Florida Senate - 2017 COMMITTEE AMENDMENT
Bill No. SB 102
Ì916996gÎ916996
LEGISLATIVE ACTION
Senate . House
Comm: WD .
04/19/2017 .
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The Committee on Rules (Flores) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete line 32
4 and insert:
5 Section 3. Subsection (1) of section 626.88, Florida
6 Statutes, is amended to read:
7 626.88 Definitions.—For the purposes of this part, the
8 term:
9 (1) “Administrator” is any person who directly or
10 indirectly solicits or effects coverage of, collects charges or
11 premiums from, or adjusts or settles claims on residents of this
12 state in connection with authorized commercial self-insurance
13 funds or with insured or self-insured programs which provide
14 life or health insurance coverage or coverage of any other
15 expenses described in s. 624.33(1); or any person who, through a
16 health care risk contract as defined in s. 641.234 with an
17 insurer or health maintenance organization, provides billing and
18 collection services to health insurers and health maintenance
19 organizations on behalf of health care providers; or a pharmacy
20 benefits manager as defined in s. 465.1862(1). The term does not
21 include the following persons, other than any of the following
22 persons:
23 (a) An employer or wholly owned direct or indirect
24 subsidiary of an employer, on behalf of such employer’s
25 employees or the employees of one or more subsidiary or
26 affiliated corporations of such employer.
27 (b) A union on behalf of its members.
28 (c) An insurance company which is either authorized to
29 transact insurance in this state or is acting as an insurer with
30 respect to a policy lawfully issued and delivered by such
31 company in and pursuant to the laws of a state in which the
32 insurer was authorized to transact an insurance business.
33 (d) A health care services plan, health maintenance
34 organization, professional service plan corporation, or person
35 in the business of providing continuing care, possessing a valid
36 certificate of authority issued by the office, and the sales
37 representatives thereof, if the activities of such entity are
38 limited to the activities permitted under the certificate of
39 authority.
40 (e) An entity that is affiliated with an insurer and that
41 only performs the contractual duties, between the administrator
42 and the insurer, of an administrator for the direct and assumed
43 insurance business of the affiliated insurer. The insurer is
44 responsible for the acts of the administrator and is responsible
45 for providing all of the administrator’s books and records to
46 the insurance commissioner, upon a request from the insurance
47 commissioner. For purposes of this paragraph, the term “insurer”
48 means a licensed insurance company, health maintenance
49 organization, prepaid limited health service organization, or
50 prepaid health clinic.
51 (f) A nonresident entity licensed in its state of domicile
52 as an administrator if its duties in this state are limited to
53 the administration of a group policy or plan of insurance and no
54 more than a total of 100 lives for all plans reside in this
55 state.
56 (g) An insurance agent licensed in this state whose
57 activities are limited exclusively to the sale of insurance.
58 (h) A person licensed as a managing general agent in this
59 state, whose activities are limited exclusively to the scope of
60 activities conveyed under such license.
61 (i) An adjuster licensed in this state whose activities are
62 limited to the adjustment of claims.
63 (j) A creditor on behalf of such creditor’s debtors with
64 respect to insurance covering a debt between the creditor and
65 its debtors.
66 (k) A trust and its trustees, agents, and employees acting
67 pursuant to such trust established in conformity with 29 U.S.C.
68 s. 186.
69 (l) A trust exempt from taxation under s. 501(a) of the
70 Internal Revenue Code, a trust satisfying the requirements of
71 ss. 624.438 and 624.439, or any governmental trust as defined in
72 s. 624.33(3), and the trustees and employees acting pursuant to
73 such trust, or a custodian and its agents and employees,
74 including individuals representing the trustees in overseeing
75 the activities of a service company or administrator, acting
76 pursuant to a custodial account which meets the requirements of
77 s. 401(f) of the Internal Revenue Code.
78 (m) A financial institution which is subject to supervision
79 or examination by federal or state authorities or a mortgage
80 lender licensed under chapter 494 who collects and remits
81 premiums to licensed insurance agents or authorized insurers
82 concurrently or in connection with mortgage loan payments.
83 (n) A credit card issuing company which advances for and
84 collects premiums or charges from its credit card holders who
85 have authorized such collection if such company does not adjust
86 or settle claims.
87 (o) A person who adjusts or settles claims in the normal
88 course of such person’s practice or employment as an attorney at
89 law and who does not collect charges or premiums in connection
90 with life or health insurance coverage.
91 (p) A person approved by the department who administers
92 only self-insured workers’ compensation plans.
93 (q) A service company or service agent and its employees,
94 authorized in accordance with ss. 626.895-626.899, serving only
95 a single employer plan, multiple-employer welfare arrangements,
96 or a combination thereof.
97 (r) Any provider or group practice, as defined in s.
98 456.053, providing services under the scope of the license of
99 the provider or the member of the group practice.
