Text of FL S 740 (2026)

Florida Senate - 2026 SB 740 By Senator Osgood 32-00791-26 2026740__ 1 A bill to be entitled 2 An act relating to comprehensive health care for 3 residents; creating part IV of ch. 641, F.S., entitled 4 the “Healthy Florida Act”; creating s. 641.71, F.S.; 5 providing a short title; creating s. 641.72, F.S.; 6 providing the purpose of the Florida Health Plan; 7 creating s. 641.73, F.S.; defining terms; creating s. 8 641.74, F.S.; providing for eligibility for and 9 coverage of the plan; authorizing the Florida Health 10 Board to establish certain financial arrangements with 11 other states and foreign countries under certain 12 circumstances; providing reimbursement rates; 13 prohibiting healthcare providers from billing the 14 patient for covered services under certain 15 circumstances; providing duties of the board relating 16 to plan enrollment; providing enrollment requirements; 17 providing that certain data collected through plan 18 applications and enrollment is private data; 19 authorizing such data to be released to certain 20 persons for specified purposes; creating s. 641.755, 21 F.S.; authorizing plan enrollees to choose to receive 22 services from certain health care providers; providing 23 covered health care benefits; authorizing the board to 24 expand health care benefits under certain 25 circumstances; specifying health care services that 26 are not covered by the plan; requiring enrollees to 27 have primary care providers and access to care 28 coordination; authorizing enrollees to see health care 29 specialists without referral; authorizing the board to 30 establish a computerized registry; authorizing the 31 plan employees to assist enrollees in choosing primary 32 care providers; prohibiting cost-sharing requirements 33 from being imposed on enrollees; creating s. 641.77, 34 F.S.; requiring the board to secure repeals and 35 waivers of certain provisions of federal law; 36 requiring the Department of Health and the Agency for 37 Health Care Administration to provide assistance to 38 the board; requiring the board to adopt rules under 39 certain circumstances; providing that the plan’s 40 responsibility for providing health care is secondary 41 to existing Federal Government programs under certain 42 circumstances; creating s. 641.78, F.S.; defining the 43 term “collateral source”; requiring the plan to 44 collect health care costs from collateral sources 45 under certain circumstances; requiring the board to 46 negotiate waivers, seek federal legislation, and make 47 arrangements to incorporate collateral sources into 48 the plan; requiring plan enrollees to notify health 49 care providers of collateral sources and health care 50 providers to forward such information to the board; 51 authorizing the board to take appropriate actions to 52 recover reimbursement from collateral sources; 53 requiring collateral sources to pay for health care 54 services under certain circumstances; providing 55 specified authority and rights to the board relating 56 to collateral sources; creating s. 641.791, F.S.; 57 providing that defaults, underpayments, and late 58 payments of certain obligations result in certain 59 remedies and penalties; prohibiting eligibility for 60 health care benefits from being impaired by such 61 defaults, underpayments, and late payments; creating 62 s. 641.792, F.S.; providing for eligible health care 63 providers to participate in the plan; requiring 64 participating providers to comply with certain federal 65 laws and regulations; providing that patient care may 66 not be affected by fee schedules and financial 67 incentives; providing requirements for the payment 68 system for noninstitutional providers; providing 69 requirements for the annual budgets for institutional 70 providers; requiring the board to develop a capital 71 investment plan; prohibiting noninstitutional and 72 institutional providers that accept payments from the 73 plan from billing patients; providing requirements for 74 capital expenditures by institutional and 75 noninstitutional providers which exceed a specified 76 amount; requiring the board to establish payment 77 criteria and payment methods for care coordination; 78 creating s. 641.793, F.S.; establishing the Florida 79 Health Board by a specified date; providing the 80 purpose of the board; providing for board membership, 81 terms, and compensation; providing duties of the 82 board; providing reporting requirements; creating s. 83 641.794, F.S.; requiring the Secretary of Health Care 84 Administration to designate health planning regions by 85 a specified date; providing considerations for such 86 designations; requiring health planning regions to be 87 administered by a regional health planning board; 88 providing requirements for regional planning boards; 89 providing board membership, terms, compensation, and 90 first meetings of regional planning boards with the 91 Florida Health Board; providing duties of the regional 92 planning boards; creating s. 641.795, F.S.; creating 93 the Office of Health Quality and Planning; providing 94 the purpose and duties of the office; authorizing the 95 Florida Health Board to convene advisory panels for 96 certain purposes; creating s. 641.796, F.S.; providing 97 applicability of the Code of Ethics for Public 98 Officers and Employees; providing for disciplinary 99 actions for failure to comply with the code of ethics; 100 prohibiting certain persons from engaging in specified 101 acts or from being employed by specified entities; 102 creating the Conflict-of-Interest Committee; providing 103 the duties of the committee; creating s. 641.797, 104 F.S.; creating the Ombudsman Office for Patient 105 Advocacy; providing the purpose of the office; 106 providing for appointment and qualifications of the 107 ombudsman; providing the duties and authority of the 108 ombudsman; providing that data collected on plan 109 enrollees in their complaints to the ombudsman is 110 private data; authorizing such data to be released to 111 certain persons and to the board for specified 112 purposes; providing requirements for the office 113 budget; requiring the ombudsman to establish specified 114 offices; creating s. 641.798, F.S.; creating the 115 position of auditor for the plan; providing the 116 purpose, appointment, and duties of the auditor; 117 creating s. 641.799, F.S.; providing that the plan 118 policies and procedures are exempt from the 119 Administrative Procedure Act; providing procedures and 120 requirements for adoption of certain rules on plan 121 policies and procedures; requiring specified persons 122 to regularly update the Legislature on certain 123 information; providing a timeline for the operation of 124 the plan; prohibiting certain health insurance 125 policies and contracts from being sold in this state 126 on and after a specified date; requiring an analysis 127 of specified capital expenditure needs; providing 128 reporting requirements; providing an effective date. 129 130 Be It Enacted by the Legislature of the State of Florida: 131 132 Section 1. Part IV of chapter 641, Florida Statutes, 133 consisting of ss. 641.71-641.799, Florida Statutes, is created 134 and entitled the “Healthy Florida Act.” 135 Section 2. Section 641.71, Florida Statutes, is created to 136 read: 137 641.71 Short title.