adopt rules, or seek 379
573	573	conforming state legislation, consistent with federal law, in an 380
574	574	effort to best fulfill the purposes of this part. 381
575	575	(c) The Florida Health Pl an's responsibility for providing 382
576	576	health care is secondary to existing Federal Government programs 383
577	577	for health care services to the extent that funding for these 384
578	578	programs is not transferred or that the transfer is delayed 385
579	579	beyond the date on which initial be nefits are provided under the 386
580	580	plan. 387
581	581	Section 8. Section 641.78, Florida Statutes, is created to 388
582	582	read: 389
583	583	641.78 Subrogation. — 390
584	584	(1)(a) As used in this section, the term "collateral 391
585	585	source" includes: 392
586	586	1. A health insurance policy, health maintenance contract, 393
587	587	continuing care contract, and prepaid health clinic contract, 394
588	588	and the medical components of motor vehicle insurance, 395
589	589	homeowner's insurance, and other forms of insurance. 396
590	590	2. The medical components of worker's compensation. 397
591	591	3. A pension plan an d retiree health care benefits. 398
592	592	4. An employer plan. 399
593	593	5. An employee benefit contract. 400
594	594
595	595	HB 1603 2025
596	596
597	597
598	598
599	599	CODING: Words stricken are deletions; words underlined are additions.
600	600	hb1603-00
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602	602	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
603	603
604	604
605	605
606	606	6. A government benefit program. 401
607	607	7. A judgment for damages for personal injury. 402
608	608	8. The state of last domicile for individuals moving to 403
609	609	Florida for medical care who have extraordinary medical needs. 404
610	610	9. Any third party who is or may be liable to an 405
611	611	individual for health care services or costs. 406
612	612	(b) The term does not include: 407
613	613	1. A contract or plan that is subject to federal 408
614	614	preemption. 409
615	615	2. Any governmental un it, agency, or service to the extent 410
616	616	that subrogation is prohibited by law. An entity described in 411
617	617	paragraph (a) is not excluded from the obligations imposed by 412
618	618	this section by virtue of a contract or relationship with a 413
619	619	governmental unit, agency, or servi ce. 414
620	620	(2) When other payers for health care have been 415
621	621	terminated, the plan shall collect health care costs from a 416
622	622	collateral source if health care services provided to a patient 417
623	623	are, or may be, covered services under the collateral source 418
624	624	available to the patient, or if the patient has a right of 419
625	625	action for compensation permitted under law. 420
626	626	(3) The board shall negotiate waivers, seek federal 421
627	627	legislation, or make other arrangements to incorporate 422
628	628	collateral sources into the plan. 423
629	629	(4) If a person who rece ives health care services under 424
630	630	the plan is entitled to coverage, reimbursement, indemnity, or 425
631	631
632	632	HB 1603 2025
633	633
634	634
635	635
636	636	CODING: Words stricken are deletions; words underlined are additions.
637	637	hb1603-00
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639	639	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
640	640
641	641
642	642
643	643	other compensation from a collateral source, the person must 426
644	644	notify the health care provider and provide information 427
645	645	identifying the collateral source, the natur e and extent of 428
646	646	coverage or entitlement, and other relevant information. The 429
647	647	health care provider shall forward this information to the 430
648	648	board. The person entitled to coverage, reimbursement, 431
649	649	indemnity, or other compensation from a collateral source must 432
650	650	provide additional information as requested by the board. 433
651	651	(a) The plan shall seek reimbursement from the collateral 434
652	652	source for services provided to the person and may take 435
653	653	appropriate action, including legal proceedings, to recover the 436
654	654	reimbursement. Upon demand, the collateral source shall pay the 437
655	655	sum that it would have paid or spent on behalf of the person for 438
656	656	the health care services provided by the plan. 439
657	657	(b) In addition to any other right to recovery provided in 440
658	658	this section, the board has the same ri ght to recover the 441
659	659	reasonable value of health care benefits from the collateral 442
660	660	source. 443
661	661	(c) If the collateral source is exempt from subrogation or 444
662	662	the obligation to reimburse the plan, the board may require that 445
663	663	the person who is entitled to health care services from the 446
664	664	collateral source first seek those services from the collateral 447
665	665	source before seeking the services from the plan. 448
666	666	(5) To the extent permitted by federal law, the board has 449
667	667	the same right of subrogation over contractual retiree health 450
668	668
669	669	HB 1603 2025
670	670
671	671
672	672
673	673	CODING: Words stricken are deletions; words underlined are additions.
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676	676	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
677	677
678	678
679	679
680	680	care benefits provided by employers as other contracts allowing 451
681	681	the plan to recover the cost of health care services provided to 452
682	682	a person covered by the retiree health care benefits, unless 453
683	683	arrangements are made to transfer the revenues of the health 454
684	684	care benefits directly to the plan. 455
685	685	Section 9. Section 641.791, Florida Statutes, is created 456
686	686	to read: 457
687	687	641.791 Defaults, underpayments, and late payments. — 458
688	688	(1) Defaults, underpayments, or late payments of any 459
689	689	premium or other obligation imposed by this p art shall result in 460
690	690	the remedies and penalties provided by law, except as provided 461
691	691	in this part. 462
692	692	(2) Eligibility for health care benefits may not be 463
693	693	impaired by any default, underpayment, or late payment of any 464
694	694	premium or other obligation imposed by this part. 465
695	695	Section 10. Section 641.792, Florida Statutes, is created 466
696	696	to read: 467
697	697	641.792 Provider payments. — 468
698	698	(1) All health care providers licensed to practice in this 469
699	699	state may participate in the Florida Health Plan. The Florida 470
700	700	Health Board may determin e the eligibility of any other health 471
701	701	care providers to participate in the plan. 472
702	702	(a) A participating health care provider shall comply with 473
703	703	all federal laws and regulations governing referral fees and fee 474
704	704	splitting, including, but not limited to, 42 U.S. C. ss. 1320a-7b 475
705	705
706	706	HB 1603 2025
707	707
708	708
709	709
710	710	CODING: Words stricken are deletions; words underlined are additions.
