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