—This part may be cited as the “Florida 138 Health Plan.” 139 Section 3. Section 641.72, Florida Statutes, is created to 140 read: 141 641.72 Purpose.—The purpose of the Florida Health Plan is 142 to keep residents of this state healthy and to provide the best 143 quality of health care by: 144 (1) Ensuring that all residents of this state, regardless 145 of immigration status, have access to health care. 146 (2) Covering all necessary care, including dental; vision; 147 hearing; mental health; reproductive care, including abortion 148 services and prenatal and postpartum care; gender-affirming 149 health care, including medication and treatment; substance use 150 disorder treatment; prescription drugs; durable medical 151 equipment and supplies; and long-term care and home care, 152 including long-term services and supports in home- and 153 community-based settings. 154 (3) Allowing patients to choose their health care 155 providers. 156 (4) Reducing costs by negotiating fair prices and cutting 157 administrative bureaucracy, through measures such as a global 158 budget approach to institutional providers, rather than by 159 restricting or denying care. 160 (5) Being affordable to all patients through financing 161 based on a patient’s ability to pay and the elimination of 162 premiums, copayments, deductibles, and out-of-pocket expenses at 163 the point of service. 164 (6) Focusing on preventive care and early intervention to 165 improve health. 166 (7) Ensuring that there are enough health care providers to 167 guarantee timely access to care. 168 (8) Continuing this state’s leadership in medical 169 education, research, and technology. 170 (9) Providing adequate and timely payments to health care 171 providers. 172 (10) Using a simple funding and payment system. 173 (11) Providing a just transition for a displaced workforce 174 affected by changes. 175 Section 4. Section 641.73, Florida Statutes, is created to 176 read: 177 641.73 Definitions.—As used in this part, the term: 178 (1) “Board” means the Florida Health Board established in 179 s. 641.793. 180 (2) “Institutional provider” means an inpatient hospital, 181 nursing facility, rehabilitation facility, or any other health 182 care facility that provides overnight care. 183 (3) “Medically necessary” means comprehensive services or 184 supplies needed to promote health and to prevent, diagnose, or 185 treat a particular patient’s medical condition. The 186 comprehensive services and supplies must meet accepted standards 187 of medical practice within a health care provider’s professional 188 peer group. 189 (4) “Noninstitutional provider” means an individual 190 provider, group practice, clinic, outpatient surgical center, 191 imaging center, or any other health care facility that does not 192 provide overnight care. 193 (5) “Plan” means the Florida Health Plan. 194 (6) “Resident of this state” means an individual who has 195 had a principal place of domicile in this state for more than 6 196 consecutive months, who has registered to vote in this state, 197 who has made a statement of domicile pursuant to s. 222.17, or 198 who has filed for homestead tax exemption on property in this 199 state. 200 Section 5. Section 641.74, Florida Statutes, is created to 201 read: 202 641.74 Eligibility for and enrollment in the Florida Health 203 Plan.— 204 (1) ELIGIBILITY.— 205 (a) All residents of this state, regardless of immigration 206 status, are eligible for the Florida Health Plan. 207 (b) Coverage for emergency care for a resident of this 208 state which is obtained out of state must be at prevailing local 209 rates where the care is provided. Coverage for nonemergency care 210 obtained out of state must be according to rates and conditions 211 established by the Florida Health Board. The board may require 212 that a resident of this state be transported back to this state 213 when prolonged treatment of an emergency condition is necessary 214 and when such transport will not adversely affect the patient’s 215 care or condition. 216 (c) A nonresident visiting this state shall be billed by 217 the board for all services received under the plan. The board 218 may enter into intergovernmental arrangements or contracts with 219 other states and foreign countries to provide reciprocal 220 coverage for temporary visitors. 221 (d) The board shall extend eligibility to nonresidents 222 employed in this state under a premium schedule set by the 223 board. 224 (e) For a business outside of this state which employs 225 residents of this state, the board shall apply for a federal 226 waiver to collect the employer contribution mandated by federal 227 law. 228 (f) A retiree who is covered under the plan and who elects 229 to reside outside of this state is eligible for benefits under 230 the terms and conditions of the retiree’s employer-employee 231 contract. 232 (g) The board may establish financial arrangements with 233 other states and foreign countries in order to facilitate 234 meeting the terms of the contracts described in paragraph (f). 235 Payments for care provided by non-Florida health care providers 236 to retirees who are covered under the plan shall be reimbursed 237 at rates established by the board. Health care providers who 238 accept any payment from the plan for a covered service may not 239 bill the patient for the covered service. 240 (h)1. A person is presumed eligible for coverage under the 241 plan, and a health care provider shall provide health care 242 services as if the person is eligible for coverage under the 243 plan, if the person: 244 a. Is a minor; 245 b. Arrives at a health care facility unconscious, comatose, 246 or otherwise unable to document eligibility or to act on the 247 person’s own behalf because of the person’s physical or mental 248 condition; or 249 c. Is involuntarily committed to an acute psychiatric 250 facility or to a hospital with psychiatric beds which provides 251 for involuntary commitment. 252 2. All health care facilities subject to state and federal 253 provisions governing emergency medical treatment must comply 254 with subparagraph 1. 255 (2) ENROLLMENT.— 256 (a) The board shall establish a procedure to enroll 257 residents of this state and provide each with identification 258 that may be used by health care providers to confirm eligibility 259 for services. The application for enrollment may not be more 260 than two pages. 261 (b) Data collected from a person through application for 262 and enrollment in the plan is private data; however, the data 263 may be released to: 264 1. A health care provider for purposes of confirming 265 enrollment and processing payments for benefits; and 266 2. The ombudsman of the Ombudsman Office for Patient 267 Advocacy and the auditor for the Florida Health Plan for 268 purposes of performing their duties under ss. 641.797 and 269 641.798, respectively. 270 Section 6. Section 641.755, Florida Statutes, is created to 271 read: 272 641.755 Benefits.