Florida Senate - 2013 SENATOR AMENDMENT Bill No. CS for SB 422 Barcode 353984 LEGISLATIVE ACTION Senate . House . . . Floor: WD . 03/27/2013 12:40 PM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Benacquisto moved the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. This act may be cited as the “Cancer Treatment 6 Fairness Act.” 7 Section 2. Section 627.42391, Florida Statutes, is created 8 to read: 9 627.42391 Cancer treatment parity; orally administered 10 cancer treatment medications.— 11 (1) As used in this section, the term: 12 (a) “Cancer treatment medication” means medication 13 prescribed by a treating physician who determines that the 14 medication is medically necessary to kill or slow the growth of 15 cancerous cells in a manner consistent with nationally accepted 16 standards of practice. 17 (b) “Cost sharing” includes copayments, coinsurance, dollar 18 limits, and deductibles imposed on the covered person. 19 (2) Beginning January 2, 2014, an individual or group 20 insurance policy, including a policy issued to a small employer 21 as defined in s. 627.6699, delivered, issued for delivery, 22 renewed, amended, or continued in this state which provides 23 medical, major medical, or similar comprehensive coverage and 24 includes coverage for cancer treatment medications, must also 25 cover prescribed, orally administered cancer treatment 26 medications and may not apply cost-sharing requirements for 27 prescribed, orally administered cancer treatment medications 28 which are less favorable to the covered person than cost-sharing 29 requirements for intravenous or injected cancer treatment 30 medications covered under the policy. 31 (3) An insurer that provides a policy described in 32 subsection (2), and any participating entity through which the 33 insurer offers health services, may not: 34 (a) Vary the terms of a policy in effect on July 1, 2013, 35 in order to avoid compliance with this section. 36 (b) Provide any incentive, including, but not limited to, a 37 monetary incentive, or impose treatment limitations to encourage 38 a covered person to accept less than the minimum protections 39 available under this section. 40 (c) Penalize a health care practitioner or reduce or limit 41 the compensation of a health care practitioner for recommending 42 or providing services or care to a covered person as required 43 under this section. 44 (d) Provide any incentive, including, but not limited to, a 45 monetary incentive, to induce a health care practitioner to 46 provide care or services that do not comply with this section. 47 (e) Change the classification of any intravenous or 48 injected cancer treatment medication or increase the amount of 49 cost sharing applicable to any intravenous or injected cancer 50 treatment medication in effect on the July 1, 2013, in order to 51 comply with this section. 52 Section 3. Section 641.313, Florida Statutes, is created to 53 read: 54 641.313 Cancer treatment parity; orally administered cancer 55 treatment medications.— 56 (1) As used in this section, the term: 57 (a) “Cancer treatment medication” means medication 58 prescribed by a treating physician who determines that the 59 medication is medically necessary to kill or slow the growth of 60 cancerous cells in a manner consistent with nationally accepted 61 standards of practice. 62 (b) “Cost sharing” includes copayments, coinsurance, dollar 63 limits, and deductibles imposed on the covered person. 64 (2) Beginning January 2, 2014, a health maintenance 65 contract, including a contract issued to a small employer as 66 defined in s. 627.6699, delivered, issued for delivery, renewed, 67 amended, or continued in this state which provides medical, 68 major medical, or similar comprehensive coverage and includes 69 coverage for cancer treatment medications, must also cover 70 prescribed, orally administered cancer treatment medications and 71 may not apply cost-sharing requirements for prescribed, orally 72 administered cancer treatment medications which are less 73 favorable to the covered person than cost-sharing requirements 74 for intravenous or injected cancer treatment medications covered 75 under the contract. 76 (3) A health maintenance organization that provides a 77 contract described in subsection (2), and any participating 78 entity through which the health maintenance organization offers 79 health services, may not: 80 (a) Vary the terms of a contract in effect on July 1, 2013, 81 in order to avoid compliance with this section. 82 (b) Provide any incentive, including, but not limited to, a 83 monetary incentive, or impose treatment limitations to encourage 84 a covered person to accept less than the minimum protections 85 available under this section. 86 (c) Penalize a health care practitioner or reduce or limit 87 the compensation of a health care practitioner for recommending 88 or providing services or care to a covered person as required 89 under this section. 90 (d) Provide any incentive, including, but not limited to, a 91 monetary incentive, to induce a health care practitioner to 92 provide care or services that do not comply with this section. 93 (e) Change the classification of any intravenous or 94 injected cancer treatment medication or increase the amount of 95 cost sharing applicable to any intravenous or injected cancer 96 treatment medication in effect on the July 1, 2013, in order to 97 comply with this section. 98 Section 4. Subsection (2) of section 627.6515, Florida 99 Statutes, is amended to read: 100 627.6515 Out-of-state groups.