HB 697 - Drug Prices and Coverage

CS/HB 697 makes it unlawful for a PBM to force a pharmacy to take a loss when dispensing a drug or to reimburse a nonaffiliated pharmacy less than an affiliated pharmacy. The bill requires PBMs to allow in-network pharmacies to submit consolidated appeals comprised of multiple adjudicated claims featuring identical drugs, day supplies, and dates of service.  

NOTE: the bill was amended to remove the MOST FAVORED NATION DRUG PRICING provisions.

SB 1756 - Medical Freedom

Require informed consent for vaccinating minor children, grant immunity for prescribing and dispensing ivermectin to adults, and broaden immunization exemptions and procedures during communicable disease emergencies.

SB 1668 - Florida Birth-Related Neurological Injury Compensation Association- NICA

Expand cost recovery for Medicaid expenses, revise plan definitions, and modify coverage and assessments within the Florida Birth-Related Neurological Injury Compensation Plan.

• Authorize AHCA to recover Medicaid costs from the Florida Birth-Related Neurological Injury Compensation Association.
• Add new definitions for “office” (Office of Insurance Regulation) and “participant,” and clarify the meaning of “birth-related neurological injury.”
• Revise exclusivity of remedies under the plan to address claims against those participating in labor, delivery, or immediate postdelivery care.
• Require that plan participants maintain continuous health insurance coverage or enroll in Medicaid.
• Expand covered services under the plan to include family therapy, transportation, housing support, and certain legal costs.
• Provide reimbursement for medically necessary services for plan participants also enrolled in Medicaid, crediting funds back to the agency’s Medical Care Trust Fund.
• Adjust and reorganize assessments paid by participating hospitals and physicians, including changes to payment due dates.
• Revise board membership to include a family member of a participant and prohibit creation or expansion of benefits if the plan is operating at a deficit.

NOTE: Even without this legislation, NICA is running a deficit and new assessments will be sent to physicians. The House & Senate bill handle those assessments differently.

SB 162 - Protection from Surgical Smoke

Require hospitals and ambulatory surgical centers to implement smoke evacuation policies to protect patients and personnel from harmful surgical smoke.

SB 1110 - Coverage for Orthotics and Prosthetics Services

Expands coverage for orthotics and prosthetics services for specified Medicaid recipients and certain insured individuals by defining eligibility and requiring coverage for medically necessary devices and related services.

• Amends current Medicaid law to define eligible individuals and authorize coverage for orthotics and prosthetics services, including medically necessary replacement and repairs.
• Directs the Agency for Health Care Administration to seek federal approval and amend contracts to implement these coverage changes for Medicaid.
• Creates new requirements for individual, group, and blanket health insurance policies and health maintenance organization contracts to cover orthotics and prosthetics for the same categories of eligible individuals.
• Allows insurers and health maintenance organizations to request supporting documentation for replacements of newer devices and prohibits denial of coverage for medically necessary prosthetic or orthotic interventions.
• Requires annual insurer and health maintenance organization reporting to the Office of Insurance Regulation on claims related to orthotics and prosthetics.

HB 527 - Mandatory Human Reviews of Insurance Claim Denials

Require that insurance claim denials or reductions be confirmed by qualified human professionals rather than relying solely on artificial intelligence or machine learning systems.

• Creates new sections in the Florida Statutes mandating that carriers, insurers, and health maintenance organizations use AI/ML only as an aid and not as the sole basis for denying or reducing claims.
• Requires a qualified human professional to independently analyze policy terms, review AI/ML outputs, and determine claim payment or denial decisions.
• Obligates carriers, insurers, and HMOs to maintain detailed records of denial decisions, including the identity of the professional making the decision and the reason for the denial or reduction.
• Mandates that written denial notices include specific contact details and a statement affirming that AI/ML alone was not the basis for the denial.
• Requires documentation in company manuals detailing how AI/ML systems are integrated into claim-handling practices.
• Authorizes regulatory agencies to conduct examinations, investigations, and adopt rules to enforce compliance.

SB 254 - Nursing Education Programs

Requires additional measures for licensure, including a remedial course for certain applicants and a temporary provisional license for graduates, and revises program approval criteria and accountability measures for nursing education programs.

SB 1404 - Memory Care

Establish new licensing requirements for facilities offering memory care services and create a statewide center to coordinate Alzheimer’s care and resources.

SB 560 - Child Welfare

Streamline medical reporting requirements for psychotropic medication, strengthen collaboration with child-focused organizations, update definitions for child welfare screening, revise consent documentation procedures, and require a comprehensive study of liability insurance coverage for community-based care providers.

SB 902 - Department of Health

Revise multiple sections of Florida’s health laws to update cannabis regulations, create a grant program for neurofibromatosis, and amend procedures for early intervention, licensing, and medication delegation.

SB 1376 - Grants for Genetic Counseling Education

Create the Genetic Counseling Education Enhancement Grant Program within the State University System to support accredited graduate-level genetic counseling programs through competitive grants.

HB 693 - Health and Human Services

CS/HB 693 addresses a host of federal requirements and policy priorities articulated in the federal “One Big Beautiful Bill Act” by codifying the federal requirements for the Medicaid program, Children’s Health Insurance Program, and the Supplemental Nutrition Assistance Program.

The bill also adopts a broad set of health care policies.

Specifically, the bill: 

• Joins the interstate licensure compacts for physician assistants, social workers, and emergency medical service providers.
• Authorizes autonomous practice for all advanced practice registered nurse specialties.
• Eliminates the cap on the number of physicians assistants a physician can supervise.
• Authorizes dentists to delegate additional tasks to dental hygienists.
• Requires practitioners to inform patients when a referral is to an out-of-network provider and requires insurers to credit out-of-network costs to cost-sharing requirements
• Requires insurers to credit patient payments for out-of-network providers toward their deductibles if certain conditions are met.    

HB 223 - Naturopathic Medicine

Modernizes regulation of naturopathic medicine by establishing new licensure requirements, a regulatory board, and updated definitions and practice parameters for naturopathic doctors.