Text of FL H 681 (2026)

HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 1 of 27 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 health care; providing a short 2 title; repealing ss. 286.31, 286.311, and 381.00321, 3 F.S., relating to the prohibited use of state funds 4 for travel to another state for the purpose of 5 abortion services, the prohibited use of state funds 6 for sex-reassignment prescriptions or procedures, and 7 the right of medical conscience of health care 8 providers and health care payors, respectively; 9 creating s. 381.027, F.S.; providing a short title; 10 defining terms; requiring a covered entity to, by a 11 specified date, adopt a policy relating to providing 12 written notice of a complete list of its refused 13 services to patients; providing requirements for such 14 notice; requiring a covered entity to submit a 15 complete list of its refused services to the 16 Department of Health by a specified date; requiring a 17 covered entity to notify the department within a 18 specified timeframe after a change is made to such 19 list; requiring a covered entity to submit the list, 20 along with its application, if applying for certain 21 state grants or contracts; providing a civil penalty; 22 requiring the department to adopt rules; requiring the 23 department to publish and maintain on its website a 24 current list of covered entities and their refused 25 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 2 of 27 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 services by a specified date; requiring the department 26 to develop and administer a certain public education 27 and awareness program; providing construction; 28 providing for severability; amending s. 381.96, F.S.; 29 revising the definition of the term "eligible client" 30 and redefining the term "pregnancy and parenting 31 support services" as "pregnancy support services"; 32 revising department duties and contract requirements 33 to conform to changes made by the act; removing an 34 obsolete provision; amending s. 390.011, F.S.; 35 deleting the definition of the term "fatal fetal 36 abnormality"; amending s. 390.0111, F.S.; revising the 37 timeframe in which a physician may perform a 38 termination of pregnancy; revising exceptions; 39 deleting the prohibition against the use of telehealth 40 to perform abortions, the requirement that medications 41 intended for use in a medical abortion be dispensed in 42 person by a physician, and the prohibition against 43 dispensing such medication through the United States 44 Postal Service or any other courier or shipping 45 service; amending s. 390.012, F.S.; revising rules the 46 Agency for Health Care Administration may develop and 47 enforce to regulate abortion clinics; repealing s. 48 395.3027, F.S., relating to patient immigration status 49 data collection in hospitals; amending s. 409.905, 50 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 3 of 27 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 F.S.; defining the terms "gender identity" and 51 "transgender individual"; requiring the agency to 52 provide Medicaid reimbursement for medically necessary 53 treatment for or related to gender dysphoria or a 54 comparable or equivalent diagnosis; prohibiting the 55 agency from discriminating in its reimbursement on the 56 basis of a recipient's gender identity or that the 57 recipient is a transgender individual; amending s. 58 456.001, F.S.; deleting the definition of the terms 59 "sex" and "sex-reassignment prescriptions or 60 procedures"; amending s. 456.47, F.S.; deleting the 61 prohibition against the use of telehealth to perform 62 abortions, including medical abortions; repealing ss. 63 456.52 and 766.318, F.S., relating to sex-reassignment 64 prescriptions and procedures and civil liability for 65 provision of sex-reassignment prescriptions or 66 procedures to minors, respectively; amending ss. 67 61.517, 61.534, 409.908, 409.913, 456.074, and 68 636.0145, F.S.; conforming provisions and cross- 69 references to changes made by the act; providing an 70 effective date. 71 72 Be It Enacted by the Legislature of the State of Florida: 73 74 Section 1. This act may be cited as the "Health Care 75 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 4 of 27 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 Freedom Act." 76 Section 2. Section 286.31, Florida Statutes, is repealed. 77 Section 3. Section 286.311, Florida Statutes, is repealed. 78 Section 4. Section 381.00321, Florida Statutes, is 79 repealed. 80 Section 5. Section 381.027, Florida Statutes, is created 81 to read: 82 381.027 Requirements for covered entities; notice of 83 refused services; department duties.— 84 (1) SHORT TITLE.—This section may be cited as the "Health 85 Care Transparency and Accessibility Act." 86 (2) DEFINITIONS.—As used in this section, the term: 87 (a) "Covered entity" means any health care facility that 88 uses, plans to use, or relies upon a denial of care provision to 89 refuse to provide a health care service, or referral for a 90 health care service, for any reason. The term does not include a 91 health care practitioner. 