711	711	hb1603-00
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713	713	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
714	714
715	715
716	716
717	717	and 1395nn, whether reimbursed by federal funds or not. 476
718	718	(b) A fee schedule or financial incentive may not 477
719	719	adversely affect the care a patient receives or the care a 478
720	720	health provider recommends. 479
721	721	(2) The board shall establish and oversee a fair and 480
722	722	efficient payment system for noninstitutional providers. 481
723	723	(a) The board shall pay noninstitutional providers based 482
724	724	on rates negotiated with noninstitutional providers. The rates 483
725	725	must take into account the need to address the shortage of 484
726	726	noninstitutional providers. 485
727	727	(b) Noninstitutional providers that accept any payment 486
728	728	from the plan for a covered health care service may not bill the 487
729	729	patient for the covered health care service. 488
730	730	(c) Noninstitutional providers shall be paid within 30 489
731	731	business days for claims filed following procedures established 490
732	732	by the board. 491
733	733	(3) The board shall set an annual budget for each 492
734	734	institutional provider, which consists of an operating and a 493
735	735	capital budget, to cover the institutional provider's 494
736	736	anticipated health c are services for the following year based on 495
737	737	past performance and projected changes in prices and health care 496
738	738	service levels. 497
739	739	(a) The annual budget for each individual institutional 498
740	740	provider must be set separately. The board may not set a joint 499
741	741	budget for a group of more than one institutional provider nor 500
742	742
743	743	HB 1603 2025
744	744
745	745
746	746
747	747	CODING: Words stricken are deletions; words underlined are additions.
748	748	hb1603-00
749	749	Page 21 of 43
750	750	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
751	751
752	752
753	753
754	754	for a parent corporation that owns or operates one or more 501
755	755	institutional providers. 502
756	756	(b) Institutional providers that accept any payment from 503
757	757	the plan for a covered health care service may not bill th e 504
758	758	patient for the covered health care service. 505
759	759	(4)(a) The board shall periodically develop a capital 506
760	760	investment plan that will serve as a guide in determining the 507
761	761	annual budgets of institutional providers and in deciding 508
762	762	whether to approve applications f or approval of capital 509
763	763	expenditures by noninstitutional providers. 510
764	764	(b) Institutional and noninstitutional providers that 511
765	765	propose to make capital purchases in excess of $500,000 must 512
766	766	obtain board approval. The board may alter the threshold 513
767	767	expenditure level that triggers the requirement to submit 514
768	768	information on capital expenditures. Institutional providers 515
769	769	must propose these expenditures and submit the required 516
770	770	information as part of the annual budget they submit to the 517
771	771	board. Noninstitutional providers m ust apply to the board for 518
772	772	approval of these expenditures. The board must respond to 519
773	773	capital expenditure applications in a timely manner. 520
774	774	(5) The board shall establish payment criteria and payment 521
775	775	methods for care coordination for patients, especially th ose 522
776	776	with chronic illness and complex medical needs. 523
777	777	Section 11. Section 641.793, Florida Statutes, is created 524
778	778	to read: 525
779	779
780	780	HB 1603 2025
781	781
782	782
783	783
784	784	CODING: Words stricken are deletions; words underlined are additions.
785	785	hb1603-00
786	786	Page 22 of 43
787	787	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
788	788
789	789
790	790
791	791	641.793 Florida Health Board. — 526
792	792	(1) By December 1, 2025, the Florida Health Board shall be 527
793	793	established to promote the delivery of high-quality, coordinated 528
794	794	health care services that enhance health; prevent illness, 529
795	795	disease, and disability; slow the progression of chronic 530
796	796	diseases; and improve personal health management. The board 531
797	797	shall administer the Florida Health Plan. The board sh all 532
798	798	oversee the Office of Health Quality and Planning established in 533
799	799	s. 641.795. 534
800	800	(2)(a) The board shall consist of at least 15 members, 535
801	801	including the representatives selected by the regional planning 536
802	802	boards established in s. 641.794. These representative s shall 537
803	803	appoint the following additional members to serve on the board: 538
804	804	1. One patient member and one employer member. 539
805	805	2. Seven representatives of labor organizations who 540
806	806	represent health care workers or social workers. 541
807	807	3. Five health care provider m embers that include one 542
808	808	physician, one registered nurse, one mental health provider, one 543
809	809	dentist, and one health care facility director. 544
810	810	(b) Each member shall take the oath of office to uphold 545
811	811	the Constitution of the United States and the Constitution of 546
812	812	the State of Florida and to operate the plan in the public 547
813	813	interest by upholding the underlying principles of this part. 548
814	814	(c) Board members shall serve 4 years; however, for the 549
815	815	purpose of providing staggered terms, of the initial 550
816	816
817	817	HB 1603 2025
818	818
819	819
820	820
821	821	CODING: Words stricken are deletions; words underlined are additions.
