House Bill hb0343

    Florida House of Representatives - 2002                 HB 343

        By Representative Fasano






  1                      A bill to be entitled

  2         An act relating to managed care; providing

  3         legislative intent; amending s. 641.315, F.S.;

  4         prohibiting termination of a provider contract

  5         except under certain circumstances; allowing

  6         patients to disenroll in certain plans and

  7         reenroll in other plans under certain

  8         circumstances; amending s. 641.3903, F.S.;

  9         prohibiting a health maintenance organization

10         from advertising availability of certain

11         providers under certain circumstances;

12         providing an exception; providing an effective

13         date.

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

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17         Section 1.  It is the intent of the Legislature to

18  prohibit the use of "bait and switch" practices relating to

19  enrolling patients in managed care plans.  The Legislature

20  finds that potential enrollees in a managed care plan often

21  choose a plan based upon whether their physician or other

22  health care provider is a provider available under the plan.

23  The Legislature also finds that managed care plans have

24  terminated providers following the closure of the enrollment

25  period to the detriment of the patients who are the

26  beneficiaries of the contracts between the managed care plans

27  and the providers of health care.  The detriments include

28  choosing a new provider, which disrupts the continuity of

29  patient care, or requiring patients to pay for services out of

30  their own pockets that otherwise would have been paid for by

31  the managed care plan if the provider were still under

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    Florida House of Representatives - 2002                 HB 343

    565-208A-02






  1  contract with the managed care plan.  While continuity of care

  2  under specified circumstances and point-of-service access to

  3  nonnetwork providers under certain circumstances has been

  4  previously addressed, the Legislature finds that there is a

  5  need for further revision of the law in order to protect

  6  patients. The Legislature finds that maintaining the

  7  physician-patient relationship is an important state interest

  8  and that the patient is the third-party beneficiary to the

  9  contract between the managed care organization and the health

10  care practitioner.  Additionally, the Legislature finds it to

11  be an unfair business practice to require enrollees in a

12  managed care plan to pay for services that would have been

13  covered under the plan had it not been for the disruption

14  caused by the termination of the provider contract.

15  Furthermore, it is the intent of the Legislature that

16  enrollees under a managed care plan should be able to change

17  managed care plans outside of the annual enrollment period if

18  there is a change in providers under a particular plan which

19  directly affects the enrollee or the enrollee's covered family

20  members.

21         Section 2.  Subsection (11) is added to section

22  641.315, Florida Statutes, to read:

23         641.315  Provider contracts.--

24         (11)  In order to protect a patient enrolled in or

25  covered by a health maintenance organization from a disruption

26  in the relationship between the patient and a contracted

27  health care practitioner, a health maintenance organization

28  may not terminate a contract, or modify reimbursement

29  arrangements under a contract, between the health maintenance

30  organization and a health care practitioner who is providing

31  health care to patients in the health maintenance organization

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    Florida House of Representatives - 2002                 HB 343

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  1  unless the health care practitioner's license has been

  2  revoked, suspended, or placed on probation, or unless the

  3  health care practitioner has been excluded as a provider of

  4  Medicaid or Medicare as a result of a finding of fraud or

  5  illegal billing practices.  If a provider contract is

  6  terminated or not renewed, a patient of that health care

  7  practitioner may immediately disenroll in that health

  8  maintenance organization and enroll in another health plan

  9  without penalty to the patient.

10         Section 3.  Subsection (13) of section 641.3903,

11  Florida Statutes, is amended to read:

12         641.3903  Unfair methods of competition and unfair or

13  deceptive acts or practices defined.--The following are

14  defined as unfair methods of competition and unfair or

15  deceptive acts or practices:

16         (13)  MISREPRESENTATION IN HEALTH MAINTENANCE

17  ORGANIZATION; AVAILABILITY OF PROVIDERS.--Knowingly misleading

18  potential enrollees as to the availability of providers. A

19  health maintenance organization shall not advertise the

20  availability of any particular provider or group of providers

21  unless the particular provider or group of providers will be

22  available to provide care to enrollees and covered family

23  members for the entire duration of the coverage period.

24  However, an advertisement of availability of a particular

25  provider or group of providers who, subsequent to the

26  advertisement, has his or her or its license revoked or

27  suspended, or is excluded as a provider of Medicaid or

28  Medicare, and is thus no longer available to provide care to

29  enrollees for the remainder of the coverage period, is not

30  considered an unfair method of competition or an unfair or

31  deceptive act or practice.

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    Florida House of Representatives - 2002                 HB 343

    565-208A-02






  1         Section 4.  This act shall take effect July 1, 2002,

  2  and shall apply to all contracts entered into or renewed on or

  3  after July 1, 2002.

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  6                          HOUSE SUMMARY

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      Prohibits a health maintenance organization from
  8    terminating a provider contract except under specified
      circumstances and allows patients to disenroll from the
  9    health maintenance organization if their health care
      practitioner's provider contract is terminated by the
10    health maintenance organization and to enroll in another
      health plan without penalty. Prohibits a health
11    maintenance organization from advertising the
      availability of specific providers if the providers will
12    not be available for the entire duration of the coverage
      period, except as specified. See bill for details.
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