Florida Senate - 2013 CS for CS for SB 1016
By the Committees on Judiciary; and Health Policy; and Senator
Hays
590-03867-13 20131016c2
1 A bill to be entitled
2 An act relating to dentistry; amending s. 627.6474,
3 F.S.; prohibiting a contract between a health insurer
4 and a dentist from requiring the dentist to provide
5 services at a fee set by the insurer under certain
6 circumstances; providing that covered services are
7 those services listed as a benefit that the insured is
8 entitled to receive under a contract; prohibiting an
9 insurer from providing merely de minimis reimbursement
10 or coverage; requiring that fees for covered services
11 be set in good faith and not be nominal; prohibiting a
12 health insurer from requiring as a condition of a
13 contract that a dentist participate in a discount
14 medical plan; amending s. 636.035, F.S.; prohibiting a
15 contract between a prepaid limited health service
16 organization and a dentist from requiring the dentist
17 to provide services at a fee set by the organization
18 under certain circumstances; providing that covered
19 services are those services listed as a benefit that a
20 subscriber of a prepaid limited health service
21 organization is entitled to receive under a contract;
22 prohibiting a prepaid limited health service
23 organization from providing merely de minimis
24 reimbursement or coverage; requiring that fees for
25 covered services be set in good faith and not be
26 nominal; prohibiting the prepaid limited health
27 service organization from requiring as a condition of
28 a contract that a dentist participate in a discount
29 medical plan; amending s. 641.315, F.S.; prohibiting a
30 contract between a health maintenance organization and
31 a dentist from requiring the dentist to provide
32 services at a fee set by the organization under
33 certain circumstances; providing that covered services
34 are those services listed as a benefit that a
35 subscriber of a health maintenance organization is
36 entitled to receive under a contract; prohibiting a
37 health maintenance organization from providing merely
38 de minimis reimbursement or coverage; requiring that
39 fees for covered services be set in good faith and not
40 be nominal; prohibiting the health maintenance
41 organization from requiring as a condition of a
42 contract that a dentist participate in a discount
43 medical plan; providing for application of the act;
44 amending s. 766.1115, F.S.; revising a definition;
45 requiring a contract with a governmental contractor
46 for health care services to include a provision for a
47 health care provider licensed under ch. 466, F.S., as
48 an agent of the governmental contractor, to allow a
49 patient or a parent or guardian of the patient to
50 voluntarily contribute a fee to cover costs of dental
51 laboratory work related to the services provided to
52 the patient without forfeiting sovereign immunity;
53 prohibiting the contribution from exceeding the actual
54 amount of the dental laboratory charges; providing
55 that the contribution complies with the requirements
56 of s. 766.1115, F.S.; providing for applicability;
57 providing an effective date.
58
59 Be It Enacted by the Legislature of the State of Florida:
60
61 Section 1. Section 627.6474, Florida Statutes, is amended
62 to read:
63 627.6474 Provider contracts.—
64 (1) A health insurer may shall not require a contracted
65 health care practitioner as defined in s. 456.001(4) to accept
66 the terms of other health care practitioner contracts with the
67 insurer or any other insurer, or health maintenance
68 organization, under common management and control with the
69 insurer, including Medicare and Medicaid practitioner contracts
70 and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
71 s. 641.315, except for a practitioner in a group practice as
72 defined in s. 456.053 who must accept the terms of a contract
73 negotiated for the practitioner by the group, as a condition of
74 continuation or renewal of the contract. Any contract provision
75 that violates this section is void. A violation of this
76 subsection section is not subject to the criminal penalty
77 specified in s. 624.15.
78 (2)(a) A contract between a health insurer and a dentist
79 licensed under chapter 466 for the provision of services to an
80 insured may not contain any provision that requires the dentist
81 to provide services to the insured under such contract at a fee
82 set by the health insurer unless such services are covered
83 services under the applicable contract.
84 (b) Covered services are those services that are listed as
85 a benefit that the insured is entitled to receive under the
86 contract. An insurer may not provide merely de minimis
87 reimbursement or coverage in order to avoid the requirements of
88 this section. Fees for covered services shall be set in good
89 faith and must not be nominal.
90 (c) A health insurer may not require as a condition of the
91 contract that the dentist participate in a discount medical plan
92 under part II of chapter 636.
