CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 1556
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Scott moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 11, line 30, through page 27, line 26,delete
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18 (e) Hire employees or contract with qualified,
19 independent third parties for any service necessary to carry
20 out the board's powers and duties, as authorized under ss.
21 408.70-408.7045. However, the board may not hire an insurance
22 agent who engages in activities on behalf of the alliance for
23 which an insurance agent's license is required by chapter 626.
24 (f) Perform any of the activities that may be
25 performed by a regional board under subsection (6), subject to
26 coordination with the regional boards to avoid duplication of
27 effort.
28 (8) Each regional board of the alliance may:
29 (a) Establish conditions of alliance membership
30 consistent with the minimum requirements established by the
31 state board.
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SENATE AMENDMENT
Bill No. CS for SB 1556
Amendment No.
1 (b) Provide to alliance members standardized
2 information for comparing health plans offered through the
3 alliance.
4 (c) Offer health plans to alliance members, subject to
5 the terms and conditions agreed to by the state board and
6 participating health insurers.
7 (d) Market and publicize the coverage and services
8 offered by the alliance.
9 (e) Collect premiums from alliance members on behalf
10 of participating health insurers.
11 (f) Assist members in resolving disputes between
12 health insurers and alliance members, consistent with
13 grievance procedures required by law.
14 (g) Set reasonable fees for alliance membership,
15 services offered by the alliance, and late payment of premiums
16 by alliance members for which the alliance is responsible.
17 (h) Receive and accept grants, loans, advances, or
18 funds from any public or private agency, and receive and
19 accept, from any source, contributions of money, property,
20 labor, or any other thing of value.
21 (i) Hire employees or contract with qualified,
22 independent third parties for any service necessary to carry
23 out the regional board's powers and duties as authorized under
24 ss. 408.70-408.7045. However, a regional board may not hire an
25 insurance agent who engages in activities on behalf of the
26 alliance for which an insurance agent's license is required by
27 chapter 626.
28 (9) No state agency may expend or provide funds to the
29 Alliance that would subsidize the pricing of health insurance
30 policies for its members, unless the Legislature specifically
31 authorizes such expenditure.
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SENATE AMENDMENT
Bill No. CS for SB 1556
Amendment No.
1 (6) Each community health purchasing alliance has the
2 following powers, duties, and responsibilities:
3 (a) Establishing the conditions of alliance membership
4 in accordance with ss. 408.70-408.706.
5 (b) Providing to alliance members clear, standardized
6 information on each accountable health partnership and each
7 health plan offered by each accountable health partnership,
8 including information on price, enrollee costs, quality,
9 patient satisfaction, enrollment, and enrollee
10 responsibilities and obligations; and providing accountable
11 health partnership comparison sheets in accordance with agency
12 rule to be used in providing members and their employees with
13 information regarding standard, basic, and specialized
14 coverage that may be obtained through the accountable health
15 partnerships.
16 (c) Annually offering to all alliance members all
17 accountable health partnerships and health plans offered by
18 the accountable health partnerships which meet the
19 requirements of ss. 408.70-408.706, and which submit a
20 responsive proposal as to information necessary for
21 accountable health partnership comparison sheets, and
22 providing assistance to alliance members in selecting and
23 obtaining coverage through accountable health partnerships
24 that meet those requirements.
25 (d) Requesting proposals for the standard and basic
26 health plans, as defined in s. 627.6699, from all accountable
27 health partnerships in the district; providing, in the format
28 required by the alliance in the request for proposals, the
29 necessary information for accountable health partnership
30 comparison sheets; and offering to its members health plans of
31 accountable health partnerships which meet those requirements.
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SENATE AMENDMENT
Bill No. CS for SB 1556
Amendment No.
1 (e) Requesting proposals from all accountable health
2 partnerships in the district for specialized benefits approved
3 by the alliance board based on input from alliance members,
4 determining if the proposals submitted by the accountable
5 health partnerships meet the requirements of the request for
6 proposals, and offering them as options through riders to
7 standard plans and basic plans. This paragraph does not limit
8 an accountable health partnership's ability to offer other
9 specialized benefits to alliance members.