822	822	hb1603-00
823	823	Page 23 of 43
824	824	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
825	825
826	826
827	827
828	828	appointments, those mem bers appointed by the representatives of 551
829	829	regional planning boards shall serve 2 -year terms. 552
830	830	(d) Board members shall set the board's compensation, not 553
831	831	to exceed the compensation of the Florida Public Service 554
832	832	Commission members. The board shall select the chair from among 555
833	833	its membership. 556
834	834	(e)1. A board member may be removed by a two -thirds vote 557
835	835	of the members voting on removal. After receiving notice and 558
836	836	hearing, a member may be removed for malfeasance or nonfeasance 559
837	837	in performance of the member's duties. 560
838	838	2. Conviction of any criminal behavior, regardless of how 561
839	839	much time has lapsed, is grounds for immediate removal. 562
840	840	(3) The board shall: 563
841	841	(a) Ensure that all of the requirements of the plan are 564
842	842	met. 565
843	843	(b) Hire a chief executive officer for the plan, wh o must 566
844	844	take the oath described in paragraph (2)(b). 567
845	845	(c) Hire a director for the Office of Health Quality and 568
846	846	Planning, who must take the oath described in paragraph (2)(b). 569
847	847	(d) Provide technical assistance to the regional planning 570
848	848	boards established in s. 641.794. 571
849	849	(e) Conduct investigations and inquiries and require the 572
850	850	submission of information, documents, and records that the board 573
851	851	considers necessary to carry out the purposes of this part. 574
852	852	(f) Establish a process for the board to receive concerns, 575
853	853
854	854	HB 1603 2025
855	855
856	856
857	857
858	858	CODING: Words stricken are deletions; words underlined are additions.
859	859	hb1603-00
860	860	Page 24 of 43
861	861	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
862	862
863	863
864	864
865	865	opinions, ideas, and recommendations of the public regarding all 576
866	866	aspects of the plan and the means of addressing those concerns. 577
867	867	(g) Conduct activities the board considers necessary to 578
868	868	carry out the purposes of this part. 579
869	869	(h) Collaborate with the Department of Health and with the 580
870	870	Agency for Health Care Administration, which licenses health 581
871	871	care facilities, to ensure that facility performance is 582
872	872	monitored and deficient practices are recognized a nd corrected 583
873	873	in a timely manner. 584
874	874	(i) Establish conflict -of-interest standards that prohibit 585
875	875	health care providers from receiving financial benefit from 586
876	876	their medical decisions outside of board reimbursement, 587
877	877	including any financial benefit for referring a patient for a 588
878	878	service, product, or health care provider or for prescribing, 589
879	879	ordering, or recommending a drug, product, or service. 590
880	880	(j) Establish conflict -of-interest standards related to 591
881	881	pharmaceuticals and medical equipment, supplies, and devices, 592
882	882	and their marketing to a health care provider, so that the 593
883	883	health care provider does not receive any incentive to 594
884	884	prescribe, administer, or use a product or service. 595
885	885	(k) Require all electronic health records used by health 596
886	886	care providers to be fully interoperable with the open source 597
887	887	electronic health records system used by the United States 598
888	888	Department of Veterans Affairs. 599
889	889	(l) Provide financial help and assistance in retraining 600
890	890
891	891	HB 1603 2025
892	892
893	893
894	894
895	895	CODING: Words stricken are deletions; words underlined are additions.
896	896	hb1603-00
897	897	Page 25 of 43
898	898	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
899	899
900	900
901	901
902	902	and job placement to workers in this state who may be displaced 601
903	903	because of the administrative efficiencies of the plan. 602
904	904	(m) Ensure that assistance is provided to all workers and 603
905	905	communities that may be affected by provisions in this part. 604
906	906	(n) Work with the Department of Commerce to ensure that 605
907	907	funding and program services are promptly and efficiently 606
908	908	provided to all affected workers. The Department of Commerce 607
909	909	shall monitor and report on a regular basis on the status of 608
910	910	displaced workers. 609
911	911	(o) Adopt rules, policies, and procedures as necessary to 610
912	912	carry out the duties assig ned under this part. 611
913	913	(4) Before submitting a waiver application under section 612
914	914	1332 of the Patient Protection and Affordable Care Act, the 613
915	915	board must do all of the following, as required by federal law: 614
916	916	(a) Conduct, or contract for, any actuarial analys es and 615
917	917	actuarial certifications necessary to support the board's 616
918	918	estimates that the waiver will comply with the comprehensive 617
919	919	coverage, affordability, and scope of coverage requirements in 618
920	920	federal law. 619
921	921	(b) Conduct or contract for any necessary economic 620
922	922	analyses needed to support the board's estimates that the waiver 621
923	923	will comply with the comprehensive coverage, affordability, 622
924	924	scope of coverage, and federal deficit requirements in federal 623
925	925	law. These analyses must include: 624
926	926	1. A detailed 10-year budget plan. 625
927	927
928	928	HB 1603 2025
929	929
930	930
931	931
932	932	CODING: Words stricken are deletions; words underlined are additions.
933	933	hb1603-00
934	934	Page 26 of 43
935	935	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
936	936
937	937
938	938
939	939	2. A detailed analysis regarding the estimated impact of 626
940	940	the waiver on health insurance coverage in this state. 627
941	941	(c) Establish a detailed draft implementation timeline for 628
942	942	the waiver plan. 629
943	943	(d) Establish quarterly, annual, and cumulative targets 630
944	944	for the comprehensive coverage, affordability, scope of 631
945	945	coverage, and federal deficit requirements in federal law. 632
946	946	(5) The board has the following financial duties: 633
947	947	(a) Approve statewide and regional budgets. 634
948	948	(b) Negotiate and establish payment rates for health care 635
949	949	providers through their professional associations. 636
950	950	(c) Monitor compliance with all budgets and payment rates 637
951	951	and take action to achieve compliance to the extent authorized 638
952	952	by law. 639
953	953	(d) Pay claims for medical products or services as 640
954	954	negotiated and, if deemed necessary, issue requests for 641
955	955	proposals from nonprofit business corporations in this state for 642
956	956	a contract to process claims. 643
957	957	(e) Seek federal approval to bill another state for health 644
958	958	care coverage provided to a patient from out of stat e who comes 645
959	959	to this state for long -term care or other costly treatment when 646
960	960	the patient's home state fails to provide such coverage, unless 647
961	961	a reciprocal agreement with the patient's home state to provide 648
962	962	similar coverage to residents of this state relocati ng to that 649
963	963	state can be negotiated. 650
964	964
965	965	HB 1603 2025
966	966
967	967
968	968
969	969	CODING: Words stricken are deletions; words underlined are additions.
