HB 1629

1	A bill to be entitled
2	An act relating to affordable health care; providing a
3	popular name; providing purposes; amending s. 381.026,
4	F.S.; requiring certain licensed facilities to provide
5	public Internet access to certain financial information;
6	expanding the Florida Patient's Bill of Rights and
7	Responsibilities to include a right to certain price and
8	procedure comparison information; amending s. 381.734,
9	F.S.; including participation by health care providers,
10	small businesses, and health insurers in the Healthy
11	Communities, Healthy People Program; requiring the
12	Department of Health to provide public Internet access to
13	certain public health programs; requiring the department
14	to monitor and assess the effectiveness of such programs;
15	requiring a report; requiring the Auditor General to
16	investigate the effectiveness of such programs; requiring
17	a report; requiring the department to develop certain
18	community emergency room diversion programs; authorizing
19	the department to provide certain private sector
20	incentives for certain purposes; amending s. 395.1041,
21	F.S.; authorizing hospitals to develop certain emergency
22	room diversion programs; amending s. 395.301, F.S.;
23	requiring certain licensed facilities to provide public
24	Internet access to certain financial information;
25	requiring certain licensed facilities to provide
26	prospective patients certain estimates of charges for
27	services; amending s. 408.061, F.S.; requiring the Agency
28	for Health Care Administration to require health care
29	facilities, health care providers, and health insurers to
30	submit certain information; requiring health care
31	facilities and health insurers to provide certain
32	information quarterly; deleting an onsite inspection
33	authorization requirement; amending s. 408.062, F.S.;
34	requiring the agency to conduct certain health care costs
35	and access research, analyses, and studies; expanding the
36	scope of such studies to include use of emergency
37	departments and Internet patient charge information
38	availability; requiring a report; requiring the agency to
39	conduct additional data-based studies and make
40	recommendations to the Legislature; amending s. 408.7056,
41	F.S.; renaming the Statewide Provider and Subscriber
42	Assistance Program as the Subscriber Assistance Program;
43	revising provisions to conform; expanding certain records
44	availability provisions; revising membership provisions
45	relating to a subscriber grievance hearing panel;
46	providing hearing procedures; amending s. 641.3154, F.S.,
47	to conform to the renaming of the Subscriber Assistance
48	Program; amending s. 641.511, F.S., to conform to the
49	renaming of the Subscriber Assistance Program; adopting
50	and incorporating by reference the Employee Retirement
51	Income Security Act of 1974, as implemented by federal
52	regulations; amending s. 641.58, F.S., to conform to the
53	renaming of the Subscriber Assistance Program; amending s.
54	408.909, F.S.; expanding a definition of "health flex plan
55	entity" to include public-private partnerships; making a
56	pilot health flex plan program apply permanently
57	statewide; providing additional program requirements;
58	creating s. 408.919, F.S.; creating the Statewide
59	Electronic Medical Records Advisory Council for certain
60	purposes; requiring the agency to provide staff support;
61	authorizing the agency to contract to assist the council
62	in creating an electronic medical records system;
63	providing for appointment of council members and meetings;
64	providing responsibilities of the council; requiring an
65	annual status report to the Governor and Legislature;
66	specifying service without compensation; providing for per
67	diem and travel expenses; providing for future repeal;
68	creating the Statewide Evidenced-based Medicine Panel for
69	certain purposes; requiring the Agency for Health Care
70	Administration to provide staff support; authorizing the
71	agency to contract to assist the panel in creating a
72	statewide evidence-based medicine program; providing for
73	appointment of panel members and meetings; providing
74	responsibilities of the panel; requiring an annual status
75	report to the Governor and Legislature; specifying service
76	without compensation; providing for per diem and travel
77	expenses; providing for future abolition of the panel;
78	amending s. 409.91255, F.S.; expanding assistance to
79	certain health centers to include urgent care services;
80	amending s. 627.410, F.S.; requiring insurers to file
81	certain rates with the Office of Insurance Regulation;
82	amending s. 627.6487, F.S.; revising a definition;
83	creating s. 627.64872, F.S.; providing legislative intent;
84	creating the Florida Health Insurance Plan for certain
85	purposes; providing definitions; providing requirements
86	for operation of the plan; providing for a board of
87	directors; providing for appointment of members; providing
88	for terms; specifying service without compensation;
89	providing for travel and per diem expenses; requiring a
90	plan of operation; providing requirements; providing for
91	powers of the plan; requiring reports to the Governor and
92	Legislature; providing certain immunity from liability for
93	plan obligations; authorizing the board to provide for
94	indemnification of certain costs; requiring an annually
95	audited financial statement; providing for eligibility for
96	coverage under the plan; providing criteria; requirements,
97	and limitations; specifying certain activity as an unfair
98	trade practice; providing for a plan administrator;
99	providing criteria; providing requirements; providing term
100	limits for the plan administrator; providing duties;
101	providing for paying the administrator; providing for
102	funding mechanisms of the plan; specifying benefits under
103	the plan; providing criteria, requirements, and
104	limitations; providing for nonduplication of benefits;
105	providing for annual and maximum lifetime benefits;
106	providing for tax exempt status; providing for abolition
107	of the Florida Comprehensive Health Association upon
108	implementation of the plan; providing for enrollment in
109	the plan of persons enrolled in the association; requiring
110	insurers to pay certain assessments to the board for
111	certain purposes; providing criteria, requirements, and
112	limitations for such assessments; providing for repeal of
113	ss. 627.6488, 627.6489, 627.649, 627.6492, 627.6494,
114	627.6496, 627.6498, and 627.6499, F.S., relating to the
115	Florida Comprehensive Health Association, upon
116	implementation of the plan; amending s. 627.662, F.S.;
117	providing for application of certain claim payment
118	methodologies to certain types of insurance; amending s.
119	627.6699, F.S.; revising provisions requiring small
120	employer carriers to offer certain health benefit plans;
121	requiring small employer carriers to file and provide
122	coverage under certain high deductible plans; including
123	high deductible plans under certain required plan
124	provisions; creating the Small Employers Access Program;
125	providing legislative intent; providing definitions;
126	providing participation eligibility requirements and
127	criteria; requiring the Office of Insurance Regulation to
128	administer the program by selecting an insurer through
129	competitive bidding; providing requirements; specifying
130	insurer qualifications; providing duties of the insurer;
131	providing a contract term; providing insurer reporting
132	requirements; providing application requirements;
133	providing for benefits under the program; requiring the
134	office to annually report to the Governor and Legislature;
135	authorizing health insurers to require higher copayments
136	for certain uses of emergency departments; amending s.
137	627.9175, F.S.; requiring certain health insurers to
138	annually report certain coverage information to the
139	office; providing requirements; deleting certain reporting
140	requirements; amending s. 636.003, F.S.; revising the
141	definition of "prepaid limited health service
142	organization" to exclude provision of discounted medical
143	service programs; creating ss. 627.6410 and 627.66912,
144	F.S.; requiring certain insurers to provide for additional
145	coverage for certain additional disorders; providing for
146	additional premiums; providing limitations and exceptions;
147	amending s. 641.31, F.S.; providing for application of
148	certain claim payment methodologies to certain types of
149	insurance; requiring health maintenance contracts to
150	provide for additional coverage for certain additional
151	disorders; providing for additional premiums; providing
152	limitations and exceptions; amending s. 626.015, F.S.;
153	defining insurance advisor; amending ss. 626.016, 626.342,
154	626.536, 626.561, 626.572, and 626.601, F.S., to include
155	application of such provisions to insurance advisors;
156	providing penalties; amending ss. 626.171, 626.191, and
157	626.201, F.S.; clarifying certain application
158	requirements; amending s. 626.6115, F.S.; providing
159	additional grounds for adverse actions against insurance
160	agency licensure; amending ss. 624.509, 626.7845, 626.292,
161	and 626.321, F.S.; correcting cross references; preserving
162	certain rights to enrollment in certain health benefit
163	coverage for certain groups under certain circumstances;
164	repealing s. 408.02, F.S., relating to the development,
165	endorsement, implementation, and evaluation of patient
166	management practice parameters by the Agency for Health
167	Care Administration; providing appropriations; providing
168	an effective date.
169
170	WHEREAS, according to the Kaiser Family Foundation, eight
171	out of ten uninsured Americans are workers or dependents of
172	workers and nearly eight out of ten uninsured Americans have
173	family incomes above the poverty level, and
174	WHEREAS, fifty-five percent of those who do not have
175	insurance state the reason they don't have insurance is lack of
176	affordability, and
177	WHEREAS, average health insurance premium increases for the
178	last two years have been in the range of ten to twenty percent
179	for Florida's employers, and
180	WHEREAS, an increasing number of employers are opting to
181	cease providing insurance coverage to their employees due to the
182	high cost, and
183	WHEREAS, an increasing number of employers who continue
184	providing coverage are forced to shift more premium cost to
185	their employees, thus diminishing the value of employee wage
186	increases, and
187	WHEREAS, according to studies, the rate of avoidable
188	hospitalization is fifty to seventy percent lower for the
189	insured versus the uninsured, and
190	WHEREAS, according to Florida Cancer Registry data, the
191	uninsured have a seventy percent greater chance of a late
192	diagnosis, thus decreasing the chances of a positive health
193	outcome, and
194	WHEREAS, according to the Agency for Health Care
195	Administration's 2002 financial data, uncompensated care in
196	Florida's hospitals is growing at the rate of twelve to thirteen
197	percent per year, and, at $4.3 billion in 2001, this cost, when
198	shifted to Floridians who remain insured, is not sustainable,
199	and
200	WHEREAS, the Florida Legislature, through the creation of
201	Health Flex, has already identified the need for lower cost
202	alternatives, and
203	WHEREAS, it is of vital importance and in the best
204	interests of the people of the State of Florida that the issue
205	of available, affordable health care insurance be addressed in a
206	cohesive and meaningful manner, and
207	WHEREAS, there is general recognition that the issues
208	surrounding the problem of access to affordable health insurance
209	are complicated and multifaceted, and
210	WHEREAS, on August 14, 2003, Speaker Johnnie Byrd created
211	the Select Committee on Affordable Health Care for Floridians
212	effort to address the issue of affordable and accessible
213	employment-based insurance, and
214	WHEREAS, the Select Committee on Affordable Health Care for
215	Floridians held public hearings with predetermined themes around
216	the state, specifically, in Orlando, Miami, Jacksonville, Tampa,
217	Pensacola, Boca Raton, and Tallahassee, from October through
218	November 2003 to effectively probe the operation of the private
219	insurance marketplace, to understand the health insurance market
220	trends, to learn from past policy initiatives, and to identify,
221	explore, and debate new ideas for change, and
222	WHEREAS, recommendations from the Select Committee on
223	Affordable Health Care were adopted on February 4, 2004, to
224	address the multifaceted issues attributed to the increase in
225	health care cost, and
226	WHEREAS, these recommendations were presented to the
227	Speaker of the House of Representatives in a final report from
228	the committee on February 18, 2004, and subsequent legislation
229	was drafted creating the "The 2004 Affordable Health Care for
230	Floridians Act," NOW, THEREFORE,
231
232	Be It Enacted by the Legislature of the State of Florida:
233
234	Section 1.  This act may be referred to by the popular name
235	"The 2004 Affordable Health Care for Floridians Act."
236	Section 2.  The purpose of this act is to address the
237	underlying cause of the double-digit increases in health
238	insurance premiums by mitigating the overall growth in health
239	care costs.
240	Section 3.  Paragraph (c) of subsection (4) and subsection
241	(6) of section 381.026, Florida Statutes, are amended to read:
242	381.026  Florida Patient's Bill of Rights and
243	Responsibilities.--
244	(4)  RIGHTS OF PATIENTS.--Each health care facility or
245	provider shall observe the following standards:
246	(c)  Financial information and disclosure.--
247	1.  A patient has the right to be given, upon request, by
248	the responsible provider, his or her designee, or a
249	representative of the health care facility full information and
250	necessary counseling on the availability of known financial
251	resources for the patient's health care.
252	2.  A health care provider or a health care facility shall,
253	upon request, disclose to each patient who is eligible for
254	Medicare, in advance of treatment, whether the health care
255	provider or the health care facility in which the patient is
256	receiving medical services accepts assignment under Medicare
257	reimbursement as payment in full for medical services and
258	treatment rendered in the health care provider's office or
259	health care facility.
260	3.  A health care provider or a health care facility shall,
261	upon request, furnish a patient, prior to provision of medical
262	services, a reasonable estimate of charges for such services.
263	Such reasonable estimate shall not preclude the health care
264	provider or health care facility from exceeding the estimate or
265	making additional charges based on changes in the patient's
266	condition or treatment needs.
267	4.  Each licensed facility not operated by the state shall
268	make available to the public on its Internet website or by other
269	electronic means package prices for each of the top 50 most
270	utilized elective inpatient and outpatient procedures. The
271	package pricing shall include all hospital-related services, and
272	shall include separate estimates of costs for professional fees
273	charged by independent contractor physicians or physician
274	groups. The licensed facilities shall also make available to the
275	public on its Internet website or by other electronic means each
276	of the top 50 most utilized inpatient and outpatient procedures.
277	Such list shall be updated quarterly. The facility shall place a
278	notice in the reception areas that such information is available
279	electronically and the website address. The licensed facility
280	may indicate that the package pricing is based on a compilation
281	of charges for the average patient and that each patient's bill
282	may vary from the average depending upon the severity of illness
283	and individual resources consumed. The licensed facility may
284	also indicate that the package pricing is negotiable based upon
285	the patient's health plan and the ability to pay. The agency
286	shall develop rules for implementation of a uniform mechanism
287	for reporting this information on the facility's website.
288	5.4.  A patient has the right to receive a copy of an
289	itemized bill upon request. A patient has a right to be given an
290	explanation of charges upon request.
291	(6)  SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any health
292	care provider who treats a patient in an office or any health
293	care facility licensed under chapter 395 that provides emergency
294	services and care or outpatient services and care to a patient,
295	or admits and treats a patient, shall adopt and make available
296	to the patient, in writing, a statement of the rights and
297	responsibilities of patients, including the following:
298
299	SUMMARY OF THE FLORIDA PATIENT'S BILL
300	OF RIGHTS AND RESPONSIBILITIES
301
302	Florida law requires that your health care provider or
303	health care facility recognize your rights while you are
304	receiving medical care and that you respect the health care
305	provider's or health care facility's right to expect certain
306	behavior on the part of patients. You may request a copy of the
307	full text of this law from your health care provider or health
308	care facility. A summary of your rights and responsibilities
309	follows:
310	A patient has the right to be treated with courtesy and
311	respect, with appreciation of his or her individual dignity, and
312	with protection of his or her need for privacy.
313	A patient has the right to a prompt and reasonable response
314	to questions and requests.
315	A patient has the right to know who is providing medical
316	services and who is responsible for his or her care.
317	A patient has the right to know what patient support
318	services are available, including whether an interpreter is
319	available if he or she does not speak English.
320	A patient has the right to know what rules and regulations
321	apply to his or her conduct.
322	A patient has the right to be given by the health care
323	provider information concerning diagnosis, planned course of
324	treatment, alternatives, risks, and prognosis.
325	A patient has the right to refuse any treatment, except as
326	otherwise provided by law.
327	A patient has the right to be given, upon request, full
328	information and necessary counseling on the availability of
329	known financial resources for his or her care.
330	A patient who is eligible for Medicare has the right to
331	know, upon request and in advance of treatment, whether the
332	health care provider or health care facility accepts the
333	Medicare assignment rate.
334	A patient has the right to receive, upon request, prior to
335	treatment, a reasonable estimate of charges for medical care.
336	A patient has the right to receive, upon request, prior to
337	treatment, a reasonable estimate of charges for proposed
338	service.
339	A patient has the right to receive a copy of a reasonably
340	clear and understandable, itemized bill and, upon request, to
341	have the charges explained.
342	A patient has the right to impartial access to medical
343	treatment or accommodations, regardless of race, national
344	origin, religion, handicap, or source of payment.
345	A patient has the right to treatment for any emergency
346	medical condition that will deteriorate from failure to provide
347	treatment.
348	A patient has the right to know if medical treatment is for
349	purposes of experimental research and to give his or her consent
350	or refusal to participate in such experimental research.
351	A patient has the right to express grievances regarding any
352	violation of his or her rights, as stated in Florida law,
353	through the grievance procedure of the health care provider or
354	health care facility which served him or her and to the
355	appropriate state licensing agency.
356	A patient is responsible for providing to the health care
357	provider, to the best of his or her knowledge, accurate and
358	complete information about present complaints, past illnesses,
359	hospitalizations, medications, and other matters relating to his
360	or her health.
361	A patient is responsible for reporting unexpected changes
362	in his or her condition to the health care provider.
363	A patient is responsible for reporting to the health care
364	provider whether he or she comprehends a contemplated course of
365	action and what is expected of him or her.
366	A patient is responsible for following the treatment plan
367	recommended by the health care provider.
368	A patient is responsible for keeping appointments and, when
369	he or she is unable to do so for any reason, for notifying the
370	health care provider or health care facility.
371	A patient is responsible for his or her actions if he or
372	she refuses treatment or does not follow the health care
373	provider's instructions.
374	A patient is responsible for assuring that the financial
375	obligations of his or her health care are fulfilled as promptly
376	as possible.
377	A patient is responsible for following health care facility
378	rules and regulations affecting patient care and conduct.
