Florida Senate - 2026                                    SB 1070
       
       
        
       By Senator Rodriguez
       
       
       
       
       
       40-00575B-26                                          20261070__
    1                        A bill to be entitled                      
    2         An act relating to state group insurance program
    3         coverage for obesity treatment; amending s. 110.12303,
    4         F.S.; requiring the Department of Management Services
    5         to provide coverage for specified strategies for the
    6         evidence-based treatment and management of obesity and
    7         related conditions for state group health insurance
    8         plan policies issued on or after a specified date;
    9         prohibiting coverage criteria for weight management
   10         medications from being more restrictive than the
   11         United States Food and Drug Administration’s
   12         indications for such medications; requiring the
   13         department to adopt certain protocols and criteria by
   14         a specified date; specifying such protocols and
   15         criteria; defining terms; requiring the department to
   16         submit a specified report to the Governor and
   17         Legislature annually by a specified date; providing an
   18         effective date.
   19          
   20  Be It Enacted by the Legislature of the State of Florida:
   21  
   22         Section 1. Subsection (9) is added to section 110.12303,
   23  Florida Statutes, to read:
   24         110.12303 State group insurance program; additional
   25  benefits; price transparency program; reporting.—
   26         (9)(a)For state group health insurance plan policies
   27  issued on or after January 1, 2027, the department shall provide
   28  coverage for all of the following evidence-based strategies for
   29  the treatment and management of obesity and related conditions,
   30  as prescribed by a licensed provider:
   31         1.Intensive health behavioral and lifestyle intervention.
   32         2.FDA-approved weight management medications.
   33         (b)Coverage criteria for FDA-approved weight management
   34  medications may not be more restrictive than the United States
   35  Food and Drug Administration-approved indications for such
   36  medications. Coverage for intensive health behavioral and
   37  lifestyle treatment may include interventions certified or
   38  recognized by the United States Centers for Disease Control and
   39  Prevention or recommended by current clinical standards of care.
   40  Services may be provided in an office setting, through
   41  telehealth, or in community-based settings to support patient
   42  access and needs.
   43         (c)The department shall adopt protocols and criteria for
   44  such coverage by January 1, 2027, which must include, but are
   45  not limited to, that the employee:
   46         1.Is enrolled in one of the state group health insurance
   47  plans or HMO plans participating under this section;
   48         2.Is 18 years of age or older;
   49         3.Was referred and is supervised by an in-network licensed
   50  provider;
   51         4.Has consented to provide personal and medical
   52  information to the department, including medical records
   53  documenting body mass index or weight-related comorbidities;
   54         5.Has received a clinical diagnosis of obesity by an in
   55  network licensed provider;
   56         6.Is required to participate in intensive health
   57  behavioral and lifestyle intervention; and
   58         7.Meets any additional clinical and participation
   59  requirements to manage the cost of coverage.
   60         (d)As used in this subsection, the term:
   61         1.“FDA-approved weight management medication” means any
   62  glucagon-like peptide-1 (GLP-1) agonist medication approved by
   63  the United States Food and Drug Administration with an
   64  indication for chronic weight management in patients with an
   65  obesity diagnosis.
   66         2.“Intensive health behavioral and lifestyle intervention”
   67  means an evidence-based, intensive, multicomponent behavioral or
   68  lifestyle modification intervention designed to support healthy
   69  weight management as recommended by current clinical standards
   70  of care. Interventions include obesity screening, nutrition
   71  assessment, nutrition diagnosis, nutrition intervention,
   72  nutrition monitoring and evaluation, and behavioral counseling
   73  and therapy aimed at weight loss through lifestyle
   74  modifications, such as changes in diet and increased physical
   75  activity. Interventions may be provided in office, through
   76  telehealth, or in community-based settings to support patient
   77  access and needs. Therapy for obesity must be delivered in
   78  accordance with applicable national clinical standards of care,
   79  using evidence-based behavioral counseling frameworks.
   80         (e)By January 15 of each year, the department shall submit
   81  a report to the Governor, the President of the Senate, and the
   82  Speaker of the House of Representatives. The report must include
   83  the participation level and cost savings to both the enrollee
   84  and the state resulting from implementation of this subsection.
   85         Section 2. This act shall take effect July 1, 2026.