— 273 (1) A person covered under the Florida Health Plan may 274 choose to receive services from any qualified, licensed health 275 care provider that participates in the plan. 276 (2) Except for the exclusions provided in subsection (4), 277 covered health care benefits under the plan include all 278 prescribed medically necessary care, including, but not limited 279 to: 280 (a) Inpatient and outpatient health care facility services. 281 (b) Inpatient and outpatient licensed health care provider 282 services. 283 (c) Diagnostic imaging, laboratory services, and other 284 diagnostic and evaluative services. 285 (d) Durable medical equipment, appliances, and assistive 286 technology, including, but not limited to, prescribed 287 prosthetics, eye care, and hearing aids and their repair, 288 technical support, and customization required for individual 289 use. 290 (e) Inpatient and outpatient rehabilitative care. 291 (f) Emergency care services. 292 (g) Necessary transportation for health care services: 293 1. As covered under Medicaid or Medicare; or 294 2. For persons with disabilities, older persons with 295 functional limitations, and low-income persons. 296 (h) Child and adult immunizations and preventive care. 297 (i) Health and wellness education for chronic or 298 preventative care as provided by licensed health care providers. 299 (j) Reproductive health care, including abortion services, 300 contraceptives, and prenatal and postpartum care. 301 (k) Childbirth and maternity care, including doula services 302 and care in freestanding childbirth centers. 303 (l) Gender-affirming health care, including medication and 304 treatment. 305 (m) Holistic licensed health care services such as 306 chiropractic, acupressure, acupuncture, massage, and nutritional 307 services. 308 (n) Mental health services, including substance use 309 disorder treatment, services in substance use disorder treatment 310 facilities, and mental health care provided by licensed or 311 certified mental health providers such as licensed 312 psychologists, licensed mental health counselors, licensed 313 professional counselors, licensed clinical social workers, 314 certified master social workers, rehabilitation support service 315 providers, and any providers that the board deems eligible. 316 (o) Dental care, including diagnostics and restoration and 317 durable equipment such as braces and mouthguards. 318 (p) Vision care. 319 (q) Hearing care. 320 (r) Prescription drugs. 321 (s) Podiatric care. 322 (t) Therapies that are shown by the National Center for 323 Complementary and Integrative Health to be safe and effective. 324 (u) Blood and blood products. 325 (v) Dialysis. 326 (w) Licensed qualified adult day care. 327 (x) Rehabilitative and habilitative services. 328 (y) Ancillary health care or social services previously 329 covered by this state’s qualified public health programs. 330 (z) Case management and care coordination. 331 (aa) Language interpretation and translation for health 332 care services, including sign language and braille or other 333 services needed for persons with communication barriers. 334 (bb) Services provided by qualified community health 335 workers. 336 (cc) Health care and long-term supportive services, 337 including in a home- or community-based setting, assisted living 338 facility, and nursing home, with home health care providers, 339 home health aides, and palliative and hospice care. 340 (dd) Any item or service described in this subsection which 341 is furnished using telehealth, to the extent practicable. 342 (3) The Florida Health Board may expand health care 343 benefits beyond the minimum benefits described in subsection (2) 344 if such expansion meets the intent of this part and when there 345 are sufficient funds to cover the expansion. 346 (4) The following health care services are excluded from 347 coverage by the plan: 348 (a) Treatments and procedures primarily for cosmetic 349 purposes, unless required to correct a congenital defect or to 350 restore or correct a part of the body that has been altered as a 351 result of an injury, a disease, or a surgery or unless 352 determined to be medically necessary by a qualified, licensed 353 health care provider in the plan. 354 (b) Services of a health care provider or facility that is 355 not licensed, certified, or accredited by this state. The 356 licensure, certification, or accreditation requirements do not 357 apply to health care providers or facilities that provide 358 services to residents of this state who require medical 359 attention while traveling out of state. 360 (5)(a) All plan enrollees must have a primary care provider 361 and must have access to care coordination. 362 (b) A plan enrollee does not need a referral to see a 363 health care specialist. 364 (c) The board may establish a computerized registry to 365 assist patients in identifying appropriate providers, and the 366 plan employees may assist an enrollee with choosing a primary 367 care provider if the enrollee so chooses. 368 (6) The plan may not impose a deductible, copayment, 369 coinsurance, or any other cost-sharing requirement on an 370 enrollee with respect to a covered benefit. 371 Section 7. Section 641.77, Florida Statutes, is created to 372 read: 373 641.77 Federal preemption.— 374 (1) The board shall secure a repeal or a waiver of any 375 provision of federal law that preempts any provision of this 376 part. The Department of Health and the Agency for Health Care 377 Administration shall provide all necessary assistance to the 378 board to secure any repeal or waiver. 379 (2)(a) The board shall, under the section 1332 waivers of 380 the Patient Protection and Affordable Care Act, request to 381 repeal or waive any of the following provisions to the extent 382 necessary to implement this part: 383 1. Title 42 of the United States Code, ss. 18021-18024. 384 2. Title 42 of the United States Code, ss. 18031-18033. 385 3. Title 42 of the United States Code, s. 18071. 386 4. Section 5000A of the Internal Revenue Code of 1986, as 387 amended. 388 (b) If a repeal or a waiver of a federal law or regulation 389 cannot be secured, the board shall adopt rules, or seek 390 conforming state legislation, consistent with federal law, in an 391 effort to best fulfill the purposes of this part. 392 (c) The plan’s responsibility for providing health care is 393 secondary to existing Federal Government programs for health 394 care services to the extent that funding for these programs is 395 not transferred or that the transfer is delayed beyond the date 396 on which initial benefits are provided under the plan. 397 Section 8. Section 641.78, Florida Statutes, is created to 398 read: 399 641.78 Subrogation.— 400 (1)(a) As used in this section, the term “collateral 401 source” includes all of the following: 402 1. A health insurance policy, health maintenance contract, 403 continuing care contract, and prepaid health clinic contract, 404 and the medical components of motor vehicle insurance, 405 homeowner’s insurance, and other forms of insurance. 406 2. The medical components of worker’s compensation. 407 3. A pension plan and retiree health care benefits. 408 4. An employer plan. 409 5. An employee benefit contract. 410 6. A government benefit program. 411 7. A judgment for damages for personal injury. 412 8. The state of last domicile for individuals moving to 413 this state for medical care who have extraordinary medical 414 needs. 