— 101 (2) Except as otherwise provided in this part, this part 102 does not apply to a group health insurance policy issued or 103 delivered outside this state under which a resident of this 104 state is provided coverage if: 105 (a) The policy is issued to an employee group the 106 composition of which is substantially as described in s. 107 627.653; a labor union group or association group the 108 composition of which is substantially as described in s. 109 627.654; an additional group the composition of which is 110 substantially as described in s. 627.656; a group insured under 111 a blanket health policy when the composition of the group is 112 substantially in compliance with s. 627.659; a group insured 113 under a franchise health policy when the composition of the 114 group is substantially in compliance with s. 627.663; an 115 association group to cover persons associated in any other 116 common group, which common group is formed primarily for 117 purposes other than providing insurance; a group that is 118 established primarily for the purpose of providing group 119 insurance, provided the benefits are reasonable in relation to 120 the premiums charged thereunder and the issuance of the group 121 policy has resulted, or will result, in economies of 122 administration; or a group of insurance agents of an insurer, 123 which insurer is the policyholder; 124 (b) Certificates evidencing coverage under the policy are 125 issued to residents of this state and contain in contrasting 126 color and not less than 10-point type the following statement: 127 “The benefits of the policy providing your coverage are governed 128 primarily by the law of a state other than Florida”; and 129 (c) The policy provides the benefits specified in ss. 130 627.419, 627.42391, 627.6574, 627.6575, 627.6579, 627.6612, 131 627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691, and 132 627.66911, and complies with the requirements of s. 627.66996. 133 (d) Applications for certificates of coverage offered to 134 residents of this state must contain, in contrasting color and 135 not less than 12-point type, the following statement on the same 136 page as the applicant’s signature: 137 138 “This policy is primarily governed by the laws of 139 ...insert state where the master policy if filed.... 140 As a result, all of the rating laws applicable to 141 policies filed in this state do not apply to this 142 coverage, which may result in increases in your 143 premium at renewal that would not be permissible under 144 a Florida-approved policy. Any purchase of individual 145 health insurance should be considered carefully, as 146 future medical conditions may make it impossible to 147 qualify for another individual health policy. For 148 information concerning individual health coverage 149 under a Florida-approved policy, consult your agent or 150 the Florida Department of Financial Services.” 151 152 This paragraph applies only to group certificates providing 153 health insurance coverage which require individualized 154 underwriting to determine coverage eligibility for an individual 155 or premium rates to be charged to an individual except for the 156 following: 157 1. Policies issued to provide coverage to groups of persons 158 all of whom are in the same or functionally related licensed 159 professions, and providing coverage only to such licensed 160 professionals, their employees, or their dependents; 161 2. Policies providing coverage to small employers as 162 defined by s. 627.6699. Such policies shall be subject to, and 163 governed by, the provisions of s. 627.6699; 164 3. Policies issued to a bona fide association, as defined 165 by s. 627.6571(5), provided that there is a person or board 166 acting as a fiduciary for the benefit of the members, and such 167 association is not owned, controlled by, or otherwise associated 168 with the insurance company; or 169 4. Any accidental death, accidental death and 170 dismemberment, accident-only, vision-only, dental-only, hospital 171 indemnity-only, hospital accident-only, cancer, specified 172 disease, Medicare supplement, products that supplement Medicare, 173 long-term care, or disability income insurance, or similar 174 supplemental plans provided under a separate policy, 175 certificate, or contract of insurance, which cannot duplicate 176 coverage under an underlying health plan, coinsurance, or 177 deductibles or coverage issued as a supplement to workers’ 178 compensation or similar insurance, or automobile medical-payment 179 insurance. 180 Section 6. This act shall take effect July 1, 2013, and 181 applies to policies and contracts issued or renewed on or after 182 that date. 183 184 ================= T I T L E A M E N D M E N T ================ 185 And the title is amended as follows: 186 Delete everything before the enacting clause 187 and insert: 188 A bill to be entitled 189 An act relating to cancer treatment; providing a short 190 title; creating ss. 627.42391 and 641.313, F.S.; 191 providing definitions; requiring that an individual or 192 group insurance policy or a health maintenance 193 contract that provides coverage for cancer treatment 194 medications provide coverage for orally administered 195 cancer treatment medications on a basis no less 196 favorable than that required by the policy or contract 197 for intravenously administered or injected cancer 198 treatment medications; prohibiting insurers, health 199 maintenance organizations, and certain other entities 200 from engaging in specified actions to avoid compliance 201 with this act; amending s. 627.6515, F.S.; adding a 202 cross-reference to conform to changes made by the act; 203 providing an effective date.