10 (f) Distributing to health care purchasers, placing
11 special emphasis on the elderly, retail price data on
12 prescription drugs and their generic equivalents, durable
13 medical equipment, and disposable medical supplies which is
14 provided by the agency pursuant to s. 408.063(3) and (4).
15 (g) Establishing administrative and accounting
16 procedures for the operation of the alliance and members'
17 services, preparing an annual alliance budget, and preparing
18 annual program and fiscal reports on alliance operations as
19 required by the agency.
20 (h) Developing and implementing a marketing plan to
21 publicize the alliance to potential members and associate
22 members and developing and implementing methods for informing
23 the public about the alliance and its services.
24 (i) Developing grievance procedures to be used in
25 resolving disputes between members and the alliance and
26 disputes between the accountable health partnerships and the
27 alliance. Any member of, or accountable health partnership
28 that serves, an alliance may appeal to the agency any
29 grievance that is not resolved by the alliance.
30 (j) Ensuring that accountable health partnerships have
31 grievance procedures to be used in resolving disputes between
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Bill No. CS for SB 1556
Amendment No.
1 members and an accountable health partnership. A member may
2 appeal to the alliance any grievance that is not resolved by
3 the accountable health partnership. An accountable health
4 partnership that is a health maintenance organization must
5 follow the grievance procedures established in ss. 408.7056
6 and 641.31(5).
7 (k) Maintaining all records, reports, and other
8 information required by the agency, ss. 408.70-408.706, or
9 other state and local laws.
10 (l) Receiving and accepting grants, loans, advances,
11 or funds from any public or private agency; and receiving and
12 accepting contributions, from any source, of money, property,
13 labor, or any other thing of value.
14 (m) Contracting, as authorized by alliance members,
15 with a qualified, independent third party for any service
16 necessary to carry out the powers and duties required by ss.
17 408.70-408.706.
18 (n) Developing a plan to facilitate participation of
19 providers in the district in an accountable health
20 partnership, placing special emphasis on ensuring
21 participation by minority physicians in accountable health
22 partnerships if such physicians are available. The use of the
23 term "minority" in ss. 408.70-408.706 is consistent with the
24 definition of "minority person" provided in s. 288.703(3).
25 (o) Ensuring that any health plan reasonably available
26 within the jurisdiction of an alliance, through a preferred
27 provider network, a point of service product, an exclusive
28 provider organization, a health maintenance organization, or a
29 pure indemnity product, is offered to members of the alliance.
30 For the purposes of this paragraph, "pure indemnity product"
31 means a health insurance policy or contract that does not
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Amendment No.
1 provide different rates of reimbursement for a specified list
2 of physicians and a "point of service product" means a
3 preferred provider network or a health maintenance
4 organization which allows members to select at a higher cost a
5 provider outside of the network or the health maintenance
6 organization.
7 (p) Petitioning the agency for a determination as to
8 the cost-effectiveness of collecting premiums on behalf of
9 participating accountable health partnerships. If determined
10 by the agency to be cost-effective, the alliance may establish
11 procedures for collecting premiums from members and distribute
12 them to the participating accountable health partnerships.
13 This may include the remittance of the share of the group
14 premium paid by both an employer and an enrollee. If an
15 alliance assumes premium collection responsibility, it shall
16 also assume liability for uncollected premium. This liability
17 may be collected through a bad debt surcharge on alliance
18 members to finance the cost of uncollected premiums. The
19 alliance shall pay participating accountable health
20 partnerships their contracting premium amounts on a prepaid
21 monthly basis, or as otherwise mutually agreed upon.
22 (7) Each alliance shall set reasonable fees for
23 membership in the alliance which will finance all reasonable
24 and necessary costs incurred in administering the alliance.