92 (b) "Denial of care provision" means any federal or state 93 law that purports or is asserted to allow a health care facility 94 to opt out of providing a health care service, or referral for a 95 health care service, including, but not limited to, ss. 96 381.0051(5), 390.0111(8), 483.918, and 765.1105; 42 U.S.C. ss. 97 18023(b)(4) and 18113; 42 U.S.C. s. 300a-7; 42 U.S.C. s. 238n; 98 42 U.S.C. s. 2000bb et seq.; s. 507(d) of the Departments of 99 Labor, Health and Human Services, and Education, and Related 100 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 5 of 27 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 Agencies Appropriations Act of 2019, Division B of Pub. L. No. 101 115-245; and 45 C.F.R. part 88. 102 (c) "Department" means the Department of Health. 103 (d) "Health care facility" has the same meaning as in s. 104 381.026(2). 105 (e) "Health care practitioner" has the same meaning as in 106 s. 456.001. 107 (f) "Health care services" has the same meaning as in s. 108 624.27(1). 109 (g) "Referral" has the same meaning as in s. 456.053(3). 110 (h) "Refused service" means a health care service that a 111 covered entity chooses not to provide, or not to provide a 112 referral for, based on one or more denials of care provisions. 113 The term includes health care services that the covered entity 114 selectively provides to some, but not all, patients based on 115 their identity, objections to a health care service, or other 116 nonmedical reasons. 117 (3) REQUIREMENTS FOR COVERED ENTITIES; PENALTY.— 118 (a) By October 1, 2026, each covered entity shall adopt a 119 policy for providing patients with a complete list of its 120 refused services. A covered entity shall: 121 1. Provide written notice to the patient or the patient's 122 representative which includes the complete list of its refused 123 services before any health care service is initiated. 124 a. In the case of an emergency, the covered entity must 125 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 6 of 27 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 promptly provide written notice after the patient is capable of 126 receiving such notice or when the patient's representative is 127 available. 128 b. The patient or patient's representative shall 129 acknowledge receipt of the written notice of refused services. 130 2. Retain all acknowledgments of receipt of the written 131 notice of refused services for a period of at least 3 years. 132 3. Provide a complete list of its refused services to any 133 person upon request. 134 (b) By October 1, 2026, a covered entity shall submit to 135 the department a complete list of its refused services. If any 136 change is made to the list, the covered entity must notify the 137 department within 30 days after making the change. 138 (c) If applying for any state grant or contract related to 139 providing a health care service, a covered entity must submit, 140 along with its application, a complete list of its refused 141 services. 142 (d) A covered entity that fails to comply with this 143 subsection is subject to a fine not to exceed $5,000 for each 144 day the covered entity is not in compliance. 145 (4) DEPARTMENT DUTIES.— 146 (a) The department shall adopt rules to implement this 147 section which must include a process for receiving and 148 investigating complaints regarding covered entities not in 149 compliance with this section. 150 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 7 of 27 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) By January 1, 2027, the department shall publish and 151 maintain on its website a current list of covered entities and 152 the refused services for each covered entity. 153 (c) The department shall develop and administer a public 154 education and awareness program regarding the denial of health 155 care services, including how the denial of health care services 156 can negatively impact health care access and quality, how the 157 denial of health care services may be avoided, and how the 158 denial of health care services affects vulnerable people and 159 communities. 160 (5) CONSTRUCTION.— 161 (a) This section does not authorize denials of health care 162 services or discrimination in the provision of health care 163 services. 164 (b) This section does not limit any cause of action under 165 state or federal law, or limit any remedy in law or equity, 166 against a health care facility or health care practitioner. 167 (c) Compliance with this section does not reduce or limit 168 any potential liability for covered entities associated with the 169 refused services or any violations of state or federal law. 170 (d) Section 761.03 does not provide a claim relating to, 171 or a defense to a claim under, this section, or provide a basis 172 for challenging the application or enforcement of this section 173 or the use of funds associated with the application or 174 enforcement of this section. 