970	970	hb1603-00
971	971	Page 27 of 43
972	972	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
973	973
974	974
975	975
976	976	(f) Implement fraud prevention measures necessary to 651
977	977	protect the operation of the plan. 652
978	978	(g) Work to ensure appropriate cost control by: 653
979	979	1. Instituting aggressive public health measures, early 654
980	980	intervention and preve ntive care, health and wellness education, 655
981	981	and promotion of personal health improvement. 656
982	982	2. Making changes in the delivery of health care services 657
983	983	and administration that improve efficiency and care quality. 658
984	984	3. Minimizing administrative costs. 659
985	985	4. Ensuring that the delivery system does not contain 660
986	986	excess capacity. 661
987	987	5. Negotiating the lowest possible prices for prescription 662
988	988	drugs, medical equipment, and health care services. 663
989	989	(6) The board has the following management duties: 664
990	990	(a) Develop and implement enrollment procedures for the 665
991	991	plan. 666
992	992	(b) Implement and review eligibility standards for the 667
993	993	plan. 668
994	994	(c) Arrange for health care services to be provided at 669
995	995	convenient locations to serve communities in need in the same 670
996	996	manner as federally qualifie d health centers, including ensuring 671
997	997	the availability of school nurses so that all students have 672
998	998	access to health care, immunizations, and preventive care at 673
999	999	public schools and encouraging health care providers to provide 674
1000	1000	services at easily accessible loca tions. 675
1001	1001
1002	1002	HB 1603 2025
1003	1003
1004	1004
1005	1005
1006	1006	CODING: Words stricken are deletions; words underlined are additions.
1007	1007	hb1603-00
1008	1008	Page 28 of 43
1009	1009	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
1010	1010
1011	1011
1012	1012
1013	1013	(d) Make recommendations, when needed, to the Legislature 676
1014	1014	about changes in the geographic boundaries of the health 677
1015	1015	planning regions. 678
1016	1016	(e) Establish an electronic claim and payment system for 679
1017	1017	the plan. 680
1018	1018	(f) Monitor the operation of the plan throu gh consumer 681
1019	1019	surveys and regular data collection and evaluation activities, 682
1020	1020	including evaluations of the adequacy and quality of services 683
1021	1021	provided under the plan, the need for changes in the benefit 684
1022	1022	package, the cost of each type of service, and the effecti veness 685
1023	1023	of cost control measures under the plan. 686
1024	1024	(g) Disseminate information and establish a health care 687
1025	1025	website to provide information to the public about the plan, 688
1026	1026	including health care providers and facilities, and state and 689
1027	1027	regional planning board mee tings and activities. 690
1028	1028	(h) Collaborate with public health agencies, schools, and 691
1029	1029	community clinics. 692
1030	1030	(i) Ensure that plan policies and health care providers, 693
1031	1031	including public health care providers, support all residents of 694
1032	1032	this state in achieving and mai ntaining maximum physical and 695
1033	1033	mental health. 696
1034	1034	(7) The board, in conjunction with the office and 697
1035	1035	administrative staff of the plan's chief executive officer, has 698
1036	1036	the following policy duties: 699
1037	1037	(a) Develop and implement cost control and quality 700
1038	1038
1039	1039	HB 1603 2025
1040	1040
1041	1041
1042	1042
1043	1043	CODING: Words stricken are deletions; words underlined are additions.
1044	1044	hb1603-00
1045	1045	Page 29 of 43
1046	1046	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
1047	1047
1048	1048
1049	1049
1050	1050	assurance procedures. 701
1051	1051	(b) Ensure strong public health services, including 702
1052	1052	education and community prevention and clinical services. 703
1053	1053	(c) Ensure a continuum of coordinated high -quality primary 704
1054	1054	to tertiary care to all residents of this state. 705
1055	1055	(d) Implement policies to ensure that all residents of 706
1056	1056	this state receive culturally and linguistically competent care. 707
1057	1057	(8) The board shall determine the feasibility of self -708
1058	1058	insuring health care providers for malpractice and shall 709
1059	1059	establish a self-insurance system and create a special fund for 710
1060	1060	payment of losses incurred if the board determines self -insuring 711
1061	1061	health care providers would reduce costs. 712
1062	1062	(9) By July 1 of each year, the board shall report to the 713
1063	1063	President of the Senate, the Speaker of the House of 714
1064	1064	Representatives, and ranking members of the committees having 715
1065	1065	cognizance over health care issues on: 716
1066	1066	(a) The performance of the plan. 717
1067	1067	(b) The fiscal condition and need for payment adjustment. 718
1068	1068	(c) Any needed changes in geographic boundaries of the 719
1069	1069	health planning regio ns. 720
1070	1070	(d) Any recommendations for statutory changes. 721
1071	1071	(e) Receipts of revenues from all sources. 722
1072	1072	(f) Whether current year goals and priorities are met. 723
1073	1073	(g) Future goals and priorities. 724
1074	1074	(h) Major new technology and prescription drugs. 725
1075	1075
1076	1076	HB 1603 2025
1077	1077
1078	1078
1079	1079
1080	1080	CODING: Words stricken are deletions; words underlined are additions.