415 9. Any third party who is or may be liable to an individual 416 for health care services or costs. 417 (b) The term does not include: 418 1. A contract or plan that is subject to federal 419 preemption. 420 2. Any governmental unit, agency, or service to the extent 421 that subrogation is prohibited by law. An entity described in 422 paragraph (a) is not excluded from the obligations imposed by 423 this section by virtue of a contract or relationship with a 424 governmental unit, agency, or service. 425 (2) When other payers for health care have been terminated, 426 the plan shall collect health care costs from a collateral 427 source if health care services provided to a patient are, or may 428 be, covered services under the collateral source available to 429 the patient, or if the patient has a right of action for 430 compensation permitted under law. 431 (3) The board shall negotiate waivers, seek federal 432 legislation, or make other arrangements to incorporate 433 collateral sources into the plan. 434 (4) If a person who receives health care services under the 435 plan is entitled to coverage, reimbursement, indemnity, or other 436 compensation from a collateral source, the person must notify 437 the health care provider and provide information identifying the 438 collateral source, the nature and extent of coverage or 439 entitlement, and other relevant information. The health care 440 provider shall forward this information to the board. The person 441 entitled to coverage, reimbursement, indemnity, or other 442 compensation from a collateral source must provide additional 443 information as requested by the board. 444 (a) The plan shall seek reimbursement from the collateral 445 source for services provided to the person and may take 446 appropriate action, including legal proceedings, to recover the 447 reimbursement. Upon demand, the collateral source must pay the 448 sum that it would have paid or spent on behalf of the person for 449 the health care services provided by the plan. 450 (b) In addition to any other right to recovery provided in 451 this section, the board has the same right to recover the 452 reasonable value of health care benefits from the collateral 453 source. 454 (c) If the collateral source is exempt from subrogation or 455 the obligation to reimburse the plan, the board may require that 456 the person who is entitled to health care services from the 457 collateral source first seek those services from the collateral 458 source before seeking the services from the plan. 459 (5) To the extent permitted by federal law, the board has 460 the same right of subrogation over contractual retiree health 461 care benefits provided by employers as other contracts, allowing 462 the plan to recover the cost of health care services provided to 463 a person covered by the retiree health care benefits, unless 464 arrangements are made to transfer the revenues of the health 465 care benefits directly to the plan. 466 Section 9. Section 641.791, Florida Statutes, is created to 467 read: 468 641.791 Defaults, underpayments, and late payments.— 469 (1) Defaults, underpayments, or late payments of any 470 premium or other obligation imposed by this part shall result in 471 the remedies and penalties provided by law, except as provided 472 in this part. 473 (2) Eligibility for health care benefits may not be 474 impaired by any default, underpayment, or late payment of any 475 premium or other obligation imposed by this part. 476 Section 10. Section 641.792, Florida Statutes, is created 477 to read: 478 641.792 Provider payments.— 479 (1) All health care providers licensed to practice in this 480 state may participate in the plan. The board may determine the 481 eligibility of any other health care providers to participate in 482 the plan. 483 (a) A participating health care provider shall comply with 484 all federal laws and regulations governing referral fees and fee 485 splitting, including, but not limited to, 42 U.S.C. ss. 1320a-7b 486 and 1395nn, whether reimbursed by federal funds or not. 487 (b) A fee schedule or financial incentive may not adversely 488 affect the care a patient receives or the care a health provider 489 recommends. 490 (2) The board shall establish and oversee a fair and 491 efficient payment system for noninstitutional providers. 492 (a) The board shall pay noninstitutional providers based on 493 rates negotiated with noninstitutional providers. The rates must 494 take into account the need to address the shortage of 495 noninstitutional providers. 496 (b) Noninstitutional providers that accept any payment from 497 the plan for a covered health care service may not bill the 498 patient for the covered health care service. 499 (c) Noninstitutional providers shall be paid within 30 500 business days for claims filed following procedures established 501 by the board. 502 (3) The board shall set an annual budget for each 503 institutional provider which consists of an operating and a 504 capital budget to cover the institutional provider’s anticipated 505 health care services for the following year based on past 506 performance and projected changes in prices and health care 507 service levels. 508 (a) The annual budget for each individual institutional 509 provider must be set separately. The board may not set a joint 510 budget for a group of more than one institutional provider nor 511 for a parent corporation that owns or operates one or more 512 institutional providers. 513 (b) Institutional providers that accept any payment from 514 the plan for a covered health care service may not bill the 515 patient for the covered health care service. 516 (4)(a) The board shall periodically develop a capital 517 investment plan that will serve as a guide in determining the 518 annual budgets of institutional providers and in deciding 519 whether to approve applications for approval of capital 520 expenditures by noninstitutional providers. 521 (b) Institutional and noninstitutional providers that 522 propose to make capital purchases in excess of $500,000 must 523 obtain board approval. The board may alter the threshold 524 expenditure level that triggers the requirement to submit 525 information on capital expenditures. Institutional providers 526 must propose these expenditures and submit the required 527 information as part of the annual budget they submit to the 528 board. Noninstitutional providers must apply to the board for 529 approval of these expenditures. The board must respond to 530 capital expenditure applications in a timely manner. 531 (5) The board shall establish payment criteria and payment 532 methods for care coordination for patients, especially those 533 with chronic illness and complex medical needs. 534 Section 11. Section 641.793, Florida Statutes, is created 535 to read: 536 641.793 Florida Health Board.— 537 (1) By December 1, 2026, the Florida Health Board shall be 538 established to promote the delivery of high-quality, coordinated 539 health care services that enhance health; prevent illness, 540 disease, and disability; slow the progression of chronic 541 diseases; and improve personal health management. The board 542 shall administer the Florida Health Plan. The board shall 543 oversee the Office of Health Quality and Planning established in 544 s. 641.795. 