175 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 8 of 27 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 (6) SEVERABILITY.—If any provision of this section or its 176 application to any person or circumstance is held invalid, the 177 invalidity does not affect other provisions or applications of 178 this section which can be given effect without the invalid 179 provision or application, and to this end the provisions of this 180 section are severable. 181 Section 6. Section 381.96, Florida Statutes, is amended to 182 read: 183 381.96 Pregnancy support and wellness services.— 184 (1) DEFINITIONS.—As used in this section, the term: 185 (a) "Department" means the Department of Health. 186 (b) "Eligible client" means any of the following: 187 1. a pregnant woman or a woman who suspects she is 188 pregnant, and the family of such woman, who voluntarily seeks 189 pregnancy support services and any woman who voluntarily seeks 190 wellness services. 191 2. A woman who has given birth in the previous 12 months 192 and her family. 193 3. A parent or parents or a legal guardian or legal 194 guardians, and the families of such parents and legal guardians, 195 for up to 12 months after the birth of a child or the adoption 196 of a child younger than 3 years of age. 197 (c) "Florida Pregnancy Care Network, Inc.," or "network" 198 means the not-for-profit statewide alliance of pregnancy support 199 organizations that provide pregnancy support and wellness 200 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 9 of 27 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 services through a comprehensive system of care to women and 201 their families. 202 (d) "Pregnancy and parenting support services" means 203 services that promote and encourage childbirth, including, but 204 not limited to: 205 1. Direct client services, such as pregnancy testing, 206 counseling, referral, training, and education for pregnant women 207 and their families. A woman and her family remain eligible to 208 receive direct client services for up to 12 months after the 209 birth of the child. 210 2. Nonmedical material assistance that improves the 211 pregnancy or parenting situation of families, including, but not 212 limited to, clothing, car seats, cribs, formula, and diapers. 213 3. Counseling or mentoring, education materials, and 214 classes regarding pregnancy, parenting, adoption, life skills, 215 and employment readiness. 216 4. Network awareness activities, including a promotional 217 campaign to educate the public about the pregnancy support 218 services offered by the network and a website that provides 219 information on the location of providers in the user's area and 220 other available community resources. 221 3.5. Communication activities, including the operation and 222 maintenance of a hotline or call center with a single statewide 223 toll-free number that is available 24 hours a day for an 224 eligible client to obtain the location and contact information 225 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 10 of 27 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 for a pregnancy center located in the client's area. 226 (e) "Wellness services" means services or activities 227 intended to maintain and improve health or prevent illness and 228 injury, including, but not limited to, high blood pressure 229 screening, anemia testing, thyroid screening, cholesterol 230 screening, diabetes screening, and assistance with smoking 231 cessation. 232 (2) DEPARTMENT DUTIES.—The department shall contract with 233 the network for the management and delivery of pregnancy and 234 parenting support services and wellness services to eligible 235 clients. 236 (3) CONTRACT REQUIREMENTS.—The department contract must 237 shall specify the contract deliverables, including financial 238 reports and other reports due to the department, timeframes for 239 achieving contractual obligations, and any other requirements 240 the department determines are necessary, such as staffing and 241 location requirements. The contract must shall require the 242 network to: 243 (a) Establish, implement, and monitor a comprehensive 244 system of care through subcontractors to meet the pregnancy and 245 parenting support and wellness needs of eligible clients. 246 (b) Establish and manage subcontracts with a sufficient 247 number of providers to ensure the availability of pregnancy and 248 parenting support services and wellness services for eligible 249 clients, and maintain and manage the delivery of such services 250 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 11 of 27 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 throughout the contract period. 251 (c) Spend at least 90 85 percent of the contract funds on 252 pregnancy and parenting support services, excluding services 253 specified in subparagraph (1)(d)4., and wellness services. 