1081	1081	hb1603-00
1082	1082	Page 30 of 43
1083	1083	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
1084	1084
1085	1085
1086	1086
1087	1087	(i) Other circumstances that may affect the cost or 726
1088	1088	quality of health care. 727
1089	1089	Section 12. Section 641.794, Florida Statutes, is created 728
1090	1090	to read: 729
1091	1091	641.794 Health planning regions. — 730
1092	1092	(1) By August 1, 2025, the Secretary of Health Care 731
1093	1093	Administration shall designate health planning regions within 732
1094	1094	this state which are composed of geographically contiguous areas 733
1095	1095	grouped on the basis of the following considerations: 734
1096	1096	(a) Patterns of use of health care services. 735
1097	1097	(b) Health care resources, including workforce resources. 736
1098	1098	(c) Health care needs of the population, including public 737
1099	1099	health needs. 738
1100	1100	(d) Geography. 739
1101	1101	(e) Population and demographic characteristics. 740
1102	1102	(f) Other considerations the board deems appropriate. 741
1103	1103	(2) Each health planning region is administere d by a 742
1104	1104	regional planning board. A minimum of eight regional planning 743
1105	1105	boards shall be created, and all regional planning boards shall 744
1106	1106	be created by October 1, 2025. 745
1107	1107	(a) Each regional planning board shall consist of: 746
1108	1108	1. One county commissioner per county , selected by the 747
1109	1109	county commission for each health planning region consisting of 748
1110	1110	at least five counties; or 749
1111	1111	2. Three county commissioners per county, selected by the 750
1112	1112
1113	1113	HB 1603 2025
1114	1114
1115	1115
1116	1116
1117	1117	CODING: Words stricken are deletions; words underlined are additions.
1118	1118	hb1603-00
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1120	1120	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
1121	1121
1122	1122
1123	1123
1124	1124	county commission for each health planning region consisting of 751
1125	1125	four counties or less. 752
1126	1126	(b) A county commission may designate a representative to 753
1127	1127	act as a member of the regional planning board in the member's 754
1128	1128	absence. 755
1129	1129	(c) Each regional planning board shall select the chair 756
1130	1130	from among its membership. 757
1131	1131	(d) Regional planning board members shall serve for 4-year 758
1132	1132	terms; however, for the purpose of providing staggered terms, of 759
1133	1133	the initial appointments, at least half of the board members 760
1134	1134	shall be appointed to 2 -year terms. Board members may receive 761
1135	1135	per diem for meetings. 762
1136	1136	(e) The Secretary of Health Care Administration, or his or 763
1137	1137	her designee, shall convene the first meeting of each regional 764
1138	1138	planning board with the Florida Health Board within 30 days 765
1139	1139	after the regional planning board is established. 766
1140	1140	(3) A regional planning board's duties sha ll consist of: 767
1141	1141	(a) Recommending health standards, goals, priorities, and 768
1142	1142	guidelines for the health planning region. 769
1143	1143	(b) Preparing an operating and capital budget for the 770
1144	1144	health planning region to recommend to the Florida Health Board. 771
1145	1145	(c) Collaborating with local public health care agencies 772
1146	1146	to: 773
1147	1147	1. Educate consumers and health care providers on public 774
1148	1148	health programs, goals, and the means of reaching those goals. 775
1149	1149
1150	1150	HB 1603 2025
1151	1151
1152	1152
1153	1153
1154	1154	CODING: Words stricken are deletions; words underlined are additions.
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1157	1157	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
1158	1158
1159	1159
1160	1160
1161	1161	2. Implement public health and wellness initiatives. 776
1162	1162	(d) Hiring a regional health pl anning director. 777
1163	1163	(e) Ensuring that all parts of the health planning region 778
1164	1164	have access to a 24-hour nurse hotline and to 24 -hour urgent 779
1165	1165	care clinics. 780
1166	1166	Section 13. Section 641.795, Florida Statutes, is created 781
1167	1167	to read: 782
1168	1168	641.795 Office of Health Qualit y and Planning.—The Florida 783
1169	1169	Health Board shall establish the Office of Health Quality and 784
1170	1170	Planning to assess the quality, access, and funding adequacy of 785
1171	1171	the Florida Health Plan. The Office of Health Quality and 786
1172	1172	Planning shall: 787
1173	1173	(1) Make annual recommenda tions to the board on the 788
1174	1174	overall direction of the plan on the following subjects: 789
1175	1175	(a) Overall effectiveness of the plan in addressing public 790
1176	1176	health and wellness. 791
1177	1177	(b) Access to health care. 792
1178	1178	(c) Quality improvement. 793
1179	1179	(d) Efficiency of administration. 794
1180	1180	(e) Adequacy of the budget and funding. 795
1181	1181	(f) Appropriateness of payments to health care providers. 796
1182	1182	(g) Capital expenditure needs. 797
1183	1183	(h) Long-term health care. 798
1184	1184	(i) Mental health and substance abuse services. 799
1185	1185	(j) Staffing levels and working conditions in health care 800
1186	1186
1187	1187	HB 1603 2025
1188	1188
1189	1189
1190	1190
1191	1191	CODING: Words stricken are deletions; words underlined are additions.
1192	1192	hb1603-00
1193	1193	Page 33 of 43
1194	1194	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
1195	1195
1196	1196
1197	1197
1198	1198	facilities. 801
1199	1199	(k) Identification of the number and mix of health care 802
1200	1200	facilities and providers necessary to meet the needs of the 803
1201	1201	plan. 804
1202	1202	(l) Care for chronically ill patients. 805
1203	1203	(m) Health care provider training on promoting the use of 806
1204	1204	advance directives with patients to enable patients to obtain 807
1205	1205	the health care of their choice. 808
1206	1206	(n) Research needs. 809
1207	1207	(o) Integration of disease management programs into health 810
1208	1208	care delivery. 811
1209	1209	(2) Analyze shortages in the health ca re workforce that is 812
1210	1210	required to meet the needs of the population and develop plans 813
1211	1211	to meet those needs in collaboration with regional planners and 814
1212	1212	educational institutions. 815
1213	1213	(3) Analyze methods of paying health care providers and 816
1214	1214	make recommendations to improve the quality of health care 817
1215	1215	services and to control costs. 818
1216	1216	(4) Assist in coordination of the plan and public health 819
1217	1217	programs. 820
1218	1218	(5) Assess and evaluate health care benefits by: 821
1219	1219	(a) Considering health care benefit additions to the plan 822
1220	1220	and evaluating the additions based on evidence of clinical 823
1221	1221	efficacy. 824
1222	1222	(b) Establishing a process and criteria by which health 825
1223	1223
1224	1224	HB 1603 2025
1225	1225
1226	1226
1227	1227
1228	1228	CODING: Words stricken are deletions; words underlined are additions.