545 (2)(a) The board shall consist of at least 15 members, 546 including the representatives selected by the regional planning 547 boards established in s. 641.794. These representatives shall 548 appoint the following additional members to serve on the board: 549 1. One patient member and one employer member. 550 2. Seven representatives of labor organizations that 551 represent health care workers or social workers. 552 3. Five health care provider members, including one 553 physician, one registered nurse, one mental health provider, one 554 dentist, and one health care facility director. 555 (b) Each member shall take the oath of office to uphold the 556 Constitution of the United States and the Constitution of the 557 State of Florida and to operate the plan in the public interest 558 by upholding the underlying principles of this part. 559 (c) Board members shall serve 4 years; however, for the 560 purpose of providing staggered terms, of the initial 561 appointments, those members appointed by the representatives of 562 regional planning boards shall serve 2-year terms. 563 (d) Board members shall set the board’s compensation, not 564 to exceed the compensation of the Florida Public Service 565 Commission members. The board shall select the chair from among 566 its membership. 567 (e)1. A board member may be removed by a two-thirds vote of 568 the members voting on removal. After receiving notice and 569 hearing, a member may be removed for malfeasance or nonfeasance 570 in performance of the member’s duties. 571 2. Conviction of any criminal behavior, regardless of how 572 much time has lapsed, is grounds for immediate removal. 573 (3) The board shall: 574 (a) Ensure that all of the requirements of the plan are 575 met. 576 (b) Hire a chief executive officer for the plan, who must 577 take the oath described in paragraph (2)(b). 578 (c) Hire a director for the Office of Health Quality and 579 Planning, who must take the oath described in paragraph (2)(b). 580 (d) Provide technical assistance to the regional planning 581 boards established in s. 641.794. 582 (e) Conduct investigations and inquiries and require the 583 submission of information, documents, and records that the board 584 considers necessary to carry out the purposes of this part. 585 (f) Establish a process for the board to receive concerns, 586 opinions, ideas, and recommendations of the public regarding all 587 aspects of the plan and the means of addressing those concerns. 588 (g) Conduct activities the board considers necessary to 589 carry out the purposes of this part. 590 (h) Collaborate with the Department of Health and with the 591 Agency for Health Care Administration, which licenses health 592 care facilities, to ensure that facility performance is 593 monitored and deficient practices are recognized and corrected 594 in a timely manner. 595 (i) Establish conflict-of-interest standards that prohibit 596 health care providers from receiving financial benefit from 597 their medical decisions outside of board reimbursement, 598 including any financial benefit for referring a patient for a 599 service, product, or health care provider or for prescribing, 600 ordering, or recommending a drug, product, or service. 601 (j) Establish conflict-of-interest standards related to 602 pharmaceuticals and medical equipment, supplies, and devices, 603 and their marketing to a health care provider, so that the 604 health care provider does not receive any incentive to 605 prescribe, administer, or use a product or service. 606 (k) Require that all electronic health records used by 607 health care providers be fully interoperable with the open 608 source electronic health records system used by the United 609 States Department of Veterans Affairs. 610 (l) Provide financial help and assistance in retraining and 611 job placement to workers in this state who may be displaced 612 because of the administrative efficiencies of the plan. 613 (m) Ensure that assistance is provided to all workers and 614 communities that may be affected by provisions in this part. 615 (n) Work with the Department of Commerce to ensure that 616 funding and program services are promptly and efficiently 617 provided to all affected workers. The Department of Commerce 618 shall monitor and report on a regular basis on the status of 619 displaced workers. 620 (o) Adopt rules, policies, and procedures as necessary to 621 carry out the duties assigned under this part. 622 (4) Before submitting a waiver application under section 623 1332 of the Patient Protection and Affordable Care Act, the 624 board must do all of the following, as required by federal law: 625 (a) Conduct, or contract for, any actuarial analyses and 626 actuarial certifications necessary to support the board’s 627 estimates that the waiver will comply with the comprehensive 628 coverage, affordability, and scope of coverage requirements in 629 federal law. 630 (b) Conduct or contract for any necessary economic analyses 631 needed to support the board’s estimates that the waiver will 632 comply with the comprehensive coverage, affordability, scope of 633 coverage, and federal deficit requirements in federal law. These 634 analyses must include: 635 1. A detailed 10-year budget plan. 636 2. A detailed analysis regarding the estimated impact of 637 the waiver on health insurance coverage in this state. 638 (c) Establish a detailed draft implementation timeline for 639 the waiver plan. 640 (d) Establish quarterly, annual, and cumulative targets for 641 the comprehensive coverage, affordability, scope of coverage, 642 and federal deficit requirements in federal law. 643 (5) The board has the following financial duties: 644 (a) To approve statewide and regional budgets. 645 (b) To negotiate and establish payment rates for health 646 care providers through their professional associations. 647 (c) To monitor compliance with all budgets and payment 648 rates and take action to achieve compliance to the extent 649 authorized by law. 650 (d) To pay claims for medical products or services as 651 negotiated and, if deemed necessary, issue requests for 652 proposals from nonprofit business corporations in this state for 653 a contract to process claims. 654 (e) To seek federal approval to bill another state for 655 health care coverage provided to a patient from out of state who 656 comes to this state for long-term care or other costly treatment 657 when the patient’s home state fails to provide such coverage, 658 unless a reciprocal agreement with the patient’s home state to 659 provide similar coverage to residents of this state relocating 660 to that state can be negotiated. 661 (f) To implement fraud prevention measures necessary to 662 protect the operation of the plan. 663 (g) To ensure appropriate cost control by: 664 1. Instituting aggressive public health measures, early 665 intervention and preventive care, health and wellness education, 666 and promotion of personal health improvement. 667 2. Making changes in the delivery of health care services 668 and administration that improve efficiency and care quality. 