254 (d) Offer wellness services through vouchers or other 255 appropriate arrangements that allow the purchase of services 256 from qualified health care providers. 257 (e) Require a background screening under s. 943.0542 for 258 all paid staff and volunteers of a subcontractor if such staff 259 or volunteers provide direct client services to an eligible 260 client who is a minor or an elderly person or who has a 261 disability. 262 (f) Annually Monitor its subcontractors annually and 263 specify the sanctions that will shall be imposed for 264 noncompliance with the terms of a subcontract. 265 (g) Subcontract only with providers that exclusively 266 promote and support childbirth. 267 (h) Ensure that informational materials provided to an 268 eligible client by a provider are current and accurate and cite 269 the reference source of any medical statement included in such 270 materials. 271 (i) Ensure that the department is provided with all 272 information necessary for the report required under subsection 273 (5). 274 (4) SERVICES.—Services provided pursuant to this section 275 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 12 of 27 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 must be provided in a noncoercive manner and may not include any 276 religious content. 277 (5) REPORT.—By July 1, 2024, and each year thereafter, The 278 department shall annually report to the Governor, the President 279 of the Senate, and the Speaker of the House of Representatives 280 on the amount and types of services provided by the network; the 281 expenditures for such services; and the number of, and 282 demographic information for, women, parents, and families served 283 by the network. 284 Section 7. Subsection (6) of section 390.011, Florida 285 Statutes, is amended to read: 286 390.011 Definitions.—As used in this chapter, the term: 287 (6) "Fatal fetal abnormality" means a terminal condition 288 that, in reasonable medical judgment, regardless of the 289 provision of life-saving medical treatment, is incompatible with 290 life outside the womb and will result in death upon birth or 291 imminently thereafter. 292 Section 8. Subsections (1) and (2) of section 390.0111, 293 Florida Statutes, are amended to read: 294 390.0111 Termination of pregnancies.— 295 (1) TERMINATION IN THIRD TRIMESTER AFTER GESTATIONAL AGE 296 OF 6 WEEKS; WHEN ALLOWED.—A physician may not knowingly perform 297 or induce a termination of pregnancy on any person in the third 298 trimester of pregnancy if the physician determines the 299 gestational age of the fetus is more than 6 weeks unless one of 300 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 13 of 27 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 the following conditions is met: 301 (a) Two physicians certify in writing that, in reasonable 302 medical judgment, the termination of the pregnancy is necessary 303 to save the pregnant woman's life or avert a serious risk of 304 substantial and irreversible physical impairment of a major 305 bodily function of the pregnant woman other than a psychological 306 condition. 307 (b) The physician certifies in writing that, in reasonable 308 medical judgment, there is a medical necessity for legitimate 309 emergency medical procedures for termination of the pregnancy to 310 save the pregnant woman's life or avert a serious risk of 311 imminent substantial and irreversible physical impairment of a 312 major bodily function of the pregnant woman other than a 313 psychological condition, and another physician is not available 314 for consultation. 315 (c) The pregnancy has not progressed to the third 316 trimester and two physicians certify in writing that, in 317 reasonable medical judgment, the fetus has a fatal fetal 318 abnormality. 319 (d) The pregnancy is the result of rape, incest, or human 320 trafficking and the gestational age of the fetus is not more 321 than 15 weeks as determined by the physician. At the time the 322 woman schedules or arrives for her appointment to obtain the 323 abortion, she must provide a copy of a restraining order, police 324 report, medical record, or other court order or documentation 325 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 14 of 27 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 providing evidence that she is obtaining the termination of 326 pregnancy because she is a victim of rape, incest, or human 327 trafficking. If the woman is 18 years of age or older, the 328 physician must report any known or suspected human trafficking 329 to a local law enforcement agency. If the woman is a minor, the 330 physician must report the incident of rape, incest, or human 331 trafficking to the central abuse hotline as required by s. 332 39.201. 333 (2) IN-PERSON PERFORMANCE BY PHYSICIAN REQUIRED.