25 (9)(8) Each regional board alliance shall annually
26 report to the state board on the operations of the alliance in
27 that region, including program and financial operations, and
28 shall provide for annual internal and independent audits.
29 (10)(9) The alliance, the state board, and regional
30 boards A community health purchasing alliance may not engage
31 in any activities for which an insurance agent's license is
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Bill No. CS for SB 1556
Amendment No.
1 required by chapter 626.
2 (11)(10) The powers and responsibilities of the a
3 community health purchasing alliance with respect to
4 purchasing health plans services from health insurers
5 accountable health partnerships do not extend beyond those
6 enumerated in ss. 408.70-408.7045 ss. 408.70-408.706.
7 (12) The Office of the Auditor General may audit and
8 inspect the operations and records of the alliance.
9 Section 4. Section 408.703, Florida Statutes, is
10 amended to read:
11 408.703 Small employer members of the alliance
12 community health purchasing alliances; eligibility
13 requirements.--
14 (1) The board agency shall establish conditions of
15 participation in the alliance for small employers, as defined
16 in s. 627.6699, which must include, but need not be limited
17 to:
18 (a) Assurance that the group is a valid small employer
19 and is not formed for the purpose of securing health benefit
20 coverage. This assurance must include requirements for sole
21 proprietors and self-employed individuals which must be based
22 on a specified requirement for the time that the sole
23 proprietor or self-employed individual has been in business,
24 required filings to verify employment status, and other
25 requirements to ensure that the individual is working.
26 (b) Assurance that the individuals in the small
27 employer group are employees and have not been added for the
28 purpose of securing health benefit coverage.
29 (2) The agency may not require a small employer to pay
30 any portion of premiums as a condition of participation in an
31 alliance.
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Amendment No.
1 (2)(3) The board agency may require a small employer
2 seeking membership to agree to participate in the alliance for
3 a specified minimum period of time, not to exceed 1 year.
4 (4) If a member small employer offers more than one
5 accountable health partnership or health plan and the employer
6 contributes to coverage of employees or dependents of the
7 employee, the alliance shall require that the employer
8 contribute the same dollar amount for each employee,
9 regardless of the accountable health partnership or benefit
10 plan chosen by the employee.
11 (5) An employer that employs 30 or fewer employees
12 must offer at least 2 accountable health partnerships or
13 health plans to its employees, and an employer that employs 31
14 or more employees must offer 3 or more accountable health
15 partnerships or health plans to its employees.
16 (3)(6) Notwithstanding any other law, if a small
17 employer member loses eligibility to purchase health care
18 through the a community health purchasing alliance solely
19 because the business of the small employer member expands to
20 more than 50 and less than 75 eligible employees, the small
21 employer member may, at its next renewal date, purchase
22 coverage through the alliance for not more than 1 additional
23 year.
24 Section 5. Section 408.704, Florida Statutes, 1998
25 Supplement, is amended to read:
26 408.704 Agency duties and responsibilities related to
27 the alliance community health purchasing alliances.--
28 (1) The agency shall supervise the operation of the
29 alliance. assist in developing a statewide system of community
30 health purchasing alliances. To this end, the agency is
31 responsible for:
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SENATE AMENDMENT
Bill No. CS for SB 1556
Amendment No.
1 (1) Initially and thereafter annually certifying that
2 each community health purchasing alliance complies with ss.
3 408.70-408.706 and rules adopted pursuant to ss.
4 408.70-408.706. The agency may decertify any community health
5 purchasing alliance if the alliance fails to comply with ss.
6 408.70-408.706 and rules adopted by the agency.
7 (2) The agency shall conduct Providing administrative
8 startup funds. Each contract for startup funds is limited to
9 $275,000.