669 3. Minimizing administrative costs. 670 4. Ensuring that the delivery system does not contain 671 excess capacity. 672 5. Negotiating the lowest possible prices for prescription 673 drugs, medical equipment, and health care services. 674 (6) The board has the following management duties: 675 (a) To develop and implement enrollment procedures for the 676 plan. 677 (b) To implement and review eligibility standards for the 678 plan. 679 (c) To arrange for health care services to be provided at 680 convenient locations to serve communities in need in the same 681 manner as federally qualified health centers, including ensuring 682 the availability of school nurses so that all students have 683 access to health care, immunizations, and preventive care at 684 public schools, and encouraging health care providers to provide 685 services at easily accessible locations. 686 (d) To make recommendations, when needed, to the 687 Legislature about changes in the geographic boundaries of the 688 health planning regions. 689 (e) To establish an electronic claim and payment system for 690 the plan. 691 (f) To monitor the operation of the plan through consumer 692 surveys and regular data collection and evaluation activities, 693 including evaluations of the adequacy and quality of services 694 provided under the plan, the need for changes in the benefit 695 package, the cost of each type of service, and the effectiveness 696 of cost control measures under the plan. 697 (g) To disseminate information and establish a health care 698 website to provide information to the public about the plan, 699 including health care providers and facilities, and state and 700 regional planning board meetings and activities. 701 (h) To collaborate with public health agencies, schools, 702 and community clinics. 703 (i) To ensure that plan policies and health care providers, 704 including public health care providers, support all residents of 705 this state in achieving and maintaining maximum physical and 706 mental health. 707 (7) The board, in conjunction with the office and 708 administrative staff of the plan’s chief executive officer, has 709 the following policy duties: 710 (a) To develop and implement cost control and quality 711 assurance procedures. 712 (b) To ensure strong public health services, including 713 education and community prevention and clinical services. 714 (c) To ensure a continuum of coordinated high-quality 715 primary to tertiary care to all residents of this state. 716 (d) To implement policies to ensure that all residents of 717 this state receive culturally and linguistically competent care. 718 (8) The board shall determine the feasibility of self 719 insuring health care providers for malpractice and shall 720 establish a self-insurance system and create a special fund for 721 payment of losses incurred if the board determines self-insuring 722 health care providers would reduce costs. 723 (9) By July 1 of each year, the board shall report to the 724 President of the Senate, the Speaker of the House of 725 Representatives, and ranking members of the committees having 726 cognizance over health care issues on: 727 (a) The performance of the plan. 728 (b) The fiscal condition and need for payment adjustment. 729 (c) Any needed changes in geographic boundaries of the 730 health planning regions. 731 (d) Any recommendations for statutory changes. 732 (e) Receipts of revenues from all sources. 733 (f) Whether current year goals and priorities are met. 734 (g) Future goals and priorities. 735 (h) Major new technology and prescription drugs. 736 (i) Other circumstances that may affect the cost or quality 737 of health care. 738 Section 12. Section 641.794, Florida Statutes, is created 739 to read: 740 641.794 Health planning regions.— 741 (1) By August 1, 2026, the Secretary of Health Care 742 Administration shall designate health planning regions within 743 this state which are composed of geographically contiguous areas 744 grouped on the basis of the following considerations: 745 (a) Patterns of use of health care services. 746 (b) Health care resources, including workforce resources. 747 (c) Health care needs of the population, including public 748 health needs. 749 (d) Geography. 750 (e) Population and demographic characteristics. 751 (f) Other considerations the board deems appropriate. 752 (2) Each health planning region is administered by a 753 regional planning board. A minimum of eight regional planning 754 boards shall be created, and all regional planning boards shall 755 be created by October 1, 2026. 756 (a) Each regional planning board shall consist of: 757 1. One county commissioner per county, selected by the 758 county commission for each health planning region consisting of 759 at least five counties; or 760 2. Three county commissioners per county, selected by the 761 county commission for each health planning region consisting of 762 four or fewer counties. 763 (b) A county commission may designate a representative to 764 act as a member of the regional planning board in the member’s 765 absence. 766 (c) Each regional planning board shall select the chair 767 from among its membership. 768 (d) Regional planning board members shall serve 4-year 769 terms; however, for the purpose of providing staggered terms, of 770 the initial appointments, at least half of the board members 771 shall be appointed to 2-year terms. Board members may receive 772 per diem for meetings. 773 (e) The Secretary of Health Care Administration, or his or 774 her designee, shall convene the first meeting of each regional 775 planning board with the Florida Health Board within 30 days 776 after the regional planning board is established. 777 (3) A regional planning board has the following duties: 778 (a) To recommend health standards, goals, priorities, and 779 guidelines for the health planning region. 780 (b) To prepare an operating and capital budget for the 781 health planning region to recommend to the Florida Health Board. 782 (c) To collaborate with local public health care agencies 783 to: 784 1. Educate consumers and health care providers on public 785 health programs, goals, and the means of reaching those goals. 786 2. Implement public health and wellness initiatives. 787 (d) To hire a regional health planning director. 788 (e) To ensure that all parts of the health planning region 789 have access to a 24-hour nurse hotline and to 24-hour urgent 790 care clinics. 791 Section 13. Section 641.795, Florida Statutes, is created 792 to read: 793 641.795 Office of Health Quality and Planning.—The Florida 794 Health Board shall establish the Office of Health Quality and 795 Planning to assess the quality, access, and funding adequacy of 796 the Florida Health Plan. The Office of Health Quality and 797 Planning shall: 798 (1) Make annual recommendations to the board on the overall 799 direction of the plan on the following subjects: 800 (a) Overall effectiveness of the plan in addressing public 801 health and wellness. 802 (b) Access to health care. 803 (c) Quality improvement. 804 (d) Efficiency of administration. 805 (e) Adequacy of the budget and funding. 806 (f) Appropriateness of payments to health care providers. 807 (g) Capital expenditure needs. 