The Florida Senate

408.706  Community health purchasing alliances; accountable health partnerships.--

(1)  An accountable health partnership may be created by health care providers, health maintenance organizations, and health insurers, for the purpose of providing health care services to alliance members.

(2)  Each accountable health partnership that seeks to offer services to members of an alliance must first obtain agency designation. The agency shall adopt rules in accordance with ss. 408.70-408.706 for designating accountable health partnerships in each district. To qualify as an accountable health partnership, an applicant must submit information considered sufficient by the agency, in a format prescribed by the agency, to satisfactorily demonstrate that the partnership:

(a)  Is licensed or certified and in good standing with the department and the licensure agency for participating providers;

(b)  Has demonstrated the capacity to administer the health plans it is offering;

(c)  Has the ability, experience, and structure to arrange for the appropriate level and type of health care services;

(d)  Has the ability, policies, and procedures to conduct utilization management;

(e)  Has the ability to achieve, monitor, and evaluate the quality and cost-effectiveness of care provided by its provider network;

(f)  Has the ability to assure enrollees adequate access to providers of health care, including geographic availability and adequate numbers and types;

(g)  Has the ability and procedures to monitor access to its provider network;

(h)  Has a satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints;

(i)  Has the ability to use medical outcome data to educate network providers, update utilization review procedures, and recommend modifications to benefit designs;

(j)  Has the ability to recruit and retain health care practitioners who are minorities as defined in s. 288.703(3), with special emphasis on the recruitment and retention of African-American health care providers; and

(k)  Has the ability and policies that allow patients to receive care in the most appropriate, least restrictive setting.

If an accountable health partnership is accredited by a nationally recognized accrediting body or federal agency whose standards are acceptable to the agency, or if it is qualified or accredited as a health maintenance organization, the accountable health partnership may be deemed to meet the requirements of paragraphs (a)-(h).

(3)  The agency shall establish a designation fee to be paid by each accountable health partnership to cover the agency's cost in performing the designation review.

(4)  An accountable health partnership shall:

(a)  Require all providers that are part of the partnership to report medical outcomes in accordance with agency standards.

(b)  Comply with all rating, underwriting, claims-handling, sales, solicitation, licensing, and unfair trade practices and other provisions of the Florida Insurance Code or of chapter 641.

(5)  An accountable health partnership may provide services to more than one community health purchasing alliance.

(6)  If an accountable health partnership elects to terminate its contract with an alliance member, the accountable health partnership must provide advance notice of its decision to the alliance at least 120 days prior to the nonrenewal of any health plan by the accountable health partnership.

(7)  An accountable health partnership shall maintain records and submit reports to the alliance as required by ss. 408.70-408.706.

(8)  An accountable health partnership shall use the services of a licensed agent for the solicitation of insurance or procurement of applications or any other activities for which a health insurance agent's license is required.

(9)  An accountable health partnership may not require any greater coverage for professional liability insurance than is currently required by the state law.

(10)  Notwithstanding any provision of this act to the contrary, if an accountable health partnership has entered into a contract with providers or facilities licensed or permitted under chapter 465 for the purpose of providing prescribed medicine services, an individual may use an independent pharmacy which is not a party to the contract, if such independent pharmacy selected agrees to provide the service at a rate equal to or less than the rate set forth in the contract negotiated by the accountable health partnership with parties to the contract and such independent pharmacy meets all of the qualifications for participation in the accountable health partnership including, but not limited to, qualifications related to professional education, skills, experience; documentation of the appropriateness, overuse or underuse of services as identified by utilization review mechanisms and criteria; and previous restrictions or sanctions imposed by licensing bodies, and favorable professional liability history. Nothing in this section applies to any health maintenance organization established under part I of chapter 641 which maintains an in-house pharmacy that is permitted under chapter 465. For the purposes of this subsection, the term "independent pharmacy" means a pharmacy facility which is not part of a group of affiliated pharmacy facilities which are under common ownership directly or indirectly in which the group has greater than 12 pharmacy facilities in the state or has directly or indirectly any interest in any facilities licensed under another state's laws for the purpose of providing prescribed medicine services, and the term "pharmacy facility" means a pharmacy facility which is permitted by the Board of Pharmacy in accordance with chapter 465.

(11)  The ability to recruit and retain alliance district health care providers in its provider network. For provider networks initially formed in an alliance district after July 1, 1993, an accountable health partnership shall make offers as to provider participation in its provider network to relevant alliance district health care providers for at least 60 percent of the available provider positions. A provider who is made an offer may participate in an accountable health partnership as long as the provider abides by the terms and conditions of the provider network contract, provides services at a rate or price equal to the rate or price negotiated by the accountable health partnership, and meets all of the accountable health partnership's qualifications for participation in its provider networks including, but not limited to, network adequacy criteria. For purposes of this subsection, "alliance district health care provider" means a health care provider who is licensed under chapter 458, chapter 459, chapter 460, chapter 461, chapter 464, or chapter 465 who has practiced in Florida for more than 1 year within the alliance district served by the accountable health partnership.

(12)(a)  Each accountable health partnership shall establish a panel of providers from its provider network to review and make recommendations to the accountable health partnership on the health plans and issues related to the plans offered by the accountable health partnership through the community health purchasing alliance.

(b)  No accountable health partnership shall be required to accept any recommendations of the panel.

(13)(a)  The agency shall suspend or revoke its designation of an accountable health partnership that fails to continue to meet the requirements of this section.

(b)  The agency shall expedite proceedings to determine whether the designation of the accountable health partnership should be suspended or revoked.

History.--s. 77, ch. 93-129; s. 6, ch. 94-96.