379	Section 4.  Subsection (1) and paragraph (g) of subsection
380	(3) of section 381.734, Florida Statutes, are amended, and
381	subsections (4), (5), and (6) are added to said section, to
382	read:
383	381.734  Healthy Communities, Healthy People Program.--
384	(1)  The department shall develop and implement the Healthy
385	Communities, Healthy People Program, a comprehensive and
386	community-based health promotion and wellness program. The
387	program shall be designed to reduce major behavioral risk
388	factors associated with chronic diseases, including those
389	chronic diseases identified in chapter 385, by enhancing the
390	knowledge, skills, motivation, and opportunities for
391	individuals, organizations, health care providers, small
392	businesses, health insurers, and communities to develop and
393	maintain healthy lifestyles.
394	(3)  The program shall include:
395	(g)  The establishment of a comprehensive program to inform
396	the public, health care professionals, health insurers, and
397	communities about the prevalence of chronic diseases in the
398	state; known and potential risks, including social and
399	behavioral risks; and behavior changes that would reduce risks.
400	(4)  The department shall make available on its Internet
401	website, no later than October 1, 2004, and in a hard-copy
402	format upon request, a listing of age-specific, disease-
403	specific, and community-specific health promotion, preventive
404	care, and wellness programs offered and established under the
405	Healthy Communities, Health People Program. The website shall
406	also provide residents with information to identify behavior
407	risk factors that lead to preventable diseases by maintaining a
408	healthy lifestyle. The website shall allow consumers to select
409	by county or region disease-specific statistical information.
410	(5)  The department shall monitor and assess the
411	effectiveness of such programs. The department shall submit a
412	status report based on this monitoring and assessment to the
413	Governor, the Speaker of the House of Representatives, the
414	President of the Senate, and the substantive legislative
415	committees of each house of the Legislature, with the first
416	annual report due January 31, 2005.
417	(6)  The Auditor General's office shall investigate and
418	report to the President of the Senate and the Speaker of the
419	House of Representatives, by February 15, 2005, on the
420	effectiveness of such programs.
421	Section 5.  Subsection (7) is added to section 395.1041,
422	Florida Statutes, to read:
423	395.1041  Access to emergency services and care.--
424	(7)  Hospitals may develop emergency room diversion
425	programs, including, but not limited to, an "Emergency Hotline"
426	which allows patients to help determine if emergency department
427	services are appropriate or if other health care settings may be
428	more appropriate for care, and a "Fast Track" program allowing
429	nonemergency patients to be treated at an alternative site.
430	Alternative sites may include health care programs funded with
431	local tax revenue and federally funded community health centers,
432	county health departments, or other nonhospital providers of
433	health care services.
434	Section 6.  Subsections (7) and (8) are added to section
435	395.301, Florida Statutes, to read:
436	395.301  Itemized patient bill; form and content prescribed
437	by the agency.--
438	(7)  Each licensed facility not operated by the state shall
439	make available to the public on its Internet website or by other
440	electronic means package prices and the Medicare reimbursement
441	rate for each of the top 50 most used elective inpatient and
442	outpatient procedures. The package pricing shall include all
443	hospital-related services and shall include separate estimates
444	of costs for professional fees charged by independent contractor
445	physicians or physician groups. The licensed facilities shall
446	also make available to the public on its Internet website or by
447	other electronic means the top 50 most used procedures in both
448	inpatient and outpatient settings. The list shall be updated
449	quarterly. The facility shall place a notice in reception areas
450	that such information is available electronically and the
451	website address. The licensed facility may indicate that the
452	package pricing is based on a compilation of charges for the
453	average patient and that each patient's bill may vary from the
454	average depending upon the severity of illness and individual
455	resources consumed. The licensed facility may also indicate that
456	the package pricing is negotiable based upon the patient's
457	health plan and the ability to pay. The agency shall develop
458	rules for implementation of a uniform mechanism for reporting
459	this information on the facility's website.
460	(8)  Each licensed facility not operated by the state
461	shall, upon request of a prospective patient prior to the
462	provision of medical services, provide a reasonable estimate of
463	charges for the proposed service. Such estimate shall not
464	preclude the actual charges from exceeding the estimate based on
465	changes in the patient's medical condition or the treatment
466	needs of the patient as determined by the attending and
467	consulting physicians.
468	Section 7.  Subsection (1) of section 408.061, Florida
469	Statutes, is amended to read:
470	408.061  Data collection; uniform systems of financial
471	reporting; information relating to physician charges;
472	confidential information; immunity.--
473	(1)  The agency shall may require the submission by health
474	care facilities, health care providers, and health insurers of
475	data necessary to carry out the agency's duties. Specifications
476	for data to be collected under this section shall be developed
477	by the agency with the assistance of technical advisory panels
478	including representatives of affected entities, consumers,
479	purchasers, and such other interested parties as may be
480	determined by the agency.
481	(a)  Data shall to be submitted by health care facilities
482	quarterly for each preceding calendar quarter no later than
483	February 1, May 1, August 1, and November 1 of each year
484	commencing August 1, 2004. Such data shall may include, but are
485	not limited to: case-mix data, patient admission and or
486	discharge data, outpatient data which shall include the number
487	of patients treated in the emergency department of a licensed
488	hospital reported by  patient acuity level, morbidity rates, and
489	mortality rates for the top 50 diagnoses which are risk
490	adjusted, with patient and provider-specific identifiers
491	included, actual charge data by diagnostic groups, financial
492	data, accounting data, operating expenses, expenses incurred for
493	rendering services to patients who cannot or do not pay,
494	interest charges, depreciation expenses based on the expected
495	useful life of the property and equipment involved, and
496	demographic data. Data may be obtained from documents such as,
497	but not limited to: leases, contracts, debt instruments,
498	itemized patient bills, medical record abstracts, and related
499	diagnostic information.
500	(b)  Data to be submitted by health care providers may
501	include, but are not limited to: Medicare and Medicaid
502	participation, types of services offered to patients, amount of
503	revenue and expenses of the health care provider, and such other
504	data which are reasonably necessary to study utilization
505	patterns.
506	(c)  Data shall to be electronically submitted by health
507	insurers quarterly for each preceding calendar quarter no later
508	than February 1, May 1, August 1, and November 1 of each year
509	commencing August 1, 2004. Such data shall may include, but are
510	not limited to: claims paid data aggregated by current
511	procedural terminology (CPT) code or service and provider,
512	premium, administration, and financial information.
513	(d)  Data submission requirements of required to be
514	submitted by health care facilities, health care providers, or
515	health insurers shall not include specific provider contract
516	reimbursement information. However, such specific provider
517	reimbursement data shall be reasonably available for onsite
518	inspection by the agency as is necessary to carry out the
519	agency's regulatory duties. Any such data obtained by the agency
520	as a result of specified reporting requirements onsite
521	inspections may not be used by the state for purposes of direct
522	provider contracting and are confidential and exempt from the
523	provisions of s. 119.07(1) and s. 24(a), Art. I of the State
524	Constitution.
525	(e)  A requirement to submit data shall be adopted by rule
526	if the submission of data is being required of all members of
527	any type of health care facility, health care provider, or
528	health insurer. Rules are not required, however, for the
529	submission of data for a special study mandated by the
530	Legislature or when information is being requested for a single
531	health care facility, health care provider, or health insurer.
532	Section 8.  Subsections (1) and (4) of section 408.062,
533	Florida Statutes, are amended to read:
534	408.062  Research, analyses, studies, and reports.--
535	(1)  The agency shall have the authority to conduct
536	research, analyses, and studies relating to health care costs
537	and access to and quality of health care services as access and
538	quality are affected by changes in health care costs. Such
539	research, analyses, and studies shall include, but not be
540	limited to, research and analysis relating to:
541	(a)  The financial status of any health care facility or
542	facilities subject to the provisions of this chapter.
543	(b)  The impact of uncompensated charity care on health
544	care facilities and health care providers.
545	(c)  The state's role in assisting to fund indigent care.
546	(d)  In conjunction with the Office of Insurance
547	Regulation, the availability and affordability of health
548	insurance for small businesses.
549	(e)  Total health care expenditures in the state according
550	to the sources of payment and the type of expenditure.
551	(f)  The quality of health services, using techniques such
552	as small area analysis, severity adjustments, and risk-adjusted
553	mortality rates.
554	(g)  The development of physician payment systems which are
555	capable of taking into account the amount of resources consumed
556	and the outcomes produced in the delivery of care.
557	(h)  The impact of subacute admissions on hospital revenues
558	and expenses for purposes of calculating adjusted admissions as
559	defined in s. 408.07.
560	(i)  The utilization of emergency department services by
561	patient acuity level and the implication of increasing hospital
562	cost by providing nonurgent care in emergency departments. The
563	agency shall submit an annual report based on this monitoring
564	and assessment to the Governor, the Speaker of the House of
565	Representatives, the President of the Senate, and the
566	substantive legislative committees with the first annual report
567	due January 1, 2005.
568	(j)  The making available on its Internet website no later
569	than October 1, 2004, and in a hard-copy format upon request, of
570	patient charge information by provider aggregated by claims data
571	submitted by insurers and performance outcome data collected
572	from health care facilities pursuant to s. 408.061(1)(a) and (d)
573	for not less than 100 inpatient and outpatient diagnostic and
574	therapeutic conditions and procedures and the volume of
575	inpatient and outpatient procedures by Medicare discharge
576	referral experience. The website shall also provide an
577	interactive search that allows consumers to view and compare the
578	information for specific facilities, a map that allows consumers
579	to select a county or region, definitions of all of the data,
580	descriptions of each procedure, and an explanation about why the
581	data may differ from facility to facility. Such public data
582	shall be updated quarterly. The agency shall submit an annual
583	report based on this monitoring and assessment to the Governor,
584	the Speaker of the House of Representatives, the President of
585	the Senate, and the substantive legislative committees with the
586	first annual report due January 1, 2005.
587	(4)(a)  The agency shall may conduct data-based studies and
588	evaluations and make recommendations to the Legislature and the
589	Governor concerning exemptions, the effectiveness of limitations
590	of referrals, restrictions on investment interests and
591	compensation arrangements, and the effectiveness of public
592	disclosure. Such analysis shall may include, but need not be
593	limited to, utilization of services, cost of care, quality of
594	care, and access to care. The agency may require the submission
595	of data necessary to carry out this duty, which may include, but
596	need not be limited to, data concerning ownership, Medicare and
597	Medicaid, charity care, types of services offered to patients,
598	revenues and expenses, patient-encounter data, and other data
599	reasonably necessary to study utilization patterns and the
600	impact of health care provider ownership interests in health-
601	care-related entities on the cost, quality, and accessibility of
602	health care.
603	(b)  The agency may collect such data from any health
604	facility or licensed health care provider as a special study.
605	Section 9.  Section 408.7056, Florida Statutes, is amended
606	to read:
607	408.7056  Statewide Provider and Subscriber Assistance
608	Program.--
609	(1)  As used in this section, the term:
610	(a)  "Agency" means the Agency for Health Care
611	Administration.
612	(b)  "Department" means the Department of Financial
613	Services.
614	(c)  "Grievance procedure" means an established set of
615	rules that specify a process for appeal of an organizational
616	decision.
617	(d)  "Health care provider" or "provider" means a state-
618	licensed or state-authorized facility, a facility principally
619	supported by a local government or by funds from a charitable
620	organization that holds a current exemption from federal income
621	tax under s. 501(c)(3) of the Internal Revenue Code, a licensed
622	practitioner, a county health department established under part
623	I of chapter 154, a prescribed pediatric extended care center
624	defined in s. 400.902, a federally supported primary care
625	program such as a migrant health center or a community health
626	center authorized under s. 329 or s. 330 of the United States
627	Public Health Services Act that delivers health care services to
628	individuals, or a community facility that receives funds from
629	the state under the Community Alcohol, Drug Abuse, and Mental
630	Health Services Act and provides mental health services to
631	individuals.
632	(e)  "Managed care entity" means a health maintenance
633	organization or a prepaid health clinic certified under chapter
634	641, a prepaid health plan authorized under s. 409.912, or an
635	exclusive provider organization certified under s. 627.6472.
636	(f)  "Office" means the Office of Insurance Regulation of
637	the Financial Services Commission.
638	(g)  "Panel" means a statewide provider and subscriber
639	assistance panel selected as provided in subsection (11).
640	(2)  The agency shall adopt and implement a program to
641	provide assistance to subscribers and providers, including those
642	whose grievances are not resolved by the managed care entity to
643	the satisfaction of the subscriber or provider. The program
644	shall consist of one or more panels that meet as often as
645	necessary to timely review, consider, and hear grievances and
646	recommend to the agency or the office any actions that should be
647	taken concerning individual cases heard by the panel. The panel
648	shall hear every grievance filed by subscribers and providers on
649	behalf of subscribers, unless the grievance:
650	(a)  Relates to a managed care entity's refusal to accept a
651	provider into its network of providers;
652	(b)  Is part of an internal grievance in a Medicare managed
653	care entity or a reconsideration appeal through the Medicare
654	appeals process which does not involve a quality of care issue;
655	(c)  Is related to a health plan not regulated by the state
656	such as an administrative services organization, third-party
657	administrator, or federal employee health benefit program;
658	(d)  Is related to appeals by in-plan suppliers and
659	providers, unless related to quality of care provided by the
660	plan;
661	(e)  Is part of a Medicaid fair hearing pursued under 42
662	C.F.R. ss. 431.220 et seq.;
663	(f)  Is the basis for an action pending in state or federal
664	court;
665	(g)  Is related to an appeal by nonparticipating providers,
666	unless related to the quality of care provided to a subscriber
667	by the managed care entity and the provider is involved in the
668	care provided to the subscriber;
669	(h)  Was filed before the subscriber or provider completed
670	the entire internal grievance procedure of the managed care
671	entity, the managed care entity has complied with its timeframes
672	for completing the internal grievance procedure, and the
673	circumstances described in subsection (6) do not apply;
674	(i)  Has been resolved to the satisfaction of the
675	subscriber or provider who filed the grievance, unless the
676	managed care entity's initial action is egregious or may be
677	indicative of a pattern of inappropriate behavior;
678	(j)  Is limited to seeking damages for pain and suffering,
679	lost wages, or other incidental expenses, including accrued
680	interest on unpaid balances, court costs, and transportation
681	costs associated with a grievance procedure;
682	(k)  Is limited to issues involving conduct of a health
683	care provider or facility, staff member, or employee of a
684	managed care entity which constitute grounds for disciplinary
685	action by the appropriate professional licensing board and is
686	not indicative of a pattern of inappropriate behavior, and the
687	agency, office, or department has reported these grievances to
688	the appropriate professional licensing board or to the health
689	facility regulation section of the agency for possible
690	investigation; or
691	(l)  Is withdrawn by the subscriber or provider. Failure of
692	the subscriber or the provider to attend the hearing shall be
693	considered a withdrawal of the grievance.
694	(3)  The agency shall review all grievances within 60 days
695	after receipt and make a determination whether the grievance
696	shall be heard. Once the agency notifies the panel, the
697	subscriber or provider, and the managed care entity that a
698	grievance will be heard by the panel, the panel shall hear the
699	grievance either in the network area or by teleconference no
700	later than 120 days after the date the grievance was filed. The
701	agency shall notify the parties, in writing, by facsimile
702	transmission, or by phone, of the time and place of the hearing.
703	The panel may take testimony under oath, request certified
704	copies of documents, and take similar actions to collect
705	information and documentation that will assist the panel in
706	making findings of fact and a recommendation. The panel shall
707	issue a written recommendation, supported by findings of fact,
708	to the provider or subscriber, to the managed care entity, and
709	to the agency or the office no later than 15 working days after
710	hearing the grievance. If at the hearing the panel requests
711	additional documentation or additional records, the time for
712	issuing a recommendation is tolled until the information or
713	documentation requested has been provided to the panel. The
714	proceedings of the panel are not subject to chapter 120.
715	(4)  If, upon receiving a proper patient authorization
716	along with a properly filed grievance, the agency requests
717	medical records from a health care provider or managed care
718	entity, the health care provider or managed care entity that has
719	custody of the records has 10 days to provide the records to the
720	agency. Records include medical records, communication logs
721	associated with the grievance both to and from the subscriber,
722	contracts, and any other contents of the internal grievance file
723	associated with the complaint filed with the Subscriber
724	Assistance Program. Failure to provide requested medical records
725	may result in the imposition of a fine of up to $500. Each day
726	that records are not produced is considered a separate
727	violation.
728	(5)  Grievances that the agency determines pose an
729	immediate and serious threat to a subscriber's health must be
730	given priority over other grievances. The panel may meet at the
731	call of the chair to hear the grievances as quickly as possible
732	but no later than 45 days after the date the grievance is filed,
733	unless the panel receives a waiver of the time requirement from
734	the subscriber. The panel shall issue a written recommendation,
735	supported by findings of fact, to the office or the agency
736	within 10 days after hearing the expedited grievance.
737	(6)  When the agency determines that the life of a
738	subscriber is in imminent and emergent jeopardy, the chair of
739	the panel may convene an emergency hearing, within 24 hours
740	after notification to the managed care entity and to the
741	subscriber, to hear the grievance. The grievance must be heard
742	notwithstanding that the subscriber has not completed the
743	internal grievance procedure of the managed care entity. The
744	panel shall, upon hearing the grievance, issue a written
745	emergency recommendation, supported by findings of fact, to the
746	managed care entity, to the subscriber, and to the agency or the
747	office for the purpose of deferring the imminent and emergent
748	jeopardy to the subscriber's life. Within 24 hours after receipt
749	of the panel's emergency recommendation, the agency or office
750	may issue an emergency order to the managed care entity. An
751	emergency order remains in force until:
752	(a)  The grievance has been resolved by the managed care
753	entity;
754	(b)  Medical intervention is no longer necessary; or
755	(c)  The panel has conducted a full hearing under
756	subsection (3) and issued a recommendation to the agency or the
757	office, and the agency or office has issued a final order.
