Florida HB 1023: Online Sellers from Foreign Countries of Concern

Bill Text

HB 1023 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1023-00
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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

A bill to be entitled 1
An act relating to insurance claims payments to health 2
care providers; amending s. 408.7057, F.S.; defining 3
the terms "claim dispute" and "denied prior 4
authorization request"; requiring the Agency for 5
Health Care Administration to establish a program to 6
assist health care providers and health plans in 7
resolving claims of denied prior authorization 8
requests; providing that the program is mandatory; 9
revising the list of claims that are not reviewed by 10
the program; prohibiting respondents from avoiding 11
default by refusing to participate in the review 12
process; requiring health plans to reimburse health 13
care providers' costs in bringing claims under certain 14
circumstances; requiring the agency to adopt rules; 15
amending ss. 627.6131 and 641.315, F.S.; prohibiting 16
contracts between health care providers and health 17
insurers and health maintenance organizations, 18
respectively, from specifying credit card payments to 19
providers as the only acceptable method for payments; 20
authorizing use of electronic funds transfers by 21
health insurers and health maintenance organizations, 22
respectively, for payments to providers under certain 23
circumstances; providing notification requirements; 24
prohibiting health insurers and health maintenance 25

HB 1023 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1023-00
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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

organizations, respectively, from charging fees for 26
automated clearinghouse transfers as claims payments 27
to providers; providing an exception; providing 28
applicability; prohibiting health insurers and health 29
maintenance organizations, respectively, from denying 30
claims subsequently submitted by providers for 31
procedures that were included in prior authorizations; 32
providing exceptions; providing applicability; 33
defining the term "provider"; providing an effective 34
date. 35
36
Be It Enacted by the Legislature of the State of Florida: 37
38
Section 1. Section 408.7057, Florida Statutes, is amended 39
to read: 40
408.7057 Statewide provider and health plan claim dispute 41
resolution program.— 42
(1) As used in this section, the term: 43
(a) "Agency" means the Agency for Health Care 44
Administration. 45
(b) "Claim dispute" may include, but is not limited to, a 46
denied prior authorization request. 47
(c) "Denied prior authorization request" means a 48
determination by a health plan that a request submitted by a 49
provider for prior authorization of a health care service, 50

HB 1023 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1023-00
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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

supply, or medication: 51
1. Has been wholly or partially denied; 52
2. Has not been acted upon within the time limits 53
established by law or contract; or 54
3. Has been approved subject to materially restrictive 55
conditions that prevent the service, supply, or medication from 56
being furnished as clinically indicated. 57
(d)(b) "Health plan" means a health maintenance 58
organization or a prepaid health clinic certified under chapter 59
641, a prepaid health plan authorized under s. 409.912, an 60
exclusive provider organization certified under s. 627.6472, or 61
a major medical expense health insurance policy, as defined in 62
s. 627.643(2)(e), offered by a group or an individual health 63
insurer licensed pursuant to chapter 624, including a preferred 64
provider organization under s. 627.6471. 65
(e)(c) "Resolution organization" means a qualified 66
independent third-party claim-dispute-resolution entity selected 67
by and contracted with the Agency for Health Care 68
Administration. 69
(2)(a) The agency shall establish a program to provide 70
assistance to contracted and noncontracted providers and health 71
plans for resolution of claim disputes that are not resolved by 72
the provider and the health plan. The agency shall contract with 73
a resolution organization to timely review and consider claim 74
disputes submitted by providers and health plans and recommend 75

HB 1023 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1023-00
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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

to the agency an appropriate resolution of those disputes. The 76
agency shall establish by rule jurisdictional amounts and 77
methods of aggregation for claim disputes that may be considered 78
by the resolution organization. 79
(b) The dispute resolution program is a mandatory program, 80
and a provider or health plan may not opt out of the process. 81
The resolution organization shall review claim disputes filed by 82
contracted and noncontracted providers and health plans unless 83
the disp