10 (3) Conducting an annual review of the performance of
11 the each alliance to ensure that the alliance is in compliance
12 with ss. 408.70-408.7045 ss. 408.70-408.706. To assist the
13 agency in its review, the each alliance shall submit,
14 quarterly, data to the agency, including, but not limited to,
15 employer enrollment by employer size, industry sector,
16 previous insurance status, and count; number of total eligible
17 employers in the alliance district participating in the
18 alliance; number of insured lives by county and insured
19 category, including employees, dependents, and other insured
20 categories, represented by alliance members; profiles of
21 potential employer membership by county; premium ranges for
22 each health insurer accountable health partnership for
23 alliance member categories; type and resolution of member
24 grievances; membership fees; and alliance financial
25 statements. A summary of this annual review shall be provided
26 to the Legislature and to each alliance.
27 (4) Developing accountable health partnership
28 comparison sheets to be used in providing members and their
29 employees with information regarding the accountable health
30 partnership.
31 (5) Establishing a data system for accountable health
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SENATE AMENDMENT
Bill No. CS for SB 1556
Amendment No.
1 partnerships.
2 (a) The agency shall establish an advisory data
3 committee comprised of the following representatives of
4 employers, medical providers, hospitals, health maintenance
5 organizations, and insurers:
6 1. Two representatives appointed by each of the
7 following organizations: Associated Industries of Florida,
8 the Florida Chamber of Commerce, the National Federation of
9 Independent Businesses, and the Florida Retail Federation;
10 2. One representative of each of the following
11 organizations: the Florida League of Hospitals, the
12 Association of Voluntary Hospitals of Florida, the Florida
13 Hospital Association, the Florida Medical Association, the
14 Florida Osteopathic Medical Association, the Florida
15 Chiropractic Association, the Florida Chapter of the National
16 Medical Association, the Association of Managed Care
17 Physicians, the Florida Insurance Council, the Florida
18 Association of Domestic Insurers, the Florida Association of
19 Health Maintenance Organizations; and
20 3. One representative of governmental health care
21 purchasers and three consumer representatives, to be appointed
22 by the agency.
23 (b) The advisory data committee shall issue a report
24 and recommendations on each of the following subjects as each
25 is completed. A final report covering all subjects must be
26 included in the final Florida Health Plan to be submitted to
27 the Legislature on December 31, 1993. The report shall
28 include recommendations regarding:
29 1. Types of data to be collected. Careful
30 consideration shall be given to other data collection projects
31 and standards for electronic data interchanges already in
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Amendment No.
1 process in this state and nationally, to evaluating and
2 recommending the feasibility and cost-effectiveness of various
3 data collection activities, and to ensuring that data
4 reporting is necessary to support the evaluation of providers
5 with respect to cost containment, access, quality, control of
6 expensive technologies, and customer satisfaction analysis.
7 Data elements to be collected from providers include prices,
8 utilization, patient outcomes, quality, and patient
9 satisfaction. The completion of this task is the first
10 priority of the advisory data committee. The agency shall
11 begin implementing these data collection activities
12 immediately upon receipt of the recommendations, but no later
13 than January 1, 1994. The data shall be submitted by
14 hospitals, other licensed health care facilities, pharmacists,
15 and group practices as defined in s. 455.654(3)(f).
16 2. A standard data set, a standard cost-effective
17 format for collecting the data, and a standard methodology for
18 reporting the data to the agency, or its designee, and to the
19 alliances. The reporting mechanisms must be designed to
20 minimize the administrative burden and cost to health care
21 providers and carriers. A methodology shall be developed for
22 aggregating data in a standardized format for making
23 comparisons between accountable health partnerships which
24 takes advantage of national models and activities.
25 3. Methods by which the agency should collect,
26 process, analyze, and distribute the data.
27 4. Standards for data interpretation. The advisory
28 data committee shall actively solicit broad input from the
29 provider community, carriers, the business community, and the
30 general public.
31 5. Structuring the data collection process to:
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Amendment No.