758	(7)  After hearing a grievance, the panel shall make a
759	recommendation to the agency or the office which may include
760	specific actions the managed care entity must take to comply
761	with state laws or rules regulating managed care entities.
762	(8)  A managed care entity, subscriber, or provider that is
763	affected by a panel recommendation may within 10 days after
764	receipt of the panel's recommendation, or 72 hours after receipt
765	of a recommendation in an expedited grievance, furnish to the
766	agency or office written evidence in opposition to the
767	recommendation or findings of fact of the panel.
768	(9)  No later than 30 days after the issuance of the
769	panel's recommendation and, for an expedited grievance, no later
770	than 10 days after the issuance of the panel's recommendation,
771	the agency or the office may adopt the panel's recommendation or
772	findings of fact in a proposed order or an emergency order, as
773	provided in chapter 120, which it shall issue to the managed
774	care entity. The agency or office may issue a proposed order or
775	an emergency order, as provided in chapter 120, imposing fines
776	or sanctions, including those contained in ss. 641.25 and
777	641.52. The agency or the office may reject all or part of the
778	panel's recommendation. All fines collected under this
779	subsection must be deposited into the Health Care Trust Fund.
780	(10)  In determining any fine or sanction to be imposed,
781	the agency and the office may consider the following factors:
782	(a)  The severity of the noncompliance, including the
783	probability that death or serious harm to the health or safety
784	of the subscriber will result or has resulted, the severity of
785	the actual or potential harm, and the extent to which provisions
786	of chapter 641 were violated.
787	(b)  Actions taken by the managed care entity to resolve or
788	remedy any quality-of-care grievance.
789	(c)  Any previous incidents of noncompliance by the managed
790	care entity.
791	(d)  Any other relevant factors the agency or office
792	considers appropriate in a particular grievance.
793	(11)(a)  The panel shall consist of the Insurance Consumer
794	Advocate, or designee thereof, established by s. 627.0613; at
795	least two members employed by the agency and at least two
796	members employed by the department, chosen by their respective
797	agencies; a consumer appointed by the Governor; a physician
798	appointed by the Governor, as a standing member; and, if
799	necessary, physicians who have expertise relevant to the case to
800	be heard, on a rotating basis. The agency may contract with a
801	medical director, and a primary care physician, or both, who
802	shall provide additional technical expertise to the panel but
803	shall not be voting members of the panel. The medical director
804	shall be selected from a health maintenance organization with a
805	current certificate of authority to operate in Florida.
806	(b)  A majority of those panel members required under
807	paragraph (a) shall constitute a quorum for any meeting or
808	hearing of the panel. A grievance may not be heard or voted upon
809	at any panel meeting or hearing unless a quorum is present,
810	except that a minority of the panel may adjourn a meeting or
811	hearing until a quorum is present. A panel convened for the
812	purpose of hearing a subscriber's grievance in accordance with
813	subsections (2) and (3) shall not consist of more than 11
814	members.
815	(12)  Every managed care entity shall submit a quarterly
816	report to the agency, the office, and the department listing the
817	number and the nature of all subscribers' and providers'
818	grievances which have not been resolved to the satisfaction of
819	the subscriber or provider after the subscriber or provider
820	follows the entire internal grievance procedure of the managed
821	care entity. The agency shall notify all subscribers and
822	providers included in the quarterly reports of their right to
823	file an unresolved grievance with the panel.
824	(13)  A proposed order issued by the agency or office which
825	only requires the managed care entity to take a specific action
826	under subsection (7) is subject to a summary hearing in
827	accordance with s. 120.574, unless all of the parties agree
828	otherwise. If the managed care entity does not prevail at the
829	hearing, the managed care entity must pay reasonable costs and
830	attorney's fees of the agency or the office incurred in that
831	proceeding.
832	(14)(a)  Any information that identifies a subscriber which
833	is held by the panel, agency, or department pursuant to this
834	section is confidential and exempt from the provisions of s.
835	119.07(1) and s. 24(a), Art. I of the State Constitution.
836	However, at the request of a subscriber or managed care entity
837	involved in a grievance procedure, the panel, agency, or
838	department shall release information identifying the subscriber
839	involved in the grievance procedure to the requesting subscriber
840	or managed care entity.
841	(b)  Meetings of the panel shall be open to the public
842	unless the provider or subscriber whose grievance will be heard
843	requests a closed meeting or the agency or the department
844	determines that information which discloses the subscriber's
845	medical treatment or history or information relating to internal
846	risk management programs as defined in s. 641.55(5)(c), (6), and
847	(8) may be revealed at the panel meeting, in which case that
848	portion of the meeting during which a subscriber's medical
849	treatment or history or internal risk management program
850	information is discussed shall be exempt from the provisions of
851	s. 286.011 and s. 24(b), Art. I of the State Constitution. All
852	closed meetings shall be recorded by a certified court reporter.
853	Section 10.  Paragraph (c) of subsection (4) of section
854	641.3154, Florida Statutes, is amended to read:
855	641.3154  Organization liability; provider billing
856	prohibited.--
857	(4)  A provider or any representative of a provider,
858	regardless of whether the provider is under contract with the
859	health maintenance organization, may not collect or attempt to
860	collect money from, maintain any action at law against, or
861	report to a credit agency a subscriber of an organization for
862	payment of services for which the organization is liable, if the
863	provider in good faith knows or should know that the
864	organization is liable. This prohibition applies during the
865	pendency of any claim for payment made by the provider to the
866	organization for payment of the services and any legal
867	proceedings or dispute resolution process to determine whether
868	the organization is liable for the services if the provider is
869	informed that the such proceedings are taking place. It is
870	presumed that a provider does not know and should not know that
871	an organization is liable unless:
872	(c)  The office or agency makes a final determination that
873	the organization is required to pay for such services subsequent
874	to a recommendation made by the Statewide Provider and
875	Subscriber Assistance Panel pursuant to s. 408.7056; or
876	Section 11.  Subsection (1), paragraphs (b) and (e) of
877	subsection (3), paragraph (d) of subsection (4), subsection (5),
878	paragraph (g) of subsection (6), and subsections  (9), (10), and
879	(11) of section 641.511, Florida Statutes, are amended to read:
880	641.511  Subscriber grievance reporting and resolution
881	requirements.--
882	(1)  Every organization must have a grievance procedure
883	available to its subscribers for the purpose of addressing
884	complaints and grievances. Every organization must notify its
885	subscribers that a subscriber must submit a grievance within 1
886	year after the date of occurrence of the action that initiated
887	the grievance, and may submit the grievance for review to the
888	Statewide Provider and Subscriber Assistance Program panel as
889	provided in s. 408.7056 after receiving a final disposition of
890	the grievance through the organization's grievance process. An
891	organization shall maintain records of all grievances and shall
892	report annually to the agency the total number of grievances
893	handled, a categorization of the cases underlying the
894	grievances, and the final disposition of the grievances.
895	(3)  Each organization's grievance procedure, as required
896	under subsection (1), must include, at a minimum:
897	(b)  The names of the appropriate employees or a list of
898	grievance departments that are responsible for implementing the
899	organization's grievance procedure. The list must include the
900	address and the toll-free telephone number of each grievance
901	department, the address of the agency and its toll-free
902	telephone hotline number, and the address of the Statewide
903	Provider and Subscriber Assistance Program and its toll-free
904	telephone number.
905	(e)  A notice that a subscriber may voluntarily pursue
906	binding arbitration in accordance with the terms of the contract
907	if offered by the organization, after completing the
908	organization's grievance procedure and as an alternative to the
909	Statewide Provider and Subscriber Assistance Program. Such
910	notice shall include an explanation that the subscriber may
911	incur some costs if the subscriber pursues binding arbitration,
912	depending upon the terms of the subscriber's contract.
913	(4)
914	(d)  In any case when the review process does not resolve a
915	difference of opinion between the organization and the
916	subscriber or the provider acting on behalf of the subscriber,
917	the subscriber or the provider acting on behalf of the
918	subscriber may submit a written grievance to the Statewide
919	Provider and Subscriber Assistance Program.
920	(5)  Except as provided in subsection (6), the organization
921	shall resolve a grievance within 60 days after receipt of the
922	grievance, or within a maximum of 90 days if the grievance
923	involves the collection of information outside the service area.
924	These time limitations are tolled if the organization has
925	notified the subscriber, in writing, that additional information
926	is required for proper review of the grievance and that such
927	time limitations are tolled until such information is provided.
928	After the organization receives the requested information, the
929	time allowed for completion of the grievance process resumes.
930	The Employee Retirement Income Security Act of 1974, as
931	implemented by 29 C.F.R. 2560.503-1, is adopted and incorporated
932	by reference as applicable to all organizations that administer
933	small and large group health plans that are subject to 29 C.F.R.
934	2560.503-1. The claims procedures of the regulations of the
935	Employee Retirement Income Security Act of 1974 as implemented
936	by 29 C.F.R. 2560.503-1 shall be the minimum standards for
937	grievance processes for claims for benefits for small and large
938	group health plans that are subject to 29 C.F.R. 2560.503-1.
939	(6)
940	(g)  In any case when the expedited review process does not
941	resolve a difference of opinion between the organization and the
942	subscriber or the provider acting on behalf of the subscriber,
943	the subscriber or the provider acting on behalf of the
944	subscriber may submit a written grievance to the Statewide
945	Provider and Subscriber Assistance Program.
946	(9)(a)  The agency shall advise subscribers with grievances
947	to follow their organization's formal grievance process for
948	resolution prior to review by the Statewide Provider and
949	Subscriber Assistance Program. The subscriber may, however,
950	submit a copy of the grievance to the agency at any time during
951	the process.
952	(b)  Requiring completion of the organization's grievance
953	process before the Statewide Provider and Subscriber Assistance
954	Program panel's review does not preclude the agency from
955	investigating any complaint or grievance before the organization
956	makes its final determination.
957	(10)  Each organization must notify the subscriber in a
958	final decision letter that the subscriber may request review of
959	the organization's decision concerning the grievance by the
960	Statewide Provider and Subscriber Assistance Program, as
961	provided in s. 408.7056, if the grievance is not resolved to the
962	satisfaction of the subscriber. The final decision letter must
963	inform the subscriber that the request for review must be made
964	within 365 days after receipt of the final decision letter, must
965	explain how to initiate such a review, and must include the
966	addresses and toll-free telephone numbers of the agency and the
967	Statewide Provider and Subscriber Assistance Program.
968	(11)  Each organization, as part of its contract with any
969	provider, must require the provider to post a consumer
970	assistance notice prominently displayed in the reception area of
971	the provider and clearly noticeable by all patients. The
972	consumer assistance notice must state the addresses and toll-
973	free telephone numbers of the Agency for Health Care
974	Administration, the Statewide Provider and Subscriber Assistance
975	Program, and the Department of Financial Services. The consumer
976	assistance notice must also clearly state that the address and
977	toll-free telephone number of the organization's grievance
978	department shall be provided upon request. The agency may adopt
979	rules to implement this section.
980	Section 12.  Subsection (4) of section 641.58, Florida
981	Statutes, is amended to read:
982	641.58  Regulatory assessment; levy and amount; use of
983	funds; tax returns; penalty for failure to pay.--
984	(4)  The moneys received and deposited into the Health Care
985	Trust Fund shall be used to defray the expenses of the agency in
986	the discharge of its administrative and regulatory powers and
987	duties under this part, including conducting an annual survey of
988	the satisfaction of members of health maintenance organizations;
989	contracting with physician consultants for the Statewide
990	Provider and Subscriber Assistance Panel; maintaining offices
991	and necessary supplies, essential equipment, and other
992	materials, salaries and expenses of required personnel; and
993	discharging the administrative and regulatory powers and duties
994	imposed under this part.
995	Section 13.  Paragraph (f) of subsection (2) and
996	subsections (3) and (9) of section 408.909, Florida Statutes,
997	are amended to read:
998	408.909  Health flex plans.--
999	(2)  DEFINITIONS.--As used in this section, the term:
1000	(f)  "Health flex plan entity" means a health insurer,
1001	health maintenance organization, health-care-provider-sponsored
1002	organization, local government, health care district, or other
1003	public or private community-based organization, or public-
1004	private partnership that develops and implements an approved
1005	health flex plan and is responsible for administering the health
1006	flex plan and paying all claims for health flex plan coverage by
1007	enrollees of the health flex plan.
1008	(3)  PILOT PROGRAM.--The agency and the office shall each
1009	approve or disapprove health flex plans that provide health care
1010	coverage for eligible participants who reside in the three areas
1011	of the state that have the highest number of uninsured persons,
1012	as identified in the Florida Health Insurance Study conducted by
1013	the agency and in Indian River County. A health flex plan may
1014	limit or exclude benefits otherwise required by law for insurers
1015	offering coverage in this state, may cap the total amount of
1016	claims paid per year per enrollee, may limit the number of
1017	enrollees, or may take any combination of those actions. A
1018	health flex plan offering may include the option of a
1019	catastrophic plan supplementing the health flex plan.
1020	(a)  The agency shall develop guidelines for the review of
1021	applications for health flex plans and shall disapprove or
1022	withdraw approval of plans that do not meet or no longer meet
1023	minimum standards for quality of care and access to care. The
1024	agency shall ensure that the health flex plans follow
1025	standardized grievance procedures similar to those required of
1026	health maintenance organizations.
1027	(b)  The office shall develop guidelines for the review of
1028	health flex plan applications and provide regulatory oversight
1029	of health flex plan advertisement and marketing procedures. The
1030	office shall disapprove or shall withdraw approval of plans
1031	that:
1032	1.  Contain any ambiguous, inconsistent, or misleading
1033	provisions or any exceptions or conditions that deceptively
1034	affect or limit the benefits purported to be assumed in the
1035	general coverage provided by the health flex plan;
1036	2.  Provide benefits that are unreasonable in relation to
1037	the premium charged or contain provisions that are unfair or
1038	inequitable or contrary to the public policy of this state, that
1039	encourage misrepresentation, or that result in unfair
1040	discrimination in sales practices; or
1041	3.  Cannot demonstrate that the health flex plan is
1042	financially sound and that the applicant is able to underwrite
1043	or finance the health care coverage provided.
1044	(c)  The agency and the Financial Services Commission may
1045	adopt rules as needed to administer this section.
1046	(9)  PROGRAM EVALUATION.--The agency and the office shall
1047	evaluate the pilot program and its effect on the entities that
1048	seek approval as health flex plans, on the number of enrollees,
1049	and on the scope of the health care coverage offered under a
1050	health flex plan; shall provide an assessment of the health flex
1051	plans and their potential applicability in other settings; shall
1052	use health flex plans to gather more information to evaluate
1053	low-income consumer driven benefit packages; and shall, by
1054	January 1, 2005 2004, jointly submit a report to the Governor,
1055	the President of the Senate, and the Speaker of the House of
1056	Representatives.
1057	Section 14.  Section 408.919, Florida Statutes, is created
1058	to read:
1059	408.919  Statewide Electronic Medical Records Advisory
1060	Council.--
1061	(1)  There is hereby created a Statewide Electronic Medical
1062	Records Advisory Council to serve as a body of experts to guide
1063	the Agency for Health Care Administration in the development of
1064	policy related to electronic medical records and the technology
1065	required for sharing clinical information among caregivers.
1066	(2)  The agency shall provide staff support to the council
1067	and may enter into contracts as are necessary or proper to carry
1068	out the provisions and purposes of this act in assisting the
1069	advisory council in creating an electronic medical records
1070	system.
1071	(3)  The advisory council shall be appointed by the
1072	Governor, the President of the Senate, and the Speaker of the
1073	House of Representatives. The advisory council shall consist of
1074	nine members, with three members appointed by the Governor,
1075	three members appointed by the President of the Senate, and
1076	three members appointed by the Speaker of the House of
1077	Representatives.
1078	(4)  The council shall meet at least quarterly and advise
1079	the Governor, the Legislature, and the agency regarding:
1080	(a)  Public and private sector initiatives related to
1081	electronic medical records and communication systems for the
1082	sharing of clinical information among caregivers.
1083	(b)  Regulatory barriers that interfere with the sharing of
1084	clinical information among caregivers.
1085	(c)  Investment incentives to promote the use of
1086	recommended technologies by health care providers.
1087	(d)  Educational strategies to promote the use of
1088	recommended technologies by health care providers.
1089	(e)  Standards for public access to facilitate transparency
1090	in pricing, costs, and quality.
1091	(5)  By November 30, 2004, and annually thereafter, the
1092	advisory council shall provide to the Executive Office of the
1093	Governor, the Speaker of the House of Representatives, and the
1094	President of the Senate a status report to include any
1095	recommendations and an implementation plan to include, but not
1096	be limited to, estimated costs, capital investment requirements,
1097	recommended investment incentives, initial committed provider
1098	participation by region, standards of functionality and
1099	features, a marketing plan, and implementation schedules for key
1100	components.
1101	(6)  Members of the advisory council shall serve without
1102	compensation but shall be entitled to receive reimbursement for
1103	per diem and travel expenses as provided in s. 112.061.
