Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS for CS for SB 966
       
       
       
       
       
       
                                Barcode 350138                          
       
                              LEGISLATIVE ACTION                        
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       Senator Latvala moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Between lines 3603 and 3604
    4  insert:
    5         Section 80. Section 627.6474, Florida Statutes, is amended
    6  to read:
    7         627.6474 Provider contracts.—
    8         (1) A health insurer may shall not require a contracted
    9  health care practitioner as defined in s. 456.001(4) to accept
   10  the terms of other health care practitioner contracts with the
   11  insurer or any other insurer, or health maintenance
   12  organization, under common management and control with the
   13  insurer, including Medicare and Medicaid practitioner contracts
   14  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
   15  s. 641.315, except for a practitioner in a group practice as
   16  defined in s. 456.053 who must accept the terms of a contract
   17  negotiated for the practitioner by the group, as a condition of
   18  continuation or renewal of the contract. Any contract provision
   19  that violates this section is void. A violation of this
   20  subsection section is not subject to the criminal penalty
   21  specified in s. 624.15.
   22         (2)(a)A contract between a health insurer and a dentist
   23  licensed under chapter 466 for the provision of services to an
   24  insured may not contain any provision that requires the dentist
   25  to provide services to the insured under such contract at a fee
   26  set by the health insurer unless such services are covered
   27  services under the applicable contract.
   28         (b) Covered services are those services that are listed as
   29  a benefit that the insured is entitled to receive under the
   30  contract. An insurer may not provide merely de minimis
   31  reimbursement or coverage in order to avoid the requirements of
   32  this section. Fees for covered services shall be set in good
   33  faith and must not be nominal.
   34         (c) A health insurer may not require as a condition of the
   35  contract that the dentist participate in a discount medical plan
   36  under part II of chapter 636.
   37         Section 81. Subsection (13) is added to section 636.035,
   38  Florida Statutes, to read:
   39         636.035 Provider arrangements.—
   40         (13)(a)A contract between a prepaid limited health service
   41  organization and a dentist licensed under chapter 466 for the
   42  provision of services to a subscriber of the prepaid limited
   43  health service organization may not contain any provision that
   44  requires the dentist to provide services to the subscriber of
   45  the prepaid limited health service organization at a fee set by
   46  the prepaid limited health service organization unless such
   47  services are covered services under the applicable contract.
   48         (b) Covered services are those services that are listed as
   49  a benefit that the subscriber is entitled to receive under the
   50  contract. A prepaid limited health service organization may not
   51  provide merely de minimis reimbursement or coverage in order to
   52  avoid the requirements of this section. Fees for covered
   53  services shall be set in good faith and must not be nominal.
   54         (c) A prepaid limited health service organization may not
   55  require as a condition of the contract that the dentist
   56  participate in a discount medical plan under part II of this
   57  chapter.
   58         Section 82. Subsection (11) is added to section 641.315,
   59  Florida Statutes, to read:
   60         641.315 Provider contracts.—
   61         (11)(a)A contract between a health maintenance
   62  organization and a dentist licensed under chapter 466 for the
   63  provision of services to a subscriber of the health maintenance
   64  organization may not contain any provision that requires the
   65  dentist to provide services to the subscriber of the health
   66  maintenance organization at a fee set by the health maintenance
   67  organization unless such services are covered services under the
   68  applicable contract.
   69         (b) Covered services are those services that are listed as
   70  a benefit that the subscriber is entitled to receive under the
   71  contract. A health maintenance organization may not provide
   72  merely de minimis reimbursement or coverage in order to avoid
   73  the requirements of this section. Fees for covered services
   74  shall be set in good faith and must not be nominal.
   75         (c) A health maintenance organization may not require as a
   76  condition of the contract that the dentist participate in a
   77  discount medical plan under part II of chapter 636.
   78         Section 83. The changes made by this act to ss. 627.6474,
   79  636.035, and 641.315, Florida Statutes apply to contracts
   80  entered into or renewed on or after July 1, 2013.
   81  
   82  ================= T I T L E  A M E N D M E N T ================
   83         And the title is amended as follows:
   84         Delete line 351
   85  and insert:
   86         the state; amending s. 627.6474, F.S.; prohibiting a
   87         contract between a health insurer and a dentist from
   88         requiring the dentist to provide services at a fee set
   89         by the insurer under certain circumstances; providing
   90         that covered services are those services listed as a
   91         benefit that the insured is entitled to receive under
   92         a contract; prohibiting an insurer from providing
   93         merely de minimis reimbursement or coverage; requiring
   94         that fees for covered services be set in good faith
   95         and not be nominal; prohibiting a health insurer from
   96         requiring as a condition of a contract that a dentist
   97         participate in a discount medical plan; amending s.
   98         636.035, F.S.; prohibiting a contract between a
   99         prepaid limited health service organization and a
  100         dentist from requiring the dentist to provide services
  101         at a fee set by the organization under certain
  102         circumstances; providing that covered services are
  103         those services listed as a benefit that a subscriber
  104         of a prepaid limited health service organization is
  105         entitled to receive under a contract; prohibiting a
  106         prepaid limited health service organization from
  107         providing merely de minimis reimbursement or coverage;
  108         requiring that fees for covered services be set in
  109         good faith and not be nominal; prohibiting the prepaid
  110         limited health service organization from requiring as
  111         a condition of a contract that a dentist participate
  112         in a discount medical plan; amending s. 641.315, F.S.;
  113         prohibiting a contract between a health maintenance
  114         organization and a dentist from requiring the dentist
  115         to provide services at a fee set by the organization
  116         under certain circumstances; providing that covered
  117         services are those services listed as a benefit that a
  118         subscriber of a health maintenance organization is
  119         entitled to receive under a contract; prohibiting a
  120         health maintenance organization from providing merely
  121         de minimis reimbursement or coverage; requiring that
  122         fees for covered services be set in good faith and not
  123         be nominal; prohibiting the health maintenance
  124         organization from requiring as a condition of a
  125         contract that a dentist participate in a discount
  126         medical plan; providing for application of certain
  127         provisions of the act; amending ss. 627.645, 627.668,
  128         627.669,