HB 0187 2003
1	A bill to be entitled
2	An act relating to managed health care; providing a
3	popular reference name; prohibiting the contract between a
4	managed care plan and a health care provider from
5	containing provisions allowing the managed care plan to
6	change a material term of the contract; providing certain
7	exceptions; requiring that a managed care plan notify a
8	provider within a specified period of its intent to change
9	a material term; providing certain exceptions; prohibiting
10	additional provisions in the contract which require a
11	provider to accept additional patients or comply with
12	certain programs or procedures without prior disclosure;
13	providing certain exceptions; prohibiting certain other
14	contract provisions that conflict with state law or
15	confidentiality requirements; providing definitions;
16	specifying acts and omissions constituting grounds for
17	disciplinary action by the Secretary of Health Care
18	Administration against a managed care plan; requiring that
19	a proceeding under the act comply with the requirements
20	for notice and a hearing provided in ch. 120, F.S.;
21	providing an effective date.
22
23	Be It Enacted by the Legislature of the State of Florida:
24
25	Section 1.Health Care Equity Act.--
26	(1) This section may be popularly referred to as the
27	"Health Care Equity Act."
28	(2) A contract issued, amended, or renewed on or after
29	January 1, 2004, between a managed care plan and a health care
30	provider for the provision of health care services to a plan
31	enrollee or subscriber may not contain any of the following
32	terms:
33	(a)1. Authority for the managed care plan to change a
34	material term of the contract, unless the change has first been
35	negotiated and agreed to by the provider and the managed care
36	plan or unless the change is necessary to comply with state or
37	federal law or any accreditation requirements of a private
38	accreditation organization. If a change is made by amending a
39	manual, policy, or procedure document that is referenced in the
40	contract, the managed care plan must provide 45 business days'
41	notice to the provider and the provider has the right to
42	negotiate and agree to the change. If the managed care plan and
43	the provider cannot agree to the change to a manual, policy, or
44	procedure document, the provider may terminate the contract
45	prior to implementation of the change. In any event, the
46	managed care plan must provide at least 45 business days'
47	notice of its intent to change a material term, unless a change
48	in state or federal law or any accreditation requirements of a
49	private accreditation organization require a shorter timeframe
50	for compliance. However, if the parties mutually agree, the
51	requirement for 45 business days' notice may be waived. This
52	subparagraph does not limit the ability of the parties to
53	mutually agree to the proposed change at any time after the
54	provider has received notice of the proposed change.
55	2. If a contract between a provider and a managed care
56	plan provides benefits to enrollees or subscribers through a
57	preferred provider arrangement, the contract may contain
58	provisions permitting a material change to the contract by the
59	managed care plan if the plan provides at least 45 business
60	days' notice to the provider of the change and if the provider
61	has the right to terminate the contract prior to the
62	implementation of the change.
63	(b) A provision that requires a health care provider to
64	accept additional patients beyond the contracted number or in
65	the absence of a number if, in the reasonable professional
66	judgment of the provider, accepting additional patients would
67	endanger patients' access to, or continuity of, care.
68	(c) A requirement to comply with quality improvement or
69	utilization management programs or procedures of a managed care
70	plan, unless the requirement is fully disclosed to the health
71	care provider at least 15 business days prior to the date the
72	provider executes the contract. However, the managed care plan
73	may make a change to the quality improvement or utilization
74	management programs or procedures at any time if the change is
75	necessary to comply with state or federal law or any
76	accreditation requirements of a private accreditation
77	organization. A change to the quality improvement or
78	utilization management programs or procedures must be made
79	pursuant to paragraph (a).
80	(d) A provision that waives or conflicts with any
81	provision of chapter 641, Florida Statutes. A provision in the
82	contract that allows the managed care plan to provide
83	professional liability or other coverage or to assume the cost
84	of defending the provider in an action relating to professional
85	liability or in any other action does not conflict with or
86	violate this paragraph.
87	(e) A requirement to permit access to patient information
88	in violation of federal or state law concerning the
89	confidentiality of patient information.
90	(3) Any contract provision that violates subsection (2) is
91	void, unlawful, and unenforceable.
92	(4) This section may not be construed or applied as
93	setting the rate of payment to be included in contracts between
94	managed care plans and health care providers.
95	(5) As used in this section, the term:
96	(a) "Health care provider" means any professional person,
97	medical group, independent practice association, organization,
98	health facility, or other person or institution licensed or
99	authorized by the Agency for Health Care Administration to
100	deliver or furnish health care services.