1104	(7)  Unless otherwise reenacted by the Legislature, the
1105	advisory council is abolished effective July 1, 2007.
1106	Section 15.  (1)  The Statewide Evidence-based Medicine
1107	Panel is created to serve as a body of experts to guide the
1108	Agency for Health Care Administration and the Department of
1109	Health in the development of policy related to evidence-based
1110	medicine and the technology required for sharing information
1111	among caregivers.
1112	(2)  The agency shall provide staff support to the panel
1113	and may enter into contracts as are necessary or proper to carry
1114	out the provisions and purposes of this section in assisting the
1115	panel in creating a statewide evidence-based medicine program.
1116	(3)  The panel shall consist of nine members, with three
1117	members appointed by the Governor, three members appointed by
1118	the President of the Senate, and three members appointed by the
1119	Speaker of the House of Representatives.
1120	(4)  The panel shall meet at least quarterly and advise the
1121	Governor, the President of the Senate, the Speaker of the House
1122	of Representatives, and the agency regarding:
1123	(a)  The ability to join or support efforts for the use of
1124	evidence-based medicine already underway, such as those of the
1125	Leapfrog Group, the international group Bandolier, and the
1126	Healthy Florida Foundation.
1127	(b)  The means by which to promote university-based or
1128	medical-school-based research using Medicaid and other data
1129	collected by the Agency for Health Care Administration to
1130	identify and quantify the most cost-effective treatment and
1131	interventions, including disease management programs.
1132	(c)  The means by which to encourage development of systems
1133	to measure and reward providers who implement evidence-based
1134	medical practices.
1135	(d)  The evaluation and identification of ways to tie a
1136	health care provider's use of evidence-based medical practice to
1137	medical malpractice liability.
1138	(e)  The review of other state and private initiatives and
1139	published literature for promising approaches and the
1140	dissemination of information about them to providers.
1141	(f)  The encouragement of the Florida Medical Association
1142	and other health care associations to regularly publish findings
1143	related to the cost-effectiveness of disease-specific evidence-
1144	based standards.
1145	(g)  Public and private sector initiatives related to
1146	evidence-based medicine and communication systems for the
1147	sharing of clinical information among caregivers.
1148	(h)  Regulatory barriers that interfere with the sharing of
1149	clinical information among caregivers.
1150	(5)  By November 30, 2004, and annually thereafter, the
1151	panel shall provide to the Office of the Governor, the Speaker
1152	of the House of Representatives, and the President of the Senate
1153	a status report including any recommendations and an
1154	implementation plan to include, but not be limited to, estimated
1155	costs, capital investment requirements, recommended investment
1156	incentives, initial committed provider participation by region,
1157	standards of functionality and features, a marketing plan, and
1158	implementation schedules for key components.
1159	(6)  Members of the panel shall serve without compensation
1160	but shall be entitled to receive reimbursement for per diem and
1161	travel expenses as provided in s. 112.061, Florida Statutes.
1162	(7)  Unless otherwise reestablished by the Legislature, the
1163	panel is abolished effective July 1, 2007.
1164	Section 16.  Subsection (3) of section 409.91255, Florida
1165	Statutes, is amended to read:
1166	409.91255  Federally qualified health center access
1167	program.--
1168	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.--The
1169	Department of Health shall develop a program for the expansion
1170	of federally qualified health centers for the purpose of
1171	providing comprehensive primary and preventive health care and
1172	urgent care services, including services that may reduce the
1173	morbidity, mortality, and cost of care among the uninsured
1174	population of the state. The program shall provide for
1175	distribution of financial assistance to federally qualified
1176	health centers that apply and demonstrate a need for such
1177	assistance in order to sustain or expand the delivery of primary
1178	and preventive health care services. In selecting centers to
1179	receive this financial assistance, the program:
1180	(a)  Shall give preference to communities that have few or
1181	no community-based primary care services or in which the current
1182	services are unable to meet the community's needs.
1183	(b)  Shall require that primary care services be provided
1184	to the medically indigent using a sliding fee schedule based on
1185	income.
1186	(c)  Shall allow innovative and creative uses of federal,
1187	state, and local health care resources.
1188	(d)  Shall require that the funds provided be used to pay
1189	for operating costs of a projected expansion in patient
1190	caseloads or services or for capital improvement projects.
1191	Capital improvement projects may include renovations to existing
1192	facilities or construction of new facilities, provided that an
1193	expansion in patient caseloads or services to a new patient
1194	population will occur as a result of the capital expenditures.
1195	The department shall include in its standard contract document a
1196	requirement that any state funds provided for the purchase of or
1197	improvements to real property are contingent upon the contractor
1198	granting to the state a security interest in the property at
1199	least to the amount of the state funds provided for at least 5
1200	years from the date of purchase or the completion of the
1201	improvements or as further required by law. The contract must
1202	include a provision that, as a condition of receipt of state
1203	funding for this purpose, the contractor agrees that, if it
1204	disposes of the property before the department's interest is
1205	vacated, the contractor will refund the proportionate share of
1206	the state's initial investment, as adjusted by depreciation.
1207	(e)  May require in-kind support from other sources.
1208	(f)  May encourage coordination among federally qualified
1209	health centers, other private-sector providers, and publicly
1210	supported programs.
1211	(g)  Shall allow the development of community diversion
1212	programs in conjunction with local resources, providing extended
1213	hours of operation to urgent care patients.
1214	Section 17.  Paragraph (a) of subsection (6) of section
1215	627.410, Florida Statutes, is amended to read:
1216	627.410  Filing, approval of forms.--
1217	(6)(a)  An insurer shall not deliver or issue for delivery
1218	or renew in this state any health insurance policy form until it
1219	has filed with the office a copy of every applicable rating
1220	manual, rating schedule, change in rating manual, and change in
1221	rating schedule; if rating manuals and rating schedules are not
1222	applicable, the insurer must file with the office order
1223	applicable premium rates and any change in applicable premium
1224	rates. This paragraph does not apply to group health insurance
1225	policies, effectuated and delivered in this state, insuring
1226	groups of 51 or more persons, except for Medicare supplement
1227	insurance, long-term care insurance, and any coverage under
1228	which the increase in claim costs over the lifetime of the
1229	contract due to advancing age or duration is prefunded in the
1230	premium.
1231	Section 18.  Paragraph (b) of subsection (3) of section
1232	627.6487, Florida Statutes, is amended to read:
1233	627.6487  Guaranteed availability of individual health
1234	insurance coverage to eligible individuals.--
1235	(3)  For the purposes of this section, the term "eligible
1236	individual" means an individual:
1237	(b)  Who is not eligible for coverage under:
1238	1.  A group health plan, as defined in s. 2791 of the
1239	Public Health Service Act;
1240	2.  A conversion policy or contract issued by an authorized
1241	insurer or health maintenance organization under s. 627.6675 or
1242	s. 641.3921, respectively, offered to an individual who is no
1243	longer eligible for coverage under either an insured or self-
1244	insured employer plan;
1245	3.  Part A or part B of Title XVIII of the Social Security
1246	Act; or
1247	4.  A state plan under Title XIX of such act, or any
1248	successor program, and does not have other health insurance
1249	coverage; or
1250	5.  The Florida Health Insurance Plan as specified in s.
1251	627.64872 and such plan is accepting new enrollment;
1252	Section 19.  Section 627.64872, Florida Statutes, is
1253	created to read:
1254	627.64872  Uninsurable risk assumption plan.--
1255	(1)  LEGISLATIVE INTENT; FLORIDA HEALTH INSURANCE PLAN.--
1256	(a)  The Legislature recognizes that to secure a more
1257	stable and orderly health insurance market, the establishment of
1258	a plan to assume risks deemed uninsurable by the private
1259	marketplace is required.
1260	(b)  The Florida Health Insurance Plan is created. The plan
1261	shall make coverage available to individuals who have no other
1262	option for similar coverage, at a premium that is commensurate
1263	with the risk and benefits provided, and with benefit designs
1264	that are reasonable in relation to the general market. While
1265	plan operations may include supplementary funding, the plan
1266	shall fundamentally operate on sound actuarial principles, using
1267	basic insurance management techniques to ensure that the plan is
1268	run in an economical, cost-efficient, and sound manner,
1269	conserving plan resources to serve the maximum number of people
1270	possible in a sustainable fashion.
1271	(2)  DEFINITIONS.--As used in this section:
1272	(a)  "Board" means the board of directors of the plan.
1273	(b)  "Governor" means the Governor of this state.
1274	(c)  "Office" means the Office of Insurance Regulation of
1275	the Financial Services Commission.
1276	(d)  "Dependent" means a resident spouse or resident
1277	unmarried child under the age of 19 years, a child who is a
1278	student under the age of 25 years and who is financially
1279	dependent upon the parent, or a child of any age who is disabled
1280	and dependent upon the parent.
1281	(e)  "Director" means the director of the Office of
1282	Insurance Regulation.
1283	(f)  "Health insurance" means any hospital or medical
1284	expense incurred policy, health maintenance organization
1285	subscriber contract pursuant to chapter 627 or chapter 641, or
1286	any other health care plan or arrangement that pays for or
1287	furnishes medical or health care services, whether by insurance
1288	or otherwise. The term does not include short term, accident,
1289	dental-only, vision-only, fixed indemnity, limited benefit, or
1290	credit insurance, coverage issued as a supplement to liability
1291	insurance, insurance arising out of a workers' compensation or
1292	similar law, automobile medical payment insurance, or insurance
1293	under which benefits are payable with or without regard to fault
1294	and which is statutorily required to be contained in any
1295	liability insurance policy or equivalent selfinsurance.
1296	(g)  "Implementation" means the enrollment of eligible
1297	individuals in the plan and provision of the benefits described
1298	in this section.
1299	(h)  "Insurer" means any entity that provides health
1300	insurance in this state. For purposes of this section, insurer
1301	includes an insurance company with a valid certificate in
1302	accordance with chapter 624, a health maintenance organization
1303	with a valid certificate of authority in accordance with part I
1304	or part III of chapter 641, a prepaid health clinic authorized
1305	to transact business in this state pursuant to part II of
1306	chapter 641, multiple employer welfare arrangements authorized
1307	to transact business in this state pursuant to ss. 624.436-
1308	624.45, or a fraternal benefit society providing health benefits
1309	to its members as authorized pursuant to chapter 632.
1310	(i)  "Medicare" means coverage under both Parts A and B of
1311	Title XVIII of the Social Security Act, 42 USC 1395 et seq., as
1312	amended.
1313	(j)  "Medicaid" means coverage under Title XIX of the
1314	Social Security Act.
1315	(k)  "Participating insurer" means any insurer providing
1316	health insurance to citizens of this state.
1317	(l)  "Provider" means any physician, hospital, or other
1318	institution, organization, or person that furnishes health care
1319	services and is licensed or otherwise authorized to practice in
1320	the state.
1321	(m)  "Plan" means the Florida Health Insurance Plan created
1322	in subsection (1).
1323	(n)  "Plan of operation" means the articles, bylaws, and
1324	operating rules and procedures adopted by the board pursuant to
1325	this section.
1326	(o)  "Resident" means an individual who has been legally
1327	domiciled in this state for a period of at least 30 days.
1328	(3)  BOARD OF DIRECTORS.--
1329	(a)  The plan shall operate subject to the supervision and
1330	control of the board. The board shall consist of the director or
1331	his or her designated representative, who shall serve as a
1332	member of the board and shall be its chair, and an additional
1333	eight members, four of whom shall be appointed by the Governor,
1334	two of whom shall be appointed by the President of the Senate,
1335	and two of whom shall be appointed by the Speaker of the House
1336	of Representatives. A majority of the board shall be composed of
1337	individuals who are not representatives of insurers or health
1338	care providers.
1339	(b)  The initial board members shall be appointed as
1340	follows: one-third of the members to serve a term of 2 years;
1341	one-third of the members to serve a term of 4 years; and one-
1342	third of the members to serve a term of 6 years. Subsequent
1343	board members shall serve for a term of 3 years. A board
1344	member's term shall continue until his or her successor is
1345	appointed.
1346	(c)  Vacancies in the board shall be filled by the
1347	appointing authority, such authority being the Governor, the
1348	President of the Senate, or the Speaker of the House of
1349	Representatives. Board members may be removed by the appointing
1350	authority for cause.
1351	(d)  The board shall conduct its first meeting by December
1352	1, 2004.
1353	(e)  Members shall not be compensated in their capacity as
1354	board members but shall be reimbursed for reasonable expenses
1355	incurred in the necessary performance of their duties in
1356	accordance with s. 112.061.
1357	(f)  The board shall submit to the Governor a plan of
1358	operation for the plan and any amendments thereto necessary or
1359	suitable to ensure the fair, reasonable, and equitable
1360	administration of the plan. The plan of operation shall ensure
1361	that the plan qualifies to apply for any available funding from
1362	the Federal Government that adds to the financial viability of
1363	the plan. The plan of operation shall become effective upon
1364	approval in writing by the Governor consistent with the date on
1365	which the coverage under this section must be made available. If
1366	the board fails to submit a suitable plan of operation within
1367	180 days after the appointment of the board of directors, or at
1368	any time thereafter fails to submit suitable amendments to the
1369	plan of operation, the office shall adopt such rules as are
1370	necessary or advisable to effectuate the provisions of this
1371	section. Such rules shall continue in force until modified by
1372	the office or superseded by a plan of operation submitted by the
1373	board and approved by the Governor.
1374	(4)  PLAN OF OPERATION.--The plan of operation shall:
1375	(a)  Establish procedures for operation of the plan.
1376	(b)  Establish procedures for selecting an administrator in
1377	accordance with subsection (11).
1378	(c)  Establish procedures to create a fund, under
1379	management of the board, for administrative expenses.
1380	(d)  Establish procedures for the handling, accounting, and
1381	auditing of assets, moneys, and claims of the plan and the plan
1382	administrator.
1383	(e)  Develop and implement a program to publicize the
1384	existence of the plan, plan eligibility requirements, and
1385	procedures for enrollment and maintain public awareness of the
1386	plan.
1387	(f)  Establish procedures under which applicants and
1388	participants may have grievances reviewed by a grievance
1389	committee appointed by the board. The grievances shall be
1390	reported to the board after completion of the review, with the
1391	committee's recommendation for grievance resolution. The board
1392	shall retain all written grievances regarding the plan for at
1393	least 3 years.
1394	(g)  Provide for other matters as may be necessary and
1395	proper for the execution of the board's powers, duties, and
1396	obligations under this section.
1397	(5)  POWERS OF THE PLAN.--The plan shall have the general
1398	powers and authority granted under the laws of this state to
1399	health insurers and, in addition thereto, the specific authority
1400	to:
1401	(a)  Enter into such contracts as are necessary or proper
1402	to carry out the provisions and purposes of this section,
1403	including the authority, with the approval of the Governor, to
1404	enter into contracts with similar plans of other states for the
1405	joint performance of common administrative functions, or with
1406	persons or other organizations for the performance of
1407	administrative functions.
1408	(b)  Take any legal actions necessary or proper to recover
1409	or collect assessments due the plan.
1410	(c)  Take such legal action as is necessary to:
1411	1.  Avoid payment of improper claims against the plan or
1412	the coverage provided by or through the plan;
1413	2.  Recover any amounts erroneously or improperly paid by
1414	the plan;
1415	3.  Recover any amounts paid by the plan as a result of
1416	mistake of fact or law; or
1417	4.  Recover other amounts due the plan.
1418	(d)  Establish, and modify as appropriate, rates, rate
1419	schedules, rate adjustments, expense allowances, agents'
1420	referral fees, claim reserve formulas, and any other actuarial
1421	functions appropriate to the operation of the plan. Rates and
1422	rate schedules may be adjusted for appropriate factors such as
1423	age, sex, and geographic variation in claim cost and shall take
1424	into consideration appropriate factors in accordance with
1425	established actuarial and underwriting practices.
1426	(e)  Issue policies of insurance in accordance with the
1427	requirements of this section.
1428	(f)  Appoint appropriate legal, actuarial, investment, and
1429	other committees as necessary to provide technical assistance in
1430	the operation of the plan and develop and educate its
1431	policyholders regarding health savings accounts, policy and
1432	contract design, and any other function within the authority of
1433	the plan.
1434	(g)  Borrow money to effectuate the purposes of the plan.
1435	Any notes or other evidence of indebtedness of the plan not in
1436	default shall be legal investments for insurers and may be
1437	carried as admitted assets.
1438	(h)  Employ and fix the compensation of employees.
1439	(i)  Prepare and distribute certificate of eligibility
1440	forms and enrollment instruction forms to insurance producers
1441	and to the general public.
1442	(j)  Provide for reinsurance of risks incurred by the plan.
1443	(k)  Provide for and employ cost-containment measures and
1444	requirements, including, but not limited to, preadmission
1445	screening, second surgical opinion, concurrent utilization
1446	review, and individual case management for the purpose of making
1447	the plan more cost-effective.
1448	(l)  Design, use, contract, or otherwise arrange for the
1449	delivery of cost-effective health care services, including, but
1450	not limited to, establishing or contracting with preferred
1451	provider organizations, health maintenance organizations, and
1452	other limited network provider arrangements.
1453	(m)  Adopt such bylaws, policies, and procedures as may be
1454	necessary or convenient for the implementation of this section
1455	and the operation of the plan.