808 (h) Long-term health care. 809 (i) Mental health and substance abuse services. 810 (j) Staffing levels and working conditions in health care 811 facilities. 812 (k) Identification of the number and mix of health care 813 facilities and providers necessary to meet the needs of the 814 plan. 815 (l) Care for chronically ill patients. 816 (m) Health care provider training on promoting the use of 817 advance directives with patients to enable patients to obtain 818 the health care of their choice. 819 (n) Research needs. 820 (o) Integration of disease management programs into health 821 care delivery. 822 (2) Analyze shortages in the health care workforce that is 823 required to meet the needs of the population and develop plans 824 to meet those needs in collaboration with regional planners and 825 educational institutions. 826 (3) Analyze methods of paying health care providers and 827 make recommendations to improve the quality of health care 828 services and to control costs. 829 (4) Assist in coordination of the plan and public health 830 programs. 831 (5) Assess and evaluate health care benefits by: 832 (a) Considering health care benefit additions to the plan 833 and evaluating the additions based on evidence of clinical 834 efficacy. 835 (b) Establishing a process and criteria by which health 836 care providers may request authorization to provide health care 837 services and treatments that are not included in the plan 838 benefit set, such as experimental health care treatments. 839 (c) Evaluating proposals to increase the efficiency and 840 effectiveness of the health care delivery system and making 841 recommendations to the board based on the cost-effectiveness of 842 the proposals. 843 (d) Identifying complementary and alternative health care 844 modalities that have been shown to be safe and effective. 845 (6) The board may convene advisory panels as needed to 846 assess the quality, access, and funding adequacy of the plan. 847 Section 14. Section 641.796, Florida Statutes, is created 848 to read: 849 641.796 Ethics and conflicts of interest; Conflict of 850 Interest Committee.— 851 (1) The Code of Ethics for Public Officers and Employees 852 under part III of chapter 112 applies to the employees and the 853 chief executive officer of the Florida Health Plan, the 854 employees and members of the Florida Health Board, the employees 855 and members of the regional planning boards and the regional 856 health planning directors, the employees and the director of the 857 Office of Health Quality and Planning, the employees and the 858 ombudsman of the Ombudsman Office for Patient Advocacy, and the 859 auditor for the Florida Health Plan. Failure to comply with the 860 code of ethics under part III of chapter 112 is grounds for 861 disciplinary action, which may include termination of employment 862 or removal from the board. 863 (2) In order to avoid the appearance of political bias or 864 impropriety, the chief executive officer of the plan may not: 865 (a) Engage in leadership of, or employment by, a political 866 party or political organization. 867 (b) Publicly endorse a political candidate. 868 (c) Contribute to a political candidate, political party, 869 or political organization. 870 (d) Attempt to avoid compliance with this subsection by 871 making a contribution through a spouse or other family member. 872 (3) In order to avoid a conflict of interest, a person 873 specified in subsection (1) may not be employed by a health care 874 provider or a pharmaceutical, health insurance, or medical 875 supply company while holding the position specified in 876 subsection (1), except for the five health care provider members 877 appointed to the Florida Health Board by the representatives of 878 regional planning boards under s. 641.793(2)(a)2. These five 879 members may be employed by a health care provider, but not by a 880 pharmaceutical, health insurance, or medical supply company 881 while serving on the board. 882 (4) The board shall establish a Conflict-of-Interest 883 Committee to develop standards of practice for persons or 884 entities doing business with the plan, including, but not 885 limited to, board members, health care providers, and medical 886 suppliers. 887 (a) The committee shall establish guidelines on the duty to 888 disclose to the committee the existence of any financial 889 interest and all material facts related to a financial interest. 890 (b) The committee shall review all proposed transactions 891 and arrangements that involve the plan. In considering a 892 proposed transaction or arrangement, if the committee determines 893 a conflict of interest exists, the committee must investigate 894 alternatives to the proposed transaction or arrangement. After 895 exercising due diligence, the committee shall determine whether 896 the plan can obtain with reasonable efforts a more advantageous 897 transaction or arrangement with a person or entity which would 898 not give rise to a conflict of interest. If the committee 899 determines that a more advantageous transaction or arrangement 900 is not reasonably possible under the circumstances, the 901 committee shall make a recommendation to the board on whether 902 the transaction or arrangement is in the best interest of the 903 plan, and whether the transaction is fair and reasonable. The 904 committee shall provide to the board all material information 905 used to make the recommendation. After reviewing all relevant 906 information, the board shall decide whether to approve the 907 transaction or arrangement. 908 Section 15. Section 641.797, Florida Statutes, is created 909 to read: 910 641.797 Ombudsman Office for Patient Advocacy.— 911 (1) The Ombudsman Office for Patient Advocacy is created to 912 represent the interests of consumers of health care and to help 913 residents of this state secure the health care services and 914 health care benefits to which they are entitled under this part. 915 The Ombudsman Office for Patient Advocacy shall also advocate on 916 behalf of enrollees of the Florida Health Plan. 917 (2) The Ombudsman Office for Patient Advocacy shall be 918 headed by the ombudsman, who shall be appointed by the Secretary 919 of Health Care Administration. The ombudsman shall serve in the 920 unclassified service and may be removed only for just cause. The 921 ombudsman must be selected without regard to political 922 affiliation and must be knowledgeable about and have experience 923 in health care services and administration. A person may not 924 serve as ombudsman while holding another public office. 925 (a) The ombudsman may gather information about decisions 926 and acts of the Florida Health Board and about any matters 927 related to the board, health care providers, and health care 928 programs. 929 (b) The ombudsman shall: 930 1. Ensure that patient advocacy services are available to 931 all residents of this state. 932 2. Establish and maintain the grievance system according to 933 subsection (3). 934 3. Receive, evaluate, and respond to consumer complaints 935 about the plan. 936 4. Establish a process to receive recommendations from the 937 public about ways to improve the plan. 938 5. Develop educational and informational guides that 939 describe consumer rights and responsibilities. 