1 a. Incorporate safeguards to ensure that the health
2 care services utilization data collected is reviewed by
3 experienced, practicing physicians licensed to practice
4 medicine in this state;
5 b. Require that carrier customer satisfaction data
6 conclusions are validated by the agency;
7 c. Protect the confidentiality of medical information
8 to protect the patient's identity and to protect the privacy
9 of individual physicians and patients. Proprietary data
10 submitted by insurers, providers, and purchasers are
11 confidential pursuant to s. 408.061; and
12 d. Afford all interested professional medical and
13 hospital associations and carriers a minimum of 60 days to
14 review and comment before data is released to the public.
15 6. Developing a data collection implementation
16 schedule, based on the data collection capabilities of
17 carriers and providers.
18 (c) In developing data recommendations, the advisory
19 data committee shall assess the cost-effectiveness of
20 collecting data from individual physician providers. The
21 initial emphasis must be placed on collecting data from those
22 providers with whom the highest percentages of the health care
23 dollars are spent: hospitals, large physician group practices,
24 outpatient facilities, and pharmacies.
25 (d) The agency shall, to the maximum extent possible,
26 adopt and implement the recommendations of the advisory data
27 committee. The agency shall report all recommendations of the
28 advisory data committee to the Legislature and submit an
29 implementation plan.
30 (e) The travel expenses of the participants of the
31 advisory data committee must be paid by the participant or by
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Amendment No.
1 the organization that nominated the participant.
2 (6) Collecting, compiling, and analyzing data on
3 accountable health partnerships and providing statistical
4 information to alliances.
5 (7) Receiving appeals by members of an alliance and
6 accountable health partnerships whose grievances were not
7 resolved by the alliance. The agency shall review these
8 appeals pursuant to chapter 120. Records or reports submitted
9 as a part of a grievance proceeding conducted as provided for
10 under this subsection are confidential and exempt from the
11 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
12 Constitution. Records or reports of patient care quality
13 assurance proceedings obtained or made by any member of a
14 community health purchasing alliance or any member of an
15 accountable health partnership and received by the agency as a
16 part of a proceeding conducted pursuant to this subsection are
17 confidential and exempt from s. 119.07(1) and s. 24(a), Art. I
18 of the State Constitution. Portions of meetings held pursuant
19 to the provisions of this subsection during which records held
20 confidential pursuant to the provisions of this subsection are
21 discussed are exempt from the provisions of s. 286.011 and s.
22 24(b), Art. I of the State Constitution. All portions of any
23 meeting closed to the public shall be recorded by a certified
24 court reporter. For any portion of a meeting that is closed,
25 the reporter shall record the times of commencement and
26 termination of the meeting, all discussion and proceedings,
27 the names of all persons present at any time, and the names of
28 all persons speaking. No portion of the closed meeting shall
29 be off the record. The court reporter's notes shall be fully
30 transcribed and given to the appropriate records custodian
31 within a reasonable time after the meeting. A copy of the
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Amendment No.
1 original transcript, with information otherwise confidential
2 or exempt from public disclosure redacted, shall be made
3 available for public inspection and copying 3 years after the
4 date of the closed meeting.
5 Section 6. Section 408.7045, Florida Statutes, is
6 amended to read:
7 408.7045 Community health purchasing Alliance
8 marketing requirements.--
9 (1) The Each alliance shall use appropriate,
10 efficient, and standardized means to notify members of the
11 availability of sponsored health coverage from the alliance.
12 (2) The Each alliance shall make available to members
13 marketing materials that accurately summarize the benefit
14 plans that are offered by its health insurer accountable
15 health partnerships and the rates, costs, and accreditation
16 information relating to those plans.
17 (3) Annually, the alliance shall offer each member
18 small employer all accountable health partnerships available
19 in the alliance and provide them with the appropriate
20 materials relating to those plans. The member small employer
21 may choose which health benefit plans shall be offered to
22 eligible employees and may change the selection each year.
23 The employee may be given options with regard to health plans
24 and the type of managed care system under which his or her
25 benefits will be provided.
26 (4) An alliance may notify the agency of any marketing
27 practices or materials that it finds are contrary to the fair
28 and affirmative marketing requirements of the program. Upon
29 the request of an alliance, the agency shall request the
30 Department of Insurance to investigate the practices and the
31 Department of Insurance may take any action authorized for a
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Amendment No.
