Florida legislation · 2026 Regular Session
Florida H1015: Insurance Claims Payments to Health Care Providers
Status: Failed, March 13, 2026
Prohibits payment adjudicators from downcoding health care services under certain circumstances; requires health insurers to ensure that their downcoding policies are updated & to ensure compliance with specified provisions on downcoding; authorizes investigations & actions against noncompliance; provides certain presumption in favor of physicians' determination regarding patients' diagnoses & service orders; provides calculations of interests on health insurers' nonpayment & underpayment due to downcoding; provides causes of action for health care providers; prohibits utilization review entities from implementing new requirements, restrictions, & changes on prior authorizations under certain circumstances; provides requirements for adverse determinations made by such entities on health care providers' claims; revises requirements & timeframes for responses from health insurers & HMOs to submitted claims.
What the bill says
An act relating to insurance claims payments to health care providers; creating s. 627.4193, F.S.; providing definitions; prohibiting payment adjudicators from downcoding health care services under certain circumstances; providing exceptions; providing requirements for such exceptions; requiring health insurers to ensure that their downcoding policies are updated and to ensure compliance with specified provisions on downcoding; authorizing investigations and actions against noncompliance…
From the introduced text, January 5, 2026:
A bill to be entitled An act relating to insurance claims payments to health care providers; creating s. 627.4193, F.S.; providing definitions; prohibiting payment adjudicators from downcoding health care services under certain circumstances; providing exceptions; providing requirements for such exceptions; requiring health insurers to ensure that their downcoding policies are updated and to ensure compliance with specified provisions on downcoding; authorizing investigations and actions against noncompliance; providing certain presumption in favor of physicians' determination regarding patients' diagnoses and service orders; providing calculations of interests on health insurers' nonpayment and underpayment due to downcoding; providing causes of action for health care providers; amending s. 627.42392, F.S.; providing and revising definitions; requiring utilization review entities to establish electronic prior authorizations to accept prior authorization requests; providing requirements for such entities and for prior authorization processes; prohibiting such entities from implementing new requirements, restrictions, and changes; providing exceptions; providing reporting requirements; requiring the Office of Insurance words underlined are additions. hb1015-00 FLORIDAHOUSEOFREPRESENTATIVES HB 1015 2026 Regulation to publish a report based on such entities' reports; providing requirements for adverse determinations made by such entities on health care providers' claims; providing a timeframe for such entities' determination on claims; prohibiting prior authorization requirements under certain circumstances; prohibiting prior authorization revocations, limits, conditions, and restrictions under certain circumstances; providing exceptions; providing validity timeframe of prior …
Sponsors
- Cassel, Hillary (R, HD-101) · primary sponsor
Latest actions
- : Died in Insurance & Banking Subcommittee
- : 1st Reading (Original Filed Version)
- : Now in Insurance & Banking Subcommittee
- : Referred to Commerce Committee
- : Referred to Health Care Facilities & Systems Subcommittee
- : Referred to Insurance & Banking Subcommittee
- : Filed
Common questions
- What is H1015?
- H1015 is a bill in the Florida Legislature (2026 Regular Session): Insurance Claims Payments to Health Care Providers.
- What does H1015 do?
- In its own words: An act relating to insurance claims payments to health care providers; creating s. 627.4193, F.S.; providing definitions; prohibiting payment adjudicators from downcoding health care services under certain circumstances; providing exceptions; providing requirements for such exceptions; requiring health insurers to ensure that their downcoding policies are updated and to ensure compliance with specified provisions on downcoding; authorizing investigations and actions against noncompliance…
- What is the status of H1015?
- Failed as of March 13, 2026. Latest action: Died in Insurance & Banking Subcommittee (March 13, 2026).
- Who sponsored H1015?
- Cassel, Hillary (R, HD-101).
- Where is the official record for H1015?
- On the Florida Legislature website: https://www.flsenate.gov/Session/Bill/2026/1015
Source: official Florida record. Tracked by Delilah, AI for legislation across all 50 states and Congress.