1456	(6)  ANNUAL REPORT.--No later than December 1, 2005, and
1457	annually thereafter, the board shall submit to the Governor, the
1458	President of the Senate, and the Speaker of the House of
1459	Representatives a report which includes an independent actuarial
1460	study to determine, including, but not be limited to:
1461	(a)  The impact the creation of the plan has on the small
1462	group insurance market, specifically on the premiums paid by
1463	insureds. This shall include an estimate of the total
1464	anticipated aggregate savings for all small employers in the
1465	state.
1466	(b)  The actual number of individuals covered at the
1467	current funding and benefit level, the projected number of
1468	individuals that may seek coverage in the forthcoming fiscal
1469	year, and the projected funding needed to cover anticipated
1470	increase or decrease in plan participation.
1471	(c)  A recommendation as to the best source of funding for
1472	the anticipated deficits of the pool.
1473	(d)  A summarization of the activities of the plan in the
1474	preceding calendar year, including the net written and earned
1475	premiums, plan enrollment, the expense of administration, and
1476	the paid and incurred losses.
1477	(e)  A review of the operation of the plan as to whether
1478	the plan has met the intent of this section.
1479	(7)  LIABILITY OF THE PLAN.--Neither the board nor its
1480	employees shall be liable for any obligations of the plan. No
1481	member or employee of the board shall be liable, and no cause of
1482	action of any nature may arise against a member or employee of
1483	the board, for any act or omission related to the performance of
1484	any powers and duties under this section, unless such act or
1485	omission constitutes willful or wanton misconduct. The board may
1486	provide in its bylaws or rules for indemnification of, and legal
1487	representation for, its members and employees.
1488	(8)  AUDITED FINANCIAL STATEMENT.--No later than June 1
1489	following the close of each calendar year, the plan shall submit
1490	to the Governor an audited financial statement prepared in
1491	accordance with statutory accounting principles as adopted by
1492	the National Association of Insurance Commissioners.
1493	(9)  ELIGIBILITY.--
1494	(a)  Any individual person who is and continues to be a
1495	resident of this state shall be eligible for coverage under the
1496	plan if:
1497	1.  Evidence is provided that the person received:
1498	a.  A notice of rejection or refusal to issue substantially
1499	similar insurance for health reasons by one insurer; or
1500	b.  A refusal by an insurer to issue insurance except at a
1501	rate exceeding the plan rate.
1502
1503	A rejection or refusal by an insurer offering only stoploss,
1504	excess of loss, or reinsurance coverage with respect to the
1505	applicant shall not be sufficient evidence under this paragraph.
1506	2.  The person is eligible for individual coverage in
1507	accordance with s. 627.6487.
1508	3.  The person is enrolled in the Florida Comprehensive
1509	Health Association as of the date the plan is implemented.
1510	(b)  The board may provide a list of medical or health
1511	conditions for which a person shall be eligible for coverage
1512	under the plan without applying for health insurance pursuant to
1513	paragraph (a). A person who can demonstrate the existence or
1514	history of any medical or health conditions on the list provided
1515	by the board shall not be required to provide the evidence
1516	specified in paragraph (a). The list shall be effective on the
1517	first day of the operation of the plan and may be amended as
1518	appropriate.
1519	(c)  Each resident dependent of a person who is eligible
1520	for coverage under the plan shall also be eligible for such
1521	coverage.
1522	(d)  A person shall not be eligible for coverage under the
1523	plan if:
1524	1.  The person has or obtains health insurance coverage
1525	substantially similar to or more comprehensive than a plan
1526	policy, or would be eligible to obtain such coverage, unless a
1527	person may maintain other coverage for the period of time the
1528	person is satisfying any preexisting condition waiting period
1529	under a plan policy or may maintain plan coverage for the period
1530	of time the person is satisfying a preexisting condition waiting
1531	period under another health insurance policy intended to replace
1532	the plan policy.
1533	2.  The person is determined to be eligible for health care
1534	benefits under Medicaid, the state's children's health insurance
1535	program, or any other federal, state, or local government
1536	program that provides health benefits;
1537	3.  The person has previously terminated plan coverage
1538	unless 12 months have elapsed since such termination;
1539	4.  The person is an inmate or resident of a public
1540	institution; or
1541	5.  The person's premiums are paid for or reimbursed under
1542	any government-sponsored program or by any government agency or
1543	health care provider, except as an otherwise qualifying fulltime
1544	employee, or dependent thereof, of a government agency or health
1545	care provider.
1546	(e)  Coverage shall cease:
1547	1.  On the date a person is no longer a resident of this
1548	state;
1549	2.  On the date a person requests coverage to end;
1550	3.  Upon the death of the covered person;
1551	4.  On the date state law requires cancellation of the
1552	policy; or
1553	5.  At the option of the plan, 30 days after the plan makes
1554	any inquiry concerning the person's eligibility or place of
1555	residence to which the person does not reply.
1556	(f)  Except under the circumstances described in this
1557	subsection, coverage of a person who ceases to meet the
1558	eligibility requirements of this subsection may be terminated at
1559	the end of the policy period for which the necessary premiums
1560	have been paid.
1561	(10)  UNFAIR REFERRAL TO PLAN.--It is an unfair trade
1562	practice for the purposes of part IX of chapter 626, Florida
1563	Statutes, or s. 641.3901 for an insurer, health maintenance
1564	organization insurance agent, insurance broker, or third-party
1565	administrator to refer an individual employee to the plan, or
1566	arrange for an individual employee to apply to the plan, for the
1567	purpose of separating that employee from group health insurance
1568	coverage provided in connection with the employee's employment.
1569	(11)  PLAN ADMINISTRATOR.--The board shall select through a
1570	competitive bidding process a plan administrator to administer
1571	the plan. The board shall evaluate bids submitted based on
1572	criteria established by the board, which shall include:
1573	(a)  The plan administrator's proven ability to handle
1574	health insurance coverage to individuals.
1575	(b)  The efficiency and timeliness of the plan
1576	administrator's claim processing procedures.
1577	(c)  An estimate of total charges for administering the
1578	plan.
1579	(d)  The plan administrator's ability to apply effective
1580	cost-containment programs and procedures and to administer the
1581	plan in a cost-efficient manner.
1582	(e)  The financial condition and stability of the plan
1583	administrator.
1584
1585	The administrator shall be an insurer, a health maintenance
1586	organization, or a third-party administrator, or another
1587	organization duly authorized to provide insurance pursuant to
1588	the Florida Insurance Code.
1589	(12)  ADMINISTRATOR TERM LIMITS.--The plan administrator
1590	shall serve for a period specified in the contract between the
1591	plan and the plan administrator subject to removal for cause and
1592	subject to any terms, conditions, and limitations of the
1593	contract between the plan and the plan administrator. At least 1
1594	year prior to the expiration of each period of service by a plan
1595	administrator, the board shall invite eligible entities,
1596	including the current plan administrator, to submit bids to
1597	serve as the plan administrator. Selection of the plan
1598	administrator for each succeeding period shall be made at least
1599	6 months prior to the end of the current period.
1600	(13)  DUTIES OF THE PLAN ADMINISTRATOR.--
1601	(a)  The plan administrator shall perform such functions
1602	relating to the plan as may be assigned to it, including, but
1603	not limited to:
1604	1.  Determination of eligibility.
1605	2.  Payment of claims.
1606	3.  Establishment of a premium billing procedure for
1607	collection of premiums from persons covered under the plan.
1608	4.  Other necessary functions to ensure timely payment of
1609	benefits to covered persons under the plan.
1610	(b)  The plan administrator shall submit regular reports to
1611	the board regarding the operation of the plan. The frequency,
1612	content, and form of the reports shall be specified in the
1613	contract between the board and the plan administrator.
1614	(c)  On March 1 following the close of each calendar year,
1615	the plan administrator shall determine net written and earned
1616	premiums, the expense of administration, and the paid and
1617	incurred losses for the year and report this information to the
1618	board and the Governor on a form prescribed by the Governor.
1619	(14)  PAYMENT OF THE PLAN ADMINISTRATOR.--The plan
1620	administrator shall be paid as provided in the contract between
1621	the plan and the plan administrator.
1622	(15)  FUNDING OF THE PLAN.--
1623	(a)  Premiums.--
1624	1.  The plan shall establish premium rates for plan
1625	coverage as provided in subparagraph (5)(a)4. Separate schedules
1626	of premium rates based on age, sex, and geographical location
1627	may apply for individual risks. Premium rates and schedules
1628	shall be submitted to the office for approval prior to use.
1629	2.  Initial rates for plan coverage shall be capped at 200
1630	percent of rates established as applicable for individual
1631	standard risks as specified in s. 627.6653. The plan shall also
1632	develop a sliding scale premium surcharge based upon the
1633	insured's income. Subject to the limits provided in this
1634	paragraph, subsequent rates shall be established to provide
1635	fully for the expected costs of claims, including recovery of
1636	prior losses, expenses of operation, investment income of claim
1637	reserves, and any other cost factors subject to the limitations
1638	described herein.
1639	(b)  Sources of additional revenue.--Any deficit incurred
1640	by the plan shall be funded through amounts appropriated by the
1641	Legislature from general revenue sources, including, but not
1642	limited to, a portion of the annual growth in existing net
1643	insurance premium taxes. The board shall operate the plan in
1644	such a manner that the estimated cost of providing health
1645	insurance during any fiscal year will not exceed total income
1646	the plan expects to receive from policy premiums and funds
1647	appropriated by the Legislature, including any interest on
1648	investments. After determining the amount of funds appropriated
1649	to the board for a fiscal year, the board shall estimate the
1650	number of new policies it believes the plan has the financial
1651	capacity to insure during that year so that costs do not exceed
1652	income. The board shall take steps necessary to ensure that plan
1653	enrollment does not exceed the number of residents it has
1654	estimated it has the financial capacity to insure.
1655	(16)  BENEFITS.--
1656	(a)  The benefits provided shall be the same as the
1657	standard and basic plans for small employers as outlined in s.
1658	627.6699. The board may also establish an option of alternative
1659	coverage such as catastrophic coverage that includes a minimum
1660	level of primary care coverage.
1661	(b)  In establishing the plan coverage, the board shall
1662	take into consideration the levels of health insurance provided
1663	in the state and such medical economic factors as may be deemed
1664	appropriate and adopt benefit levels, deductibles, copayments,
1665	coinsurance factors, exclusions, and limitations determined to
1666	be generally reflective of and commensurate with health
1667	insurance provided through a representative number of large
1668	employers in the state.
1669	(c)  The board may adjust any deductibles and coinsurance
1670	factors annually according to the medical component of the
1671	Consumer Price Index.
1672	(d)1.  Plan coverage shall exclude charges or expenses
1673	incurred during the first 6 months following the effective date
1674	of coverage for any condition for which medical advice, care, or
1675	treatment was recommended or received for such condition during
1676	the 6-month period immediately preceding the effective date of
1677	coverage.
1678	2.  Such preexisting condition exclusions shall be waived
1679	to the extent that similar exclusions, if any, have been
1680	satisfied under any prior health insurance coverage which was
1681	involuntarily terminated, provided application for pool coverage
1682	is made not later than 63 days following such involuntary
1683	termination. In such case, coverage under the plan shall be
1684	effective from the date on which such prior coverage was
1685	terminated and the applicant is not eligible for continuation or
1686	conversion rights that would provide coverage substantially
1687	similar to plan coverage.
1688	(17)  NONDUPLICATION OF BENEFITS.--
1689	(a)  The plan shall be payor of last resort of benefits
1690	whenever any other benefit or source of third-party payment is
1691	available. Benefits otherwise payable under plan coverage shall
1692	be reduced by all amounts paid or payable through any other
1693	health insurance, by all hospital and medical expense benefits
1694	paid or payable under any workers' compensation coverage,
1695	automobile medical payment, or liability insurance, whether
1696	provided on the basis of fault or nonfault, and by any hospital
1697	or medical benefits paid or payable under or provided pursuant
1698	to any state or federal law or program.
1699	(b)  The plan shall have a cause of action against an
1700	eligible person for the recovery of the amount of benefits paid
1701	that are not for covered expenses. Benefits due from the plan
1702	may be reduced or refused as a setoff against any amount
1703	recoverable under this paragraph.
1704	(18)  ANNUAL AND MAXIMUM BENEFITS.--Maximum benefits under
1705	the plan shall be determined by the board.
1706	(19)  TAXATION.--The plan is exempt from any tax imposed by
1707	this state. The plan shall apply for federal tax exemption
1708	status.
1709	(20)  COMBINING MEMBERSHIP OF THE FLORIDA COMPREHENSIVE
1710	HEALTH ASSOCIATION.--
1711	(a)1. Upon implementation of the plan, the Florida
1712	Comprehensive Health Association is abolished and all high-risk
1713	individuals actively enrolled in the Florida Comprehensive
1714	Health Association shall be enrolled in the plan subject to its
1715	rules and requirements.
1716	2.  Persons formerly enrolled in the Florida Comprehensive
1717	Health Association are only eligible for the benefits authorized
1718	under subsection (18).
1719	(b)1.  As a condition of doing business in this state, an
1720	insurer shall pay an assessment to the board in the amount
1721	prescribed by this paragraph. For operating losses incurred on
1722	or after July 1, 2004, by persons previously enrolled in the
1723	Florida Comprehensive Health Association, each insurer shall
1724	annually be assessed by the board in the following calendar year
1725	a portion of such incurred operating losses of the plan. Such
1726	portion shall be determined by multiplying such operating losses
1727	by a fraction, the numerator of which equals the insurer's
1728	earned premium pertaining to direct writings of health insurance
1729	in the state during the calendar year proceeding that for which
1730	the assessment is levied, and the denominator of which equals
1731	the total of all such premiums earned by participating insurers
1732	in the state during such calendar year.
1733	2.  The total of all assessments under this paragraph upon
1734	a participating insurer shall not exceed 1 percent of such
1735	insurer's health insurance premium earned in this state during
1736	the calendar year preceeding the year for which the assessments
1737	were levied.
1738	3.  All rights, title, and interest in the assessment funds
1739	collected under this paragraph shall vest in this state.
1740	However, all of such funds and interest earned shall be used by
1741	the plan to pay claims and administrative expenses.
1742	(c)  If assessments and other receipts by the plan, board,
1743	or plan administrator exceed the actual losses and
1744	administrative expenses of the plan, the excess shall be held in
1745	interest and used by the board to offset future losses. As used
1746	in this subsection, the term "future losses" includes reserves
1747	for claims incurred but not reported.
1748	(d)  Each insurer's assessment shall be determined annually
1749	by the board or plan administrator based on annual statements
1750	and other reports deemed necessary by the board or plan
1751	administrator and filed with the board or plan administrator by
1752	the insurer. Any deficit incurred under the plan by persons
1753	previously enrolled in the Florida Comprehensive Health
1754	Association shall be recouped by the assessments against
1755	participating insurers by the board or plan administrator in the
1756	manner provided in paragraph (b), and the insurers may recover
1757	the assessment in the normal course of their respective
1758	businesses without time limitation.
1759	(e)  If a person enrolled in the Florida Comprehensive
1760	Health Association as of July 1, 2004, loses eligibility for
1761	participation in the plan, such person shall not be included in
1762	the calculation of incurred operational losses as described in
1763	paragraph (b) if the person later regains eligibility for
1764	participation in the plan.
1765	(f)  After all persons enrolled in the Florida
1766	Comprehensive Health Association as of July 1, 2004, are no
1767	longer eligible for participation in the plan, the plan, board,
1768	or plan administrator shall no longer be allowed to assess
1769	insurers in this state for incurred losses as described in
1770	paragraph (b).
1771	Section 20.  Upon implementation, as defined in s.
1772	627.64872(2), Florida Statutes, and provided in s.
1773	627.64872(22), Florida Statutes, of the Florida Health Benefit
1774	Plan created under s. 627.64872, Florida Statutes, sections
1775	627.6488, 627.6489, 627.649, 627.6492, 627.6494, 627.6496,
1776	627.6498, and 627.6499, Florida Statutes, are repealed.
1777	Section 21.  Subsection (12) is added to section 627.662,
1778	Florida Statutes, to read:
1779	627.662  Other provisions applicable.--The following
1780	provisions apply to group health insurance, blanket health
1781	insurance, and franchise health insurance:
1782	(12)  Section 627.6044, relating to the use of specific
1783	methodology for payment of claims.
1784	Section 22.  Paragraphs (c) and (d) of subsection (5),
1785	paragraph (b) of subsection (6), and subsection (12) of section
1786	627.6699, Florida Statutes, are amended, subsections (15) and
1787	(16) of said section are renumbered as subsections (16) and
1788	(17), respectively, present subsection (15) of said section is
1789	amended, and new subsections (15) and (18) are added to said
1790	section, to read:
1791	627.6699  Employee Health Care Access Act.--
1792	(5)  AVAILABILITY OF COVERAGE.--
1793	(c)  Every small employer carrier must, as a condition of
1794	transacting business in this state:
1795	1.  Offer and issue all small employer health benefit plans
1796	on a guaranteed-issue basis to every eligible small employer,
1797	with 2 to 50 eligible employees, that elects to be covered under
1798	such plan, agrees to make the required premium payments, and
1799	satisfies the other provisions of the plan. A rider for
1800	additional or increased benefits may be medically underwritten
1801	and may only be added to the standard health benefit plan. The
1802	increased rate charged for the additional or increased benefit
1803	must be rated in accordance with this section.
