Senate Bill 1196

CODING: Words stricken are deletions; words underlined are additions.



    Florida Senate - 1998                                  SB 1196

    By Senator Forman





    32-31-98

  1                      A bill to be entitled

  2         An act relating to health care for low-income

  3         persons; providing legislative intent with

  4         respect to access to health care services for

  5         low-income employees of small employers and

  6         self-employed individuals; providing

  7         definitions; authorizing community health

  8         purchasing alliances in a specified county to

  9         contract, under a pilot project, with provider

10         networks for clinic-based health care services

11         for low-income employees of small employers,

12         self-employed individuals, and dependents of

13         low-income employees and self-employed

14         individuals; requiring the Agency for Health

15         Care Administration to adopt rules for

16         eligibility requirements and for administrative

17         and accounting standards; requiring the

18         Department of Insurance to adopt by rule

19         requirements for licensure, financial reserves,

20         and financial solvency; providing an effective

21         date.

22

23  Be It Enacted by the Legislature of the State of Florida:

24

25         Section 1.  Provider networks; pilot program for health

26  care services in Broward County.--

27         (1)  The Legislature finds there is insufficient group

28  health insurance coverage available for low-income employees

29  who work for small employers or for self-employed individuals,

30  that these uninsured employees and their dependents represent

31  a significant portion of the uncompensated costs of health

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    Florida Senate - 1998                                  SB 1196
    32-31-98




  1  care providers, and that uninsured employees have impaired

  2  access to health care services and a correspondingly low

  3  health status. It is therefore the intent of the Legislature

  4  to create a pilot project in Broward County to ensure access

  5  to health care services by low-income employees who work for

  6  small employers and by self-employed individuals.

  7         (2)  As used in this section, the term "small employer"

  8  has the meaning ascribed in section 627.6699, Florida

  9  Statutes.

10         (3)  A community health purchasing alliance may, in

11  addition to its other powers and duties:

12         (a)  Directly contract with a provider network to

13  provide clinic-based health care services, including

14  preventive and comprehensive health care services, to

15  low-income employees of small employers, self-employed

16  individuals, or dependents of low-income employees and

17  self-employed individuals.

18         (b)  Directly market provider network services to

19  low-income employees of small employers, self-employed

20  individuals, dependents of low-income employees and

21  self-employed individuals, or small employers, and may enroll

22  such individuals or small employers as members of the provider

23  network.

24         (4)  The Agency for Health Care Administration shall:

25         (a)  Establish by rule eligibility requirements for

26  low-income employees of small employers, self-employed

27  individuals, and dependents of low-income employees and

28  self-employed individuals, and shall establish grievance

29  procedures.

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    Florida Senate - 1998                                  SB 1196
    32-31-98




  1         (b)  License provider networks located in Broward

  2  County which contract to provide services under this section

  3  and meet quality-of-care standards established by agency rule.

  4         (c)  Adopt standards for quality of care for preventive

  5  and comprehensive health care services which are consistent

  6  with prevailing standards for medical practice in the

  7  community.

  8         (d)  In consultation with the Department of Insurance,

  9  adopt rules that establish administrative and accounting

10  standards necessary for an efficient contractual relationship

11  between a community health purchasing alliance located in

12  Broward County and a provider network located in Broward

13  County.

14         (5)  In consultation with the agency, the Department of

15  Insurance shall adopt rules that provide requirements for the

16  provider networks with respect to state licensure, financial

17  reserves, and financial solvency. The standards must ensure

18  the solvency of provider networks to protect the members of

19  the community health purchasing alliance from loss due to the

20  insolvency or financial instability of a provider network.

21         Section 2.  This act shall take effect July 1, 1998.

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23            *****************************************

24                          SENATE SUMMARY

25    Provides for a pilot project to be established in Broward
      County under which a community health purchasing alliance
26    may directly contract with a provider network for the
      purpose of providing clinic-based health services for
27    low-income employees of small employers, self-employed
      individuals, and the dependents of those employees and
28    individuals. Requires the Agency for Health Care
      Administration and the Department of Insurance to adopt
29    rules for administering the pilot project, including
      eligibility requirements for employees, quality-of-care
30    standards for health care services, and administrative
      and accounting standards for provider networks.
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