940 6. Ensure that the guides described in subparagraph 5. are 941 widely available to consumers and available in health care 942 provider offices and facilities. 943 7. Prepare an annual report about the consumer’s 944 perspective on the performance of the plan, including 945 recommendations for needed improvements. 946 (3) The ombudsman shall establish a grievance system for 947 complaints. The system must provide a process that ensures 948 adequate consideration of plan enrollee grievances and 949 appropriate remedies. 950 (a) The ombudsman may refer any complaint that does not 951 pertain to compliance with this part to the federal Centers for 952 Medicare and Medicaid Services or any other appropriate local, 953 state, and federal government entity for investigation and 954 resolution. 955 (b) A health care provider or an employee of a health care 956 provider may join with, or otherwise assist, a complainant in 957 submitting a complaint to the ombudsman. A health care provider 958 or an employee of a health care provider who, in good faith, 959 joins with or assists a complainant in submitting a complaint is 960 subject to protections and remedies under this part or under 961 general law. 962 (c) In reviewing a complaint, the ombudsman may require a 963 health care provider or the board to submit any information the 964 ombudsman deems necessary. 965 (d)1. The ombudsman shall send a written notice of the 966 final disposition of the complaint and the reasons for the 967 decision to: 968 a. The complainant; 969 b. Any health care provider or employee of a health care 970 provider who joins with or assists the complainant in submitting 971 the complaint; and 972 c. The board, 973 974 within 30 calendar days after receipt of the complaint, unless 975 the ombudsman determines that additional time is reasonably 976 necessary to fully and fairly evaluate the relevant grievance. 977 2. The ombudsman’s order of corrective action is binding on 978 the plan. A decision of the ombudsman is subject to de novo 979 review by the district court. 980 (4) Data collected on a plan enrollee in the enrollee’s 981 complaint to the ombudsman is private data; however, the data 982 may be released to a health care provider that is the subject of 983 the complaint or to the board for purposes of this section. 984 (5) The budget for the Ombudsman Office for Patient 985 Advocacy shall be determined by the Legislature and shall be 986 independent from the board. 987 (6) The ombudsman shall establish offices to provide 988 convenient access to residents of this state. 989 Section 16. Section 641.798, Florida Statutes, is created 990 to read: 991 641.798 Auditor for the Florida Health Plan.— 992 (1) There is created in the Office of the Auditor General 993 the position of auditor for the Florida Health Plan to prevent 994 health care fraud and abuse of the plan. The auditor for the 995 Florida Health Plan shall be appointed by the Auditor General. 996 (2) The auditor for the Florida Health Plan shall: 997 (a) Investigate, audit, and review the financial and 998 business records of the plan. 999 (b) Investigate, audit, and review the financial and 1000 business records of individuals, public and private agencies and 1001 institutions, and private corporations that provide services or 1002 products to the plan which are reimbursed by the plan. 1003 (c) Investigate allegations of misconduct on the part of an 1004 employee or appointee of the Florida Health Board and on the 1005 part of any health care provider that is reimbursed by the plan 1006 and report any findings of misconduct to the Attorney General. 1007 (d) Investigate fraud and abuse. 1008 (e) Arrange for the collection and analysis of data needed 1009 to investigate inappropriate use of a product or service that is 1010 reimbursed by the plan. 1011 (f) Annually report recommendations for improvements to the 1012 plan to the board. 1013 Section 17. Section 641.799, Florida Statutes, is created 1014 to read: 1015 641.799 Florida Health Plan policies and procedures; 1016 rulemaking.— 1017 (1) The Florida Health Plan policies and procedures are 1018 exempt from the Administrative Procedure Act. 1019 (2)(a) If the board determines that a rule should be 1020 adopted under this part to establish, modify, or revoke a policy 1021 or procedure, the board must publish in the state register the 1022 proposed rule and must afford interested persons a period of 30 1023 days after publication to submit written data or comments. 1024 (b) On or before the last day of the 30-day period provided 1025 for the submission of written data or comments under paragraph 1026 (a), any interested person may file with the board written 1027 objections to the proposed rule, stating the grounds for 1028 objection and requesting a public hearing on those objections. 1029 Within 30 days after the last day for submitting written data or 1030 comments, the board shall publish in the state register a notice 1031 specifying the rule to which objections have been filed and a 1032 hearing requested and specifying a time and place for the 1033 hearing. 1034 (c) Within 60 days after the expiration of the period 1035 provided for the submission of written data or comments, or 1036 within 60 days after the completion of any hearing, the board 1037 shall issue a rule adopting, modifying, or revoking a policy or 1038 procedure, or make a determination that a rule should not be 1039 adopted. The rule may contain a provision delaying its effective 1040 date for such period as the board determines necessary. 1041 Section 18. (1) The Director of the Office of Financial 1042 Regulation of the Department of Financial Services and the chief 1043 executive officer of the Florida Health Plan shall regularly 1044 update the Legislature on the status of the planning, 1045 implementation, and financing of this act. 1046 (2) The Florida Health Plan must be operational within 2 1047 years after July 1, 2026. 1048 (3) On and after the day the Florida Health Plan becomes 1049 operational, a health insurance policy, a health maintenance 1050 contract, a continuing care contract, a prepaid health clinic 1051 contract, or any policy or contract that offers coverage for 1052 services covered by the Florida Health Plan may not be sold in 1053 this state. 1054 (4) The Office of the Inspector General of the Agency for 1055 Health Care Administration shall prepare an analysis of this 1056 state’s capital expenditure needs for the purpose of assisting 1057 the Florida Health Board in adopting the statewide capital 1058 budget for the year following implementation. The Office of the 1059 Inspector General shall submit this analysis to the board. 1060 (5) By July 1, 2027, the Department of Commerce shall 1061 provide to the Florida Health Board, the Governor, and the 1062 chairs and ranking members of the legislative committees with 1063 jurisdiction over health, human services, and commerce a report 1064 determining the appropriations and legislation necessary to 1065 assist all affected individuals and communities through the 1066 transition to the Florida Health Plan. 1067 Section 19. This act shall take effect July 1, 2026.