1804	2.  Depending upon the absence of the availability of new
1805	enrollment into the Florida Health Insurance Plan, offer and
1806	issue basic and standard small employer health benefit plans on
1807	a guaranteed-issue basis, during a 31-day open enrollment period
1808	of August 1 through August 31 of each year, to every eligible
1809	small employer, with fewer than two eligible employees, which
1810	small employer is not formed primarily for the purpose of buying
1811	health insurance and which elects to be covered under such plan,
1812	agrees to make the required premium payments, and satisfies the
1813	other provisions of the plan. Coverage provided under this
1814	subparagraph shall begin on October 1 of the same year as the
1815	date of enrollment, unless the small employer carrier and the
1816	small employer agree to a different date. A rider for additional
1817	or increased benefits may be medically underwritten and may only
1818	be added to the standard health benefit plan. The increased rate
1819	charged for the additional or increased benefit must be rated in
1820	accordance with this section. For purposes of this subparagraph,
1821	a person, his or her spouse, and his or her dependent children
1822	constitute a single eligible employee if that person and spouse
1823	are employed by the same small employer and either that person
1824	or his or her spouse has a normal work week of less than 25
1825	hours.
1826	3.  This paragraph does not limit a carrier's ability to
1827	offer other health benefit plans to small employers if the
1828	standard and basic health benefit plans are offered and
1829	rejected.
1830	(d)  A small employer carrier must file with the office, in
1831	a format and manner prescribed by the committee, a standard
1832	health care plan, a high deductible plan that meets the federal
1833	requirements of a health savings account plan, and a basic
1834	health care plan to be used by the carrier.
1835	(6)  RESTRICTIONS RELATING TO PREMIUM RATES.--
1836	(b)  For all small employer health benefit plans that are
1837	subject to this section and are issued by small employer
1838	carriers on or after January 1, 1994, premium rates for health
1839	benefit plans subject to this section are subject to the
1840	following:
1841	1.  Small employer carriers must use a modified community
1842	rating methodology in which the premium for each small employer
1843	must be determined solely on the basis of the eligible
1844	employee's and eligible dependent's gender, age, family
1845	composition, tobacco use, or geographic area as determined under
1846	paragraph (5)(j) and in which the premium may be adjusted as
1847	permitted by this paragraph.
1848	2.  Rating factors related to age, gender, family
1849	composition, tobacco use, or geographic location may be
1850	developed by each carrier to reflect the carrier's experience.
1851	The factors used by carriers are subject to office review and
1852	approval.
1853	3.  Small employer carriers may not modify the rate for a
1854	small employer for 12 months from the initial issue date or
1855	renewal date, unless the composition of the group changes or
1856	benefits are changed. However, a small employer carrier may
1857	modify the rate one time prior to 12 months after the initial
1858	issue date for a small employer who enrolls under a previously
1859	issued group policy that has a common anniversary date for all
1860	employers covered under the policy if:
1861	a.  The carrier discloses to the employer in a clear and
1862	conspicuous manner the date of the first renewal and the fact
1863	that the premium may increase on or after that date.
1864	b.  The insurer demonstrates to the office that
1865	efficiencies in administration are achieved and reflected in the
1866	rates charged to small employers covered under the policy.
1867	4.  A carrier may issue a group health insurance policy to
1868	a small employer health alliance or other group association with
1869	rates that reflect a premium credit for expense savings
1870	attributable to administrative activities being performed by the
1871	alliance or group association if such expense savings are
1872	specifically documented in the insurer's rate filing and are
1873	approved by the office. Any such credit may not be based on
1874	different morbidity assumptions or on any other factor related
1875	to the health status or claims experience of any person covered
1876	under the policy. Nothing in this subparagraph exempts an
1877	alliance or group association from licensure for any activities
1878	that require licensure under the insurance code. A carrier
1879	issuing a group health insurance policy to a small employer
1880	health alliance or other group association shall allow any
1881	properly licensed and appointed agent of that carrier to market
1882	and sell the small employer health alliance or other group
1883	association policy. Such agent shall be paid the usual and
1884	customary commission paid to any agent selling the policy.
1885	5.  Any adjustments in rates for claims experience, health
1886	status, or duration of coverage may not be charged to individual
1887	employees or dependents. For a small employer's policy, such
1888	adjustments may not result in a rate for the small employer
1889	which deviates more than 15 percent from the carrier's approved
1890	rate. Any such adjustment must be applied uniformly to the rates
1891	charged for all employees and dependents of the small employer.
1892	A small employer carrier may make an adjustment to a small
1893	employer's renewal premium, not to exceed 10 percent annually,
1894	due to the claims experience, health status, or duration of
1895	coverage of the employees or dependents of the small employer.
1896	Semiannually, small group carriers shall report information on
1897	forms adopted by rule by the commission, to enable the office to
1898	monitor the relationship of aggregate adjusted premiums actually
1899	charged policyholders by each carrier to the premiums that would
1900	have been charged by application of the carrier's approved
1901	modified community rates. If the aggregate resulting from the
1902	application of such adjustment exceeds the premium that would
1903	have been charged by application of the approved modified
1904	community rate by 5 percent for the current reporting period,
1905	the carrier shall limit the application of such adjustments only
1906	to minus adjustments beginning not more than 60 days after the
1907	report is sent to the office. For any subsequent reporting
1908	period, if the total aggregate adjusted premium actually charged
1909	does not exceed the premium that would have been charged by
1910	application of the approved modified community rate by 2 5
1911	percent, the carrier may apply both plus and minus adjustments.
1912	A small employer carrier may provide a credit to a small
1913	employer's premium based on administrative and acquisition
1914	expense differences resulting from the size of the group. Group
1915	size administrative and acquisition expense factors may be
1916	developed by each carrier to reflect the carrier's experience
1917	and are subject to office review and approval.
1918	6.  A small employer carrier rating methodology may include
1919	separate rating categories for one dependent child, for two
1920	dependent children, and for three or more dependent children for
1921	family coverage of employees having a spouse and dependent
1922	children or employees having dependent children only. A small
1923	employer carrier may have fewer, but not greater, numbers of
1924	categories for dependent children than those specified in this
1925	subparagraph.
1926	7.  Small employer carriers may not use a composite rating
1927	methodology to rate a small employer with fewer than 10
1928	employees. For the purposes of this subparagraph, a "composite
1929	rating methodology" means a rating methodology that averages the
1930	impact of the rating factors for age and gender in the premiums
1931	charged to all of the employees of a small employer.
1932	8.a.  A carrier may separate the experience of small
1933	employer groups with less than 2 eligible employees from the
1934	experience of small employer groups with 2-50 eligible employees
1935	for purposes of determining an alternative modified community
1936	rating.
1937	b.  If a carrier separates the experience of small employer
1938	groups as provided in sub-subparagraph a., the rate to be
1939	charged to small employer groups of less than 2 eligible
1940	employees may not exceed 150 percent of the rate determined for
1941	small employer groups of 2-50 eligible employees. However, the
1942	carrier may charge excess losses of the experience pool
1943	consisting of small employer groups with less than 2 eligible
1944	employees to the experience pool consisting of small employer
1945	groups with 2-50 eligible employees so that all losses are
1946	allocated and the 150-percent rate limit on the experience pool
1947	consisting of small employer groups with less than 2 eligible
1948	employees is maintained. Notwithstanding s. 627.411(1), the rate
1949	to be charged to a small employer group of fewer than 2 eligible
1950	employees, insured as of July 1, 2002, may be up to 125 percent
1951	of the rate determined for small employer groups of 2-50
1952	eligible employees for the first annual renewal and 150 percent
1953	for subsequent annual renewals.
1954	(12)  STANDARD, BASIC, HIGH DEDUCTIBLE, AND LIMITED HEALTH
1955	BENEFIT PLANS.--
1956	(a)1.  The Chief Financial Officer shall appoint a health
1957	benefit plan committee composed of four representatives of
1958	carriers which shall include at least two representatives of
1959	HMOs, at least one of which is a staff model HMO, two
1960	representatives of agents, four representatives of small
1961	employers, and one employee of a small employer. The carrier
1962	members shall be selected from a list of individuals recommended
1963	by the board. The Chief Financial Officer may require the board
1964	to submit additional recommendations of individuals for
1965	appointment.
1966	2.  The plans shall comply with all of the requirements of
1967	this subsection.
1968	3.  The plans must be filed with and approved by the office
1969	prior to issuance or delivery by any small employer carrier.
1970	4.  After approval of the revised health benefit plans, if
1971	the office determines that modifications to a plan might be
1972	appropriate, the Chief Financial Officer shall appoint a new
1973	health benefit plan committee in the manner provided in
1974	subparagraph 1. to submit recommended modifications to the
1975	office for approval.
1976	(b)1.  Each small employer carrier issuing new health
1977	benefit plans shall offer to any small employer, upon request, a
1978	standard health benefit plan, and a basic health benefit plan,
1979	and a high deductible plan that meets the requirements of a
1980	health savings account plan as defined by federal law, that meet
1981	meets the criteria set forth in this section.
1982	2.  For purposes of this subsection, the terms "standard
1983	health benefit plan," and "basic health benefit plan," and "high
1984	deductible plan" mean policies or contracts that a small
1985	employer carrier offers to eligible small employers that
1986	contain:
1987	a.  An exclusion for services that are not medically
1988	necessary or that are not covered preventive health services;
1989	and
1990	b.  A procedure for preauthorization by the small employer
1991	carrier, or its designees.
1992	3.  A small employer carrier may include the following
1993	managed care provisions in the policy or contract to control
1994	costs:
1995	a.  A preferred provider arrangement or exclusive provider
1996	organization or any combination thereof, in which a small
1997	employer carrier enters into a written agreement with the
1998	provider to provide services at specified levels of
1999	reimbursement or to provide reimbursement to specified
2000	providers. Any such written agreement between a provider and a
2001	small employer carrier must contain a provision under which the
2002	parties agree that the insured individual or covered member has
2003	no obligation to make payment for any medical service rendered
2004	by the provider which is determined not to be medically
2005	necessary. A carrier may use preferred provider arrangements or
2006	exclusive provider arrangements to the same extent as allowed in
2007	group products that are not issued to small employers.
2008	b.  A procedure for utilization review by the small
2009	employer carrier or its designees.
2010
2011	This subparagraph does not prohibit a small employer carrier
2012	from including in its policy or contract additional managed care
2013	and cost containment provisions, subject to the approval of the
2014	office, which have potential for controlling costs in a manner
2015	that does not result in inequitable treatment of insureds or
2016	subscribers. The carrier may use such provisions to the same
2017	extent as authorized for group products that are not issued to
2018	small employers.
2019	4.  The standard health benefit plan shall include:
2020	a.  Coverage for inpatient hospitalization;
2021	b.  Coverage for outpatient services;
2022	c.  Coverage for newborn children pursuant to s. 627.6575;
2023	d.  Coverage for child care supervision services pursuant
2024	to s. 627.6579;
2025	e.  Coverage for adopted children upon placement in the
2026	residence pursuant to s. 627.6578;
2027	f.  Coverage for mammograms pursuant to s. 627.6613;
2028	g.  Coverage for handicapped children pursuant to s.
2029	627.6615;
2030	h.  Emergency or urgent care out of the geographic service
2031	area; and
2032	i.  Coverage for services provided by a hospice licensed
2033	under s. 400.602 in cases where such coverage would be the most
2034	appropriate and the most cost-effective method for treating a
2035	covered illness.
2036	5.  The standard health benefit plan and the basic health
2037	benefit plan may include a schedule of benefit limitations for
2038	specified services and procedures. If the committee develops
2039	such a schedule of benefits limitation for the standard health
2040	benefit plan or the basic health benefit plan, a small employer
2041	carrier offering the plan must offer the employer an option for
2042	increasing the benefit schedule amounts by 4 percent annually.
2043	6.  The basic health benefit plan shall include all of the
2044	benefits specified in subparagraph 4.; however, the basic health
2045	benefit plan shall place additional restrictions on the benefits
2046	and utilization and may also impose additional cost containment
2047	measures.
2048	7.  Sections 627.419(2), (3), and (4), 627.6574, 627.6612,
2049	627.66121, 627.66122, 627.6616, 627.6618, 627.668, and 627.66911
2050	apply to the standard health benefit plan and to the basic
2051	health benefit plan. However, notwithstanding said provisions,
2052	the plans may specify limits on the number of authorized
2053	treatments, if such limits are reasonable and do not
2054	discriminate against any type of provider.
2055	8.  The plan associated with a health savings account shall
2056	include all the benefits specified in subparagraph 4.
2057	9.8.  Each small employer carrier that provides for
2058	inpatient and outpatient services by allopathic hospitals may
2059	provide as an option of the insured similar inpatient and
2060	outpatient services by hospitals accredited by the American
2061	Osteopathic Association when such services are available and the
2062	osteopathic hospital agrees to provide the service.
2063	(c)  If a small employer rejects, in writing, the standard
2064	health benefit plan, and the basic health benefit plan, and the
2065	high-deductible health savings account plan, the small employer
2066	carrier may offer the small employer a limited benefit policy or
2067	contract.
2068	(d)1.  Upon offering coverage under a standard health
2069	benefit plan, a basic health benefit plan, or a limited benefit
2070	policy or contract for any small employer, the small employer
2071	carrier shall provide such employer group with a written
2072	statement that contains, at a minimum:
2073	a.  An explanation of those mandated benefits and providers
2074	that are not covered by the policy or contract;
2075	b.  An explanation of the managed care and cost control
2076	features of the policy or contract, along with all appropriate
2077	mailing addresses and telephone numbers to be used by insureds
2078	in seeking information or authorization; and
2079	c.  An explanation of the primary and preventive care
2080	features of the policy or contract.
2081
2082	Such disclosure statement must be presented in a clear and
2083	understandable form and format and must be separate from the
2084	policy or certificate or evidence of coverage provided to the
2085	employer group.
2086	2.  Before a small employer carrier issues a standard
2087	health benefit plan, a basic health benefit plan, or a limited
2088	benefit policy or contract, it must obtain from the prospective
2089	policyholder a signed written statement in which the prospective
2090	policyholder:
2091	a.  Certifies as to eligibility for coverage under the
2092	standard health benefit plan, basic health benefit plan, or
2093	limited benefit policy or contract;
2094	b.  Acknowledges the limited nature of the coverage and an
2095	understanding of the managed care and cost control features of
2096	the policy or contract;
2097	c.  Acknowledges that if misrepresentations are made
2098	regarding eligibility for coverage under a standard health
2099	benefit plan, a basic health benefit plan, or a limited benefit
2100	policy or contract, the person making such misrepresentations
2101	forfeits coverage provided by the policy or contract; and
2102	d.  If a limited plan is requested, acknowledges that the
2103	prospective policyholder had been offered, at the time of
2104	application for the insurance policy or contract, the
2105	opportunity to purchase any health benefit plan offered by the
2106	carrier and that the prospective policyholder had rejected that
2107	coverage.
2108
2109	A copy of such written statement shall be provided to the
2110	prospective policyholder no later than at the time of delivery
2111	of the policy or contract, and the original of such written
2112	statement shall be retained in the files of the small employer
2113	carrier for the period of time that the policy or contract
2114	remains in effect or for 5 years, whichever period is longer.
2115	3.  Any material statement made by an applicant for
2116	coverage under a health benefit plan which falsely certifies as
2117	to the applicant's eligibility for coverage serves as the basis
2118	for terminating coverage under the policy or contract.
2119	4.  Each marketing communication that is intended to be
2120	used in the marketing of a health benefit plan in this state
2121	must be submitted for review by the office prior to use and must
2122	contain the disclosures stated in this subsection.
2123	(e)  A small employer carrier may not use any policy,
2124	contract, form, or rate under this section, including
2125	applications, enrollment forms, policies, contracts,
2126	certificates, evidences of coverage, riders, amendments,
2127	endorsements, and disclosure forms, until the insurer has filed
2128	it with the office and the office has approved it under ss.
2129	627.410 and 627.411 and this section.
2130	(15)  SMALL EMPLOYERS ACCESS PROGRAM.--
2131	(a)  Popular name.--This subsection may be referred to by
2132	the popular name "The Small Employers Access Program."
2133	(b)  Intent.--The Legislature finds that increased access
2134	to health care coverage for small employers with up to 25
2135	employees could improve employees' health and reduce the
2136	incidence and costs of illness and disabilities among residents
2137	in this state. Many employers do not offer health care benefits
2138	to their employees citing the increased cost of this benefit. It
2139	is the intent of the Legislature to create the Small Business
2140	Health Plan to provide small employers the option and ability to
2141	provide health care benefits to their employees at an affordable
2142	cost through the creation of purchasing pools for employers with
2143	up to 25 employees, and rural hospital employers and nursing
2144	home employers regardless of the number of employees.
2145	(c)  Definitions.--For purposes of this subsection:
2146	1.  "Fair commission" means a commission structure
2147	determined by the office and the insurers, which will carry out
2148	the intent of this subsection.
2149	2.  "Insurer" means any entity that provides health
2150	insurance in this state. For purposes of this subsection,
2151	insurer includes an insurance company holding a certificate of
2152	authority pursuant to chapter 624 or a health maintenance
2153	organization holding a certificate of authority pursuant to
2154	chapter 641, which qualifies to provide coverage to small
2155	employer groups pursuant to this section.
2156	3.  "Mutually supported benefit plan" means an optional
2157	alternative coverage plan developed within a defined geographic
2158	region which may include, but is not limited to, a minimum level
2159	of primary care coverage in which the percentage of the premium
2160	is distributed among the employer, the employee, and community-
2161	generated revenue either alone or in conjunction with federal
2162	matching funds.