1 violation of the insurance code or the Health Maintenance
2 Organization Act.
3 Section 7. Paragraph (b) of subsection (6) of section
4 627.6699, Florida Statutes, 1998 Supplement, is amended to
5 read:
6 627.6699 Employee Health Care Access Act.--
7 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
8 (b) For all small employer health benefit plans that
9 are subject to this section and are issued by small employer
10 carriers on or after January 1, 1994, premium rates for health
11 benefit plans subject to this section are subject to the
12 following:
13 1. Small employer carriers must use a modified
14 community rating methodology in which the premium for each
15 small employer must be determined solely on the basis of the
16 eligible employee's and eligible dependent's gender, age,
17 family composition, tobacco use, or geographic area as
18 determined under paragraph (5)(j) (5)(k).
19 2. Rating factors related to age, gender, family
20 composition, tobacco use, or geographic location may be
21 developed by each carrier to reflect the carrier's experience.
22 The factors used by carriers are subject to department review
23 and approval.
24 3. Small employer carriers may not modify the rate for
25 a small employer for 12 months from the initial issue date or
26 renewal date, unless the composition of the group changes or
27 benefits are changed. However, a small employer carrier may
28 modify the rate one time prior to 12 months after the initial
29 issue date for a small employer who enrolls under a previously
30 issued group policy that has a common anniversary date for all
31 employers covered under the policy, if the carrier discloses
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1 to the employer in a clear and conspicuous manner the date of
2 the first renewal and the fact that the premium may increase
3 on or after that date and if the insurer demonstrates to the
4 department that efficiencies in administration are achieved
5 and reflected in the rates charged to small employers covered
6 under the policy.
7 4. A small employer carrier may issue a policy to a
8 group association with rates that reflect a premium credit for
9 expense savings attributable to administrative activities
10 being performed by the group association, if these expense
11 savings are specifically documented in the carrier's rate
12 filing and are approved by the department. Any such credit may
13 not be based on different morbidity assumptions or on any
14 other factor related to the health status or claims experience
15 of the group or its members. Carriers participating in the
16 alliance program, in accordance with ss. 408.700-408.707, may
17 apply a different community rate to business written in that
18 program.
19 (c) For all small employer health benefit plans that
20 are subject to this section, that are issued by small employer
21 carriers before January 1, 1994, and that are renewed on or
22 after January 1, 1995, renewal rates must be based on the same
23 modified community rating standard applied to new business.
24 (d) Notwithstanding s. 627.401(2), this section and
25 ss. 627.410 and 627.411 apply to any health benefit plan
26 provided by a small employer carrier that provides coverage to
27 one or more employees of a small employer regardless of where
28 the policy, certificate, or contract is issued or delivered,
29 if the health benefit plan covers employees or their covered
30 dependents who are residents of this state.
31 Section 8. Sections 408.7041, 408.7042, 408.7055, and
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Amendment No.
1 408.706, Florida Statutes, are repealed.
2
3 (Redesignate subsequent sections.)
4
5
6 ================ T I T L E A M E N D M E N T ===============
7 And the title is amended as follows:
8 On page 1, line 29, through page 2, line 12, delete
9 those lines
10
11 and insert:
12 Administration; amending s. 408.7045, F.S.;
13 revising marketing requirements of the
14 alliance; amending s. 627.6699, F.S.; revising
15 restrictions related to premium rates for small
16 employer health benefit plans; repealing ss.
17 408.7041, 408.7042, 408.7055, 408.706, F.S.,
18 relating to anti-trust protection, relating to
19 purchasing coverage for state employees and
20 Medicaid recipients through community health
21 purchasing alliances, relating to the
22 establishment of practitioner advisory groups
23 by the Agency for Health Care Administration,
24 and relating to requirements for accountable
25 health partnerships; providing an effective
26 date.
27
28
29
30
31
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