Bill > H1097

This bill strengthens accountability for health insurers and managed care plans by requiring health plans to participate in filed claim disputes and imposing penalties for failure to respond, with the Agency for Health Care Administration (AHCA) now mandated to notify relevant entities within seven days of a health plan's failure to pay a provider and requiring the health plan to pay the provider within 35 days of an AHCA order, facing daily penalties for delays. It also introduces new credentialing requirements for managed care plans, including a 30-day timeframe to decide on contracting with a provider after receiving verified information and ensuring internal systems are updated promptly, and mandates that managed care plans disclose any ownership interests or affiliations with entities providing various health services or administrative functions to AHCA and the Office of Insurance Regulation (OIR), with changes to this information needing to be reported within 60 days. Furthermore, the bill prohibits insurers from denying claims for previously authorized health care services unless both the insured and the treating provider are notified of any coverage changes or benefit limitations contemporaneously, with failure to provide such notification preventing the insurer from denying payment, and it also makes conforming cross-references within existing statutes related to benefits and pilot programs for individuals with developmental disabilities, with the entire act taking effect on July 1, 2026.

Health and Social Services

https://www.flsenate.gov/Session/Bill/2026/1097