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    1. 2024 Legislative Updates

    New Legislation

    ● House Bill 885 (Biomarker Testing Expansion) – Passed in 2024, this law requires Florida Medicaid and state employee health plans to cover biomarker testing when medical evidence supports its clinical utility.

    ● House Bill 1421 (Independent Hospital District Privatization Study) – This bill required independent hospital districts to assess the benefits of converting to private nonprofit entities. It passed in the House but died in the Senate.

    ● Prior Authorization Reform Proposal – While no comprehensive reform was enacted in 2024, ongoing discussions have laid the groundwork for rulemaking in 2025 to simplify and streamline prior authorization processes.

    ● Medicaid Managed Care Realignment—AHCA is realigning Medicaid regions to improve access and efficiency, and it is set to be completed by late 2025.

    Regulatory Changes

    ● Criminal Background Screening Expansion (House Bill 975 - Pending Signature) – If signed into law, this will expand background screening requirements for healthcare professionals licensed by the Florida Department of Health, with compliance required by July 1, 2025.

    ● Ambulatory Surgical Centers (ASC) Regulations – ASCs must now adopt pediatric care protocols and enhance emergency service readiness as part of new state regulations.

    ● Florida Hospital Association’s Payer Accountability Push – FHA advocates for statutory timeframes for prior authorization requests and limitations on insurer audits.


    Key Laws Taking Effect

    ● Biomarker Testing Coverage – As of January 1, 2025, Florida Medicaid and state employee health plans must cover biomarker testing for qualifying patients.

    ● Skin Cancer Screenings for State Employees – State health plans now provide free skin cancer screenings for over 300,000 employees.

    ● Annual Reporting for Healthcare Quality and Outcomes – The AHCA must now submit annual reports on "Potentially Preventable Health Care Events" for Florida Medicaid enrollees.

    Impact on Medical Practices:

    ● Increased coverage for biomarker testing will expand access to precision medicine, benefiting oncology and diagnostic providers.

    ● Enhanced reporting requirements may create additional compliance obligations for Medicaid providers.

    3. What to Watch for in 2025

    New or Pending Legislation

    ● Prior Authorization Reform (Rulemaking by April 1, 2025) – The Florida Department of Health is expected to propose new regulations streamlining prior authorization processes, potentially introducing gold card programs for efficient providers.

    ● Hospital District Privatization (Potential Reintroduction of House Bill 1421) – Discussions on hospital district privatization may reemerge in the 2025 legislative session.

    ● Site-Neutral Payment Policies – Ongoing industry advocacy could push for payment equity between hospital-based and independent outpatient services.

    ● Step Therapy Reform – Expected legislation may allow exemptions from insurer-mandated step therapy protocols when medically necessary.

    ● Medicaid Reimbursement Adjustments – Lawmakers and industry groups continue to push for increased reimbursement rates to support independent practices and specialty providers.

    Key Dates

    ● January 7, 2025 – Public workshop for rulemaking on Qualified Residential Treatment Program Services (59G-4.128).

    ● April 1, 2025 – Deadline for the Florida Department of Health to release proposed rules on prior authorization reform.

    ● July 1, 2025 – Compliance deadline for criminal background screenings if House Bill 975 is enacted.

    ● Late 2025 – Medicaid managed care realignment expected to be completed.

    Industry Trends

    ● Increased Focus on Payer Accountability – FHA and other industry advocates are pushing for stronger regulations on insurer payment practices, including transparency in Medicaid managed care plan performance.

    ● Rising Importance of Behavioral Health Services – Legislative discussions continue on expanding Florida’s behavioral health workforce and enhancing crisis response services.

    ● Expansion of Telehealth and Hospital-at-Home Models – Expect discussions on state-level policies to support these models within Medicaid.

    4. Resources and Next Steps

    Key Resources 

    ● Florida Hospital Association Legislative Priorities – www.fha.org

     ● Florida Agency for Health Care Administration Rulemaking Notices – ahca.myflorida.com

     ● National Conference of State Legislatures Healthcare Policy Tracker – www.ncsl.org 

    ● Multistate Legislative Resources – www.multistate.us

    Recommended Actions for Practices

    ● Monitor Prior Authorization Rulemaking – Engage in public comment periods for proposed reforms in early 2025.

    ● Prepare for Medicaid Realignment – Assess how changes may impact patient access and reimbursement structures.

    ● Review Compliance for Background Screening – Ensure all licensed healthcare professionals meet new screening requirements if House Bill 975 is enacted.

    Prepared By: Jennifer Thompson, Florida MGMA State Chapter Legislative Liaison


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