—Only a 334 physician may perform or induce a termination of pregnancy. A 335 physician may not use telehealth as defined in s. 456.47 to 336 perform an abortion, including, but not limited to, medical 337 abortions. Any medications intended for use in a medical 338 abortion must be dispensed in person by a physician and may not 339 be dispensed through the United States Postal Service or by any 340 other courier or shipping service. 341 Section 9. Subsection (1) of section 390.012, Florida 342 Statutes, is amended to read: 343 390.012 Powers of agency; rules; disposal of fetal 344 remains.— 345 (1) The agency may develop and enforce rules pursuant to 346 ss. 390.011-390.018 and part II of chapter 408 for the health, 347 care, and treatment of persons in abortion clinics and for the 348 safe operation of such clinics. The rules must be reasonably 349 related to the preservation of maternal health of the clients, 350 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 15 of 27 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 must be in accordance with s. 797.03, may not impose an 351 unconstitutional burden on a woman's freedom to decide whether 352 to terminate her pregnancy, and must provide for all of the 353 following: 354 (a) The performance of pregnancy termination procedures 355 only by a licensed physician. 356 (b) The making, protection, and preservation of patient 357 records, which must be treated as medical records under chapter 358 458. When performing a license inspection of a clinic, the 359 agency shall inspect at least 50 percent of patient records 360 generated since the clinic's last license inspection. 361 (c) Annual inspections by the agency of all clinics 362 licensed under this chapter to ensure that such clinics are in 363 compliance with this chapter and agency rules. 364 (d) The prompt investigation of credible allegations of 365 abortions being performed at a clinic that is not licensed to 366 perform such procedures. 367 Section 10. Section 395.3027, Florida Statutes, is 368 repealed. 369 Section 11. Present subsections (4) through (12) of 370 section 409.905, Florida Statutes, are redesignated as 371 subsections (5) through (13), respectively, and a new subsection 372 (4) is added to that section, to read: 373 409.905 Mandatory Medicaid services.—The agency may make 374 payments for the following services, which are required of the 375 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 16 of 27 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 state by Title XIX of the Social Security Act, furnished by 376 Medicaid providers to recipients who are determined to be 377 eligible on the dates on which the services were provided. Any 378 service under this section shall be provided only when medically 379 necessary and in accordance with state and federal law. 380 Mandatory services rendered by providers in mobile units to 381 Medicaid recipients may be restricted by the agency. Nothing in 382 this section shall be construed to prevent or limit the agency 383 from adjusting fees, reimbursement rates, lengths of stay, 384 number of visits, number of services, or any other adjustments 385 necessary to comply with the availability of moneys and any 386 limitations or directions provided for in the General 387 Appropriations Act or chapter 216. 388 (4) GENDER-AFFIRMING CARE.— 389 (a) Definitions.—As used in this section, the term: 390 1. "Gender identity" means an individual's internal sense 391 of that individual's gender, regardless of the sex assigned to 392 that individual at birth. 393 2. "Transgender individual" means an individual who 394 identifies as a gender different from the sex assigned to that 395 individual at birth. 396 (b) Reimbursement.—The agency shall provide reimbursement 397 for medically necessary treatment for or related to gender 398 dysphoria as defined by the Diagnostic and Statistical Manual of 399 Mental Disorders, Fifth Edition, published by the American 400 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 17 of 27 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 Psychiatric Association or a comparable or equivalent diagnosis. 401 (c) Discrimination prohibited.—The agency may not 402 discriminate in its reimbursement of medically necessary 403 treatment on the basis of the recipient's gender identity or on 404 the basis that the recipient is a transgender individual. 405 Section 12. Subsections (8) and (9) of section 456.001, 406 Florida Statutes, are amended to read: 407 456.001 Definitions.—As used in this chapter, the term: 408 (8) "Sex" means the classification of a person as either 409 male or female based on the organization of the human body of 410 such person for a specific reproductive role, as indicated by 411 the person's sex chromosomes, naturally occurring sex hormones, 412 and internal and external genitalia present at birth. 413 (9)(a) "Sex-reassignment prescriptions or procedures" 414 means: 415 1. The prescription or administration of puberty blockers 416 for the purpose of attempting to stop or delay normal puberty in 417 order to affirm a person's perception of his or her sex if that 418 perception is inconsistent with the person's sex as defined in 419 subsection (8). 