2163	4.  "Office" means the Office of Insurance Regulation of
2164	the Department of Financial Services.
2165	5.  "Participating insurer" means any insurer providing
2166	health insurance to small employers that has been selected by
2167	the office in accordance with this subsection for its designated
2168	region.
2169	6.  "Program" means the Small Employer Access Program as
2170	created by this subsection.
2171	(d)  Eligibility.--
2172	1.  Any small employer group of up to 25 employees that has
2173	had no prior coverage for the last 6 months may participate.
2174	2.  Rural hospital employers may participate.
2175	3.  Nursing home employers may participate.
2176	4.  Each dependent of a person eligible for coverage is
2177	also eligible to participate.
2178	5.  Any small employer that is actively engaged in
2179	business, has its principal place of business in this state,
2180	employed up to 25 eligible employees on business days during the
2181	preceding calendar year, and employs at least 2 employees on the
2182	first day of the plan year may participate.
2183
2184	Coverage for a small employer group that ceases to meet the
2185	eligibility requirements of this section may be terminated at
2186	the end of the policy period for which the necessary premiums
2187	have been paid.
2188	(e)  Administration.--
2189	1.  The office shall by competitive bid, in accordance with
2190	current state law, select an insurer to provide coverage through
2191	the program to eligible small employers within an established
2192	geographical area of this state. The office may develop
2193	exclusive regions for the program similar to those used by the
2194	Healthy Kids Corporation. However the office is not precluded
2195	from developing, in conjunction with insurers, regions different
2196	from those used by the Healthy Kids Corporation if the office
2197	deems that such a region will carry out the intentions of this
2198	subsection.
2199	2.  The office shall evaluate bids submitted based upon
2200	criteria established by the office, which shall include, but not
2201	be limited to:
2202	a.  The insurer's proven ability to handle health insurance
2203	coverage to small employer groups.
2204	b.  The efficiency and timeliness of the insurer's claim
2205	processing procedures.
2206	c.  The insurer's ability to apply effective cost-
2207	containment programs and procedures and to administer the
2208	program in a cost-efficient manner.
2209	d.  The financial condition and stability of the insurer.
2210	e.  The insurer's ability to develop an optional mutually
2211	supported benefit plan.
2212
2213	The office may use any financial information available to it
2214	through its regulatory duties to make this evaluation.
2215	(f)  Insurer qualifications.--The insurer shall be a duly
2216	authorized insurer or health maintenance organization.
2217	(g)  Duties of the insurer.--The insurer shall:
2218	1.  Develop and implement a program to publicize the
2219	existence of the program, program eligibility requirements, and
2220	procedures for enrollment and maintain public awareness of the
2221	program.
2222	2.  Maintain employer awareness of the program.
2223	3.  Demonstrate the ability to use delivery of cost-
2224	effective health care services.
2225	4.  Encourage, educate, advise, and administer the
2226	effective use of health savings accounts by covered employees
2227	and dependents.
2228	5.  Serve for a period specified in the contract between
2229	the office and the insurer, subject to removal for cause and
2230	subject to any terms, conditions, and limitations of the
2231	contract between the office and the insurer as may be specified
2232	in the request for proposal.
2233	(h)  Contract term.--The contract term shall not exceed 3
2234	years. At least 6 months prior to the expiration of each
2235	contract period, the office shall invite eligible entities,
2236	including the current insurer, to submit bids to serve as the
2237	insurer for a designated geographic area. Selection of the
2238	insurer for the succeeding period shall be made at least 3
2239	months prior to the end of the current period.
2240	(i)  Insurer reporting requirements.--On March 1 following
2241	the close of each calendar year, the insurer shall determine net
2242	written and earned premiums, the expense of administration, and
2243	the paid and incurred losses for the year and report this
2244	information to the office on a form prescribed by the office.
2245	(j)  Application requirements.--The insurer shall permit or
2246	allow any licensed and duly appointed health insurance agent
2247	residing in the designated region to submit applications for
2248	coverage, and such agent shall be paid a fair commission if
2249	coverage is written. The agent must be appointed to at least one
2250	insurer.
2251	(k)  Benefits.--The benefits provided by the plan shall be
2252	the same as the coverage required for small employers under
2253	subsection (12). Upon the approval of the office, the insurer
2254	may also establish an optional mutually supported benefit plan
2255	which is an alternative coverage plan developed within a defined
2256	geographic region of this state or any other such alternative
2257	coverage benefit plan which will carry out the intent of this
2258	subsection.
2259	(l)  Annual reporting.--The office shall make an annual
2260	report to the Governor, the President of the Senate, and the
2261	Speaker of the House of Representatives. The report shall
2262	summarize the activities of the program in the preceding
2263	calendar year, including the net written and earned premiums,
2264	program enrollment, the expense of administration, and the paid
2265	and incurred losses. The report shall be submitted no later than
2266	March 15 following the close of the prior calendar year.
2267	(16)(15)  APPLICABILITY OF OTHER STATE LAWS.--
2268	(a)  Except as expressly provided in this section, a law
2269	requiring coverage for a specific health care service or
2270	benefit, or a law requiring reimbursement, utilization, or
2271	consideration of a specific category of licensed health care
2272	practitioner, does not apply to a standard or basic health
2273	benefit plan policy or contract, a small employer access
2274	program, or a limited benefit policy or contract offered or
2275	delivered to a small employer unless that law is made expressly
2276	applicable to such policies or contracts. A law restricting or
2277	limiting deductibles, coinsurance, copayments, or annual or
2278	lifetime maximum payments does not apply to any health plan
2279	policy, including a standard or basic health benefit plan policy
2280	or contract, offered or delivered to a small employer unless
2281	such law is made expressly applicable to such policy or
2282	contract. However, every small employer carrier must offer to
2283	eligible small employers the standard benefit plan and the basic
2284	benefit plan, as required by subsection (5), as such plans have
2285	been approved by the office pursuant to subsection (12).
2286	(b)  Except as provided in this section, a standard or
2287	basic health benefit plan policy or contract or limited benefit
2288	policy or contract offered to a small employer is not subject to
2289	any provision of this code which:
2290	1.  Inhibits a small employer carrier from contracting with
2291	providers or groups of providers with respect to health care
2292	services or benefits;
2293	2.  Imposes any restriction on a small employer carrier's
2294	ability to negotiate with providers regarding the level or
2295	method of reimbursing care or services provided under a health
2296	benefit plan; or
2297	3.  Requires a small employer carrier to either include a
2298	specific provider or class of providers when contracting for
2299	health care services or benefits or to exclude any class of
2300	providers that is generally authorized by statute to provide
2301	such care.
2302	(c)  Any second tier assessment paid by a carrier pursuant
2303	to paragraph (11)(j) may be credited against assessments levied
2304	against the carrier pursuant to s. 627.6494.
2305	(d)  Notwithstanding chapter 641, a health maintenance
2306	organization is authorized to issue contracts providing benefits
2307	equal to the standard health benefit plan, the basic health
2308	benefit plan, and the limited benefit policy authorized by this
2309	section.
2310	(17)(16)  RULEMAKING AUTHORITY.--The commission may adopt
2311	rules to administer this section, including rules governing
2312	compliance by small employer carriers and small employers.
2313	(18)  DECREASE IN INAPPROPRIATE UTILIZATION OF EMERGENCY
2314	CARE.--Health insurers may require higher copayments for
2315	nonemergency use of emergency departments and higher copayments
2316	for out-of-network emergency department use and are encouraged
2317	to create the development of emergency room diversion programs.
2318	Section 23.  Subsection (1) of section 627.9175, Florida
2319	Statutes, is amended to read:
2320	627.9175  Reports of information on health and accident
2321	insurance.--
2322	(1)  Each health insurer, prepaid limited health services
2323	organization, and health maintenance organization shall submit,
2324	no later than April 1 of each year, annually to the office
2325	information concerning health and accident insurance coverage
2326	and medical plans being marketed and currently in force in this
2327	state. The required information shall be described by market
2328	segment, to include, but not be limited to:
2329	(a)  Issuing, servicing company, and entity contact
2330	information.
2331	(b)  Information on all health and accident insurance
2332	policies and prepaid limited health service organizations and
2333	health maintenance organization contracts in force and issued in
2334	the previous year. Such information shall include, but not be
2335	limited to, direct premiums earned, direct losses incurred,
2336	number of policies, number of certificates, and number of
2337	covered lives. as to policies of individual health insurance:
2338	(a)  A summary of typical benefits, exclusions, and
2339	limitations for each type of individual policy form currently
2340	being issued in the state. The summary shall include, as
2341	appropriate:
2342	1.  The deductible amount;
2343	2.  The coinsurance percentage;
2344	3.  The out-of-pocket maximum;
2345	4.  Outpatient benefits;
2346	5.  Inpatient benefits; and
2347	6.  Any exclusions for preexisting conditions.
2348
2349	The commission shall determine other appropriate benefits,
2350	exclusions, and limitations to be reported for inclusion in the
2351	consumer's guide published pursuant to this section.
2352	(b)  A schedule of rates for each type of individual policy
2353	form reflecting typical variations by age, sex, region of the
2354	state, or any other applicable factor which is in use and is
2355	determined to be appropriate for inclusion by the commission.
2356
2357	The commission may establish rules governing shall provide by
2358	rule a uniform format for the submission of this information
2359	described in this section, including the use of uniform formats
2360	and electronic data transmission order to allow for meaningful
2361	comparisons of premiums charged for comparable benefits. The
2362	office shall provide this information to the department, which
2363	shall publish annually a consumer's guide which summarizes and
2364	compares the information required to be reported under this
2365	subsection.
2366	Section 24.  Subsection (7) of section 636.003, Florida
2367	Statutes, is amended to read:
2368	636.003  Definitions.--As used in this act, the term:
2369	(7)  "Prepaid limited health service organization" means
2370	any person, corporation, partnership, or any other entity which,
2371	in return for a prepayment, undertakes to provide or arrange
2372	for, or provide access to, the provision of a limited health
2373	service to enrollees through an exclusive panel of providers or
2374	undertakes to provide access to any discounted medical services.
2375	Prepaid limited health service organization does not include:
2376	(a)  An entity otherwise authorized pursuant to the laws of
2377	this state to indemnify for any limited health service;
2378	(b)  A provider or entity when providing limited health
2379	services pursuant to a contract with a prepaid limited health
2380	service organization, a health maintenance organization, a
2381	health insurer, or a self-insurance plan; or
2382	(c)  Any person who, in exchange for fees, dues, charges or
2383	other consideration, provides access to a limited health service
2384	provider without assuming any responsibility for payment for the
2385	limited health service or any portion thereof; or
2386	(d)  Any plan or program of discounted medical services for
2387	which fees, dues, charges, or other consideration paid to the
2388	plan by consumers do not exceed $15 per month or $180 per year
2389	and which, in its advertising and contracts:
2390	1.  Clearly indicates that the plan is not insurance, that
2391	the plan is not obligated to pay any portion of the discounted
2392	medical fees, and that the consumer is responsible for paying
2393	the full amount of the discounted fees.
2394	2.  Does not use the terms "affordable health care" or
2395	"coverage" or other terms which misrepresent the nature of the
2396	program.
2397	3.  Requires a statement, together with the provider
2398	network, on the discount card alerting the network providers and
2399	facilities that the cardholder does not have insurance and is
2400	merely entitled to the network discount rate for services
2401	provided.
2402	Section 25.  Section 627.6410, Florida Statutes, is created
2403	to read:
2404	627.6410  Optional coverage for speech, language,
2405	swallowing, and hearing disorders.--
2406	(1)  Insurers issuing individual health insurance policies
2407	in this state shall make available to the policyholder as part
2408	of the application for any such policy of insurance, for an
2409	appropriate additional premium, the benefits or levels of
2410	benefits specified in the December 1999 Florida Medicaid Therapy
2411	Services Handbook for genetic or congenital disorders or
2412	conditions involving speech, language, swallowing, and hearing
2413	and a hearing aid and earmolds benefit at the level of benefits
2414	specified in the January 2001 Florida Medicaid Hearing Services
2415	Handbook.
2416	(2)  This section does not apply to specified accident,
2417	specified disease, hospital indemnity, limited benefit,
2418	disability income, or long-term care insurance policies.
2419	(3)  Such optional coverage is not required to be offered
2420	when substantially similar benefits are included in the policy
2421	of insurance issued to the policyholder.
2422	(4)  This section does not require or prohibit the use of a
2423	provider network.
2424	(5)  This section does not prohibit an insurer from
2425	requiring prior authorization for the benefits under this
2426	section.
2427	Section 26.  Section 627.66912, Florida Statutes, is
2428	created to read:
2429	627.66912  Optional coverage for speech, language,
2430	swallowing, and hearing disorders.--
2431	(1)  Insurers issuing group health insurance policies in
2432	this state shall make available to the policyholder as part of
2433	the application for any such policy of insurance, for an
2434	appropriate additional premium, the benefits or levels of
2435	benefits specified in the December 1999 Florida Medicaid Therapy
2436	Services Handbook for genetic or congenital disorders or
2437	conditions involving speech, language, swallowing, and hearing
2438	and a hearing aid and earmolds benefit at the level of benefits
2439	specified in the January 2001 Florida Medicaid Hearing Services
2440	Handbook.
2441	(2)  This section does not apply to specified accident,
2442	specified disease, hospital indemnity, limited benefit,
2443	disability income, or long-term care insurance policies.
2444	(3)  Such optional coverage is not required to be offered
2445	when substantially similar benefits are included in the policy
2446	of insurance issued to the policyholder.
2447	(4)  This section does not require or prohibit the use of a
2448	provider network.
2449	(5)  This section does not prohibit an insurer from
2450	requiring prior authorization for the benefits under this
2451	section.
2452	Section 27.  Subsection (38) of section 641.31, Florida
2453	Statutes, is amended, and subsection (40) is added to said
2454	section, to read:
2455	641.31  Health maintenance contracts.--
2456	(38)(a)  Notwithstanding any other provision of this part,
2457	a health maintenance organization that meets the requirements of
2458	paragraph (b) may, through a point-of-service rider to its
2459	contract providing comprehensive health care services, include a
2460	point-of-service benefit. Under such a rider, a subscriber or
2461	other covered person of the health maintenance organization may
2462	choose, at the time of covered service, a provider with whom the
2463	health maintenance organization does not have a health
2464	maintenance organization provider contract. The rider may not
2465	require a referral from the health maintenance organization for
2466	the point-of-service benefits.
2467	(b)  A health maintenance organization offering a point-of-
2468	service rider under this subsection must have a valid
2469	certificate of authority issued under the provisions of the
2470	chapter, must have been licensed under this chapter for a
2471	minimum of 3 years, and must at all times that it has riders in
2472	effect maintain a minimum surplus of $5 million.
2473	(c)  Premiums paid in for the point-of-service riders may
2474	not exceed 15 percent of total premiums for all health plan
2475	products sold by the health maintenance organization offering
2476	the rider. If the premiums paid for point-of-service riders
2477	exceed 15 percent, the health maintenance organization must
2478	notify the office and, once this fact is known, must immediately
2479	cease offering such a rider until it is in compliance with the
2480	rider premium cap.
2481	(d)  Notwithstanding the limitations of deductibles and
2482	copayment provisions in this part, a point-of-service rider may
2483	require the subscriber to pay a reasonable copayment for each
2484	visit for services provided by a noncontracted provider chosen
2485	at the time of the service. The copayment by the subscriber may
2486	either be a specific dollar amount or a percentage of the
2487	reimbursable provider charges covered by the contract and must
2488	be paid by the subscriber to the noncontracted provider upon
2489	receipt of covered services. The point-of-service rider may
2490	require that a reasonable annual deductible for the expenses
2491	associated with the point-of-service rider be met and may
2492	include a lifetime maximum benefit amount. The rider must
2493	include the language required by s. 627.6044 and must comply
2494	with copayment limits described in s. 627.6471. Section 641.3154
2495	does not apply to a point-of-service rider authorized under this
2496	subsection.
2497	(e)  The point-of-service rider must contain provisions
2498	that comply with s. 627.6044.
2499	(f)(e)  The term "point of service" may not be used by a
2500	health maintenance organization except with riders permitted
2501	under this section or with forms approved by the office in which
2502	a point-of-service product is offered with an indemnity carrier.
2503	(g)(f)  A point-of-service rider must be filed and approved
2504	under ss. 627.410 and 627.411.
2505	(40)  Health maintenance organizations shall make available
2506	to the contract holder as part of the application for any such
2507	contract, for an appropriate additional premium, the benefits or
2508	levels of benefits specified in the December 1999 Florida
2509	Medicaid Therapy Services Handbook for genetic or congenital
2510	disorders or conditions involving speech, language, swallowing,
2511	and hearing and a hearing aid and earmolds benefit at the level
2512	of benefits specified in the January 2001 Florida Medicaid
2513	Hearing Services Handbook.
2514	(a)  Such optional coverage is not required to be offered
2515	when substantially similar benefits are included in
2516	the contract issued to the subscriber.
2517	(b)  This section does not require or prohibit the use of a
2518	provider network.
2519	(c)  This section does not prohibit an organization from
2520	requiring prior authorization for the benefits under this
2521	subsection.
2522	(d)  This subsection does not apply to health maintenance
2523	organizations issuing individual coverage to fewer than 50,000
2524	members.
