Florida SB 1130: Florida Building Code

Bill Text

1130 
Insurance Claims Payments to Health Care Providers 
2026-01-05T11:48:00Z 
Prohibiting payment adjudicators from downcoding health care services under certain circumstances; specifying that payment adjudicators are solely responsible for certain violations of law; requiring certain utilization review entities to only use a certain prior authorization form; revising the definition of the term “claim”, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 1130 

 By Senator Massullo 

 11-00698A-26 20261130__ 
 1 A bill to be entitled 
 2 An act relating to insurance claims payments to health 
 3 care providers; creating s. 627.4193, F.S.; defining 
 4 terms; prohibiting payment adjudicators from 
 5 downcoding health care services under certain 
 6 circumstances; providing exceptions; requiring payment 
 7 adjudicators to provide certain information to the 
 8 provider; prohibiting payment adjudicators from 
 9 downcoding a service under certain circumstances; 
 10 prohibiting payment adjudicators for downcoding orders 
 11 by a licensed nurse; specifying that payment 
 12 adjudicators are solely responsible for certain 
 13 violations of law; requiring payment adjudicators to 
 14 maintain downcoding policies on their websites; 
 15 specifying requirements for such policies; requiring 
 16 health insurers to ensure that their downcoding 
 17 policies are updated and to ensure compliance with 
 18 specified provisions on downcoding; authorizing 
 19 investigations and actions against noncompliance; 
 20 providing certain presumption in favor of physicians’ 
 21 determinations regarding diagnoses of patients and 
 22 service orders; providing the calculation of interest 
 23 on health insurers’ nonpayment or underpayment due to 
 24 downcoding; providing a cause of action for health 
 25 care providers; amending s. 627.42392, F.S.; defining 
 26 terms; revising the definition of the term “health 
 27 insurer”; requiring certain utilization review 
 28 entities to only use a certain prior authorization 
 29 form; deleting provisions related to pharmacy benefits 
 30 managers’ or health insurers’ requirement to use a 
 31 specified prior authorization form; requiring 
 32 utilization review entities to establish and offer a 
 33 specified electronic prior authorization process; 
 34 specifying requirements for such process; specifying 
 35 that the provider is deemed to have supplied all 
 36 information necessary for prior authorization under 
 37 certain circumstances; specifying that additional 
 38 information is deemed unnecessary under certain 
 39 circumstances; prohibiting utilization review 
 40 entities’ prior authorization process from requiring 
 41 information that is not needed; requiring utilization 
 42 review entities to disclose all prior authorization 
 43 requirements and restrictions; requiring such 
 44 requirements and restrictions to be explained in a 
 45 specified manner; prohibiting utilization review 
 46 entities from implementing certain new requirements or 
 47 restrictions; providing exceptions; providing 
 48 reporting requirements; requiring the Office of 
 49 Insurance Regulation to publish on its website a 
 50 report based on such entities’ reports; providing 
 51 requirements for adverse determinations made by such 
 52 entities on health care providers’ claims; providing a 
 53 timeframe for such entities’ determination on claims; 
 54 prohibiting prior authorization requirements under 
 55 certain circumstances; prohibiting prior authorization 
 56 revocations, limits, conditions, and restrictions 
 57 under certain circumstances; providing exceptions; 
 58 providing a timeframe for the validity of prior 
 59 authorizations under certain circumstances; providing 
 60 construction; amending ss. 627.6131 and 641.3155, 
 61 F.S.; defining terms; revising the definition of the 
 62 term “claim”; revising requirements and timeframes for 
 63 responses from health insurers and health maintenance 
 64 organizations, respectively, to submitted claims; 
 65 revising the interest rate on overdue payments of 
 66 claims; authorizing health care providers to refuse to 
 67 participate in internal dispute resolution processes 
 68 under certain circumstances; prohibiting health 
 69 insurers and health maintenance organizations, 
 70 respectively, from retrospectively, rather than 
 71 retroactively, denying claims because of insured and 
 72 enrollee ineligibility beyond a specified timeframe; 
 73 revising such timeframe; revising applicability; 
 74 providing construction; prohibiting health insurers 
 75 and health maintenance organizations, respectively, 
 76 from requesting or requiring certain information from 
 77 health care providers under certain circumstances; 
 78 providing causes of action for health care providers 
 79 under certain circumstances; amending s. 395.1065, 
 80 F.S.; conforming cross-references; p