420 2. The prescription or administration of hormones or 421 hormone antagonists to affirm a person's perception of his or 422 her sex if that perception is inconsistent with the person's sex 423 as defined in subsection (8). 424 3. Any medical procedure, including a surgical procedure, 425 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 18 of 27 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 affirm a person's perception of his or her sex if that 426 perception is inconsistent with the person's sex as defined in 427 subsection (8). 428 (b) The term does not include: 429 1. Treatment provided by a physician who, in his or her 430 good faith clinical judgment, performs procedures upon or 431 provides therapies to a minor born with a medically verifiable 432 genetic disorder of sexual development, including any of the 433 following: 434 a. External biological sex characteristics that are 435 unresolvably ambiguous. 436 b. A disorder of sexual development in which the physician 437 has determined through genetic or biochemical testing that the 438 patient does not have a normal sex chromosome structure, sex 439 steroid hormone production, or sex steroid hormone action for a 440 male or female, as applicable. 441 2. Prescriptions or procedures to treat an infection, an 442 injury, a disease, or a disorder that has been caused or 443 exacerbated by the performance of any sex-reassignment 444 prescription or procedure, regardless of whether such 445 prescription or procedure was performed in accordance with state 446 or federal law. 447 3. Prescriptions or procedures provided to a patient for 448 the treatment of a physical disorder, physical injury, or 449 physical illness that would, as certified by a physician 450 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 19 of 27 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 licensed under chapter 458 or chapter 459, place the individual 451 in imminent danger of death or impairment of a major bodily 452 function without the prescription or procedure. 453 Section 13. Paragraph (f) of subsection (2) of section 454 456.47, Florida Statutes, is amended to read: 455 456.47 Use of telehealth to provide services.— 456 (2) PRACTICE STANDARDS.— 457 (f) A telehealth provider may not use telehealth to 458 perform an abortion, including, but not limited to, medical 459 abortions as defined in s. 390.011. 460 Section 14. Section 456.52, Florida Statutes, is repealed. 461 Section 15. Section 766.318, Florida Statutes, is 462 repealed. 463 Section 16. Subsection (1) of section 61.517, Florida 464 Statutes, is amended to read: 465 61.517 Temporary emergency jurisdiction.— 466 (1) A court of this state has temporary emergency 467 jurisdiction if the child is present in this state and: 468 (a) The child has been abandoned; or 469 (b) It is necessary in an emergency to protect the child 470 because the child, or a sibling or parent of the child, is 471 subjected to or threatened with mistreatment or abuse; or 472 (c) It is necessary in an emergency to protect the child 473 because the child has been subjected to or is threatened with 474 being subjected to sex-reassignment prescriptions or procedures, 475 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 20 of 27 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 as defined in s. 456.001. 476 Section 17. Subsection (1) of section 61.534, Florida 477 Statutes, is amended to read: 478 61.534 Warrant to take physical custody of child.— 479 (1) Upon the filing of a petition seeking enforcement of a 480 child custody determination, the petitioner may file a verified 481 application for the issuance of a warrant to take physical 482 custody of the child if the child is likely to imminently suffer 483 serious physical harm or removal from this state. Serious 484 physical harm includes, but is not limited to, being subjected 485 to sex-reassignment prescriptions or procedures as defined in s. 486 456.001. 487 Section 18. Paragraph (a) of subsection (1) of section 488 409.908, Florida Statutes, is amended to read: 489 409.908 Reimbursement of Medicaid providers.—Subject to 490 specific appropriations, the agency shall reimburse Medicaid 491 providers, in accordance with state and federal law, according 492 to methodologies set forth in the rules of the agency and in 493 policy manuals and handbooks incorporated by reference therein. 494 These methodologies may include fee schedules, reimbursement 495 methods based on cost reporting, negotiated fees, competitive 496 bidding pursuant to s. 287.057, and other mechanisms the agency 497 considers efficient and effective for purchasing services or 498 goods on behalf of recipients. If a provider is reimbursed based 499 on cost reporting and submits a cost report late and that cost 500 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 21 of 27 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 report would have been used to set a lower reimbursement rate 501 for a rate semester, then the provider's rate for that semester 502 shall be retroactively calculated using the new cost report, and 503 full payment at the recalculated rate shall be effected 504 retroactively. Medicare-granted extensions for filing cost 505 reports, if applicable, shall also apply to Medicaid cost 506 reports. Payment for Medicaid compensable services made on 507 behalf of Medicaid-eligible persons is subject to the 508 availability of moneys and any limitations or directions 509 provided for in the General Appropriations Act or chapter 216. 