2525	Section 28.  Subsection (2) of section 626.015, Florida
2526	Statutes, is amended, subsections (8) through (17) of said
2527	section are renumbered as subsections (9) through (18),
2528	respectively, and a new subsection (8) is added to said section,
2529	to read:
2530	626.015  Definitions.--As used in this part:
2531	(2)  "Agent" means a general lines agent, life agent,
2532	health agent, or title agent, or all such agents, as indicated
2533	by context. The term "agent" includes an insurance producer or
2534	producer, but does not include a customer representative,
2535	limited customer representative, or service representative but
2536	does include an insurance advisor.
2537	(8)  "Insurance advisor" means any person who, for money,
2538	fee, commission, or any other thing of value offers to examine
2539	or examines any policy of life, accident, or health insurance,
2540	any health benefit plan, or any annuity or pure endowment
2541	contract for the purpose of giving, or gives, or offers to give,
2542	any advice, counsel, recommendation, or information in respect
2543	to the terms, conditions, benefits, coverage, or premium of any
2544	such policy or contract, or in respect to the expediency or
2545	advisability of altering, changing, exchanging, converting,
2546	replacing, surrendering, continuing, or rejecting any such
2547	policy, plan, or contract, or of accepting or procuring any such
2548	policy, plan, or contract from any insurer or issuer of a health
2549	benefit plan, or who in or on advertisements, cards, signs,
2550	circulars, or letterheads, or elsewhere, or in any other way or
2551	manner by which public announcements are made, uses the title
2552	"insurance advisor," "insurance specialist," "insurance
2553	counselor," "insurance analyst," "policyholders' adviser,"
2554	"policyholders' counselor," or any other similar title, or any
2555	title indicating that the person gives, or is engaged in the
2556	business of giving advice, counsel, recommendation, or
2557	information to an insured, or a beneficiary, or any person
2558	having any interest in a life, accident, or health insurance
2559	contract, health benefit plan contract, annuity, or pure
2560	endowment contract. This definition is not intended to prevent a
2561	person who has obtained the professional designation of life
2562	underwriter, chartered financial consultant, or certified
2563	financial planner by completing a course of instruction
2564	recognized within the business of insurance from using that
2565	designation to indicate professional achievement.
2566	Section 29.  Subsection (1) of section 626.016, Florida
2567	Statutes, is amended to read:
2568	626.016  Powers and duties of department, commission, and
2569	office.--
2570	(1)  The powers and duties of the Chief Financial Officer
2571	and the department specified in this part apply only with
2572	respect to insurance agents, insurance advisors, managing
2573	general agents, reinsurance intermediaries, viatical settlement
2574	brokers, customer representatives, service representatives, and
2575	agencies.
2576	Section 30.  Section 626.171, Florida Statutes, is amended
2577	to read:
2578	626.171  Application for license.--
2579	(1)  The department or office shall not issue a license as
2580	agent, insurance advisor, customer representative, adjuster,
2581	insurance agency, service representative, managing general
2582	agent, or reinsurance intermediary to any person except upon
2583	written application therefor filed with it, qualification
2584	therefor, and payment in advance of all applicable fees. Any
2585	such application shall be made under the oath of the applicant
2586	and be signed by the applicant. Beginning November 1, 2002, The
2587	department shall accept the uniform application for nonresident
2588	agent licensing. The department may adopt revised versions of
2589	the uniform application by rule.
2590	(2)  In the application, the applicant shall set forth:
2591	(a)  His or her full name, age, social security number,
2592	residence address, business address, and mailing address.
2593	(b)  Proof that he or she has completed or is in the
2594	process of completing any required prelicensing course.
2595	(c)  Whether he or she has been refused or has voluntarily
2596	surrendered or has had suspended or revoked a license to solicit
2597	insurance by the department or by the supervising officials of
2598	any state.
2599	(d)  Whether any insurer or any managing general agent
2600	claims the applicant is indebted under any agency contract or
2601	otherwise and, if so, the name of the claimant, the nature of
2602	the claim, and the applicant's defense thereto, if any.
2603	(e)  Proof that the applicant meets the requirements for
2604	the type of license for which he or she is applying.
2605	(f)  Such other or additional information as the department
2606	or office may deem proper to enable it to determine the
2607	character, experience, ability, and other qualifications of the
2608	applicant to hold himself or herself out to the public as an
2609	insurance representative.
2610	(3)  An application for an insurance agency license shall
2611	be signed by the owner or owners of the agency. If the agency is
2612	incorporated, the application shall be signed by the president
2613	and secretary of the corporation.
2614	(3)(4)  Each application shall be accompanied by payment of
2615	any applicable fee.
2616	(4)(5)  An application for a license as an agent, customer
2617	representative, adjuster, insurance agency, service
2618	representative, managing general agent, or reinsurance
2619	intermediary must be accompanied by a set of the individual
2620	applicant's fingerprints, or, if the applicant is not an
2621	individual, by a set of the fingerprints of the sole proprietor,
2622	majority owner, partners, officers, and directors, on a form
2623	adopted by rule of the department or commission and accompanied
2624	by the fingerprint processing fee set forth in s. 624.501.
2625	Fingerprints shall be used to investigate the applicant's
2626	qualifications pursuant to s. 626.201. The fingerprints shall be
2627	taken by a law enforcement agency or other department-approved
2628	entity.
2629	(5)(6)  The application for license filing fee prescribed
2630	in s. 624.501 is not subject to refund.
2631	(6)(7)  Pursuant to the federal Personal Responsibility and
2632	Work Opportunity Reconciliation Act of 1996, each party is
2633	required to provide his or her social security number in
2634	accordance with this section. Disclosure of social security
2635	numbers obtained through this requirement shall be limited to
2636	the purpose of administration of the Title IV-D program for
2637	child support enforcement.
2638	Section 31.  Section 626.191, Florida Statutes, is amended
2639	to read:
2640	626.191  Repeated applications.--The failure of an
2641	applicant to secure a license upon an application shall not
2642	preclude the applicant him or her from applying again as many
2643	times as desired, but the department or office shall not give
2644	consideration to or accept any further application by the same
2645	individual for a similar license dated or filed within 30 days
2646	subsequent to the date the department or office denied the last
2647	application, except as provided in s. 626.281.
2648	Section 32.  Subsection (1) of section 626.201, Florida
2649	Statutes, is amended to read:
2650	626.201  Investigation.--
2651	(1)  The department or office may propound any reasonable
2652	interrogatories in addition to those contained in the
2653	application, to any applicant for license or appointment, or on
2654	any renewal, reinstatement, or continuation thereof, relating to
2655	the applicant's his or her qualifications, residence,
2656	prospective place of business, and any other matter which, in
2657	the opinion of the department or office, is deemed necessary or
2658	advisable for the protection of the public and to ascertain the
2659	applicant's qualifications.
2660	Section 33.  Subsections (1) and (2) of section 626.342,
2661	Florida Statutes, are amended to read:
2662	626.342  Furnishing supplies to unlicensed life, health, or
2663	general lines agent prohibited; civil liability.--
2664	(1)  An insurer, a managing general agent, an insurance
2665	advisor, or an agent, directly or through any representative,
2666	may not furnish to any agent any blank forms, applications,
2667	stationery, or other supplies to be used in soliciting,
2668	negotiating, or effecting contracts of insurance on its behalf
2669	unless such blank forms, applications, stationery, or other
2670	supplies relate to a class of business with respect to which the
2671	agent is licensed and appointed, whether for that insurer or
2672	another insurer.
2673	(2)  Any insurer, general agent, insurance advisor, or
2674	agent who furnishes any of the supplies specified in subsection
2675	(1) to any agent or prospective agent not appointed to represent
2676	the insurer and who accepts from or writes any insurance
2677	business for such agent or agency is subject to civil liability
2678	to any insured of such insurer to the same extent and in the
2679	same manner as if such agent or prospective agent had been
2680	appointed or authorized by the insurer or such agent to act in
2681	its or his or her behalf. The provisions of this subsection do
2682	not apply to insurance risk apportionment plans under s.
2683	627.351.
2684	Section 34.  Section 626.536, Florida Statutes, is amended
2685	to read:
2686	626.536  Reporting of actions.--An agent and insurance
2687	broker shall submit to the department, within 30 days after the
2688	final disposition of any administrative action taken against the
2689	agent by a governmental agency in this or any other state or
2690	jurisdiction relating to the business of insurance, the sale of
2691	securities, or activity involving fraud, dishonesty,
2692	trustworthiness, or breach of a fiduciary duty, a copy of the
2693	order, consent to order, or other relevant legal documents. The
2694	department may adopt rules implementing the provisions of this
2695	section.
2696	Section 35.  Subsections (1) and (3) of section 626.561,
2697	Florida Statutes, are amended to read:
2698	626.561  Reporting and accounting for funds.--
2699	(1)  All premiums, return premiums, or other funds
2700	belonging to insurers or others received by an insurance broker,
2701	agent, customer representative, or adjuster in transactions
2702	under a his or her license are trust funds received by the
2703	licensee in a fiduciary capacity. An agent or insurance advisor
2704	shall keep the funds belonging to each insurer for which an
2705	agent or insurance advisor he or she is not appointed, other
2706	than a surplus lines insurer, in a separate account so as to
2707	allow the department or office to properly audit such funds. The
2708	licensee in the applicable regular course of business shall
2709	account for and pay the same to the insurer, insured, or other
2710	person entitled thereto.
2711	(3)  Any insurance advisor, agent, customer representative,
2712	or adjuster who, not being lawfully entitled thereto, either
2713	temporarily or permanently diverts or misappropriates such funds
2714	or any portion thereof or deprives the other person of a benefit
2715	therefrom commits the offense specified below:
2716	(a)  If the funds diverted or misappropriated are $300 or
2717	less, a misdemeanor of the first degree, punishable as provided
2718	in s. 775.082 or s. 775.083.
2719	(b)  If the funds diverted or misappropriated are more than
2720	$300, but less than $20,000, a felony of the third degree,
2721	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
2722	(c)  If the funds diverted or misappropriated are $20,000
2723	or more, but less than $100,000, a felony of the second degree,
2724	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
2725	(d)  If the funds diverted or misappropriated are $100,000
2726	or more, a felony of the first degree, punishable as provided in
2727	s. 775.082, s. 775.083, or s. 775.084.
2728	Section 36.  Subsections (1) and (2) of section 626.572,
2729	Florida Statutes, are amended to read:
2730	626.572  Rebating; when allowed.--
2731	(1)  No insurance advisor or agent shall rebate any portion
2732	of a his or her commission except as follows:
2733	(a)  The rebate shall be available to all insureds in the
2734	same actuarial class.
2735	(b)  The rebate shall be in accordance with a rebating
2736	schedule filed by the agent with the insurer issuing the policy
2737	to which the rebate applies.
2738	(c)  The rebating schedule shall be uniformly applied in
2739	that all insureds who purchase the same policy through the agent
2740	for the same amount of insurance receive the same percentage
2741	rebate.
2742	(d)  Rebates shall not be given to an insured with respect
2743	to a policy purchased from an insurer that prohibits its agents
2744	from rebating commissions.
2745	(e)  The rebate schedule is prominently displayed in public
2746	view in the agent's place of doing business and a copy is
2747	available to insureds on request at no charge.
2748	(f)  The age, sex, place of residence, race, nationality,
2749	ethnic origin, marital status, or occupation of the insured or
2750	location of the risk is not utilized in determining the
2751	percentage of the rebate or whether a rebate is available.
2752	(2)  The insurance advisor or agent shall maintain a copy
2753	of all rebate schedules for the most recent 5 years and their
2754	effective dates.
2755	Section 37.  Subsection (1) of section 626.601, Florida
2756	Statutes, is amended to read:
2757	626.601  Improper conduct; inquiry; fingerprinting.--
2758	(1)  The department or office may, upon its own motion or
2759	upon a written complaint signed by any interested person and
2760	filed with the department or office, inquire into any alleged
2761	improper conduct of any licensed insurance advisor, agent,
2762	adjuster, service representative, managing general agent,
2763	customer representative, title insurance agent, title insurance
2764	agency, continuing education course provider, instructor, school
2765	official, or monitor group under this code. The department or
2766	office may thereafter initiate an investigation of any such
2767	licensee if it has reasonable cause to believe that the licensee
2768	has violated any provision of the insurance code. During the
2769	course of its investigation, the department or office shall
2770	contact the licensee being investigated unless it determines
2771	that contacting such person could jeopardize the successful
2772	completion of the investigation or cause injury to the public.
2773	Section 38.  Section 626.6115, Florida Statutes, is amended
2774	to read:
2775	626.6115  Grounds for compulsory refusal, suspension, or
2776	revocation of insurance agency license.--The department shall
2777	deny, suspend, revoke, or refuse to continue the license of any
2778	insurance agency if it finds, as to any insurance agency or as
2779	to any majority owner, partner, manager, director, officer, or
2780	other person who manages or controls such agency, that any
2781	either one or both of the following applicable grounds exist:
2782	(1)  Lack by the agency of one or more of the
2783	qualifications for the license as specified in this code;.
2784	(2)  Material misstatement, misrepresentation, or fraud in
2785	obtaining the license or in attempting to obtain the license;
2786	or.
2787	(3)  Denial, suspension, or revocation of a license to
2788	practice or conduct any regulated profession, business, or
2789	vocation relating to the business of insurance by this state,
2790	any other state, any nation, any possession or district of the
2791	United States, any court, or any lawful agency thereof.
2792	Section 39.  Paragraph (b) of subsection (5) of section
2793	624.509, Florida Statutes, is amended to read:
2794	624.509  Premium tax; rate and computation.--
2795	(5)  There shall be allowed a credit against the net tax
2796	imposed by this section equal to 15 percent of the amount paid
2797	by the insurer in salaries to employees located or based within
2798	this state and who are covered by the provisions of chapter 443.
2799	For purposes of this subsection:
2800	(b)  The term "employees" does not include independent
2801	contractors or any person whose duties require that the person
2802	hold a valid license under the Florida Insurance Code, except
2803	persons defined in s. 626.015(1), (16)(15), and (18)(17).
2804	Section 40.  Subsection (2) of section 626.7845, Florida
2805	Statutes, is amended to read:
2806	626.7845  Prohibition against unlicensed transaction of
2807	life insurance.--
2808	(2)  Except as provided in s. 626.112(6), with respect to
2809	any line of authority specified in s. 626.015(12)(11), no
2810	individual shall, unless licensed as a life agent:
2811	(a)  Solicit insurance or annuities or procure
2812	applications; or
2813	(b)  In this state, engage or hold himself or herself out
2814	as engaging in the business of analyzing or abstracting
2815	insurance policies or of counseling or advising or giving
2816	opinions to persons relative to insurance or insurance contracts
2817	other than:
2818	1.  As a consulting actuary advising an insurer; or
2819	2.  As to the counseling and advising of labor unions,
2820	associations, trustees, employers, or other business entities,
2821	the subsidiaries and affiliates of each, relative to their
2822	interests and those of their members or employees under
2823	insurance benefit plans.
2824	Section 41.  Paragraph (c) of subsection (2) of section
2825	626.292, Florida Statutes, is amended to read:
2826	626.292  Transfer of license from another state.--
2827	(2)  To qualify for a license transfer, an individual
2828	applicant must meet the following requirements:
2829	(c)  The individual shall submit a completed application
2830	for this state which is received by the department within 90
2831	days after the date the individual became a resident of this
2832	state, along with payment of the applicable fees set forth in s.
2833	624.501 and submission of the following documents:
2834	1.  A certification issued by the appropriate official of
2835	the applicant's home state identifying the type of license and
2836	lines of authority under the license and stating that, at the
2837	time the license from the home state was canceled, the applicant
2838	was in good standing in that state or that the state's Producer
2839	Database records, maintained by the National Association of
2840	Insurance Commissioners, its affiliates, or subsidiaries,
2841	indicate that the agent is or was licensed in good standing for
2842	the line of authority requested.
2843	2.  A set of the individual applicant's fingerprints in
2844	accordance with s. 626.171(4)(5).
2845	Section 42.  Paragraph (a) of subsection (2) of section
2846	626.321, Florida Statutes, is amended to read:
2847	626.321  Limited licenses.--
2848	(2)  An entity applying for a license under this section is
2849	required to:
2850	(a)  Submit only one application for a license under s.
2851	626.171. The requirements of s. 626.171(4)(5) shall only apply
2852	to the officers and directors of the entity submitting the
2853	application.
2854	Section 43.  Notwithstanding the amendment to s.
2855	627.6699(5)(c), Florida Statutes, by this act, any right to an
2856	open enrollment offer of health benefit coverage for groups of
2857	fewer than two employees, pursuant to s. 627.6699(5)(c), Florida
2858	Statutes, as it existed immediately before the effective date of
2859	this act, shall remain in full force and effect until the
2860	enactment of s. 627.64872, Florida Statutes, and the subsequent
2861	date upon which such plan begins to accept new risks or members.
2862	Section 44.  Section 408.02, Florida Statutes, is repealed.
2863	Section 45.  The sum of $250,000 is appropriated from the
2864	Insurance Regulatory Trust Fund in the Department of Financial
2865	Services to the Office of Insurance Regulation for the purpose
2866	of implementing the provisions in this act related to the Small
2867	Business Health Plan.
2868	Section 46.  There is hereby appropriated a sum of $2
2869	million from General Revenue to the Agency for Health Care
2870	Administration for funding activities relative to the Statewide
2871	Electronic Medical Records Advisory Council provided under s.
2872	408.919, Florida Statutes.
2873	Section 47.  This act shall take effect October 1, 2004.

CODING: Words stricken are deletions; words underlined are additions.