100 (s) Any hospital providing billing, claims, and collection
101 services solely on its own and its physicians’ behalf and
102 providing services under the scope of its license.
103 (t) A corporation not for profit whose membership consists
104 entirely of local governmental units authorized to enter into
105 risk management consortiums under s. 112.08.
106
107 A person who provides billing and collection services to health
108 insurers and health maintenance organizations on behalf of
109 health care providers shall comply with the provisions of ss.
110 627.6131, 641.3155, and 641.51(4).
111 Section 4. Present subsection (6) of section 626.8805,
112 Florida Statutes, is redesignated as subsection (7), and a new
113 subsection (6) is added to that section, to read:
114 626.8805 Certificate of authority to act as administrator.—
115 (6) The office shall conduct quarterly audits of each
116 pharmacy benefits manager who holds a certificate of authority
117 to act as an administrator under this part for the purpose of
118 determining whether the pharmacy benefits manager violated any
119 provision of s. 465.1862 or failed to perform as required under
120 that section.
121 Section 5. Subsection (2) of section 626.891, Florida
122 Statutes, is amended to read:
123 626.891 Grounds for suspension or revocation of certificate
124 of authority.—
125 (2) The office may, in its discretion, suspend or revoke
126 the certificate of authority of an administrator if it finds
127 that the administrator:
128 (a) Has violated any lawful rule or order of the commission
129 or office, or any provision of this chapter, s. 465.1862, or s.
130 465.1885;
131 (b) Has refused to be examined or to produce its accounts,
132 records, and files for examination, or if any of its officers
133 has refused to give information with respect to its affairs or
134 has refused to perform any other legal obligation as to such
135 examination, when required by the office;
136 (c) Has, without just cause, refused to pay proper claims
137 or perform services arising under its contracts or has, without
138 just cause, compelled insured persons to accept less than the
139 amount due them or to employ attorneys or bring suit against the
140 administrator to secure full payment or settlement of such
141 claims;
142 (d) Is or was affiliated with and under the same general
143 management or interlocking directorate or ownership as another
144 administrator which transacts business in this state without
145 having a certificate of authority;
146 (e) At any time fails to meet any qualification for which
147 issuance of the certificate could have been refused had such
148 failure then existed and been known to the office;
149 (f) Has been convicted of, or has entered a plea of guilty
150 or nolo contendere to, a felony relating to the business of
151 insurance or insurance administration in this state or in any
152 other state without regard to whether adjudication was withheld;
153 or
154 (g) Is under suspension or revocation in another state.
155 Section 6. Subsection (3) of section 626.894, Florida
156 Statutes, is amended to read:
157 626.894 Administrative fine in lieu of suspension or
158 revocation.—
159 (3) With respect to any knowing and willful violation of a
160 lawful order or rule of the office or commission, or a provision
161 of this part, s. 465.1862, or s. 465.1885, the office may impose
162 a fine upon the administrator in an amount not to exceed $5,000
163 for each such violation. In no event may such fine exceed an
164 aggregate amount of $25,000 for all knowing and willful
165 violations arising out of the same action. In addition to such
166 fine, the administrator shall make restitution when due in
167 accordance with the provisions of subsection (2).
168 Section 7. Until December 31, 2017, the Office of Insurance
169 Regulation may not penalize a pharmacy benefits manager, as
170 defined in s. 465.1862(1), Florida Statutes, for operating as an
171 administrator if the pharmacy benefits manager applies for a
172 certificate of authority by October 1, 2017, and is issued such
173 certificate of authority by December 1, 2017.
174 Section 8. This act shall take effect July 1, 2017.
175
176 ================= T I T L E A M E N D M E N T ================
177 And the title is amended as follows:
178 Delete lines 2 - 8
179 and insert:
180 An act relating to health care; amending s. 627.6131,
181 F.S.; prohibiting a health insurer from retroactively
182 denying a claim under specified circumstances;
183 amending s. 641.3155, F.S.; prohibiting a health
184 maintenance organization from retroactively denying a
185 claim under specified circumstances; amending s.
186 626.88, F.S.; redefining the term “administrator” to
187 include a pharmacy benefits manager; amending s.
188 626.8805, F.S.; requiring the Office of Insurance
189 Regulation to conduct quarterly audits, for a certain
190 purpose, of pharmacy benefits managers that hold
191 certificates of authority to act as administrators;
192 amending ss. 626.891 and 626.894, F.S.; adding
193 violations of certain provisions of the Florida
194 Pharmacy Act as grounds for the office’s suspension or
195 revocation of an administrator’s certificate of
196 authority or imposition of a fine, respectively;
197 prohibiting the office, within a specified timeframe,
198 from penalizing a pharmacy benefits manager for
199 operating as an administrator if the pharmacy benefits
200 manager meets certain conditions; providing an
201 effective date.