1229	1229	hb1603-00
1230	1230	Page 34 of 43
1231	1231	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
1232	1232
1233	1233
1234	1234
1235	1235	care providers may request authorization to provide health care 826
1236	1236	services and treatments that are not included in the plan 827
1237	1237	benefit set, such as experimental health care treatments. 828
1238	1238	(c) Evaluating proposals to increase the efficiency and 829
1239	1239	effectiveness of the health delivery system, and making 830
1240	1240	recommendations to the board based on the cost -effectiveness of 831
1241	1241	the proposals. 832
1242	1242	(d) Identifying complementary and alternative health care 833
1243	1243	modalities that have been shown to be safe and effective. 834
1244	1244	(6) The board may convene advisory panels as needed to 835
1245	1245	assess the quality, access, and funding adequacy of the plan. 836
1246	1246	Section 14. Section 641.796, Florid a Statutes, is created 837
1247	1247	to read: 838
1248	1248	641.796 Ethics and conflicts of interest; Conflict of 839
1249	1249	Interest Committee.— 840
1250	1250	(1) The Code of Ethics for Public Officers and Employees 841
1251	1251	under part III of chapter 112 applies to the employees and the 842
1252	1252	chief executive officer o f the Florida Health Plan, the 843
1253	1253	employees and members of the Florida Health Board, the employees 844
1254	1254	and members of the regional planning boards and the regional 845
1255	1255	health planning directors, the employees and the director of the 846
1256	1256	Office of Health Quality and Plann ing, the employees and the 847
1257	1257	ombudsman of the Ombudsman Office for Patient Advocacy, and the 848
1258	1258	auditor for the Florida Health Plan. Failure to comply with the 849
1259	1259	code of ethics under part III of chapter 112 is grounds for 850
1260	1260
1261	1261	HB 1603 2025
1262	1262
1263	1263
1264	1264
1265	1265	CODING: Words stricken are deletions; words underlined are additions.
1266	1266	hb1603-00
1267	1267	Page 35 of 43
1268	1268	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
1269	1269
1270	1270
1271	1271
1272	1272	disciplinary action, which may include te rmination of employment 851
1273	1273	or removal from the board. 852
1274	1274	(2) In order to avoid the appearance of political bias or 853
1275	1275	impropriety, the chief executive officer of the plan may not: 854
1276	1276	(a) Engage in leadership of, or employment by, a political 855
1277	1277	party or political org anization. 856
1278	1278	(b) Publicly endorse a political candidate. 857
1279	1279	(c) Contribute to a political candidate, political party, 858
1280	1280	or political organization. 859
1281	1281	(d) Attempt to avoid compliance with this subsection by 860
1282	1282	making a contribution through a spouse or other family member. 861
1283	1283	(3) In order to avoid a conflict of interest, a person 862
1284	1284	specified in subsection (1) may not be employed by a health care 863
1285	1285	provider or a pharmaceutical, health insurance, or medical 864
1286	1286	supply company while holding the position specified in 865
1287	1287	subsection (1), except for the five health care provider members 866
1288	1288	appointed to the Florida Health Board by the representatives of 867
1289	1289	regional planning boards under s. 641.793(2)(a)2. These five 868
1290	1290	members may be employed by a health care provider, but not by a 869
1291	1291	pharmaceutical, health insurance, or medical supply company 870
1292	1292	while serving on the board. 871
1293	1293	(4) The board shall establish a Conflict -of-Interest 872
1294	1294	Committee to develop standards of practice for persons or 873
1295	1295	entities doing business with the plan, including, but not 874
1296	1296	limited to, board members, health care providers, and medical 875
1297	1297
1298	1298	HB 1603 2025
1299	1299
1300	1300
1301	1301
1302	1302	CODING: Words stricken are deletions; words underlined are additions.
1303	1303	hb1603-00
1304	1304	Page 36 of 43
1305	1305	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
1306	1306
1307	1307
1308	1308
1309	1309	suppliers. 876
1310	1310	(a) The committee shall establish guidelines on the duty 877
1311	1311	to disclose to the committee the existence of any financial 878
1312	1312	interest and all material facts related to a financial interest. 879
1313	1313	(b) The committee shall review all proposed transactions 880
1314	1314	and arrangements that invo lve the plan. In considering a 881
1315	1315	proposed transaction or arrangement, if the committee determines 882
1316	1316	a conflict of interest exists, the committee must investigate 883
1317	1317	alternatives to the proposed transaction or arrangement. After 884
1318	1318	exercising due diligence, the commi ttee shall determine whether 885
1319	1319	the plan can obtain with reasonable efforts a more advantageous 886
1320	1320	transaction or arrangement with a person or entity which would 887
1321	1321	not give rise to a conflict of interest. If the committee 888
1322	1322	determines that a more advantageous transa ction or arrangement 889
1323	1323	is not reasonably possible under the circumstances, the 890
1324	1324	committee shall make a recommendation to the board on whether 891
1325	1325	the transaction or arrangement is in the best interest of the 892
1326	1326	plan, and whether the transaction is fair and reasonabl e. The 893
1327	1327	committee shall provide to the board all material information 894
1328	1328	used to make the recommendation. After reviewing all relevant 895
1329	1329	information, the board shall decide whether to approve the 896
1330	1330	transaction or arrangement. 897
1331	1331	Section 15. Section 641.797, Flori da Statutes, is created 898
1332	1332	to read: 899
1333	1333	641.797 Ombudsman Office for Patient Advocacy. — 900
1334	1334
1335	1335	HB 1603 2025
1336	1336
1337	1337
1338	1338
1339	1339	CODING: Words stricken are deletions; words underlined are additions.