510 Further, nothing in this section shall be construed to prevent 511 or limit the agency from adjusting fees, reimbursement rates, 512 lengths of stay, number of visits, or number of services, or 513 making any other adjustments necessary to comply with the 514 availability of moneys and any limitations or directions 515 provided for in the General Appropriations Act, provided the 516 adjustment is consistent with legislative intent. 517 (1) Reimbursement to hospitals licensed under part I of 518 chapter 395 must be made prospectively or on the basis of 519 negotiation. 520 (a) Reimbursement for inpatient care is limited as 521 provided in s. 409.905(6) s. 409.905(5), except as otherwise 522 provided in this subsection. 523 1. If authorized by the General Appropriations Act, the 524 agency may modify reimbursement for specific types of services 525 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 22 of 27 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 or diagnoses, recipient ages, and hospital provider types. 526 2. The agency may establish an alternative methodology to 527 the DRG-based prospective payment system to set reimbursement 528 rates for: 529 a. State-owned psychiatric hospitals. 530 b. Newborn hearing screening services. 531 c. Transplant services for which the agency has 532 established a global fee. 533 d. Recipients who have tuberculosis that is resistant to 534 therapy who are in need of long-term, hospital-based treatment 535 pursuant to s. 392.62. 536 3. The agency shall modify reimbursement according to 537 other methodologies recognized in the General Appropriations 538 Act. 539 540 The agency may receive funds from state entities, including, but 541 not limited to, the Department of Health, local governments, and 542 other local political subdivisions, for the purpose of making 543 special exception payments, including federal matching funds, 544 through the Medicaid inpatient reimbursement methodologies. 545 Funds received for this purpose shall be separately accounted 546 for and may not be commingled with other state or local funds in 547 any manner. The agency may certify all local governmental funds 548 used as state match under Title XIX of the Social Security Act, 549 to the extent and in the manner authorized under the General 550 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 23 of 27 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 Appropriations Act and pursuant to an agreement between the 551 agency and the local governmental entity. In order for the 552 agency to certify such local governmental funds, a local 553 governmental entity must submit a final, executed letter of 554 agreement to the agency, which must be received by October 1 of 555 each fiscal year and provide the total amount of local 556 governmental funds authorized by the entity for that fiscal year 557 under this paragraph, paragraph (b), or the General 558 Appropriations Act. The local governmental entity shall use a 559 certification form prescribed by the agency. At a minimum, the 560 certification form must identify the amount being certified and 561 describe the relationship between the certifying local 562 governmental entity and the local health care provider. The 563 agency shall prepare an annual statement of impact which 564 documents the specific activities undertaken during the previous 565 fiscal year pursuant to this paragraph, to be submitted to the 566 Legislature annually by January 1. 567 Section 19. Subsection (36) of section 409.913, Florida 568 Statutes, is amended to read: 569 409.913 Oversight of the integrity of the Medicaid 570 program.—The agency shall operate a program to oversee the 571 activities of Florida Medicaid recipients, and providers and 572 their representatives, to ensure that fraudulent and abusive 573 behavior and neglect of recipients occur to the minimum extent 574 possible, and to recover overpayments and impose sanctions as 575 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 24 of 27 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 appropriate. Each January 15, the agency and the Medicaid Fraud 576 Control Unit of the Department of Legal Affairs shall submit a 577 report to the Legislature documenting the effectiveness of the 578 state's efforts to control Medicaid fraud and abuse and to 579 recover Medicaid overpayments during the previous fiscal year. 580 The report must describe the number of