Florida Senate - 2026                                    SB 1082
       
       
        
       By Senator Grall
       
       
       
       
       
       29-01080-26                                           20261082__
    1                        A bill to be entitled                      
    2         An act relating to the statewide provider and health
    3         plan claim dispute resolution program; amending s.
    4         408.7057, F.S.; specifying additional circumstances
    5         under which a disputed claim is not subject to review
    6         under the statewide provider and health plan claim
    7         dispute resolution program; providing an effective
    8         date.
    9          
   10  Be It Enacted by the Legislature of the State of Florida:
   11  
   12         Section 1. Paragraph (b) of subsection (2) of section
   13  408.7057, Florida Statutes, is amended to read:
   14         408.7057 Statewide provider and health plan claim dispute
   15  resolution program.—
   16         (2)
   17         (b) The resolution organization shall review claim disputes
   18  filed by contracted and noncontracted providers and health plans
   19  unless the disputed claim:
   20         1. Is related to interest payment;
   21         2. Does not meet the jurisdictional amounts or the methods
   22  of aggregation established by agency rule, as provided in
   23  paragraph (a);
   24         3. Is part of an internal grievance in a Medicare managed
   25  care organization or a reconsideration appeal through the
   26  Medicare appeals process;
   27         4. Is related to a health plan that is not regulated by the
   28  state;
   29         5. Is part of a Medicaid fair hearing pursued under 42
   30  C.F.R. ss. 431.220 et seq.;
   31         6. Is the basis for an action pending in state or federal
   32  court; or
   33         7. Is subject to a binding claim-dispute-resolution process
   34  provided by contract entered into prior to October 1, 2000,
   35  between the provider and the managed care organization;
   36         8. Is related to services initiated pursuant to s. 395.1041
   37  or 42 U.S.C. s. 1395dd and has been submitted for resolution
   38  through the federal independent dispute resolution process; or
   39         9. Is related to services rendered by out-of-network
   40  providers and has been submitted for resolution through the
   41  federal independent dispute resolution process.
   42         Section 2. This act shall take effect July 1, 2026.