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HB 815

Patient Referrals by Medicaid Managed Care Organizations and Managed Care Plans

2025 Regular Session Introduced by Fabián Basabe

HB 815 would establish referral requirements for Florida Medicaid managed care organizations to improve patient access to specialists and outside providers.

Died in Health & Human Services Committee
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Bill Summary · HB 815

Legislative bill overview

HB 815 would regulate how Medicaid managed care organizations and plans handle patient referrals to specialists and other providers. The bill establishes requirements for the referral process, presumably addressing approval timelines, documentation standards, or patient choice protections within Florida's Medicaid managed care system.

Why is this important

Medicaid managed care affects hundreds of thousands of low-income Floridians, and referral processes directly impact patients' ability to access necessary specialist care. Poorly functioning referral systems can delay critical treatment, while overly restrictive requirements increase administrative burden on providers and insurers.

Potential points of contention

  • Administrative burden vs. cost control: The bill may require additional documentation or faster approval timelines, which managed care organizations argue increases costs while patient advocates say is necessary for timely care
  • Network adequacy concerns: Requirements around referrals could relate to whether managed care plans must refer outside their networks, balancing plan profitability against access to specialized services
  • Implementation costs: Healthcare facilities and managed care plans would bear costs of new referral processes, which may be passed to taxpayers or result in provider participation changes

Compiled from official sources — confirm details with the bill’s official record.

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