Florida Senate - 2013                                     SB 924
       
       
       
       By Senator Latvala
       
       
       
       
       20-00157A-13                                           2013924__
    1                        A bill to be entitled                      
    2         An act relating to dentists; 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         providing an effective date.
   45  
   46  Be It Enacted by the Legislature of the State of Florida:
   47  
   48         Section 1. Section 627.6474, Florida Statutes, is amended
   49  to read:
   50         627.6474 Provider contracts.—
   51         (1) A health insurer may shall not require a contracted
   52  health care practitioner as defined in s. 456.001(4) to accept
   53  the terms of other health care practitioner contracts with the
   54  insurer or any other insurer, or health maintenance
   55  organization, under common management and control with the
   56  insurer, including Medicare and Medicaid practitioner contracts
   57  and those authorized by s. 627.6471, s. 627.6472, s. 636.035, or
   58  s. 641.315, except for a practitioner in a group practice as
   59  defined in s. 456.053 who must accept the terms of a contract
   60  negotiated for the practitioner by the group, as a condition of
   61  continuation or renewal of the contract. Any contract provision
   62  that violates this section is void. A violation of this
   63  subsection section is not subject to the criminal penalty
   64  specified in s. 624.15.
   65         (2)(a)A contract between a health insurer and a dentist
   66  licensed under chapter 466 for the provision of services to an
   67  insured may not contain any provision that requires the dentist
   68  to provide services to the insured under such contract at a fee
   69  set by the health insurer unless such services are covered
   70  services under the applicable contract.
   71         (b) Covered services are those services that are listed as
   72  a benefit that the insured is entitled to receive under the
   73  contract. An insurer may not provide merely de minimis
   74  reimbursement or coverage in order to avoid the requirements of
   75  this section. Fees for covered services shall be set in good
   76  faith and must not be nominal.
   77         (c) A health insurer may not require as a condition of the
   78  contract that the dentist participate in a discount medical plan
   79  under part II of chapter 636.
   80         Section 2. Subsection (13) is added to section 636.035,
   81  Florida Statutes, to read:
   82         636.035 Provider arrangements.—
   83         (13)(a)A contract between a prepaid limited health service
   84  organization and a dentist licensed under chapter 466 for the
   85  provision of services to a subscriber of the prepaid limited
   86  health service organization may not contain any provision that
   87  requires the dentist to provide services to the subscriber of
   88  the prepaid limited health service organization at a fee set by
   89  the prepaid limited health service organization unless such
   90  services are covered services under the applicable contract.
   91         (b) Covered services are those services that are listed as
   92  a benefit that the subscriber is entitled to receive under the
   93  contract. A prepaid limited health service organization may not
   94  provide merely de minimis reimbursement or coverage in order to
   95  avoid the requirements of this section. Fees for covered
   96  services shall be set in good faith and must not be nominal.
   97         (c) A prepaid limited health service organization may not
   98  require as a condition of the contract that the dentist
   99  participate in a discount medical plan under part II of this
  100  chapter.
  101         Section 3. Subsection (11) is added to section 641.315,
  102  Florida Statutes, to read:
  103         641.315 Provider contracts.—
  104         (11)(a)A contract between a health maintenance
  105  organization and a dentist licensed under chapter 466 for the
  106  provision of services to a subscriber of the health maintenance
  107  organization may not contain any provision that requires the
  108  dentist to provide services to the subscriber of the health
  109  maintenance organization at a fee set by the health maintenance
  110  organization unless such services are covered services under the
  111  applicable contract.
  112         (b) Covered services are those services that are listed as
  113  a benefit that the subscriber is entitled to receive under the
  114  contract. A health maintenance organization may not provide
  115  merely de minimis reimbursement or coverage in order to avoid
  116  the requirements of this section. Fees for covered services
  117  shall be set in good faith and must not be nominal.
  118         (c) A health maintenance organization may not require as a
  119  condition of the contract that the dentist participate in a
  120  discount medical plan under part II of chapter 636.
  121         Section 4. This act shall take effect July 1, 2013, and
  122  applies to contracts entered into or renewed on or after that
  123  date.