1340	1340	hb1603-00
1341	1341	Page 37 of 43
1342	1342	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
1343	1343
1344	1344
1345	1345
1346	1346	(1) The Ombudsman Office for Patient Advocacy is created 901
1347	1347	to represent the interests of consumers of health care and to 902
1348	1348	help residents of this state secure the health care services and 903
1349	1349	health care benefits to which they are entitled under this part. 904
1350	1350	The Ombudsman Office for Patient Advocacy shall also advocate on 905
1351	1351	behalf of enrollees of the Florida Health Plan. 906
1352	1352	(2) The Ombudsman Office for Patient Advocacy shall be 907
1353	1353	headed by the ombudsman, who shall be appointed by the Secretary 908
1354	1354	of Health Care Administration. The ombudsman shall serve in the 909
1355	1355	unclassified service and may be removed only for just cause. The 910
1356	1356	ombudsman must be selected without regard to political 911
1357	1357	affiliation and must be knowledgeable about and have experience 912
1358	1358	in health care services and administration. A person may not 913
1359	1359	serve as ombudsman while holding another public office. 914
1360	1360	(a) The ombudsman may gather information about decisions 915
1361	1361	and acts of the Florida Health Board and about any matters 916
1362	1362	related to the board, health care providers, and health care 917
1363	1363	programs. 918
1364	1364	(b) The ombudsman shall: 919
1365	1365	1. Ensure that patient advocacy services are available to 920
1366	1366	all residents of this state. 921
1367	1367	2. Establish and maintain the grievance system according 922
1368	1368	to subsection (3). 923
1369	1369	3. Receive, evaluate, and respond to consumer complaints 924
1370	1370	about the plan. 925
1371	1371
1372	1372	HB 1603 2025
1373	1373
1374	1374
1375	1375
1376	1376	CODING: Words stricken are deletions; words underlined are additions.
1377	1377	hb1603-00
1378	1378	Page 38 of 43
1379	1379	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
1380	1380
1381	1381
1382	1382
1383	1383	4. Establish a process to receive recommendations from the 926
1384	1384	public about ways to improve the plan. 927
1385	1385	5. Develop educational and informational guides that 928
1386	1386	describe consumer rights and responsibilities. 929
1387	1387	6. Ensure that the guides described in subparagraph 5. are 930
1388	1388	widely available to consumers and available in health care 931
1389	1389	provider offices and facilities. 932
1390	1390	7. Prepare an annual report about the cons umer's 933
1391	1391	perspective on the performance of the plan, including 934
1392	1392	recommendations for needed improvements. 935
1393	1393	(3) The ombudsman shall establish a grievance system for 936
1394	1394	complaints. The system must provide a process that ensures 937
1395	1395	adequate consideration of plan enrol lee grievances and 938
1396	1396	appropriate remedies. 939
1397	1397	(a) The ombudsman may refer any complaint that does not 940
1398	1398	pertain to compliance with this part to the federal Centers for 941
1399	1399	Medicare and Medicaid Services or any other appropriate local, 942
1400	1400	state, and federal government entity for investigation and 943
1401	1401	resolution. 944
1402	1402	(b) A health care provider or an employee of a health care 945
1403	1403	provider may join with, or otherwise assist, a complainant in 946
1404	1404	submitting a complaint to the ombudsman. A health care provider 947
1405	1405	or an employee of a health c are provider who, in good faith, 948
1406	1406	joins with or assists a complainant in submitting a complaint is 949
1407	1407	subject to protections and remedies under this part or under 950
1408	1408
1409	1409	HB 1603 2025
1410	1410
1411	1411
1412	1412
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1414	1414	hb1603-00
1415	1415	Page 39 of 43
1416	1416	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
1417	1417
1418	1418
1419	1419
1420	1420	general law. 951
1421	1421	(c) In reviewing a complaint, the ombudsman may require a 952
1422	1422	health care provider or the board to submit any information the 953
1423	1423	ombudsman deems necessary. 954
1424	1424	(d)1. The ombudsman shall send a written notice of the 955
1425	1425	final disposition of the complaint and the reasons for the 956
1426	1426	decision to: 957
1427	1427	a. The complainant; 958
1428	1428	b. Any health care provider or employee of a health care 959
1429	1429	provider who joins with or assists the complainant in submitting 960
1430	1430	the complaint; and 961
1431	1431	c. The board, 962
1432	1432	963
1433	1433	within 30 calendar days after receipt of the complaint, unless 964
1434	1434	the ombudsman determines that additional time is reasonably 965
1435	1435	necessary to fully and fairly evaluate the relevant grievance. 966
1436	1436	2. The ombudsman's order of corrective action is binding 967
1437	1437	on the plan. A decision of the ombudsman is subject to de novo 968
1438	1438	review by the district court. 969
1439	1439	(4) Data collected on a plan enrollee in the enrollee's 970
1440	1440	complaint to the ombudsman is private data; however, the data 971
1441	1441	may be released to a health care provider that is the subject of 972
1442	1442	the complaint or to the board for purposes of this section. 973
1443	1443	(5) The budget for the Ombudsman Office for Patient 974
1444	1444	Advocacy shall be determined by the Legislature and shall be 975
1445	1445
1446	1446	HB 1603 2025
1447	1447
1448	1448
1449	1449
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1451	1451	hb1603-00
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1453	1453	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
1454	1454
1455	1455
1456	1456
1457	1457	independent from the board. 976
1458	1458	(6) The ombudsman shall establish offices to provide 977
1459	1459	convenient access to residents of this state. 978
1460	1460	Section 16. Section 641.798, Florida Statutes, is created 979
1461	1461	to read: 980
1462	1462	641.798 Auditor for the Florida Health Plan. — 981
1463	1463	(1) There is created in the Office of the Auditor General 982
