Senate Bill 2554c1
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Florida Senate - 1999 CS for SB 2554
By the Committee on Banking and Insurance; and Senator King
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1 A bill to be entitled
2 An act relating to health maintenance
3 contracts; amending s. 626.883, F.S.; requiring
4 that certain information be included with the
5 payments made by a fiscal intermediary to a
6 health care provider; amending s. 641.31, F.S.,
7 relating to health maintenance contracts;
8 requiring a health maintenance organization to
9 provide notice prior to increasing the
10 copayments or limiting any benefits under a
11 group contract; requiring certain health
12 maintenance contracts to cover persons licensed
13 to practice massage under certain
14 circumstances; amending s. 641.315, F.S.;
15 providing that a contract between a health
16 maintenance organization and a health care
17 provider may not restrict the provider from
18 entering into a contract with any other health
19 maintenance organizations and may not restrict
20 the health maintenance organization from
21 entering into a contract with any other
22 provider; amending s. 641.316, F.S.; requiring
23 that certain information be included with the
24 payments made by a fiscal intermediary to a
25 health care provider; providing for
26 applicability; providing an effective date.
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28 Be It Enacted by the Legislature of the State of Florida:
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30 Section 1. Subsection (6) is added to section 626.883,
31 Florida Statutes, to read:
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Florida Senate - 1999 CS for SB 2554
311-2187-99
1 626.883 Administrator as intermediary; collections
2 held in fiduciary capacity; establishment of account;
3 disbursement; payments on behalf of insurer.--
4 (6) All payments to a health care provider by a fiscal
5 intermediary for noncapitated providers must include an
6 explanation of services being reimbursed which includes, at a
7 minimum, the patient's name, the date of service, the
8 procedure code, the amount of reimbursement, and the
9 identification of the plan on whose behalf the payment is
10 being made. For capitated providers, the statement of services
11 must include the number of patients covered by the contract,
12 the rate per patient, the total amount of the payment, and the
13 identification of the plan on whose behalf the payment is
14 being made.
15 Section 2. Subsections (36) and (37) are added to
16 section 641.31, Florida Statutes, 1998 Supplement, to read:
17 641.31 Health maintenance contracts.--
18 (36) A health maintenance organization may increase
19 the copayment for any benefit, or delete, amend, or limit any
20 of the benefits to which a subscriber is entitled under the
21 group contract, upon written notice to the contract holder at
22 least 45 days in advance of the time of coverage renewal. The
23 health maintenance organization may amend the contract with
24 the contract holder, with such amendment to be effective
25 immediately at the time of coverage renewal. The written
26 notice to the contract holder shall specifically identify any
27 deletions, amendments, or limitations to any of the benefits
28 provided in the group contract during the current contract
29 period which will be included in the group contract upon
30 renewal. This subsection does not apply to any increases in
31 benefits.
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Florida Senate - 1999 CS for SB 2554
311-2187-99
1 (37) All health maintenance contracts that provide
2 coverage for massage must also cover the services of persons
3 licensed to practice massage pursuant to chapter 480 if the
4 massage is prescribed by a physician licensed under chapter
5 458, chapter 459, chapter 460, or chapter 461 as medically
6 necessary and the prescription specifies the number of
7 treatments. Such massage services are subject to the same
8 terms, conditions, and limitations as those of other
9 providers.
10 Section 3. Subsection (9) is added to section 641.315,
11 Florida Statutes, to read:
12 641.315 Provider contracts.--
13 (9) A contract between a health maintenance
14 organization and a provider of health care services may not
15 contain any provision that in any way prohibits or restricts:
16 (a) The health care provider from entering into a
17 contract with any other health maintenance organization; or
18 (b) The health maintenance organization from entering
19 into a contract with any other health care provider.
20 Section 4. Paragraph (a) of subsection (2) of section
21 641.316, Florida Statutes, 1998 Supplement, is amended to
22 read:
23 641.316 Fiscal intermediary services.--
24 (2)(a) The term "fiduciary" or "fiscal intermediary
25 services" means reimbursements received or collected on behalf
26 of health care professionals for services rendered, patient
27 and provider accounting, financial reporting and auditing,
28 receipts and collections management, compensation and
29 reimbursement disbursement services, or other related
30 fiduciary services pursuant to health care professional
31 contracts with health maintenance organizations. All payments
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Florida Senate - 1999 CS for SB 2554
311-2187-99
1 to a health care provider by a fiscal intermediary for
2 noncapitated providers must include an explanation of services
3 being reimbursed which includes, at a minimum, the patient's
4 name, the date of service, the procedure code, the amount of
5 reimbursement, and the identification of the plan on whose
6 behalf the payment is being made. For capitated providers, the
7 statement of services must include the number of patients
8 covered by the contract, the rate per patient, the total
9 amount of the payment, and the identification of the plan on
10 whose behalf the payment is being made.
11 (b) The term "fiscal intermediary services
12 organization" means a person or entity which performs
13 fiduciary or fiscal intermediary services to health care
14 professionals who contract with health maintenance
15 organizations other than a fiscal intermediary services
16 organization owned, operated, or controlled by a hospital
17 licensed under chapter 395, an insurer licensed under chapter
18 624, a third-party administrator licensed under chapter 626, a
19 prepaid limited health service organization licensed under
20 chapter 636, a health maintenance organization licensed under
21 this chapter, or physician group practices as defined in s.
22 455.654(3)(f).
23 Section 5. This act shall take effect July 1, 1999,
24 and shall apply to all contracts renewed or entered into on or
25 after that date.
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Florida Senate - 1999 CS for SB 2554
311-2187-99
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 2554
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4 1. Removes the requirement that insurance administrators
and fiscal intermediaries provide prompt payment to
5 health care providers and inserts provisions that
mandate payments by fiscal intermediaries to capitated
6 and noncapitated health care providers to include
certain specified information.
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2. Removes the provision allowing subscribers to terminate
8 their health maintenance organization (HMO) contracts
under certain circumstances. Allows benefits to which a
9 subscriber is entitled under a group contract, subject
to written notice to the contract holder at least 45
10 days in advance of the time of coverage renewal. This
provision does not apply to increases in benefits by the
11 HMO.
12 3. Provides that HMO contracts providing for massage must
also cover the services of persons licensed to practice
13 massage under certain circumstances.
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