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