Florida Senate - 2013 SENATOR AMENDMENT Bill No. CS for CS for SB 966 Barcode 350138 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— 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 mayshallnot 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 subsectionsectionis 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,