cases opened and 581 investigated each year; the sources of the cases opened; the 582 disposition of the cases closed each year; the amount of 583 overpayments alleged in preliminary and final audit letters; the 584 number and amount of fines or penalties imposed; any reductions 585 in overpayment amounts negotiated in settlement agreements or by 586 other means; the amount of final agency determinations of 587 overpayments; the amount deducted from federal claiming as a 588 result of overpayments; the amount of overpayments recovered 589 each year; the amount of cost of investigation recovered each 590 year; the average length of time to collect from the time the 591 case was opened until the overpayment is paid in full; the 592 amount determined as uncollectible and the portion of the 593 uncollectible amount subsequently reclaimed from the Federal 594 Government; the number of providers, by type, that are 595 terminated from participation in the Medicaid program as a 596 result of fraud and abuse; and all costs associated with 597 discovering and prosecuting cases of Medicaid overpayments and 598 making recoveries in such cases. The report must also document 599 actions taken to prevent overpayments and the number of 600 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 25 of 27 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 providers prevented from enrolling in or reenrolling in the 601 Medicaid program as a result of documented Medicaid fraud and 602 abuse and must include policy recommendations necessary to 603 prevent or recover overpayments and changes necessary to prevent 604 and detect Medicaid fraud. All policy recommendations in the 605 report must include a detailed fiscal analysis, including, but 606 not limited to, implementation costs, estimated savings to the 607 Medicaid program, and the return on investment. The agency must 608 submit the policy recommendations and fiscal analyses in the 609 report to the appropriate estimating conference, pursuant to s. 610 216.137, by February 15 of each year. The agency and the 611 Medicaid Fraud Control Unit of the Department of Legal Affairs 612 each must include detailed unit-specific performance standards, 613 benchmarks, and metrics in the report, including projected cost 614 savings to the state Medicaid program during the following 615 fiscal year. 616 (36) The agency may provide to a sample of Medicaid 617 recipients or their representatives through the distribution of 618 explanations of benefits information about services reimbursed 619 by the Medicaid program for goods and services to such 620 recipients, including information on how to report inappropriate 621 or incorrect billing to the agency or other law enforcement 622 entities for review or investigation, information on how to 623 report criminal Medicaid fraud to the Medicaid Fraud Control 624 Unit's toll-free hotline number, and information about the 625 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 26 of 27 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 rewards available under s. 409.9203. The explanation of benefits 626 may not be mailed for Medicaid independent laboratory services 627 as described in s. 409.905(8) s. 409.905(7) or for Medicaid 628 certified match services as described in ss. 409.9071 and 629 1011.70. 630 Section 20. Paragraph (c) of subsection (5) of section 631 456.074, Florida Statutes, is amended to read: 632 456.074 Certain health care practitioners; immediate 633 suspension of license.— 634 (5) The department shall issue an emergency order 635 suspending the license of any health care practitioner who is 636 arrested for committing or attempting, soliciting, or conspiring 637 to commit any act that would constitute a violation of any of 638 the following criminal offenses in this state or similar 639 offenses in another jurisdiction: 640 (c) Section 456.52(5)(b), relating to prescribing, 641 administering, or performing sex-reassignment prescriptions or 642 procedures for a patient younger than 18 years of age. 643 Section 21. Section 636.0145, Florida Statutes, is amended 644 to read: 645 636.0145 Certain entities contracting with Medicaid.—An 646 entity that is providing comprehensive inpatient and outpatient 647 mental health care services to certain Medicaid recipients in 648 Hillsborough, Highlands, Hardee, Manatee, and Polk Counties 649 through a capitated, prepaid arrangement pursuant to the federal 650 HB 681 2026 CODING: Words stricken are deletions; words underlined are additions. hb681-00 Page 27 of 27 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 waiver provided for in s. 409.905(6) s. 409.905(5) must become 651 licensed under this chapter by December 31, 1998. Any entity 652 licensed under this chapter which provides services solely to 653 Medicaid recipients under a contract with Medicaid is exempt 654 from ss. 636.017, 636.018, 636.022, 636.028, 636.034, and 655 636.066(1). 656 Section 22. This act shall take effect July 1, 2026. 657