House Bill 0393

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    Florida House of Representatives - 2000                 HB 393

        By Representative Murman






  1                      A bill to be entitled

  2         An act relating to children's cancer insurance

  3         coverage; providing definitions; requiring

  4         health insurance coverage for certain costs

  5         relating to certain child cancer treatment

  6         programs; providing for application; providing

  7         construction; providing an effective date.

  8

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

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11         Section 1.  (1)  For purposes of this act:

12         (a)  "Health insurance benefit plan, policy, or

13  contract" means:

14         1.  Any individual health insurance policy or contract

15  issued under part VI of chapter 627, Florida Statutes;

16         2.  Any group, blanket, or franchise health insurance

17  policy or contract issued in this state under part VII of

18  chapter 627, Florida Statutes;

19         3.  Any individual or group contract of the type issued

20  in this state by a nonprofit hospital service plan corporation

21  or nonprofit medical service plan corporation;

22         4.  Any individual or group contract of the type issued

23  in this state by a health maintenance organization or prepaid

24  health clinic for health care services under chapter 641,

25  Florida Statutes; or

26         5.  Any similar individual or group health insurance

27  benefit plan, policy, or contract.

28         (b)  "Approved clinical trial program for treatment of

29  children's cancer" means a phase II or III prescription drug

30  clinical trial program in this state, as approved by the

31  federal Food and Drug Administration or the National Cancer

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    Florida House of Representatives - 2000                 HB 393

    583-187-00






  1  Institute for the treatment of cancer that generally first

  2  manifests itself in children under the age of 19 and that:

  3         1.a.  Tests new therapies, regimens, or combinations of

  4  therapies or regimens against standard therapies or regimens

  5  for the treatment of cancer in children;

  6         b.  Introduces a new therapy or regimen to treat

  7  recurrent cancer in children; or

  8         c.  Seeks to discover new therapies or regimens for the

  9  treatment of cancer in children which are more cost-effective

10  than standard therapies or regimens; and

11         2.  Has been certified by and uses the standards for

12  acceptable protocols established by the:

13         a.  Pediatric oncology group;

14         b.  Children's cancer group; or

15         c.  Insurance Commissioner as he or she may otherwise

16  define by rule after due notice, any required hearing, and

17  compliance with any other requirements of applicable law, but

18  only providing for such definition in a manner at least as

19  restrictive as that established in this act.

20         (c)  "Routine patient care costs" means those medically

21  necessary costs of blood tests, X-rays, bone scans, magnetic

22  resonance images, patient visits, hospital stays, or other

23  similar costs generally incurred by the insured party in

24  connection with the provision of goods, services, or benefits

25  to dependent children under an approved clinical trial program

26  for treatment of children's cancer which otherwise would be

27  covered under the major medical health insurance benefit plan,

28  policy, or contract if such medically necessary costs were not

29  incurred in connection with an approved clinical trial program

30  for treatment of children's cancer.  Routine patient care

31  costs specifically shall not include the costs of any clinical

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    Florida House of Representatives - 2000                 HB 393

    583-187-00






  1  trial therapies, regimens, or combinations thereof, any drugs

  2  or pharmaceuticals, any costs associated with the provision of

  3  any goods, services, or benefits to dependent children which

  4  generally are furnished without charge in connection with such

  5  an approved clinical trial program for treatment of children's

  6  cancer, any additional costs associated with the provision of

  7  any goods, services, or benefits which previously have been

  8  provided to the dependent child, paid for, or reimbursed, or

  9  any other similar costs.  It is specifically the intent of

10  this act not to relieve the sponsor of a clinical trial

11  program of financial responsibility for accepted costs of such

12  program.

13         (d)  "State health plan" means any health insurance

14  plan established for employees of this state under s. 110.123,

15  Florida Statutes.

16         (2)  On and after July 1, 2000, any state health plan

17  or any health insurance benefit plan, policy, or contract that

18  provides major medical coverage for dependent children and

19  which is issued, delivered, issued for delivery, or renewed in

20  this state on or after July 1, 2000, shall provide coverage

21  for routine patient care costs incurred in connection with the

22  provision of goods, services, and benefits to such dependent

23  children in connection with approved clinical trial programs

24  for the treatment of children's cancer with respect to those

25  dependent children who:

26         (a)  Are covered dependents under a state health plan

27  or the major medical coverage of a health insurance benefit

28  plan, policy, or contract.

29         (b)  Have been diagnosed with cancer prior to their

30  19th birthday.

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    Florida House of Representatives - 2000                 HB 393

    583-187-00






  1         (c)  Are enrolled in an approved clinical trial program

  2  for treatment of children's cancer.

  3         (d)  Are not otherwise eligible for benefits, payments,

  4  or reimbursements from any other third party payors or other

  5  similar sources.

  6         (3)  For purposes of this act, any exclusions,

  7  reductions, or limitations as to coverages or any cost-sharing

  8  arrangements provided for in a state health plan or in a

  9  health insurance benefit plan, policy, or contract which

10  provides major medical coverage for dependent children and

11  which applies to any benefits, payments, or reimbursements for

12  routine patient care provided to dependent children in

13  connection with generally recognized therapies or regimens for

14  the treatment of children's cancer shall also apply to such

15  benefits, payments, or reimbursements for any dependent child

16  who is enrolled in an approved clinical trial program for

17  treatment of children's cancer.

18         (4)  Except as provided in subsections (2) and (3),

19  nothing in this act shall be construed to:

20         (a)  Prohibit a state health plan or an insurer,

21  nonprofit corporation, health care plan, health maintenance

22  organization, fraternal benefit society, or other person from

23  issuing or continuing to issue a health insurance benefit

24  plan, policy, or contract which has benefits that are greater

25  than the minimum benefits required by this act or from issuing

26  or continuing to issue any health insurance benefit plan,

27  policy, or contract which provides benefits which are

28  generally more favorable to the insured than the benefits

29  required by this act; or

30         (b)  Change the contractual relationships between any

31  insurer, nonprofit corporation, health care plan, health

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    Florida House of Representatives - 2000                 HB 393

    583-187-00






  1  maintenance organization, fraternal benefit society, or other

  2  similar person and their insureds or covered dependents by

  3  whatever name called.

  4         Section 2.  This act shall take effect July 1, 2000.

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  7                          HOUSE SUMMARY

  8
      Requires health insurance contracts, policies, and plans
  9    to provide coverage for routine patient care costs
      incurred in providing specified dependent children with
10    goods, services, and benefits in connection with approved
      clinical trial child cancer treatment programs.
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