93 Section 2. Subsection (13) is added to section 636.035,
94 Florida Statutes, to read:
95 636.035 Provider arrangements.—
96 (13)(a) A contract between a prepaid limited health service
97 organization and a dentist licensed under chapter 466 for the
98 provision of services to a subscriber of the prepaid limited
99 health service organization may not contain any provision that
100 requires the dentist to provide services to the subscriber of
101 the prepaid limited health service organization at a fee set by
102 the prepaid limited health service organization unless such
103 services are covered services under the applicable contract.
104 (b) Covered services are those services that are listed as
105 a benefit that the subscriber is entitled to receive under the
106 contract. A prepaid limited health service organization may not
107 provide merely de minimis reimbursement or coverage in order to
108 avoid the requirements of this section. Fees for covered
109 services shall be set in good faith and must not be nominal.
110 (c) A prepaid limited health service organization may not
111 require as a condition of the contract that the dentist
112 participate in a discount medical plan under part II of this
113 chapter.
114 Section 3. Subsection (11) is added to section 641.315,
115 Florida Statutes, to read:
116 641.315 Provider contracts.—
117 (11)(a) A contract between a health maintenance
118 organization and a dentist licensed under chapter 466 for the
119 provision of services to a subscriber of the health maintenance
120 organization may not contain any provision that requires the
121 dentist to provide services to the subscriber of the health
122 maintenance organization at a fee set by the health maintenance
123 organization unless such services are covered services under the
124 applicable contract.
125 (b) Covered services are those services that are listed as
126 a benefit that the subscriber is entitled to receive under the
127 contract. A health maintenance organization may not provide
128 merely de minimis reimbursement or coverage in order to avoid
129 the requirements of this section. Fees for covered services
130 shall be set in good faith and must not be nominal.
131 (c) A health maintenance organization may not require as a
132 condition of the contract that the dentist participate in a
133 discount medical plan under part II of chapter 636.
134 Section 4. Paragraph (a) of subsection (3) of section
135 766.1115, Florida Statutes, is amended, and paragraph (h) is
136 added to subsection (4) of that section, to read:
137 766.1115 Health care providers; creation of agency
138 relationship with governmental contractors.—
139 (3) DEFINITIONS.—As used in this section, the term:
140 (a) “Contract” means an agreement executed in compliance
141 with this section between a health care provider and a
142 governmental contractor which allows. This contract shall allow
143 the health care provider to deliver health care services to low
144 income recipients as an agent of the governmental contractor.
145 The contract must be for volunteer, uncompensated services. For
146 services to qualify as volunteer, uncompensated services under
147 this section, the health care provider must receive no
148 compensation from the governmental contractor for any services
149 provided under the contract and must not bill or accept
150 compensation from the recipient, or a any public or private
151 third-party payor, for the specific services provided to the
152 low-income recipients covered by the contract.
153 (4) CONTRACT REQUIREMENTS.—A health care provider that
154 executes a contract with a governmental contractor to deliver
155 health care services on or after April 17, 1992, as an agent of
156 the governmental contractor is an agent for purposes of s.
157 768.28(9), while acting within the scope of duties under the
158 contract, if the contract complies with the requirements of this
159 section and regardless of whether the individual treated is
160 later found to be ineligible. A health care provider under
161 contract with the state may not be named as a defendant in any
162 action arising out of medical care or treatment provided on or
163 after April 17, 1992, under contracts entered into under this
164 section. The contract must provide that:
165 (h) As an agent of the governmental contractor for purposes
166 of s. 768.28(9), while acting within the scope of duties under
167 the contract, a health care provider licensed under chapter 466
168 may allow a patient or a parent or guardian of the patient to
169 voluntarily contribute a fee to cover costs of dental laboratory
170 work related to the services provided to the patient. This
171 contribution may not exceed the actual cost of the dental
172 laboratory charges and is deemed in compliance with this
173 section.
174
175 A governmental contractor that is also a health care provider is
176 not required to enter into a contract under this section with
177 respect to the health care services delivered by its employees.
178 Section 5. The amendments to ss. 627.6474, 636.035, and
179 641.315, Florida Statutes, apply to contracts entered into or
180 renewed on or after July 1, 2013.
181 Section 6. This act shall take effect July 1, 2013.