Florida HB 1097: Urban and Inner-City Crime and Gun Violence Prevention Commission

Bill Text

HB 1097 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1097-00
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A bill to be entitled 1
An act relating to health insurer accountability; 2
amending s. 408.7057, F.S.; requiring a health plan to 3
participate in a filed claim dispute; providing 4
penalties for failure to respond to a claim; requiring 5
the Agency for Health Care Administration to notify a 6
certain entity within a specified timeframe when a 7
health plan fails to pay a provider under certain 8
circumstances; requiring a health plan to pay a 9
provider within a specified timeframe after the 10
agency's order; providing penalties; amending s. 11
409.967, F.S.; providing credentialing requirements 12
for a managed care plan; requiring each managed care 13
plan to identify to the agency and the Office of 14
Insurance Regulation any ownership interest or 15
affiliation of any kind with certain entities; 16
providing requirements for the identification of such 17
information; requiring each managed care plan to 18
report specified information to the agency and the 19
office in writing within a specified timeframe; 20
removing a provision requiring the results of certain 21
audit reports to be dispositive; amending s. 409.975, 22
F.S.; requiring managed care contracts to include 23
provider notifications regarding certain denials of 24
coverage; amending ss. 627.6131 and 641.315, F.S.; 25

HB 1097 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1097-00
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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

prohibiting an insurer from denying certain claims 26
under certain circumstances; providing notification 27
requirements and penalties; amending ss. 409.973 and 28
409.9855, F.S.; conforming cross-references; providing 29
an effective date. 30
31
Be It Enacted by the Legislature of the State of Florida: 32
33
Section 1. Subsection (7) of section 408.7057, Florida 34
Statutes, is renumbered as subsection (8), subsection (5) is 35
amended, paragraph (i) is added to subsection (2), and a new 36
subsection (7) is added to that section, to read: 37
408.7057 Statewide provider and health plan claim dispute 38
resolution program.— 39
(2) 40
(i) A health plan must participate in a filed claim 41
dispute. Failure to respond as provided in paragraph (f) shall 42
result in a default against the health plan. 43
(5) The agency shall notify within 7 days the appropriate 44
licensure or certification entity whenever there is: 45
(a) A failure to pay as provided in subsection (7); or 46
(b) A violation of a final order issued by the agency 47
pursuant to this section. 48
(7) A health plan that does not prevail in the agency's 49
order shall pay the provider the amount provided in the order 50

HB 1097 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1097-00
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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

within 35 days after the order is entered. A health plan that 51
does not pay the required amount within the required timeframe 52
is subject to a penalty of up to $500 per day until the amount 53
is paid. 54
Section 2. Subsections (3) and (4) of section 409.967, 55
Florida Statutes, are renumbered as subsections (4) and (5), 56
respectively, paragraph (e) of present subsection (3) is 57
amended, paragraphs (p) and (q) are added to subsection (2), and 58
a new subsection (3) is added to that section, to read: 59
409.967 Managed care plan accountability.— 60
(2) The agency shall establish such contract requirements 61
as are necessary for the operation of the statewide managed care 62
program. In addition to any other provisions the agency may deem 63
necessary, the contract must require: 64
(p) Credentialing.— 65
1. A managed care plan shall determine whether it will 66
contract with a provider within 30 calendar days after receipt 67
of the verified credentialing information from a credentialing 68
verification organization either designated by the agency or 69
contracted by managed care organizations as part of a 70
credentialing alliance. Within 15 days after a contract is 71
executed, a managed care plan shall ensure that any internal 72
processing systems of the managed care plan have been updated to 73
include: 74
a. The accepted provider contract. 75

HB 1097 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1097-00
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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

b. The provider as a participating provider. 76
2. For the purpose of reimbursement of claims, once a 77
provider has met the terms and conditions for credentialing and 78
enrollment, the provider's credentialing application date shall 79
be the date from which the provider's claims become eligible for 80
payment. 81
3. A managed care plan may not require a provider to 82
appeal or resubmit any clean claim submitted during the time 83
period between