1464	1464	the position of auditor for the Florida Health Plan to prevent 983
1465	1465	health care fraud and abuse of the plan. The auditor for the 984
1466	1466	Florida Health Plan sha ll be appointed by the legislative 985
1467	1467	auditor. 986
1468	1468	(2) The auditor for the Florida Health Plan shall: 987
1469	1469	(a) Investigate, audit, and review the financial and 988
1470	1470	business records of the plan. 989
1471	1471	(b) Investigate, audit, and review the financial and 990
1472	1472	business records of individuals, public and private agencies and 991
1473	1473	institutions, and private corporations that provide services or 992
1474	1474	products to the plan which are reimbursed by the plan. 993
1475	1475	(c) Investigate allegations of misconduct on the part of 994
1476	1476	an employee or appointee of the Florida Health Board and on the 995
1477	1477	part of any health care provider that is reimbursed by the plan, 996
1478	1478	and report any findings of misconduct to the Attorney General. 997
1479	1479	(d) Investigate fraud and abuse. 998
1480	1480	(e) Arrange for the collection and analysis of data needed 999
1481	1481	to investigate inappropriate use of a product or service that is 1000
1482	1482
1483	1483	HB 1603 2025
1484	1484
1485	1485
1486	1486
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1490	1490	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
1491	1491
1492	1492
1493	1493
1494	1494	reimbursed by the plan. 1001
1495	1495	(f) Annually report recommendations for improvements to 1002
1496	1496	the plan to the board. 1003
1497	1497	Section 17. Section 641.799, Florida Statutes, is created 1004
1498	1498	to read: 1005
1499	1499	641.799 Florida Health Plan policies and procedures; 1006
1500	1500	rulemaking.— 1007
1501	1501	(1) The Florida Health Plan policies and procedures are 1008
1502	1502	exempt from the Administrative Procedure Act. 1009
1503	1503	(2)(a) If the board determines that a rule should be 1010
1504	1504	adopted under this part to establish, modify , or revoke a policy 1011
1505	1505	or procedure, the board must publish in the state register the 1012
1506	1506	proposed rule and must afford interested persons a period of 30 1013
1507	1507	days after publication to submit written data or comments. 1014
1508	1508	(b) On or before the last day of the 30 -day period 1015
1509	1509	provided for the submission of written data or comments under 1016
1510	1510	paragraph (a), any interested person may file with the board 1017
1511	1511	written objections to the proposed rule, stating the grounds for 1018
1512	1512	objection and requesting a public hearing on those objections. 1019
1513	1513	Within 30 days after the last day for submitting written data or 1020
1514	1514	comments, the board shall publish in the state register a notice 1021
1515	1515	specifying the rule to which objections have been filed and a 1022
1516	1516	hearing requested and specifying a time and place for the 1023
1517	1517	hearing. 1024
1518	1518	(c) Within 60 days after the expiration of the period 1025
1519	1519
1520	1520	HB 1603 2025
1521	1521
1522	1522
1523	1523
1524	1524	CODING: Words stricken are deletions; words underlined are additions.
1525	1525	hb1603-00
1526	1526	Page 42 of 43
1527	1527	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
1528	1528
1529	1529
1530	1530
1531	1531	provided for the submission of written data or comments, or 1026
1532	1532	within 60 days after the completion of any hearing, the board 1027
1533	1533	shall issue a rule adopting, modifying, or revoking a policy or 1028
1534	1534	procedure, or make a determination that a rule should not be 1029
1535	1535	adopted. The rule may contain a provision delaying its effective 1030
1536	1536	date for such period as the board determines is necessary. 1031
1537	1537	Section 18. (1) The Director of the Office of Financial 1032
1538	1538	Regulation of the Depa rtment of Financial Services and the chief 1033
1539	1539	executive officer of the Florida Health Plan shall regularly 1034
1540	1540	update the Legislature on the status of the planning, 1035
1541	1541	implementation, and financing of this act. 1036
1542	1542	(2) The Florida Health Plan must be operational withi n 2 1037
1543	1543	years after July 1, 2025. 1038
1544	1544	(3) On and after the day the Florida Health Plan becomes 1039
1545	1545	operational, a health insurance policy, a health maintenance 1040
1546	1546	contract, a continuing care contract, a prepaid health clinic 1041
1547	1547	contract, or any policy or contract that off ers coverage for 1042
1548	1548	services covered by the Florida Health Plan may not be sold in 1043
1549	1549	this state. 1044
1550	1550	(4) The Office of the Inspector General of the Agency for 1045
1551	1551	Health Care Administration shall prepare an analysis of this 1046
1552	1552	state's capital expenditure needs for the p urpose of assisting 1047
1553	1553	the Florida Health Board in adopting the statewide capital 1048
1554	1554	budget for the year following implementation. The Office of the 1049
1555	1555	Inspector General shall submit this analysis to the board. 1050
1556	1556
1557	1557	HB 1603 2025
1558	1558
1559	1559
1560	1560
1561	1561	CODING: Words stricken are deletions; words underlined are additions.
1562	1562	hb1603-00
1563	1563	Page 43 of 43
1564	1564	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
1565	1565
1566	1566
1567	1567
1568	1568	(5) By July 1, 2026, the Department of Commerce shal l 1051
1569	1569	provide to the Florida Health Board, the Governor, and the 1052
1570	1570	chairs and ranking members of the legislative committees with 1053
1571	1571	jurisdiction over health, human services, and commerce a report 1054
1572	1572	determining the appropriations and legislation necessary to 1055
1573	1573	assist all affected individuals and communities through the 1056
1574	1574	transition to the Florida Health Plan. 1057
1575	1575	Section 19. This act shall take effect July 1, 2025, but 1058
1576	1576	only if HB 1605 or similar legislation is adopted in the same 1059
1577	1577	legislative session or an extension there of and becomes a law. 1060