101	(b) "Material" means a provision in a contract to which a
102	reasonable person would attach importance in determining the
103	action to be taken upon the provision.
104	Section 2.Grounds for disciplinary action.--
105	(1) The Secretary of Health Care Administration may, after
106	appropriate notice and opportunity for a hearing, by order
107	suspend or revoke any license issued by the agency to a managed
108	care plan or assess administrative penalties if the secretary
109	finds that the licensee has committed any of the acts or
110	omissions constituting grounds for disciplinary action.
111	(2) The following acts or omissions constitute grounds for
112	disciplinary action by the secretary:
113	(a) The managed care plan is operating at variance with
114	the basic organizational documents filed with the agency, or
115	with its published plan, or the managed care plan is operating
116	in any manner contrary to that described in, and reasonably
117	inferred from, its application for licensure and annual report,
118	or any modification thereof, unless amendments allowing the
119	variation have been submitted to, and approved by, the
120	secretary.
121	(b) The managed care plan has issued or uses, or permits
122	others to use, evidence of coverage or a schedule of charges
123	for health care services which do not comply with those
124	published in the latest evidence of coverage approved by the
125	agency.
126	(c) The managed care plan does not provide basic health
127	care services to its enrollees and subscribers as set forth in
128	the evidence of coverage. This paragraph does not apply to a
129	contract for specialized health care services.
130	(d) The continued operation of the managed care plan will
131	constitute a substantial risk to its subscribers and enrollees.
132	(e) The managed care plan has violated, attempted to
133	violate, or conspired to violate, directly or indirectly, or
134	assisted in or abetted a violation of or conspiracy to violate
135	any provision of chapter 641, Florida Statutes, any rule
136	adopted by the agency under chapter 641, Florida Statutes, or
137	any order issued by the agency under chapter 641, Florida
138	Statutes.
139	(f) The managed care plan has engaged in any conduct that
140	constitutes an unfair method of competition or unfair or
141	deceptive act or practice, as defined in s. 641.3903, Florida
142	Statutes.
143	(g) The managed care plan has permitted, or aided or
144	abetted, any violation by an employee or contractor who holds a
145	certificate, license, permit, registration, or exemption which
146	would constitute grounds for discipline against the holder of
147	the certificate, license, permit, registration, or exemption.
148	(h) The managed care plan has permitted, or aided or
149	abetted, the commission of any illegal act.
150	(i) The managed care plan has engaged the services of an
151	officer, director, employee, associate, or provider of the plan
152	in violation of an order issued by the secretary.
153	(j) The managed care plan has engaged a solicitor or
154	supervisor of solicitation contrary to the provisions of an
155	order issued by the secretary.
156	(k) The managed care plan, its management company, or any
157	other affiliate of the plan, or any controlling person,
158	officer, director, or other person occupying a principal
159	management or supervisory position in the managed care plan,
160	management company, or affiliate, has been convicted of or has
161	pled nolo contendere to a crime, or committed any act involving
162	dishonesty, fraud, or deceit, which crime or act is
163	substantially related to the qualifications, functions, or
164	duties of a person engaged in business in accordance with
165	chapter 641, Florida Statutes.
166	(l) The managed care plan has been subject to a final
167	disciplinary action taken by this state, another state, an
168	agency of the Federal Government, or another country for any
169	act or omission that would constitute a violation of chapter
170	641, Florida Statutes.
171	(m) The managed care plan has violated any law requiring
172	that medical information be kept confidential.
173	(3)(a) The secretary may prohibit any person from serving
174	as an officer, director, employee, associate, or provider of
175	any managed care plan, or of any management company of a
176	managed care plan, if:
177	1. The prohibition is in the public interest and the
178	person has committed, caused, participated in, or had knowledge
179	of a violation of chapter 641, Florida Statutes, by a managed
180	care plan or management company of a managed care plan.
181	2. The person was an officer, director, employee,
182	associate, or provider of a managed care plan, or of a
183	management company of a managed care plan, whose license has
184	been suspended or revoked and the person had knowledge of, or
185	participated in, any of the prohibited acts for which the
186	license was suspended or revoked.
187	(b) A proceeding for issuing an order under this
188	subsection may be included as a part of a proceeding against a
189	managed care plan under this section or may constitute a
190	separate proceeding, subject in either case to subsection (4).
191	(4) A proceeding under this section requires notice to,
192	and the opportunity for a hearing with regard to, the person
193	affected in accordance with chapter 120, Florida Statutes.
194	Section 3. This act shall take effect July 1, 2003.
195